3. _The Association of Lust with the Idea of Certain Portions of the

Female Person, or with Certain Articles of Female Attire—Fetichism._—In the considerations concerning the psychology of the normal sexual life in the introduction to this work (_vide_ p. 17), it was shown that, within physiological limits, the pronounced preference for a certain portion of the body of persons of the opposite sex, particularly for a certain form of this part, may attain great psycho-sexual importance. Indeed, the especial power of attraction possessed by certain forms and peculiarities for many men—in fact, the majority—may be regarded as the real principle of individualization in love. This preference for certain particular physical characteristics in persons of the opposite sex,—by the side of which, likewise, a marked preference for certain psychical characteristics may be demonstrated,—following Binet (“du Fetischisme dans l’amour,” _Revue philosophique_, 1887) and Lombroso (Introduction to the Italian edition of the second edition of this work), I have called “fetichism”; because this enthusiasm for certain portions of the body (or even articles of attire) and the worship of them, in obedience to sexual impulses, frequently call to mind the reverence for relics, holy objects, etc., in religious cults. This physiological fetichism has already been described in detail on page 17 _et seq._ By the side of this physiological fetichism, however, there is, in the psycho-sexual sphere, an undoubted pathological, erotic fetichism, of which there is already a numerous series of cases presenting phenomena having great clinical and psychiatric interest, and, under certain circumstances, forensic importance. This pathological fetichism does not confine itself to certain parts of the body alone, but it is even extended to inanimate objects, which, however, are almost always articles of female wearing-apparel, and thus stand in close relation with the female person. This pathological fetichism is connected, through gradual transitions, with physiological fetichism; so that (at least in body-fetichism) it is almost impossible to sharply define the beginning of the perversion. Moreover, the whole field of body-fetichism does not really extend beyond the limits of things which normally stimulate the sexual instinct. Here the abnormality consists only in the fact that the whole sexual interest is concentrated on the impression made by a part of the person of the opposite sex, so that all other impressions fade and become more or less indifferent. Therefore, the body-fetichist is not to be regarded as a _monstrum per excessum_, like the sadist or masochist, but rather as a _monstrum per defectum_. What stimulates him is not abnormal, but rather what does not affect him,—the limitation of sexual interest that has taken place in him. Of course, this limited sexual interest, within its narrower limits, is usually expressed with a correspondingly greater and abnormal intensity. It would seem reasonable to assume, as the distinguishing mark of pathological fetichism, the necessity for the presence of the fetich as a _conditio sine qua non_ for the possibility of performance of coitus. But when the facts are more carefully studied, it is seen that this limitation is really only indefinite. There are numerous cases in which, even in the absence of the fetich, coitus is possible, but it is incomplete and forced (often with the help of fancies relating to the fetich), and particularly unsatisfying and exhausting; and, too, closer study of the distinctive subjective psychical conditions in these cases shows that there are transitional states, passing, on the one hand, to mere physiological preferences, and, on the other, to psychical impotence in the absence of the fetich. It is therefore better, perhaps, to seek the pathological criterion of body-fetichism in purely subjective psychical states. The concentration of the sexual interest on a certain portion of the body that has no direct relation to sex (as have the mammæ and external genitals)—a peculiarity to be emphasized—often leads body-fetichists to such a condition that they do not regard coitus as the real means of sexual gratification, but rather some form of manipulation of that portion of the body that is effectual as a fetich. This perverse instinct of body-fetichists may be taken as the pathological criterion, no matter whether actual coitus is also possible or not. Fetichism of inanimate objects or articles of dress, however, in all cases, may well be regarded as a pathological phenomenon; since its objects fall without the circle of normal sexual stimuli. But even here, in the phenomena, there is a certain outward correspondence with processes of the normal psychical vita sexualis; the inner connection and meaning of pathological fetichism, however, are entirely different. In the ecstatic love of a man mentally normal, a handkerchief or shoe, a glove or letter, the flower “she gave,” or a lock of hair, etc., may become the object of worship, but only because they represent a mnemonic symbol of the beloved person—absent or dead—whose whole personality is reproduced by them. The pathological fetichist has no such relations. The fetich constitutes the entire content of his idea. When he is possessed by it, sexual excitement occurs, and the fetich makes itself felt.[87] According to all observations thus far made, pathological fetichism seems to arise only on the basis of a psychopathic constitution that is for the most part hereditary, or on the basis of existent mental disease. Thus it happens that it not infrequently appears combined with the other (original) sexual perversions that arise on the same basis. Not infrequently fetichism occurs in the most various forms in combination with contrary sexuality, sadism, and masochism. Indeed, certain forms of body-fetichism (hand- and foot-fetichism) probably have a more or less distinct connection with the latter two perversions (_v. infra_). But if fetichism also rests upon a congenital general psychopathic disposition, yet this perversion is not, like those previously considered, essentially of an original nature; it is not congenitally perfect, as we may well assume sadism and masochism to be. While in the sexual perversions thus far described we have met only cases of a congenital nature, here we meet only _acquired_ cases. Aside from the fact that in fetichism the causative circumstance of its acquirement is often demonstrable, here the physiological conditions are wanting, which in sadism and masochism, by means of sexual hyperæsthesia, are intensified to perversions, and justify the assumption of congenital origin. In fetichism, every case requires an event which affords the subject of perversion. As has been said, it is, of course, physiological in sexual life to be partial to one or another of woman’s peculiarities, and to be enthusiastic about it; but concentration of the entire sexual interest on such partial impressions is here the essential thing; and for this concentration there must be a particular reason in every individual affected. Therefore, we may accept Binet’s conclusion that _in the life of every fetichist there may be assumed to have been some event which determined the association of lustful feeling with the single impression_. This event is to be referred to the time of early youth, and, as a rule, occurs in connection with the first awakening of the vita sexualis. This first awakening is associated with some partial sexual impression (since it is always something standing in some relation to woman), and stamps it for life as the principal object of sexual interest. The circumstances under which the association arises are usually forgotten. It is only the result of the association that is retained. The general predisposition to psychopathic states and the sexual hyperæsthesia of such individuals are all that is original here.[88] Like the other perversions thus far considered, erotic (pathological) fetichism may also express itself in strange, unnatural, and even criminal acts: gratification with the female person _loco indebito_, theft and robbery of objects of fetichism, pollution of such objects, etc. Here, too, it only depends upon the intensity of the perverse impulse and the relative power of opposing ethical motives, whether and to what extent such acts are performed. These perverse acts of fetichists, like those of other sexually perverse individuals, may either alone constitute the entire external vita sexualis, or occur together with the normal sexual act. This depends upon the condition of physical and psychical sexual power, and the degree of excitability to normal stimuli that has been retained. Where excitability is diminished, not infrequently the sight or touch of the fetich serves as a necessary preparatory act. The great practical importance which attaches to the facts of fetichism, in accordance with what has been said, lies in two factors. First, pathological fetichism is not infrequently a cause of _psychical impotence_.[89] Since the object upon which the sexual interest of the fetichist is concentrated stands, in itself, in no immediate relation to the normal sexual act, it often happens that the fetichist diminishes his excitability to normal stimuli by his perversion, or, at least is capable of coitus only by means of concentration of his fancy upon his fetich. In this perversion, and in the difficulty of its adequate satisfaction, just as in the other perversions of the sexual instinct, lie conditions favoring psychical and physical onanism, which again reacts deleteriously on the constitution and sexual power. This is especially true in the case of youthful individuals, and particularly in the case of those who, on account of opposing ethical and æsthetic motives, shrink from the realization of their perverse desires. Secondly, fetichism is of great forensic importance. Just as sadism may extend to murder and the infliction of bodily injury, fetichism may lead to theft and even to robbery for the possession of the desired articles. Erotic fetichism has for its object either a certain portion of the body of a person of the opposite sex, or a certain article or material of wearing-apparel of the opposite sex. (Only cases of pathological fetichism in men have thus far been observed, and therefore only portions of the female person and attire are spoken of here.) In accordance with this, fetichists fall into three groups. (a) _The Fetich is a Part of the Female Body._—Just as, in physiological fetichism, the eyes, the hand, the foot, and the hair of woman very frequently become fetiches, so, in the pathological domain, the same portions of the body become the sole objects of sexual interest. This exclusive concentration of interest on these parts, by the side of which everything else feminine fades, and all other sexual value of woman may sink to _nil_, so that, instead of coitus, strange manipulations of the fetich become the object of desire,—this it is that makes these cases pathological. Case 74. (Binet, _op. cit._) X., aged 34, teacher in a Gymnasium. In childhood he suffered with convulsions. At the age of ten he began to masturbate, with lustful feelings, which were connected with very strange ideas. He was particularly partial to women’s eyes; but since he wished to imagine some form of coitus, and was absolutely innocent in sexual matters, to avoid too great a separation from the eyes, he evolved the idea of making the nostrils the seat of the female sexual organs. Then his lively sexual desires were connected with this idea. He sketched drawings representing correct Greek profiles of female heads, but the nostrils were so large that immissio penis would have been possible. One day, in an omnibus, he saw a girl in whom he thought he recognized his ideal. He followed her to her home and immediately proposed to her. Shown the door, he returned again and again, until arrested. X. never had sexual intercourse. Hand-fetichists are very numerous. The following case is not really pathological. It is given here as a transitional case:— Case 75. B., of neuropathic family, very sensual, mentally intact. At the sight of the hand of a beautiful young lady he is always charmed and feels sexual excitement to the extent of ejaculation. It is his delight to kiss and press such hands. As long as they are covered with gloves he feels unhappy. By pretexts he tries to get hold of such hands. He is indifferent to the foot. If the beautiful hands are ornamented with rings, his lust is increased. Only the living hand, not its image, causes him this lustful excitement. It is only when he is exhausted sexually by frequent coitus that the hand loses its sexual charm. At first the memory-picture of female hands disturbed him even while at work. (Binet, _op. cit._) Binet states that such cases of enthusiasm for the female hand are numerous. Here it may be recalled that, according to Case 24, a man may be partial to the female hand as a result of sadistic impulses; and that, according to Case 46, the same thing may be due to masochistic desires. Thus such cases have more than one meaning. But this is by no means to say that all, or even a majority, of the cases of hand-fetichism allow or require a sadistic or masochistic explanation. The following interesting case, that has been studied in detail, shows that, in spite of the fact that at first a sadistic or masochistic element seems to have exercised an influence, at the time of the individual’s maturity and the complete development of the perversion, the latter contained nothing of these elements. Of course, it is possible that, in the course of time, these disappeared; but here the assumption of the origin of the fetichism in an accidental association meets every requirement:— Case 76. A case of _hand-fetichism_, communicated by Albert Moll. P. L., aged 28, a merchant of Westphalia. Aside from the fact that the patient’s father was remarkably moody and somewhat quick-tempered, nothing of an hereditary nature could be proved in the family. At school the patient was not very diligent; he was never able to concentrate his attention on any one subject for any length of time; on the other hand, from childhood he had a great inclination for music. His temperament was always nervous. In August, 1890, he came to me complaining of headache and abdominal pain, which in every way gave the impression of being neurasthenic. The patient also said he was destitute of energy. Only after accurately directed questions did the patient make the following statements concerning his sexual life. As far as he could remember, the beginnings of sexual excitement occurred in his seventh year. Whenever he saw a boy of his own age urinate and caught sight of his genitals, he became lustfully excited. L. states with certainty that this excitement was associated with very evident erections. Led astray by another boy, L. learned to masturbate at the age of seven or eight. “Being of a very excitable nature,” said L., “I practiced masturbation very frequently until my eighteenth year, without gaining any clear idea of the evil results or the meaning of the practice.” He was particularly fond of practicing mutual onanism with some of his school-friends, but it was by no means an indifferent matter who the other boy was; on the contrary, only a few of his companions could satisfy him in this respect. To the question as to what particularly caused him to prefer this or that boy, L. replied that a _white, beautifully-formed hand_ in his school-fellows impelled him to practice mutual onanism with them. L. further remembered that frequently, at the beginning of the gymnastic lesson, he would exercise by himself on a bar standing apart. He did this for the purpose of exciting himself as much as possible; and he was so successful that, without using his hand and without ejaculation,—L. was still too young,—he had lustful pleasure. Another early event which L. remembers is interesting. One day his favorite companion, N., who practiced mutual onanism with him, proposed that L. should try to get hold of his (N.’s) penis, and he would do all he could to prevent it. L. acquiesced. In this way the onanism way directly combined with a struggle between both parties, in which N. was always overcome. The struggle always finally ended in N.’s being compelled to allow L. to practice onanism on him. L. assured me that this kind of masturbation had given him, as well as N., especial pleasure.[90] In this way L. continued to practice masturbation very frequently until his eighteenth year. Warned by a friend, he then began to struggle with all his might against his evil habit. He became more and more successful, and finally, after the first performance of coitus, he stopped the practice of onanism entirely. But this was only accomplished in his twenty-second year. It now seems incomprehensible to the patient—and he says he is filled with disgust at the thought of it—how he could ever have found pleasure in performing masturbation with other boys. Now, nothing could induce him to touch another man’s genitals, the sight of which is even unpleasant to him. He has lost all inclination for men, and feels attracted by women exclusively. It must be mentioned, however, that, though L. has a decided inclination for the female sex, he presents an abnormal phenomenon. The essential thing in woman that excites him is the sight of her beautiful hands; L. is by far more impressed when he touches a beautiful female hand than he would be were he to see its possessor in a state of complete nudity. The extent to which L.’s preference for beautiful female hands goes is shown by the following incident:— L. knew a beautiful young lady possessed of every charm, but her hands were quite large and not beautifully formed, and often they were not as clean as L. could wish. For this reason it was not only impossible for L. to conceive a deeper interest in the lady, but he was not able even to touch her. L. believes that there is nothing more disgusting to him than dirty finger-nails; this alone would make it impossible for him to touch a woman who in all other respects was most beautiful. L. formerly, as a substitute for coitus, had the puella perform genital manipulation with her hand until ejaculation took place. To the question as to what there was about a woman’s hand that attracted him in particular, whether he saw in it a symbol of power, and whether it gave him pleasure to be directly humiliated by a woman, the patient answered that only the _beautiful form_ of the hand charmed him; that it afforded him no gratification to be humiliated by a woman; and that he had never had any thought to regard the hand as the symbol or instrument of a woman’s power. The preference for the hand is still so great that the patient has greater pleasure when his genitals are touched by it than when he performs coitus in vaginam. Yet, the patient prefers to perform the latter, because it seems to him to be natural, while the former seems abnormal. The touch of a beautiful female hand on his body immediately causes him to have erection; he thinks that kissing and other contacts do not exert nearly so strong an influence. It is only of late years that the patient has performed coitus frequently, but it has always been very difficult for him to determine to do it. Too, in coitus, he did not find the complete satisfaction he sought. However, when he finds himself near a woman whom he would like to possess, sometimes, at mere sight of her, his sexual excitement becomes so intense that ejaculation results. L. says expressly that during this he does not intentionally touch or press his genitals; ejaculation under such circumstances affords him much more pleasure than he experiences in actual coitus.[91] To go back, the patient’s dreams were never about coitus. When he had pollutions at night, they were almost always associated with other thoughts than those that occur in the normal man. The patient’s dreams are of events of his school-days. During his school-days, besides the mutual onanism described, he had ejaculations whenever he became anxiously excited. When, for example, the teacher dictated an extemporaneous exercise, and L. was unable to follow in translation, ejaculation often occurred.[92] The pollutions that now occur occasionally, at night, are only accompanied by dreams that have the same or a similar subject,—the events at school just mentioned. On account of his unnatural feeling and sensibility, the patient thinks he is incapable of loving a woman long. Treatment of the patient’s perversion has not yet been possible. This case of hand-fetichism certainly does not depend on masochism or sadism, but is to be explained simply by early indulgence in mutual onanism. There is here, also, quite as little of contrary sexual instinct. Before the sexual appetite was clearly conscious of its object, the hands of school-fellows were used. As soon as the instinct for the opposite sex became evident, the interest for the hand was transferred to woman. In hand-fetichists, who, according to Binet, are so numerous, it is possible that other associations lead to the same result. Next to the hand-fetichists, naturally come the foot-fetichists. While glove-fetichism, which belongs to the next group of object-fetichism, seldom takes the place of hand-fetichism, we find shoe- and boot-fetichism, of which there are innumerable cases occurring everywhere, taking the place of enthusiasm for the naked female foot. There are only here and there traces of the latter enthusiasm, and these are scarcely pathological. It is easy to see the reason for this. The female hand is usually seen uncovered; the foot, covered. Thus the early associations which determine the direction of the vita sexualis are naturally connected with the naked hand, but with the covered foot. Shoe-fetichism also finds its place in the following group of dress-fetichism; however, on account of its demonstrable masochistic character in the majority of cases, it has been, for the most part, described already (p. 123 _et seq._). Besides the eyes, hand, and foot, the mouth and ears often play the _rôle_ of a fetich. Among others, Moll (_op. cit._) mentions such cases. (Comp. also Belot’s romance, “La Bouche de Madame X.,” which, B. states, rests upon actual observation.) The following remarkable case came under my personal observation:— Case 77. A gentleman of very bad heredity consulted me concerning impotence that was driving him almost to despair. While he was young, his fetich was women of plump form. He married such a lady, and was happy and potent with her. After a few months the lady fell very ill, and lost much flesh. When, one day, he tried to resume his marital duty, he was absolutely impotent, and remained so. If, however, he attempted coitus with plump women, he was perfectly potent. Even bodily defects may become fetiches. Descartes, who himself (“Traité des Passions,” cxxxvi) expresses some opinions concerning the origin of peculiar affections in associations of ideas, was always partial to cross-eyed women, because the object of his first love had such a defect. (Binet, _op. cit._) Lydston (“A Lecture on Sexual Perversion,” Chicago, 1890[93]) reports the case of a man who had a love-affair with a woman whose right lower extremity had been amputated. After separation from her, he searched for other women with a like defect.[94]—A negative fetich. When the part of the female body forming the fetich is capable of removal, like the hair, the most extravagant acts may be performed. Therefore, hair-fetichists form an interesting and forensically-important category. While such admirers of female hair are probably not infrequent within physiological limits, and possibly various senses (sight, smell, and hearing, through crepitant sounds,—and certainly touch, just as with velvet- and silk-fetichists, _v. infra_) are thus excited with an accompaniment of lustful feeling; yet, a series of similar pathological cases has also been observed, in which the hair-fetichism had become an overpowering impulse, and driven the individuals to commit crimes.[95],[96] These form the group of hair-despoilers. Case 78. _A hair-despoiler._ P., aged 40, artistic locksmith, single. His father was temporarily insane, and his mother was very nervous. He developed well, and was intelligent; but he was early affected with _tics_ and imperative ideas. He had never masturbated. He loved platonically, and often busied himself with matrimonial plans. He had coitus infrequently with prostitutes, but never felt satisfied with such intercourse—rather, disgusted. Three years ago he was overtaken by misfortune (financial ruin), and, besides, he had a febrile disease, with delirium. These things had a very bad effect on his hereditarily-predisposed nervous system. On August 28, 1889, P. was arrested at the Trocadero, in Paris, _in flagranti_, as he forcibly cut off a young girl’s hair. He was arrested with the hair in his hand and a pair of shears in his pocket. He excused himself on the ground of momentary mental confusion and an unfortunate, irresistible passion; he confessed that he had ten times cut off hair, which he took great delight in keeping at home. On searching his home, sixty-five switches and tresses of hair were found, assorted in packets. P. had already been once arrested, on December 15, 1886, under similar circumstances, but was released for lack of evidence. P. states that, for the last three years, when he is alone in his room at night, he feels ill, anxious, excited, and dizzy, and then is troubled by the impulse to touch female hair. When it happened that he could actually take a young girl’s hair in his hand, he felt intensely excited sexually, and had erection and ejaculation without touching the girl in any other way. On reaching home, he would feel ashamed of what had taken place; but the wish to possess hair, always accompanied by great sensual pleasure, became more and more powerful in him. He wondered that previously, even in the most intimate intercourse with women, he had experienced no such feeling. One evening he could not resist the impulse to cut off a girl’s hair. With the hair in his hand, at home, the sensual process was repeated. He was forced to rub his body with the hair and envelop his genitals in it. Finally, quite exhausted, he grew ashamed, and could not trust himself to go out for several days. After months of rest he was again impelled to possess himself of female hair, indifferent as to whose it might be. If he attained his end, he felt himself possessed by a supernatural power and unable to give up his booty. If he could not attain the object of his desire, he became greatly depressed, hurried home, and there reveled in his collection of hair. He combed and fondled it, and thus had intense orgasm, satisfying himself by masturbation. Hair exposed in the cases of hair-dressers made no impression on him; it required hair hanging down from a female head. At the height of his act, he states, he is in such a state of excitement that he has only imperfect apperception and subsequent memory of what he does. When he touches the hair with the shears he has erection, and, at the instant of cutting it off, ejaculation. Since his misfortune, about three years ago, he states that he has had weakness of memory, is easily exhausted mentally, and has been troubled by sleeplessness and night-terrors. P. deeply regrets his crime. Not only hair, but a number of hair-pins, ribbons, and other articles of the feminine toilet, were found in his possession, which he had had presented to him. He had always had an actual mania for collecting such things, as well as newspapers, pieces of wood, and other worthless trash, which he would never give up. He also had a strange and, to him, inexplicable fear of passing a certain street; if he ever tried it, it made him ill. The opinion (medico-legal) showed him to be hereditarily predisposed, and proved the imperative, impulsive, and decidedly involuntary character of the criminal acts, which had the significance of an imperative act, induced by an imperative idea, with an accompaniment of overpowering abnormal sexual feeling. Pardon; asylum for insane. (Voisin, Socquet, Motet, _Annales d’hygiène_, April, 1890.) Following this case, is a similar one which also deserves attention; for it has been well studied, and may be called almost classical; and, too, it places the fetich, as well as the original associative awakening of the idea, in a clear light:— Case 79. _A hair-despoiler._ E., aged 25. Maternal aunt, epileptic; brother had convulsions. E. says he was fairly healthy as a child, and learned quite easily. At the age of fifteen he had a sensual feeling of pleasure, with erection, at the sight of one of the village beauties combing her hair. Until that time persons of the opposite sex had made no impression on him. Two months later, in Paris, the sight of young girls with their hair flowing down over their shoulders always excited him intensely. One day he could not resist an opportunity to twist a young girl’s hair in his fingers. For this he was arrested and sentenced to imprisonment for three months. After that he served five years as a soldier. During this time hair was not dangerous for him, though also not very accessible; but he dreamed sometimes of female heads with the hair braided or flowing. Occasional coitus with women, but without having their hair effective as a fetich. Once more in Paris, he again dreamed as before, and became greatly excited by female hair. He never dreamed about the whole form of a woman, only of heads with braids of hair. His sexual excitement due to this fetich had become so intense of late that he had resorted to masturbation. The idea of touching female hair, or, better, of possessing it to masturbate while handling it, grew more and more powerful. Of late, when he had female hair in his fingers, ejaculation was induced. One day he succeeded in cutting hair, about 25 centimetres long, from three little girls in the street, and keeping it in his possession, when he was arrested in a fourth attempt. Deep regret and shame. He was not sentenced. Since spending some time in the asylum, he has so far improved that female hair no longer excites him. Set at liberty, he thought of going to his native place, where the women wear their hair done up. (Magnan, _Archiv. de l’anthropol. criminelle_, v, Nr. 28.) A third case is the following, which is likewise suited to illustrate the psychopathic nature of such phenomena; and the remarkable means which induced a cure are worthy of note:— Case 80. _Hair-fetichism._ Mr. X., between thirty and forty years old; from the higher class of society; single. He says that he comes of a healthy family, but from childhood has been nervous, vacillating, and peculiar; that since his eighth year he has been powerfully attracted by female hair. This was particularly true in the case of young girls. When he was nine years old, a girl of thirteen seduced him. He did not understand it, and was not at all excited. A twelve-year-old sister of this girl also courted, kissed, and hugged him. He allowed this quietly, because this girl’s hair pleased him so well. When about ten years old, he began to have sensual feelings at the sight of female hair that pleased him. Gradually these feelings occurred spontaneously, and memory-pictures of girls’ hair were always immediately associated with them. At the age of eleven he was taught to masturbate by school-mates. The associative connection of sexual feelings and a fetichistic idea was already established, and always appeared when the patient indulged in evil practices with his companions. With advancing years, the fetich grew more and more powerful. Even false hair began to excite him, but he always preferred natural hair. When he could touch or kiss it, he was perfectly happy. He wrote essays and poems on the beauty of female hair; he sketched heads of hair and masturbated. After his fourteenth year he became so powerfully excited by his fetich that he had violent erections. In contrast with his early taste while a boy, he was now charmed only by luxuriant, thick black hair. He experienced intense desire to kiss such hair, particularly to suck it. To touch such hair afforded him but little satisfaction; he obtained much more pleasure in looking at it, but particularly in kissing and sucking it. If this were impossible, he would become unhappy, even to the extent of tædium vitæ. Then he would attempt to relieve himself, imagining fantastic “hair-adventures” and masturbating. Not infrequently, in the street and in crowds, he could not keep from imprinting a kiss on ladies’ heads. He would then hurry home to masturbate. Sometimes he could resist this impulse; but it was then necessary for him, filled with feelings of fear, to run away as quickly as possible, in order to escape the domination of his fetich. He was only once impelled to cut off a girl’s hair in a crowd. In the act he was seized with fear, and was not successful with his pocket-knife; and, by flight, he narrowly escaped detection. When he became mature, he attempted to satisfy himself in coitus with puellis. He induced powerful erection by kissing the hair, but could not induce ejaculation. Therefore, he was unsatisfied by coitus. At the same time, his favorite idea was coitus with kissing of hair; but even this did not satisfy him, because it did not induce ejaculation. _Faute de mieux_, he once stole the combings of a lady’s hair, put it in his mouth, and masturbated while calling its owner up in imagination. In the dark a woman could not interest him, because he could not then see her hair. Flowing hair also had no charm for him; nor did the hair about the genitals. His erotic dreams were all about hair. Of late the patient had become so excited that he had a kind of satyriasis. He was incapable of business, and felt so unhappy that he sought to drown his sorrow in alcohol. He drank large quantities, had alcoholic delirium, an attack of alcoholic epilepsy, and required hospital treatment. After the intoxication had passed away, under appropriate treatment, the sexual excitement soon disappeared; and when the patient was discharged, he was freed from his fetichistic idea, save for its occasional occurrence in dreams. The physical examination showed normal genitals and no degenerative signs whatever. Such cases of hair-fetichism, which lead to attacks on female hair, seem to occur everywhere, from time to time. In November, 1890, according to reports in American newspapers, several cities in the United States were troubled by such hair-despoilers. (b) _The Fetich is an Article of Female Attire._—The great importance of adornment, ornament, and dress, in the normal vita sexualis of man, is very generally recognized. Culture and fashion[97] have, to a certain extent, endowed woman with artificial sexual characteristics, the removal of which, when woman is seen unattired, in spite of the normal sensual effect of this sight, may exert an opposite influence.[98] It should not be overlooked that female dress often shows a tendency to emphasize and exaggerate certain sexual peculiarities,—secondary sexual characteristics (bosom, waist, hips). In most individuals the sexual instinct awakes long before there is any possibility or opportunity of intimate intercourse, and the early desires of youth are concerned with the ordinary appearance of the attired female form. Thus it happens that not infrequently, at the beginning of the vita sexualis, ideas of the persons exerting sexual charms and ideas of their attire become associated. This association may be lasting—the attired woman may be always preferred—if the individuals dominated by this perversion do not in other respects attain to a normal vita sexualis, and find gratification in natural charms. In psychopathic individuals, sexually hyperæsthetic, as a result of this, it actually happens that the dressed woman is always preferred to the nude female form. It may be recalled that in Case 48 the woman was not to take off a garment, and that in Case 51, _equus eroticus_, the woman was preferred dressed. In Case 89, of the sixth edition,—that of a man manifesting contrary sexuality,—the same preference is expressed. Dr. Moll (_op. cit._) mentions a patient who could not perform coitus with puella nuda; the woman had to have on a chemise, at least. The same author (_op. cit._, p. 129) mentions a man affected with contrary sexuality, who was subject to the same dress-fetichism. The reason for this phenomenon is apparently to be found in the mental onanism of such individuals. In seeing innumerable clothed forms, they have cultivated desires before seeing nudity.[99] A more marked form of dress-fetichism is that in which, instead of the dressed woman, a certain kind of attire becomes a fetich. One can understand how, with an intense and early sexual impression, combined with the idea of a particular garment on the woman, in hyperæsthetic individuals, a very intense interest in this garment might be developed. Hammond (_op. cit._) reports the following case, taken from Roubaud (“Traité de l’impuissance,” Paris):— Case 81. X., son of a general. He was raised in the country. At the age of fourteen he was initiated into the joys of love by a young lady. This lady was a blonde, and wore her hair in ringlets; and, in order to avoid detection in sexual intercourse with her young lover, she always wore her usual clothing,—gaiters, a corset, and a silk dress. When his studies were completed, and he was sent to a garrison where he could enjoy freedom, he found that his sexual desire could be excited only under certain conditions. A brunette could not excite him in the least, and a woman in night-clothes could stifle every bit of love in him. In order to awaken his desire, a woman had to be a blonde, and wear gaiters, a corset, and a silk dress,—in short, she had to be dressed like the lady who had first awakened his sexual desire. He was always compelled to give up thoughts of matrimony, because he knew he would be unable to fulfill his marital duty with a woman in night-clothes. Hammond reports another case where coitus maritalis could be performed only by the help of a certain costume; and Dr. Moll mentions several similar cases in individuals of hetero- and homo-sexuality. The cause may often be shown to be an early association, and such may always be assumed. It is only in this way that one can explain why a certain costume cannot be resisted by such individuals, no matter what person wears the fetich. Thus one can understand why, as Coffignon (_op. cit._) relates, men at brothels demand that the women with whom they are concerned put on certain costumes, such as that of a ballet-dancer, or nun, etc.; and why these houses are furnished with a complete wardrobe for such purposes. Binet (_op. cit._) relates the case of a judge who was exclusively in love with Italian girls who came to Paris as artists’ models, and their peculiar costume. The cause was here demonstrably an impression made at the time of the awakening of the sexual instinct. A third form of dress-fetichism, having a much higher degree of pathological significance, is by far the most frequent. In this form it is no longer the woman herself, dressed, or even dressed in a particular fashion, that constitutes the principal sexual stimulus, but the sexual interest is so concentrated on some certain article of female attire that the lustful idea of this object is entirely separated from the idea of woman, and thus obtains an independent value. This is the real domain of dress-fetichism, where an inanimate object—an isolated article of wearing-apparel—is alone used for the excitation and satisfaction of the sexual instinct. This third form of dress-fetichism is also the one that is important forensically. In a large number of these cases the fetiches are articles of female underwear, which, owing to their private use, are suited to occasion such associations. Case 82. K., aged 45, shoemaker, is reported to be without hereditary taint. He is peculiar, and has small mental endowment. He is of masculine habitus and without signs of degeneration. Previously blameless in conduct, on the evening of July 5, 1876, he was detected taking stolen female under-garments from a place of concealment. There were found with him about three hundred articles of the female toilet, among them, besides chemises and drawers, night-caps, garters, and a female doll. When arrested he was wearing a chemise. Since his thirteenth year he had been a slave to an impulse to steal women’s linen; but, after his first punishment for it, he had become very careful, and stolen with refinement and success. When this longing came over him, he would grow anxious, and his head would become heavy. Then he could not resist the impulse, cost what it might. He was indifferent to the source of the articles. At night, on going to bed, he would put on the stolen clothing and create beautiful women in imagination, thus inducing pleasurable feeling and ejaculation. This was apparently the motive of his thefts; at least, he had never disposed of any of the articles, but had hidden them here and there. He declared that, earlier in his life, he had indulged in normal sexual intercourse with women. He denied onanism, pederasty, and other sexual acts. He said he was engaged at twenty-five, but the engagement was broken through no fault of his. He was incapable of insight into the abnormality of his condition and the wrong of his acts. (Passow, _Vierteljahrsschrift f. ger. Medic._, N. F. xxviii, p. 61; Krauss, “Psychologie des Verbrechens,” 1884, p. 190.) Hammond (_op. cit._) reports a case of passionate interest in single articles of female wearing-apparel. Here, also, the patient’s pleasure consisted in wearing a corset and other female garments (without any traces of contrary sexual instinct). The pain of tight lacing, experienced by himself or induced in women, is a delight to him,—sadistic-masochistic element. A case probably belonging here is one reported by Diez (“Der Selbstmord,” 1838, p. 24), where a young man could not resist the impulse to tear female linen. While tearing it, he always had ejaculation. A combination of fetichism with an impulse to destroy the fetich (in a certain sense, sadism with inanimate objects) seems to occur quite frequently (comp. Case 93). An article of dress, which, though it has not really a private character, by its material and color, as well as by the place where it is worn, recalls under-garments, and hence has sexual relations, is the apron (comp. also the metonymic use of the word “apron” for “petticoat” in the saying, “To chase every apron,” etc.). This explains the following case:— Case 83. C., aged 37; of a badly tainted family; of small mental endowment; plagiocephalic. At fifteen his attention was attracted by aprons hung out to dry. He bound them about himself and masturbated behind the fence. From that time he could not see aprons without repeating the act. If any one—no matter whether man or woman—with an apron on came near him, he was compelled to run after the person. In order to free him from this constant stealing of aprons, he was sent as a marine in his sixteenth year. In this calling he saw no aprons, and had continual rest. When, at nineteen, he returned home, he was again compelled to steal aprons, and, as a result, got into serious complications, and was several times locked up. He sought to free himself of his weakness by a sojourn of several years in a cloister. When he came out, he was just as bad as before. As a result of a new theft, he underwent a medico-legal examination, and was committed to an asylum. He never stole anything but aprons. It was a pleasure to him to revel in the memory of the first apron he ever stole. His dreams were filled with aprons. He occasionally used the memory of his thefts to make coitus possible, or for masturbation. (Charcot and Magnan, _Arch. de neurolog._, 1882, Nr. 12.) In a case reported by Lombroso (“Amori anomali precoci nei pazzi,” _Arch. di psich._, 1883, p. 17), analogous to those of this series, a boy of very bad heredity, at the age of four, had erections and great sexual excitement at the sight of white garments, particularly underclothing. He was lustfully excited by handling and crumpling them. At the age of ten he began to masturbate at the sight of white, starched linen. He seems to have been affected with moral insanity, and was executed for murder. The following case of petticoat-fetichism is combined with peculiar circumstances:— Case 84. Z., aged 35; official; the only child of a nervous mother and healthy father. From childhood he was “nervous,” and at the consultation his neuropathic eyes, delicate, slender body, fine features, very thin voice, and sparse growth of beard attracted attention. The patient presents nothing abnormal except symptoms of slight neurasthenia. Genitals and sexual functions normal. Patient states that he has only masturbated four or five times, and that when he was very young. As early as at the age of thirteen, the patient was powerfully excited sexually by the sight of wet female dresses; while the same dresses, when dry, had no effect upon him. His greatest delight was to look at women with wet garments in the rain. If he met a woman having a pleasing face under such circumstances, he experienced an intense feeling of lustful pleasure, had erection, and felt impelled to perform coitus. He states that he has never had any desire to wet female dresses or to throw water on women. He can give no explanation of the origin of his peculiarity. It is possible that, in this case, the sexual instinct was first awakened by the sight of a woman as she exposed her charms by raising her skirts in wet weather. The obscure instinct, not yet conscious of its object, then became directed to the wet garments, as in other cases. _Lovers of female handkerchiefs_ are frequent, and, therefore, important forensically. As to the frequency of handkerchief-fetichism, it may be remarked that the handkerchief is the one article of feminine attire which, outside of intimate association, is most frequently displayed, and which, with its warmth from the person and specific odors, may by accident fall into the hands of others. The frequency of early association of lustful feelings with the idea of a handkerchief, which may always be presumed to have occurred in such cases of fetichism, probably is due to this. Case 85. A baker’s assistant, aged 32, single, previously of good repute, was discovered stealing a handkerchief from a lady. In sincere remorse, he confessed that he had stolen from eighty to ninety such handkerchiefs. He had cared only for handkerchiefs, and, indeed, only for those belonging to young women attractive to him. In his outward appearance the culprit presents nothing peculiar. He dresses himself with much taste. His conduct is peculiar, anxious, depressed, and unmanly, and he often lapses into whining and tears. Lack of self-reliance, weakness of comprehension, and slowness of perception and reflection, are noticeable. One of his sisters is epileptic. He lives in good circumstances; was never severely sick; developed well. In relating his history, he shows weakness of memory and lack of clearness; calculation is hard for him, though when young he learned and comprehended easily. His anxious, uncertain state of mind gives rise to a suspicion of onanism. The culprit confessed that he had been given to this practice excessively since his nineteenth year. For some years, as a result of his vice, he had suffered with depression, lassitude, trembling of the limbs, pain in the back, and disinclination for work. Frequently a depressed, anxious state of mind came over him, in which he avoided people. He had exaggerated, fantastic notions about the results of sexual intercourse with women, and could not bring himself to indulge in it. Of late, however, he had thought of marriage. With great remorse and in a weak-minded way, X. now confessed that six months before, while in a crowd, he became violently excited sexually at the sight of a pretty young girl, and was compelled to crowd up against her. He felt an impulse to compensate himself for the want of a more complete satisfaction of his sexual excitement, by stealing her handkerchief. Thereafter, as soon as he came near attractive females, with violent sexual excitement, palpitation of the heart, erection and _impetus coeundi_, the impulse would seize him to crowd up against them and, _faute de mieux_, steal their handkerchiefs. Although the consciousness of his criminal act never left him for a moment, he was unable to make any resistance to the impulse. During the act he felt an anxiety which was in part due to his inordinate sexual impulse, and partly to the fear of detection. The medico-legal opinion rightly gave weight to the congenital mental enfeeblement and the pernicious influence of masturbation, and referred the abnormal impulses to a perverse sexual impulse, calling attention to the presence of an interesting and well-known physiological connection between the olfactory and sexual senses. The inability to resist the pathological impulse was recognized. X. was not punished. (Zippe, _Wiener Med. Wochenschrift_, 1879, Nr. 23.) I am indebted to the kindness of Dr. Fritsch, of Vienna, for further facts concerning this handkerchief-fetichist, who was again arrested in August, 1890, in the act of taking a handkerchief from a lady’s pocket:— On searching his house, four hundred and forty-six ladies’ handkerchiefs were found. He stated that he had burned besides two bundles of them. In the course of the examination, it was further shown that X. had been punished with imprisonment for fourteen days, in 1883, for stealing twenty-seven handkerchiefs, and again with imprisonment for three weeks, in 1886, for a similar crime. Concerning his relatives, nothing more could be learned than that his father was subject to congestions, and that a brother’s daughter was weak-minded and constitutionally neuropathic. X. had married in 1879, and embarked in an independent business, and in 1881 he made an assignment. Soon after that, his wife, who could not live with him, and with whom he did not perform his marital duty (denied by X.), demanded a divorce. Thereafter he lived as assistant baker to his brother. He complained bitterly of an impulse for ladies’ handkerchiefs, but when opportunity offered, unfortunately, he could not resist it. In the act he experienced a feeling of delight, and felt as if some one were forcing him to it. Sometimes he could restrain himself, but, when the lady was pleasing to him, he yielded to the first impulse. He would be wet with sweat, partly from fear of detection, and partly on account of the impulse to perform the act. He says he has been sensually excited, by the sight of handkerchiefs belonging to women, since puberty. He cannot recall the exact circumstances of this fetichistic association. The sensual excitement, occasioned by the sight of a lady with a handkerchief hanging out of her pocket, had constantly increased. This had repeatedly caused erection, but never ejaculation. After his twenty-first year, he says, he had inclination to normal sexual indulgence, and had coitus without difficulty without ideas of handkerchiefs. With increasing fetichism, the appropriation of handkerchiefs had afforded him much more satisfaction than coitus. The appropriation of the handkerchief of a lady attractive to him was the same to him as intercourse with her would have been. In the act he had true orgasm. If he could not gain possession of the handkerchief he desired, he would become painfully excited, tremble, and sweat all over. He kept separate the handkerchiefs of ladies particularly pleasing to him, and reveled in the sight of them, taking great pleasure in it. The odor of them also gave him great delight, though he states that it was really the odor peculiar to the linen, and not the perfume, which excited him sensually. He had masturbated but very seldom. X. complained of no physical ailments except occasional headache and vertigo. He greatly regretted his misfortune, his abnormal impulse,—the evil spirit that impelled him to such criminal acts. He had but one wish: that some one might help him. Objectively there are mild neurasthenic symptoms, anomalies of the distribution of blood, and unequal pupils. It was proved that X. had committed his crimes in obedience to an abnormal, irresistible impulse. Pardon. Such cases of handkerchief-fetichism, where an abnormal individual is driven to theft, are very numerous. They also occur in combination with contrary sexuality, as is proved by the following case, which I borrow from page 125 of Dr. Moll’s frequently-cited work[100]:— Case 86. _Handkerchief-fetichism in a Case of Contrary Sexual Instinct._—K., aged 38; mechanic; a powerfully built man. He makes numerous complaints,—weakness of the legs, pain in the back, headache, want of pleasure in work, etc. The complaints give the decided impression of neurasthenia with tendency to hypochondria. Only after the patient had been under my treatment several months did he state that he was also abnormal sexually. K. had never had any inclination whatever for women; but handsome men, on the other hand, had a peculiar charm for him. Patient had masturbated frequently until he came to me. He had never practiced mutual onanism or pederasty. He did not think that he would have found satisfaction in this, because, in spite of his preference for men, an article of white linen was his chief charm, though the beauty of its owner played a _rôle_. The handkerchiefs of handsome men particularly excite him sexually. His greatest delight is to masturbate in men’s handkerchiefs. For this reason he often took his friend’s handkerchiefs. In order to save himself from detection, he always left one of his own handkerchiefs with his friend in place of the one he stole. In this way he sought to escape the suspicion of theft, by creating the appearance of a mistake. Other articles of men’s linen also excited K. sexually, but not to the extent handkerchiefs did. K. had often performed coitus with women, having erection and ejaculation, but without lustful pleasure. There was also nothing which could stimulate the patient to the performance of coitus. Erection and ejaculation occurred only when, during the act, he thought of a man’s handkerchief; and this was easier for the patient when he took a friend’s handkerchief with him, and had it in his hand during coitus. In accordance with his sexual perversion, in his nightly pollutions with lustful ideas, men’s linen played the principal _rôle_. It is possible that, in this interest in (used) handkerchiefs, elements of feeling in the sense of masochism, group “_c_,” are also often at work. Still far more frequent than the fetichism of linen garments is that of women’s shoes. These cases are, in fact, almost innumerable, and a great many of them have been scientifically studied; but I have but a few reports at second hand of the similar glove-fetichism (concerning the reason for the relative infrequency of glove-fetichism, _vide_ p. 161). In shoe-fetichism the close relationship of the object to the feminine person, which explains linen-fetichism, is absolutely wanting. For this reason, and because there is a large number of well-observed cases at hand, in which the fetichistic enthusiasm for the female shoe or boot consciously and undoubtedly arises from masochistic ideas, an origin of a masochistic nature, even when it is concealed, may always be assumed in shoe-fetichism, when, in the concrete case, no other manner of origin is demonstrable. For this reason the majority of the cases of shoe- or foot-fetichism have been given under “Masochism.” There the constant masochistic character of this form of erotic fetichism has been sufficiently demonstrated by means of transitional conditions. This presumption of the masochistic character of shoe-fetichism is weakened and removed only where another accidental cause for an association between sexual excitation and the idea of women’s shoes—the occurrence of which is quite improbable _a priori_—is demonstrable. In the two following cases, however, there is such a demonstrable connection:— Case 87. _Shoe-fetichism._ Mr. v. P., of an old and honorable family, Pole, aged 32, consulted me, in 1890, on account of “unnaturalness” of his vita sexualis. He gave the assurance that he came of a perfectly healthy family. He had been nervous from childhood, and had suffered with chorea minor at the age of eleven. For ten years he had suffered with sleeplessness and various neurasthenic ailments. From his fifteenth year he had recognized the difference of the sexes and been capable of sexual excitation. At the age of seventeen he had been seduced by a French governess, but coitus was not permitted; so that intense mutual sensual excitement (mutual masturbation) was all that was possible. In this situation his attention was attracted by her very elegant boots. They made a very deep impression. His intercourse with this lewd person lasted four months. During this association her shoes became a fetich for the unfortunate boy. He began to have an interest in ladies’ shoes in general, and actually went about trying to catch sight of ladies wearing pretty boots. The shoe-fetichism gained great power over his mind. He had the governess touch his penis with her shoes, and thus ejaculation with great lustful feeling was immediately induced. After separation from the governess, he went to puellis, whom he had perform the same manipulation. This was usually sufficient for satisfaction. Only seldom did he resort to coitus as an auxiliary, and inclination for it grew less and less. His vita sexualis consisted of dream-pollutions, in which women’s shoes played the exclusive _rôle_; and of gratification with women’s shoes apposita ad mentulam, but this had to be done by the puella. In the society of the opposite sex the only thing that interested him was the shoe, and that only when it was elegant, of the French style, with heels, and of a brilliant black, like the original. In the course of time the following conditions have become accessory: A prostitute’s shoe that is elegant and _chic_; starched petticoats, and black hose, if possible. Nothing else in woman interests him. _He is absolutely indifferent to the naked foot._ Women have not the slightest mental charm for him. He had never had masochistic desires, in the sense of being trod upon. In the course of years his fetichism had gained such power that when he saw a lady on the street, of a certain appearance and with certain shoes, he was so intensely excited that he had to masturbate. Slight pressure on the penis sufficed to induce ejaculation, in his state of severe neurasthenia. Shoes displayed in shops, and, of late, even advertisements of shoes, sufficed to excite him intensely. In states of intense libido he made use of onanism, if shoes were not at his immediate command. The patient quite early recognized the pain and danger of his condition, and, even when he was free from neurasthenic ailments, he was morally very much depressed. He sought help of various physicians. Cold-water cures and hypnotism were unsuccessful. The most celebrated physicians advised him to marry, and assured him that, as soon as he once really loved a girl, he would be free from his fetichism. The patient had no confidence in his future, but he followed the advice of the physicians. He was cruelly disappointed in the hope which the authority of the physicians had aroused in him, though he led to the altar a lady distinguished by both mental and physical charms. The wedding-night was terrible; he felt like a criminal, and did not approach his wife. The next day he saw a prostitute with the required _chic_. He was weak enough to have intercourse with her in his way. Then he bought a pair of elegant ladies’ boots, and hid them in bed, and, by touching them, while in marital embrace, after a few days, he was able to perform his marital duty. He ejaculated tardily, for he had to force himself to coitus; and, after a few weeks, this artifice failed, because his imagination failed. He felt unspeakably miserable, and would have preferred to make an end of himself. He could no longer satisfy his wife, who was sensual, and much excited by their previous intercourse; and he saw her suffering severely, both mentally and morally. He could not, and would not, disclose his secret. He experienced disgust in marital intercourse; he felt afraid of his wife, and feared the coming of night and being alone with her. He could no longer induce erection. He again made attempts with prostitutes, and satisfied himself by touching their shoes. Then the puella had to touch his penis, when he would have ejaculation; but, if this did not take place, he would attempt coitus with the lewd woman; without success, however, for ejaculation would occur immediately. In absolute despair, the patient comes for consultation. He deeply regretted that, against his inner conviction, he had followed the unfortunate advice of the physicians, and made a virtuous wife unhappy, having deeply injured her, both mentally and morally. Could he answer God for continuing such a marriage? Even if he were to discover himself to his wife, and she were to do everything for him, it would not help him; for the familiar perfume of the _demi-monde_ was also necessary. Aside from his mental pain, this unfortunate man presented no remarkable symptoms. Genitals perfectly normal. Prostate somewhat enlarged. He complained that he was so under the domination of his boot-ideas that he would even blush when boots were talked about. His whole imagination was given up to such ideas. When he was on his estate, he often suddenly had to go a distance of ten miles to the city, to satisfy his fetichism with shoe-stores or with puellis. This pitiable man could not bring himself to take treatment; for his faith in physicians had been greatly shaken. An attempt to ascertain whether hypnosis and a removal of the fetichistic association by this means, were possible, increased the mental excitement of the unfortunate man, who was exclusively controlled by the thought that he had made his wife unhappy. Case 88. X., aged 24, from a badly-tainted family (mother’s brother and grandfather insane, one sister epileptic, another sister subject to migraine, parents of excitable temperament). During dentition he had had convulsions. At the age of seven he was taught to masturbate by a servant-girl. X. first experienced pleasure in these manipulations when this girl occasionally _stroked his penis with her foot with her shoe on_. Thus, in the predisposed boy, an association was established, as a result of which, from that time on, merely the sight of women’s shoes, and, finally, merely the idea of them, sufficed to induce sexual excitement and erection. He now masturbated while looking at women’s shoes, or while calling them up in imagination. At school the teacher’s shoes excited him intensely, and in general he was affected by shoes that were partly concealed by female garments. One day he could not keep from grasping the teacher’s shoes,—an act that caused him great sexual excitement. In spite of punishment he could not keep from performing this act repeatedly. Finally, it was recognized that there must be an abnormal motive in play, and he was sent to a male teacher. He then reveled in the memory of shoe-scenes with his former school-mistress, and thus had erections, orgasm, and, after his fourteenth year, ejaculation. At the same time, he masturbated while thinking of a woman’s shoe. One day the thought came to him to increase his pleasure by using such a shoe for masturbation. Thereafter he frequently took shoes secretly, and used them for that purpose. Nothing else in a woman could excite him; the thought of coitus filled him with horror. Men did not interest him in any way. At the age of eighteen he opened a general store, and, among other things handled ladies’ shoes. He was excited sexually by fitting shoes for his female patrons, or by manipulating shoes that they had worn. One day, while doing this, he had an epileptic attack, and, soon after, another, while practicing onanism in his customary way. Then he recognized, for the first time, the injury to health caused by his sexual practices. He tried to overcome his onanism, sold no more shoes, and strove to free himself from the abnormal association between women’s shoes and the sexual function. Then frequent pollutions, with erotic dreams about shoes, occurred, and the epileptic attacks continued. Though devoid of the slightest feeling for the female sex, he determined on marriage, which seemed to him to be the only remedy. He married a pretty young lady. In spite of lively erections when he thought of his wife’s shoes, in attempts at cohabitation he was absolutely impotent; for his distaste for coitus, and for close intercourse in general, was far more powerful than the influence of the shoe-idea, which induced sexual excitement. On account of his impotence, the patient applied to Dr. Hammond, who treated his epilepsy with bromides, and advised him to hang a shoe up over his bed, and look at it fixedly during coitus, at the same time imagining his wife to be a shoe. The patient became free from epileptic attacks, and potent so that he could have coitus about once a week. Too, his sexual excitation by women’s shoes grew less and less. (Hammond, “Sexual Impotence.”) Following these two cases of shoe-fetichism, which apparently depend merely upon accidental association, and are not favored by any inner relation between the things themselves, is given the very strange case of a fetichist who was excited sexually only by the idea of a night-cap on the head of an ugly old woman; also a case arising apparently from merely accidental association:— Case 89. L., aged 37, clerk, from tainted family, had his first erection at five years, when he saw his bed-fellow—an aged relative—put on a night-cap. The same thing occurred later, when he saw an old servant put on her night-cap. Later, simply the idea of an old, ugly woman’s head, covered with a night-cap, was sufficient to cause an erection. Simply the sight of a cap, or of a naked woman or man, made no impression, but the mere touch of a night-cap induced erection, and sometimes even ejaculation. L. was not a masturbator, and had never been sexually active until his thirty-second year, when he married a young girl with whom he had fallen in love. On his marriage-night he remained cold until, from necessity, he brought to his aid the memory-picture of an ugly woman’s head with a night-cap. Coitus was immediately successful. Thereafter it was always necessary for him to use this means. Since childhood he had been subject to occasional attacks of depression, with tendency to suicide, and now and then to frightful hallucinations at night. When looking out of windows, he became dizzy and anxious. He was a perverse, peculiar, and easily embarrassed man, of bad mental constitution. (Charcot and Magnan, _Arch. de neurol._, 1882, No. 12.) In this very peculiar case, the simultaneous coincidence of the first sexual excitation and an absolutely heterogeneous impression seems to have determined the association. Hammond (_op. cit._) also mentions a case of accidental associative fetichism that is quite as peculiar. A married man, aged 30, who, in other respects, was healthy, physically and mentally, is said to have suddenly lost his sexual power, after moving to another house, and to have regained it as soon as the furniture of the sleeping-room had been arranged as it was before. (c) _The Fetich is Some Special Material._—There is a third principal group of fetichists who have as a fetich neither a portion of the female body nor a part of female attire, but some particular material which is so used, not because it is a material for female garments, but because in itself it can arouse or increase sexual feelings. In many cases of this kind, the act of feeling of such material during the sexual act seems indispensable, in order to make the latter possible, or at least satisfactory. Such materials are furs, velvet, and silk. These cases differ from the foregoing instances of erotic dress-fetichism, in that these materials, unlike female linen, do not have any close relation to the female body; and, unlike shoes and gloves, they are not related to certain parts of the person which have peculiar symbolic significance. Moreover, this fetichism cannot be due to an accidental association, like that in the cases of the night-caps and the arrangement of the sleeping-room; for these cases form an entire group having the same object. It must be presumed that certain tactile sensations (a kind of tickling which stands in some distant relation to lustful sensations?), in hyperæsthetic individuals, furnish the occasion for the origin of this fetichism. The following is a personal observation of a man affected with this peculiar fetichism:— Case 90. N. N., aged 37; of a neuropathic family; neuropathic constitution. He makes the following statement: “From my earliest youth I have always had a deeply-rooted partiality for furs and velvet, in that these materials cause me sexual excitement, and the sight and touch of them give me lustful pleasure. I can recall no event that caused this peculiarity (such as the simultaneous occurrence of the first sexual excitation and an impression of these materials,—_i.e._, first excitation by a woman dressed in them); in fact, I cannot remember when this enthusiasm began. However, by this I would not exclude the possibility of such an event,—of an accidental connection in a first impression and consequent association; but I think it very improbable that such a thing took place, because I believe such an occurrence would have deeply impressed me. All I know is, that even when a small child I had a lively desire to see and stroke furs, and thus had an obscure sensual pleasure. With the first occurrence of definite sexual ideas,—_i.e._, the direction of sexual thoughts to woman,—the peculiar preference for women dressed in such materials was present. Since then, up to mature manhood, it has remained unchanged. A woman wearing furs or velvet, or, better, both, excites me much more quickly and intensely than one devoid of these auxiliaries. To be sure, these materials are not a _conditio sine qua non_ of excitation; the desire occurs also without them, in response to the usual stimuli; but the sight and, particularly, the touch of these fetich-materials form for me a powerful aid to other normal stimuli, and intensify erotic pleasure. Often merely the sight of only a passably pretty girl, dressed in these materials, causes me lively excitement, and overcomes me completely. Even the sight of my fetich-materials gives me pleasure, but the touch of them much more. (To the penetrating odor of furs I am indifferent—rather, it is unpleasant—and it is endurable only by reason of the association with pleasing visual and tactile impressions.) I have an intense longing to touch these materials while on a woman’s person, to stroke and kiss them, and bury my face in them. My greatest pleasure is, _inter actum_, to see and feel my fetich on the woman’s shoulder. “Fur, or velvet alone, exerts on me the effect described, the former much more intensely than the latter. The combination of the two has the most intense effect. Too, female garments of velvet and fur, seen and touched without the wearer, cause me sexual excitement; indeed, though to a less extent, the same effect is exerted by furs or robes having no relation to female attire, and also by the velvet and plush of furniture and drapery. Merely pictures of costumes of furs and velvet are objects of erotic interest to me; indeed, simply the word “fur” has a magic charm for me, and immediately calls up erotic ideas. “Fur is such an object of sexual interest for me that a man wearing fur that is effective (_v. infra_) makes a very unpleasant, repugnant, and disgusting impression on me; such as would be made on a normal person by a man in the costume and attire of a ballet-dancer. Similarly repugnant to me is the sight of an old or ugly woman clad in beautiful furs; because opposing feelings are thus aroused. “This erotic delight in furs and velvet is something entirely different from simple æsthetic pleasure. I have a very lively appreciation of beautiful female attire, and, at the same time, a particular partiality for point-lace; but it is purely of an æsthetic nature. A woman dressed in a point-lace _toilette_ (or in other elegant, elaborate attire) is more _beautiful_ than another; but one dressed in my fetich-material is more _charming_. “But furs exercise on me the effect described only when the fur has very thick, fine, smooth, and rather long hair, that stands out like that of the so-called bearded furs. I have noticed that the effect depends upon this. I am entirely indifferent not only to the common coarse, bushy furs, but also to those that are commonly regarded as beautiful and precious, from which the long hair has been removed (seal, beaver), or of which the hair is naturally short (ermine); and likewise to those of which the hair is over-long and lies down (monkey, bear). The specific effect is exerted only by the standing long hair of the sable, marten, skunk, etc. But velvet is made of thick, fine, standing hairs (fibres); and its effect may be due to this. The effect seems to depend upon a very definite impression of the points of thick, fine hair upon the end-organs of the sensory nerves. “But how this peculiar impression on the tactile nerves is related to sexual instinct is a perfect enigma to me. The fact is, that this is the case with many men. I would also state expressly that beautiful female hair pleases me, but plays no more important part than the other charm; and that while touching fur I have no thought of female hair. The tactile sensation, also, has not the least resemblance to that imparted by female hair. There is never association of any other idea. Fur, _per se_, arouses sensuality in me,—how, I cannot explain. “The mere æsthetic effect, the beauty of costly furs, to which every one is more or less susceptible; which, since Raphael’s Fornarina and Reuben’s Helene Fourment, has been used as the foil and frame of female beauty by innumerable painters; and which plays so important a _rôle_ in fashion,—the art and science of female dress,—this æsthetic effect, as has been remarked, explains nothing here. Beautiful furs have the same æsthetic effect on me as on normal individuals, and affect me in the same way that flowers, ribbons, precious stones, and other ornaments affect every one. Such things, when skillfully used, enhance female beauty, and thus, under certain circumstances, may have an indirect sensual effect. They never have a direct, powerful, sensual effect on me, as do the fetich-materials mentioned. “Though in me, and, in fact, in all ‘fetichists,’ the sensual and æsthetic effect must be strictly differentiated, nevertheless, that does not prevent me from demanding in my fetich a whole series of æsthetic qualities in form, style, color, etc. I could give a very lengthy description of these qualities that my taste demands; but I omit it as not being essential to the real subject in hand. I would only call attention to the fact that erotic fetichism is complicated with purely æsthetic tastes. “The specific erotic effect of my fetich-materials can be explained no better by the association with the idea of the person of the female wearing them, than by their æsthetic impression. For, in the first place, as has been said, these materials, as such, affect me when entirely isolated from the body; and, in the second place, articles of clothing of a much more private nature, and which undoubtedly call up associations, exert a much weaker influence over me. Thus the fetich-materials have an independent sensual value for me; why, is an enigma to me. “Feathers in women’s hats, fans, etc., have the same erotic fetichistic effect on me as furs and velvet (similar tactile sensation of airy, peculiar tickling). Finally, the fetichistic effect, with much less intensity, is exerted by other smooth materials (satin and silk); but rough goods (cloth, flannel) have a repelling effect. “In conclusion, I will mention that somewhere I read an article by Carl Vogt on microcephalic men, according to which these creatures, at the sight of furs, rushed for them and stroked them with every manifestation of delight. I am far from any thought, on this ground, to see in wide-spread fur-fetichism an atavistic retrogression to the taste of our hairy ancestors. Every cretin, with that simplicity belonging to his condition, touches anything that pleases him; and the act is not necessarily of a sexual nature; just as many normal men like to stroke a cat and the like, or even velvet and furs, and are not thus excited sexually.” In the literature of this subject, there are a few cases belonging here:— Case 91. A boy, aged 12, became powerfully excited sexually when he chanced to put on a fox-skin. From that time there was masturbation with the employment of furs, or by means of taking a furry dog to bed. Ejaculation would result, sometimes followed by an hysterical attack. His nocturnal pollutions were induced by dreaming that he lay entirely covered up in a white skin. He was absolutely insusceptible to stimuli coming from men or women. He was neurasthenic, suffered with delusions of being watched, and thought that every one noticed his sexual anomaly. He had tædium vitæ on account of this, and finally became insane. He had marked taint; his genitals were imperfectly formed, and he presented other signs of degeneration. (Tarnowsky, _op. cit._, p. 22.) Case 92. C. is an especial lover of velvet. He is attracted in a normal way by beautiful women, but it particularly excites him to have the person with whom he has sexual intercourse dressed in velvet. In this, it is remarkable that it is not so much the sight as the touch of the velvet that causes the excitation. C. told me that stroking a woman’s velvet jacket would excite him sexually to an extent scarcely possible in any other way. (Dr. Moll, _op. cit._, p. 127.) The following is a very peculiar case of material-fetichism. It is combined with the impulse to injure the fetich, which, in this case, represents an element of sadism toward the woman wearing the fetich, or impersonal sadism toward objects, which is of frequent occurrence in fetichists (comp. p. 170). This impulse to injure made this a remarkable criminal case:— Case 93. In July, 1891, Alfred Bachmann, aged 25, locksmith, was brought before Judge I., in the second term of the criminal court, in Berlin. In April, 1891, the police had had numerous complaints, according to which some evil hand had cut women’s dresses with a very sharp instrument. On April 25, they were successful in arresting the perpetrator in the person of the accused. A policeman noticed how the accused pressed, in a remarkable manner, against a lady in the company of a gentleman, while they were going through a passage. The officer requested the lady to examine her dress, while he held the man under suspicion. It was ascertained that the dress had received quite a long slit. The accused was taken to the station, where he was examined. Besides a sharp knife, which he confessed he used for cutting dresses, two silk sashes, such as ladies wear on their dresses, were found on him; he also confessed that he had taken these from dresses in crowds. Finally, the examination of his person brought to light a lady’s silk neck-cloth. The accused said he had found this. Since his statement in this case could not be refuted, complaint was therefore made to rest on the result of the search; in two instances in which complaint was made by the injured parties his acts were designated as injury to property, and in two other instances as theft. The accused, a man who had been often punished before, with a pale, expressionless face, before the judge, gave a strange explanation of his enigmatical action. A major’s cook had once thrown him down-stairs when he was begging of her, and since that time he had entertained great hatred of the whole female sex. There was a doubt about his responsibility, and he was therefore examined by a physician. The medical expert gave the opinion, at the final trial, that there was no reason to regard the accused as insane, though he was of low intelligence. The culprit defended himself in a peculiar manner. An irresistible impulse forced him to approach women wearing silk dresses. _The touch of silk material gave him a feeling of delight_, and this went so far that, while in prison for examination, he had been excited if a silk thread happened to pass through his fingers while raveling rags. Judge Müller considered the accused to be simply a dangerous, vicious man, who should be made harmless for a long time. He advised imprisonment for one year. The court sentenced him to six months’ imprisonment, with loss of honor for a year. The following case was communicated to me by a physician:— In a brothel a certain man was known by the name of “Velvet.” He dressed a puella pleasing to him in a black velvet dress, and excited and satisfied his sexual appetite simply by stroking his face with a part of the velvet skirt, touching the woman in no other way. I am assured by an officer that, among masochists, a partiality for furs, velvet, and feathers, is very frequent (comp. Case 44). In the novels of Sacher-Masoch, fur plays an important part; indeed, it furnishes a title to some of them. The explanation given there seems far-fetched and unsatisfactory,—that fur (ermine) is the symbol of royalty, and therefore the fetich of the men described in the novels. II. _Great Diminution or Complete Absence of Sexual Feeling for the Opposite Sex, with Substitution of Sexual Feeling and Instinct for the Same Sex. (Homo-sexuality, or Contrary Sexual Instinct)._ After the attainment of complete sexual development, among the most constant elements of self-consciousness in the individual, are the knowledge of representing a definite sexual personality and the consciousness of desire, during the period of physiological activity of the reproductive organs (production of semen and ova), to perform sexual acts corresponding with that sexual personality,—acts which, consciously or unconsciously, have a procreative purpose. The sexual instinct and desire, save for indistinct feelings and impulses, remain latent until the period of development of the sexual organs. The child is _generis neutrius_; and though, during this latent period,—when sexuality has not yet risen into clear consciousness, is but virtually present, and unconnected with powerful organic sensations,—too early excitation of the genitals may occur, either spontaneously or as a result of external influence, and find satisfaction in masturbation; yet, notwithstanding this, the _psychical_ relation to persons of the opposite sex is still absolutely wanting, and the sexual acts during this period partake more or less of a reflex spinal nature. The fact of innocence, or of sexual neutrality, is the more remarkable, since very early, in education, employment, dress, etc., the child undergoes a differentiation from children of the opposite sex. These impressions, however, remain destitute of mental meaning, because they apparently are without sexual coloring; for the central organ (cortex) of sexual emotions and ideas is not yet capable of activity, owing to its undeveloped condition. With the inception of anatomical and functional development of the generative organs, and the differentiation of form belonging to each sex, which goes hand in hand with it in the boy or girl, rudiments of a mental feeling corresponding with the sex are developed; and in this, of course, education and external influences in general have a powerful effect upon the individual, who is now all attention. If the sexual development is normal and undisturbed, a definite character, corresponding with the sex, is developed. Certain definite inclinations and reactions in intercourse with persons of the opposite sex arise; and it is psychologically worthy of note with what relative rapidity the definite mental type corresponding with the sex is evolved. While modesty, for example, during childhood, is essentially but an uncomprehended and incomprehensible exaction of education and imitation, and in the innocence and _näiveté_ of the child but imperfectly expressed; in the youth and maiden it becomes an imperative requirement of self-respect; and, if in any way it is offended, intense vasomotor reaction (blushing) and psychical emotion are induced. If the original constitution is favorable and normal, and factors injurious to the psycho-sexual development exercise no influence, then a psycho-sexual personality is developed that is so unchangeable, and corresponds so completely and harmoniously with the sex the individual represents, that subsequent loss of the generative organs (as by castration), or the climacteric or senility, cannot essentially alter it. But this, of course, is not to declare that the castrated man or woman, the youth and the aged man, the maiden and matron, the impotent and the potent man, do not differ essentially from one another mentally. An interesting and important question for what follows is, whether the peripheral influences of the generative glands (testes and ovaries), or central cerebral conditions, are the determining factors in psycho-sexual development. The fact that congenital deficiency of the generative glands, or removal of them before puberty, has a great influence on physical and psycho-sexual development, so that the latter is distorted and assumes a type more closely resembling the opposite sex (eunuchs, certain viragoes, etc.), betokens their great importance in this respect. But that the physical processes taking place in the genital organs are only co-operative, and not the exclusive factors in the process of development of the psycho-sexual character, is shown by the fact that, notwithstanding a normal anatomical and physiological state of these organs, a sexual instinct may be developed which is the exact opposite of that characteristic of the sex to which the individual belongs. In this case, the cause is to be sought only in an anomaly of central conditions,—in an abnormal psycho-sexual constitution. This constitution, as far as its anatomical and functional foundation is concerned, is absolutely unknown. Since, in almost all such cases, the individual subject to the perverse sexual instinct displays a neuropathic predisposition in several directions, and the latter may be brought into relation with hereditary degenerate conditions, this anomaly of psycho-sexual feeling may be called, clinically, a functional sign of degeneration. This perverse sexuality appears spontaneously, without external cause, with the development of sexual life, as an individual manifestation of an abnormal form of the vita sexualis, and then has the force of a _congenital_ phenomenon; or it develops upon a sexuality the beginning of which was normal, as a result of very definite injurious influences, and thus appears as an _acquired_ anomaly. Upon what this enigmatical phenomenon of acquired homo-sexual instinct depends is still inexplicable, and only a matter for hypothesis. Careful examination of the so-called acquired cases makes it probable that the predisposition also present here consists of a latent homo-sexuality, or, at least, bi-sexuality, which, for its manifestation, requires the influence of accidental exciting causes to rouse it from its slumber. In so-called contrary sexual instinct there are degrees of the phenomenon which quite correspond with the degrees of predisposition of the individuals. Thus, in the milder cases, there is simple hermaphroditism; in more pronounced cases, only homo-sexual feeling and instinct, but limited to the vita sexualis; in still more complete cases, the whole psychical personality, and even the bodily sensations, are transformed to correspond with the sexual perversion; and, in the complete cases, the physical form is correspondingly altered. The following division of the various phenomena of this psycho-sexual anomaly is made, therefore, in accordance with these clinical facts:— A. _Homo-sexual Feeling as an Acquired Manifestation._—The determining condition here is the demonstration of perverse feeling for the same sex; not the proof of sexual acts with the same sex. These two phenomena must not be confounded with each other; perversity must not be taken for perversion. Perverse sexual acts, not dependent upon perversion, often come under observation. This is especially true with reference to sexual acts between persons of the same sex, particularly pederasty. Here paræsthesia sexualis is not necessarily at work; but hyperæsthesia, with physical or mental impossibility of natural sexual satisfaction. Thus we find homo-sexual intercourse in impotent masturbators or debauchees, or _faute de mieux_ in sensual men and women in imprisonment, on ship-board, in garrisons, bagnios, boarding-schools, etc. There is an immediate return to normal sexual intercourse as soon as obstacles to it are removed. Very frequently the cause of such temporary aberration is masturbation and its results in youthful individuals. Nothing is so prone to contaminate—under certain circumstances, even to exhaust—the source of all noble and ideal sentiments, which arise of themselves from a normally developing sexual instinct, as the practice of masturbation in early years. It despoils the unfolding bud of perfume and beauty, and leaves behind only the coarse, animal desire for sexual satisfaction. If an individual, spoiled in this manner, reaches an age of maturity, there is wanting in him that æsthetic, ideal, pure, and free impulse which draws one toward the opposite sex. Thus the glow of sensual sensibility wanes, and the inclination toward the opposite sex becomes weakened. This defect influences the morals, character, fancy, feeling, and instinct of the youthful masturbator, male or female, in an unfavorable way, and, under certain circumstances, allows the desire for the opposite sex to sink to _nil_; so that masturbation is preferred to the natural mode of satisfaction. Sometimes the development of higher sexual feelings toward the opposite sex suffers, on account of hypochondriacal fear of infection in sexual intercourse; or on account of an actual infection; or they suffer as a result of a faulty education which points out such dangers and exaggerates them. Again (especially in females), fear of the result of coitus (pregnancy), or abhorrence of men, by reason of mental or moral weakness, may direct into perverse channels an instinct that makes itself felt with abnormal intensity. But too early and perverse sexual satisfaction injures not merely the mind, but also the body; inasmuch as it induces neuroses of the sexual apparatus (irritable weakness of the centres governing erection and ejaculation; defective pleasurable feeling in coitus), while, at the same time, it maintains the imagination and libido in continuous excitement. Almost every masturbator at last reaches a point where, frightened on learning the results of the vice, or on experiencing them (neurasthenia), or led by example or seduction to the opposite sex, he wishes to free himself of the vice and re-instate his vita sexualis. The moral and mental conditions are the most unfavorable possible. The pure glow of sexual feeling is destroyed; the fire of sexual instinct is wanting, and self-confidence, no less; for every masturbator is more or less timid and cowardly. If the youthful sinner at last comes to make an attempt at coitus, he is either disappointed because enjoyment is wanting, on account of defective sensual feeling, or he is lacking in the mental strength necessary to accomplish the act. The fiasco has a fatal effect, and leads to absolute psychical impotence. A bad conscience and the memory of past failures prevent success in any further attempts. The constant libido sexualis, however, demands satisfaction; but this moral and mental perversion separates him further and further from women. For various reasons, however (neurasthenic complaints, hypochondriacal fear of the results, etc.), the individual is kept from masturbation. Occasionally, under such circumstances, there may be bestiality. Intercourse with the same sex is then near at hand,—as a result of occasional seduction or of the feelings of friendship which, on the level of pathological sexuality, easily associate themselves with sexual feelings. Passive and mutual onanism then becomes the equivalent of the avoided act. If there is a seducer,—which, unfortunately, is so frequent,—then the cultivated pederast is produced,—_i.e._, a man who performs _quasi_ acts of onanism with persons of his own sex, and, at the same time, feels and prefers himself in an active _rôle_ corresponding with his real sex; who is mentally indifferent not only to persons of the opposite sex, but also to those of his own sex. Sexual aberration in the _normally_ constituted, _untainted_, mentally healthy individual, reaches this degree. No case has been demonstrated in which perversity has been transformed into perversion,—into a reversal of the sexual instinct.[101] With tainted individuals, the matter is quite different. The latent perverse sexuality is developed under the influence of neurasthenia induced by masturbation, abstinence, or otherwise. Gradually, in contact with persons of the same sex, sexual excitation by them is induced. Related ideas are colored with lustful feelings, and awaken corresponding desires. This decidedly degenerate reaction is the beginning of a process of physical and mental transformation, a description of which is attempted in what follows, and which is one of the most interesting psychological phenomena that has been observed. This metamorphosis presents different stages, or degrees. _I. Degree: Simple Reversal of Sexual Feeling._—This degree is attained when persons of the same sex have an aphrodisiac effect, and the individual has a sexual feeling for them. Character and feeling, however, still correspond with the sex of the individual presenting the reversal of sexual feeling. He feels himself in the active _rôle_; he recognizes his impulse toward his own sex as an aberration, and finally seeks aid. With episodical improvement of the neurosis, at first even normal sexual feelings may re-appear and assert themselves. The following case seems well suited to exemplify this stage of the psycho-sexual degeneration:— Case 94. _Acquired Contrary Sexual Instinct._—“I am an official, and, as far as I know, come of an untainted family. My father died of an acute disease; my mother is living and is _quite nervous_. _A sister has been very intensely religious for some years._ “I myself am tall, and, in speech, gait, and manner, give a perfectly masculine impression. Measles is the only disease I have had; but since my thirteenth year I have suffered with so-called nervous headache. My sexual life began in my thirteenth year, when I became acquainted with a boy somewhat older than myself, with whom I took pleasure in mutual fondling of the genitals. I had the first ejaculation in my fourteenth year. Seduced to onanism by two older school-mates, I practiced it partly with others and partly alone; in the latter case, however, always with the thought of persons of the female sex. My libido sexualis was very great, as it is to-day. Later, I tried to win a pretty, stout servant-girl who had very large mammæ; id solum assecutus sum, ut me praesente superiorem corporis sui partem enudaret mihique concederet os mammasque osculari, dum ipsa penem meum valde erectum in manum suam recepit eumque trivit. “Notwithstanding my urgent demand for coitus, she would not allow it; but she finally permitted me to touch her genitals. “After going to the University, I visited a brothel and succeeded without especial effort. “There an event occurred which brought a change in me. One evening I accompanied a friend home, and in a mild state of intoxication I grasped him ad genitalia. He made but slight opposition. I then went up to his room with him, and we practiced mutual masturbation. From that time we indulged in it quite frequently; in fact, it came to immissio penis in os, with resultant ejaculations. But it is strange that I was not at all in love with this person, but passionately in love with another friend, near whom I never felt the slightest sexual excitement, and whom I never connected with sexual matters, even in thought. My visits to brothels, where I was gladly received, became more infrequent; in my friend I found a substitute, and did not desire sexual intercourse with women. “We never practiced pederasty, and that word was not even known between us. From the beginning of this relation with my friend, I again masturbated more frequently, and naturally the thought of females receded more and more into the background, and I thought more and more about young, handsome, strong men with the largest genitals. I preferred young fellows, from sixteen to twenty-five years old, without beards, but they had to be handsome and clean. Young laborers dressed in trousers of Manchester cloth or English leather, particularly masons, especially excited me. “Persons in my own position had hardly any effect on me; but, at the sight of one of those strapping fellows of the lower class, I experienced marked sexual excitement. It seems to me that the touch of such trousers, the opening of them, and the grasping of the penis, as well as kissing the fellow, would be the greatest delight. My sensibility to female charms is somewhat dulled; yet in sexual intercourse with a woman, particularly when she has well-developed mammæ, I am always potent without the help of imagination. I have never attempted to make use of a young laborer, or the like, for the satisfaction of my evil desires, and never shall; but I often feel the longing to do it. I often impress on myself the mental image of such a man, and then masturbate at home. “I am absolutely devoid of taste for female work. I rather like to move in female society, but dancing is repugnant to me. I have a lively interest in the fine arts. That my sexual sense is partly reversed is, I believe, in part due to greater convenience, which keeps me from entering into a relation with a girl; as the latter is a matter of too much trouble. To be constantly visiting houses of prostitution is, for æsthetic reasons, repugnant to me; and thus I am always returning to solitary onanism, which is very difficult for me to avoid. “Hundreds of times I have said to myself that, in order to have a normal sexual sense, it would be necessary for me, first of all, to overcome my irresistible passion for onanism,—a practice so repugnant to my æsthetic feeling. Again and again I have resolved with all my might to fight this passion; but I am still unsuccessful. When I felt the sexual impulse gaining strength, instead of seeking satisfaction in the natural manner, I preferred to masturbate, because I felt that I would thus have more enjoyment. “And yet experience has taught me that I am always potent with girls, and that, too, without trouble and without the help of imagining masculine genitals. In one case, however, I did not attain ejaculation because the woman—it was in a brothel—was devoid of every charm. I cannot avoid the thought and severe self-accusation that, to a certain extent, my contrary sexuality is the result of excessive onanism; and this especially depresses me, because I am compelled to acknowledge that I scarcely feel strong enough to overcome this vice by the force of my own will. “As a result of my relations with my fellow-student and school-mate for years, mentioned in this communication,—which, however, began while we were at the University, and after we had been friends for seven years,—the impulse to unnatural satisfaction of libido has grown much stronger. I trust you will permit the description of an incident which occupied me for months:— “In the summer of 1882, I made the acquaintance of a companion six years younger than myself, who, with several others, had been introduced to me and my acquaintances. I very soon felt a deep interest in this handsome man, who was unusually well proportioned, slim, and full of health. After a few weeks of association, this feeling became friendship, and at last passionate love, with feelings of the most intense jealousy. I very soon noticed that, in this, sexual excitation was also very marked; and, notwithstanding my determination, aside from all others, to keep myself in check in relation to this man, whom I respected so highly for his superior character, one night, after free indulgence in beer, as we were enjoying a bottle of champagne in my room and drinking to good, true, and lasting friendship, I yielded to the irresistible impulse to embrace him, etc. “When I saw him, next day, I was so ashamed that I could not look him in the face. I felt the deepest regret for my action, and accused myself bitterly for having thus sullied this friendship, which was to be and remain so pure and precious. In order to prove to him that I had lost control of myself only momentarily, at the end of the semester I urged him to make an excursion with me; and after some reluctance, the reason of which was only too clear to me, he consented. Several nights we slept in the same room without any attempt on my part to repeat my action. I wished to talk with him about the event of that night, but I could not bring myself to it; even when, during the next semester, we were separated, I could not induce myself to write to him on the subject; and when I visited him, in March, at X., it was the same. And yet I felt a great desire to clear up this dark point by an open statement. In October of the same year, I was again in X., and this time found courage to speak without reserve; indeed, I asked him why he had not resisted me. He answered that, in part, it was because he wished to please me, and, in part, owing to the fact that he was somewhat apathetic as a result of being a little intoxicated. I explained to him my condition, and also gave him “Psychopathia Sexualis” to read, expressing the hope that by the force of my own will I should become fully and lastingly master of my unnatural impulse. Since this confession, the relation between this friend and me has been the most delightful and happy possible; there are the most friendly feelings on both sides, which are heart-felt and true; and it is to be hoped that they will endure. “If I should not improve my abnormal condition, I am determined to put myself under your treatment; the more because, after a careful study of your work, I cannot count myself as belonging to the category of so-called urnings; and, too, because I have the firm conviction, or hope, at least, that a strong will, assisted and combined with skillful treatment, could transform me into a man of normal feeling.” Case 95. Ilma S.,[102] aged 29; single; merchant’s daughter. She comes of a family having bad nervous taint. Father was a drinker and died by suicide, as also did the patient’s brother and sister. A sister suffers with convulsive hysteria. Mother’s father shot himself while insane. Mother was sickly, and died paralyzed after apoplexy. The patient never had any severe illness. She is bright, enthusiastic, and dreamy. Menses at the age of eighteen without difficulty; but thereafter they were very irregular. At fourteen, chlorosis and catalepsy from fright. Later, hysteria gravis and an attack of hysterical insanity. At eighteen, relations with a young man which were not platonic. This man’s love was passionately returned. From statements of the patient, it seems that she was very sensual, and after separation from her lover practiced masturbation. After this she led a romantic life. In order to earn a living, she put on male clothing, and became a tutor; but she gave up her place because her mistress, not knowing her sex, fell in love with her and courted her. Then she became a railway-employé. In the company of her companions, in order to conceal her sex, she was compelled to visit brothels with them, and hear the most vulgar stories. This became so distasteful to her that she gave up her place, resumed the garments of a female, and again sought to earn her living. She was arrested for a theft, and on account of severe hystero-epilepsy was sent to the hospital. There, inclination and impulse toward the same sex were discovered. The patient became troublesome on account of passionate love for female nurses and patients. Her sexual perversion was considered congenital. With regard to this the patient made some interesting statements:— “I am judged incorrectly, if it is thought that I feel myself a man toward the female sex. In my whole thought and feeling I am much more a woman. I loved my cousin as only a woman can love a man. “The change of my feeling originated in this, that, in Pesth, dressed as a man, I had an opportunity to observe my cousin. I saw that I had wholly deceived myself in him. That gave me terrible heart-pangs. I knew that I could never love another man; that I belonged to those who love but once. Of similar effect was the fact that, in the society of my companions at the railway, I was compelled to hear the most offensive language and visit the most disreputable houses. As a result of the insight into men’s motives, gained in this way, I took an unconquerable dislike to them. However, since I am of a very passionate nature and need to have some loving person on whom to depend, and to whom I can wholly surrender myself, I felt myself more and more powerfully drawn toward intelligent women and girls who were in sympathy with me.” The contrary sexual instinct of this patient, which was clearly acquired, expressed itself in a stormy and decidedly sensual way, and was further augmented by masturbation; because constant oversight in hospitals made sexual satisfaction with the same sex impossible. Character and occupation remained feminine. There were no manifestations of viraginity. According to information lately received by the author, this patient, after two years of treatment in an asylum, was entirely freed from her neurosis and sexual perversion, and discharged cured. Case 96. X., aged 19; mother nervous; two sisters of mother’s father were insane. Patient of nervous temperament; well endowed mentally; well developed; normally formed. When he was twelve years old, he was seduced into mutual onanism by an elder brother. After this, the patient continued the vice alone. In the last three years, during the act of masturbation, he had had peculiar fancies in the sense of “contrary sexual instinct.” He fancies himself a female; as, for example, a ballet-dancer in the act of coitus with an officer or circus rider. These perverse fancies have accompanied the act of masturbation since the patient became neurasthenic. He understands the harm of masturbation, fights desperately against it, but always gives up to the impulse. If he is able to withstand the impulse for a few days, a normal desire for sexual intercourse with females is awakened; but a certain fear of infection holds these desires in check, and always drives him again to masturbation. It is worthy of remark that this unfortunate’s lascivious dreams concerned only females. In the course of the last few months, the patient had become very neurasthenic and hypochondriacal. He feared tabes. I advised treatment of the neurasthenia, suppression of masturbation, and marital cohabitation, if possible, after improvement of the neurasthenia. Case 97. Mr. X, aged 35, single, official; mother insane, brother hypochondriacal. Patient was healthy, strong, of lively sensual temperament. He had manifested powerful sexual instinct abnormally early, and masturbated while yet a small boy. He had coitus the first time at the age of fourteen, he says, with enjoyment and complete power. When fifteen years old, a man sought to seduce him, and performed manustupration on him. X. experienced a feeling of repulsion, and freed himself from the disgusting situation. At maturity he committed excesses in libido, with coitus; in 1880 he became neurasthenic, being afflicted with weakness of erection and ejaculatio præcox. He thus became less and less potent, and no longer experienced pleasure in the sexual act. At this time of sexual decadence, for a long time, he still had what was previously foreign to him, and is still incomprehensible to him,—an inclination for sexual intercourse with immature girls of the age of twelve or thirteen. His libido increased as virility diminished. Gradually he developed inclination for boys of thirteen or fourteen. He was impelled to approach them. Quodsi ei occasio data est ut tangere posset pueros qui ei placuere, penis vehementer se erexit tum maxime quum crura puerorum tangere potuisset. Abhinc feminas non cupivit. Nonnunquam feminas ad coitum coëgit sed erectio debilis, ejaculatio præmatura erat sine ulla voluptate. Now only youths interested him. He dreamed about them and had pollutions. After 1882 he now and then had opportunity concumbere cum juvenibus. This led to powerful sexual excitement, which he satisfied by masturbation. It was only exceptional for him to venture to touch his bed-fellow and indulge in mutual masturbation. He shunned pederasty. For the most part, he was compelled to satisfy his sexual needs by means of solitary masturbation. In the act he called up the vision of pleasing boys. After sexual intercourse with such boys, he always felt strengthened and refreshed, but morally depressed; because there was consciousness of having performed a perverse, indecent, and punishable act. He found it painful that his disgusting impulse was more powerful than his will. X. thinks that his love for his own sex has resulted from great excess in natural sexual intercourse, and bemoans his situation. On the occasion of a consultation, in December, 1889, he asked whether there were any means to bring him back to a normal sexual condition, since he had no real horror feminæ, and would very gladly marry. This intelligent patient, free from degenerative signs, presented no abnormal symptoms except those of sexual and spinal neurasthenia of moderate degree. _II. Degree: Eviration and Defemination._—If, in cases of contrary sexual instinct thus developed, no restoration occurs, then deep and lasting transformations of the psychical personality may occur. The process completing itself in this way may be briefly designated _eviration_. The patient undergoes a deep change of character, particularly in his feelings and inclinations, which become those of a female. After this, he also feels himself to be a woman during the sexual act, has desire only for passive sexual indulgence, and, under certain circumstances, sinks to the level of a prostitute. In this condition of deep and more lasting psycho-sexual transformation, the individual is like the (congenital) urning of high grade. The possibility of a restoration of the previous mental and sexual personality seems, in such a case, excluded. The following case is a classical example of this variety of lasting acquired contrary sexual instinct:— Case 98. Sch., aged 30, physician, one day told me the story of his life and malady, asking explanation, and advice concerning certain anomalies of his vita sexualis. The following description gives, for the most part verbatim, the details of the autobiography; only in some portions is it shortened:— “My parents were healthy. As a child I was sickly; but with good care I thrived, and got on well in school. When eleven years old, I was taught to masturbate by my playmates, and gave myself up to it passionately. Until I was fifteen, I learned easily. On account of frequent pollutions, I became less capable, did not get on easily in school, and was uncertain and embarrassed when called on by the teacher. Frightened by my loss of capability, and recognizing that the loss of semen was responsible for it, I gave up masturbation; but the pollutions became even more frequent, so that I often had two or three in a night. In despair, I now consulted one physician after another. None were able to help me. “Since I grew weaker and weaker, by reason of the loss of semen, with the impulse to sexual satisfaction growing more and more powerful, I sought houses of prostitution. But I was there unable to find satisfaction; for, even though the sight of a naked female pleased me, neither orgasm nor erection occurred; and even manustupration by the puella was not capable of inducing erection. Scarcely would I leave the house, when the impulse would seize me again, and I would have violent erections. I grew ashamed before the girls, and ceased to visit such houses. Thus a couple of years passed. My sexual life consisted of pollutions. My inclination toward the opposite sex grew less and less. At nineteen I went to the University. The theatre had more attractions for me. I wished to become an actor. My parents were not willing. At the Capital I was compelled now and then to visit girls with my comrades. I feared such a situation; because I knew that coitus was impossible for me, and because my friends might discover my impotence. Therefore, I avoided, as far as possible, the danger of becoming the butt of jokes and ridicule. “One evening, in the opera-house, an old gentleman sat near me. He courted me. I laughed heartily at the foolish old man, and entered into his joke. Exinapinato genitalia mea prehendit, quo facto statim penis meus se erexit. Frightened, I demanded of him what he meant. He said that he was in love with me. Having heard of hermaphrodites in the clinics, I thought I had one before me, and became curious to see his genitals. The old man was very willing, and went with me to the water-closet. Sicuti penem maximum ejus erectum adspexi, perterritus effugi. “This man followed me, and made strange proposals which I did not understand, and repelled. He did not give me any rest. I learned the secrets of male love for males, and felt that my sexuality was excited by it. But I resisted the shameful passion (as I then regarded it), and, for the next three years, I remained free from it. During this time I repeatedly attempted coitus with girls in vain. My attempts to free myself of my impotence by means of medical treatment were also vain. Once, when my libido sexualis was troubling me again, I recalled what the old man had told me: that male-loving men were accustomed to meet on the E. Promenade. “After a hard struggle, and with beating heart, I went there, made the acquaintance of a blonde man, and allowed myself to be seduced. The first step was taken. This kind of sexual love was satisfactory to me. I always preferred to be in the arms of a strong man. The satisfaction consisted of mutual manustupration; occasionally in osculum ad penem alterius. I was then twenty-three years old. Sitting, together with my comrades, on the beds of patients in the clinic during the lectures, excited me so intensely that I could scarcely listen to the lectures. In the same year I entered into a formal love-relation with a merchant of thirty-four. We lived as man and wife. X. played the man, and fell more and more in love. I gave up to him, but now and then I had to play the man. After a time I grew tired of him, became unfaithful, and he became jealous. There were terrible scenes, which led to temporary separation, and finally to actual rupture. (The merchant afterward became insane, and died by suicide.) “I made many acquaintances, and loved the most ordinary people. I preferred those having a full beard, and who were tall and of middle age, and able to play the active _rôle_ well. I developed a proctitis. The professor thought it was the result of sitting too much while preparing for examinations. I developed a fistula, and had to undergo an operation; but this did not cure me of my desire to allow myself to be used passively. I became a physician, and went to a provincial city, where I had to live like a nun. I developed a desire to move in ladies’ society, and was gladly welcomed there; because it was found that I was not so one-sided as most men, and was interested in _toilettes_ and such feminine things. However, I felt very unhappy and lonesome. Fortunately, in this town, I made the acquaintance of a man, a ‘sister,’ who felt like me. For some time I was taken care of by him. When he had to leave, I had an attack of despair, with depression, which was accompanied by thoughts of suicide. “When it became impossible for me to longer endure the town, I became a military surgeon in the Capital. There I began to live again, and often made two or three acquaintances in one day. I had never loved boys or young people; only fully-developed men. The thought of falling into the hands of the police was frightful. Thus I have escaped the clutches of the blackmailer. At the same time, I could not keep myself from the satisfaction of my impulse. After some months I fell in love with an official of forty. I remained true to him for a year, and we lived like a pair of lovers. I was the wife, and was formally courted by the lover. One day I was transferred to a small town. We were in despair. The last night was spent in continually kissing and caressing one another. “In T. I was unspeakably unhappy, in spite of some ‘sisters’ whom I found. I could not forget my lover. In order to satisfy my sexual desire, which cried for satisfaction, I chose soldiers. Money obtained men; but they remained cold, and I had no enjoyment with them. I was successful in being re-transferred to the Capital. There, there was a new love-relation, but much jealousy; because my lover liked to go into the society of ‘sisters,’ and was proud and coquettish. There was a rupture. I was very unhappy and very glad to be transferred from the Capital. I now stayed in C., alone and in despair. Two infantry privates were brought into service, but with the same unsatisfactory result. When shall I ever find true love again? “I am over medium height, well developed, and look somewhat aged; and, therefore, when I wish to make conquests I use the arts of the toilet. My manner, movements, and face are masculine. Physically I feel as youthful as a boy of twenty. I love the theatre, and especially art. My interest in the stage is in the actresses, whose every movement and gesture I notice and criticise. “In the society of gentlemen I am silent and embarrassed, while in the society of those like myself I am free, witty, and as fawning as a cat, if a man is sympathetic. If I am without love, I become deeply melancholic; but the favors of the first handsome man dispel my depression. In other ways I am frivolous; anything but ambitious. My profession is nothing to me. Masculine pursuits do not interest me. I prefer novels and going to the theatre. I am effeminate, sensitive, easily moved, easily injured, and nervous. A sudden noise makes my whole body tremble, and I have to collect myself in order to keep from crying out.” _Remarks_: The foregoing case is certainly one of acquired contrary sexual instinct, since the sexual instinct and impulse were originally directed toward the female sex. Sch. became neurasthenic through masturbation. As an accompanying manifestation of the neurasthenic neurosis, lessened impressionability of the erection-centre and consequent relative impotence came on. As a result of this, sexual sensibility toward the opposite sex was lessened, with simultaneous persistence of libido sexualis. The acquired contrary sexual instinct must be abnormal, since the first touch by a person of the same sex is an adequate stimulus for the erection-centre. The perverse sexual feeling became complete. At first Sch. felt like a man in the sexual act; but more and more, as the change progressed, the feeling and desire of satisfaction changed to the form which, as a rule, characterizes the (congenital) urning. This eviration induces a desire for the passive _rôle_, and, further, for (passive) pederasty. It makes a deeper impress on the character. The character becomes feminine, inasmuch as Sch. now prefers to move in the society of actual females, has an increasing desire for feminine occupations, and, indeed, makes use of the arts of the toilet in order to improve his fading charms and make “conquests.” The foregoing facts, concerning acquired contrary sexual instinct and effemination, find an interesting confirmation in the following ethnological data:— Even Herodotus describes a peculiar disease which frequently affected the Scythians. The disease consisted in this: that men became effeminate in character, put on female garments, did the work of women, and even became effeminate in appearance. As an explanation of this insanity of the Scythians,[103] Herodotus relates the myth that the goddess Venus, angered by the plundering of the temple at Ascalon by the Scythians, had made women of these plunderers and their posterity. Hippocrates, not believing in supernatural diseases, recognized that impotence was here a causative factor, and explained it, though incorrectly, as due to the custom of the Scythians, by attributing it to disease of the jugular veins induced by excessive riding. He thought that these veins were of great importance in the preservation of the sexual powers, and that when they were severed, impotence was induced. Since the Scythians considered their impotence due to divine punishment, and incurable, they put on the clothing of females, and lived as women among women. It is worthy of note that, according to Klaproth (“Reise in den Kaukasus,” Berlin, 1812, v, p. 285) and Chotomski, even at the present time impotence is very frequent among the Tartars, as a result of riding unsaddled horses. The same is observed among the Apaches and Navajos of the Western Continent, who ride excessively, scarcely ever going on foot, and are remarkable for small genitals and mild libido and virility. Sprengel, Lallemand, and Nysten recognized the fact that excessive riding may be injurious to the sexual organs. Hammond reports analogous observations of great interest concerning the Pueblo Indians of New Mexico. These descendants of the Aztecs cultivate so-called “mujerados,” of which every Pueblo tribe requires one in the religious ceremonies (actual orgies in the spring), in which pederasty plays an important part. In order to cultivate a “mujerado,” a very powerful man is chosen, and he is made to masturbate excessively and ride constantly. Gradually such irritable weakness of the genital organs is engendered that, in riding, great loss of semen is induced. This condition of irritability passes into paralytic impotence. Then the testicles and penis atrophy, the hair of the beard falls out, the voice loses its depth and compass, and physical strength and energy decrease. Inclinations and disposition become feminine. The “mujerado” loses his position in society as a man. He takes on feminine manners and customs, and associates with women. Yet, for religious reasons, he is held in honor. It is probable that, at other times than during the festivals, he is used by the chiefs for pederasty. Hammond had an opportunity to examine two “mujerados.” One had become such seven years before, and was thirty-five years old at the time. Seven years before, he was entirely masculine and potent. He had noticed gradual atrophy of the testicles and penis. At the same time he lost libido and the power of erection. He differed in nowise, in dress and manner, from the women among whom Hammond found him. The genital hair was wanting, the penis was shrunken, the scrotum lax and pendulous, and the testicles were very much atrophied and no longer sensitive to pressure. The “mujerado” had large mammæ like a pregnant woman, and asserted that he had nursed several children whose mothers had died. A second “mujerado,” aged thirty-six, after he had been ten years in the condition, presented the same peculiarities, though with less development of mammæ. Like the first, the voice was high and thin. The body was plump.[104] _III. Degree: Stage of Transition to Metamorphosis Sexualis Paranoica._ A further degree of development is represented by those cases in which bodily sensation is also transformed in the sense of a _transmutatio sexus_. In this respect the following case is unique:— Case 99. _Autobiography._ “Born in Hungary in 1844, for many years I was the only child of my parents; for the other children died for the most part of general weakness. A brother came late, who is still living. “I come of a family in which nervous and mental diseases have been numerous. It is said that I was very pretty as a little child, with blonde locks and transparent skin; very obedient, quiet, and modest, so that I was taken everywhere in the society of ladies without any offense on my part. “With a very active imagination—my enemy through life—my talents developed rapidly. I could read and write at the age of four; my memory reaches back to my third year. I played with everything that fell into my hands,—with leaden soldiers, or stones, or ribbons from a children’s store; but a machine for working in wood, that was given to me as a present, I did not like. I liked best to be at home with my mother, who was everything to me. I had two or three friends, with whom I got on good-naturedly; but I liked to play with their sisters quite as well, who always treated me like a girl, which at first did not embarrass me. I must have already been on the road to become just like a girl; at least, I can still well remember how it was always said: ‘He is not intended for a boy.’ At this I tried to play the boy,—imitated my companions in everything, and tried to surpass them in wildness. In this I succeeded. There was no tree or building too high for me to reach its top. I took great delight in soldiers. I avoided girls more, because I did not wish to play with their play-things; and it always annoyed me that they treated me so much like one of themselves. “In the society of mature people, however, I was always modest, and, also, always regarded with favor. Fantastic dreams about wild animals—which once drove me out of bed without waking me—frequently troubled me. I was always very simply, but very elegantly, dressed, and thus developed a taste for beautiful clothing. It seems peculiar to me that, from the time of my school-days, I had a partiality for ladies’ gloves, which I put on secretly as often as I could. Thus, when once my mother was about to give away a pair of gloves, I made great opposition to it, and told her, when she asked why I acted so, that I wanted them myself. I was laughed at; and from that time I took good care not to display my preference for female things. Yet my delight in them was very great. I took especial pleasure in masquerade costumes,—_i.e._, only in female attire. If I saw them, I envied their owners. What seemed to me the prettiest sight was: two young men, beautifully dressed as white ladies, with masks on; and yet I would not have shown myself to others as a girl for anything; I was so afraid of being ridiculed. At school I worked very hard, and was always among the first. From childhood my parents taught me that duty came first; and they always set me an example. It was also a pleasure for me to attend school; for the teachers were kind, and the elder scholars did not plague the younger ones. We left my first home; for my father was compelled, on account of his business,—which was dear to him,—to separate from his family for a year. We moved to Germany. Here there was a stricter, rougher manner, partly in teachers and partly in scholars; and I was again ridiculed on account of my girlishness. My school-mates went so far as to give a girl, who had exactly my features, my name, and me hers; so that I hated the girl. But I later came to be on terms of friendship with her after her marriage. My mother tried to dress me elegantly; but this was repugnant to me, because it made me the object of joke. So, finally, I was delighted when I had correct trousers and coats. But with these came a new annoyance. They irritated my genitals, particularly when the cloth was rough; and the touch of tailors while measuring me, on account of their tickling, which almost convulsed me, was unendurable, particularly about the genitals. Then I had to practice gymnastics; and I simply could do nothing at all, or only indifferently the things that girls cannot do easily. While bathing I was troubled by feeling ashamed to undress; but I liked to bathe. Until my twelfth year I had a great weakness in my back. I learned to swim late, but ultimately so well that I took long swims. At thirteen I had pubic hair, and was about six feet tall; but my face was feminine until my eighteenth year, when my beard came in abundance and gave me rest from resemblance to woman. An inguinal hernia that was acquired in my twelfth year, and cured when I was twenty, gave me much trouble, particularly in gymnastics. Besides, from my twelfth year on, I had, after sitting long, and particularly while working at night, an itching, burning, and twitching, extending from the penis to my back, which the acts of sitting and standing increased, and which was made worse by catching cold. But I had no suspicion whatever that this could be connected with the genitals. Since none of my friends suffered in this way, it seemed strange to me; and it required the greatest patience to endure it; the more owing to the fact that my abdomen troubled me. “In _sexualibus_ I was still perfectly innocent; but now, as at the age of twelve or thirteen, I had a definite feeling of preferring to be a young lady. A young lady’s form was more pleasing to me; her quiet manner, her deportment, but particularly her attire, attracted me. But I was careful not to allow this to be noticed; and yet, I am sure that I should not have shrunk from the castration-knife, could I have thus attained my desire. If I had been asked to say why I preferred female attire, I could have said nothing more than that it attracted me powerfully; perhaps, too, I seemed to myself, on account of my uncommonly white skin, more like a girl. The skin of my face and hands, particularly, was very sensitive. Girls liked my society; and, though I should have preferred to have been with them constantly, I avoided them when I could; for I had to exaggerate in order not to appear feminine. In my heart I always envied them. I was particularly envious when one of my young girl friends got long dresses and wore gloves and veils. When, at the age of fifteen, I was on a journey, a young lady, with whom I was boarding, proposed that I mask as a lady and go out with her; but, owing to the fact that she was not alone, I did not acquiesce, much as I should have liked it. Others stood on very little ceremony with me. While on this journey, I was pleased at seeing boys in one city wearing blouses with short sleeves, and the arms bare. A lady elaborately dressed was like a goddess to me; and if even her hand touched me coldly I was happy and envious, and only too gladly would have put myself in her place in the beautiful garments and lovely form. Nevertheless, I studied assiduously, and passed through the Realschule and the Gymnasium in nine years, passing a good final examination. I remember, when fifteen, to have first expressed to a friend the wish to be a girl. In answer to his question, I could not give the reason why. At seventeen I got into fast society; I drank beer, smoked, and tried to joke with waiter-girls. The latter liked my society, but they always treated me as if I wore petticoats. I could not take dancing lessons, they repelled me so; but if I could have gone as a mask, it would have been different. My friends loved me dearly; I hated only one, who seduced me into onanism. Shame on those days, which injured me for life! I practiced it quite frequently, but in it seemed to myself like a double man. I cannot describe the feeling; I think it was masculine, but mixed with feminine elements. I could not approach girls; I feared them, but they were not strange to me. They impressed me as being more like myself; I envied them. I would have denied myself all pleasures if, after my classes, at home I could have been a girl and thus have gone out. Crinoline and a smoothly-fitting glove were my ideals. With every lady’s gown I saw I fancied how I should feel in it,—_i.e._, as a lady. I had no inclination toward men. But I remember that I was somewhat lovingly attached to a very handsome friend with a girl’s face and dark hair, though I think I had no other wish than that we both might be girls. “At the high-school I finally once had coitus; hoc modo sensi, me libentius sub puella concubuisse et penem meum cum cunno mutatum maluisse. To my astonishment, too, the girl had to treat me as a girl, and did it willingly; but she treated me as if I were she (she was still quite inexperienced, and, therefore, did not laugh at me). “When a student, at times I was wild, but I always felt that I assumed this wildness as a mask. I drank and duelled, but I could not take lessons in dancing, because I was afraid of betraying myself. My friendships were close, but without other thoughts. It pleased me most to have a friend masked as a lady, or to study the ladies’ costumes at a ball. I understood such things perfectly. Gradually I began to feel like a girl. “On account of unhappy circumstances, I twice attempted suicide. Without any cause I once slept fourteen days, had many hallucinations (visual and auditory at the same time), and was with both the living and the dead. The latter habit of thought remains. I also had a friend (a lady) who knew my hobby and put on my gloves for me; but she always looked upon me as a girl. Thus I understood women better than other men did, and in what they differed from men; so I was always treated _more feminarum_,—as if they had found in me a female friend. On the whole, I could not endure obscenity, and indulged in it myself only out of braggadocio when it was necessary. I soon overcame my aversion to foul odors and blood, and even liked them. I was wanting in only one respect: I could not understand my own condition. I knew that I had feminine inclinations, but believed that I was a man. Yet I doubt whether, with the exception of the attempts at coitus, which never gave me pleasure (which I ascribe to onanism), I ever admired a woman without wishing I were she; or without asking myself whether I should not like to be the woman, or be in her attire. Obstetrics I learned with difficulty (I was ashamed for the exposed girls, and had a feeling of pity for them); and even now I have to overcome a feeling of fright in obstetrical cases; indeed, it has happened that I thought I felt the traction myself. After filling several positions successfully as a physician, I went through a military campaign as a volunteer surgeon. Riding, which, while a student, was painful to me, because in it the genitals had more of a feminine feeling, was difficult for me (it would have been easier in the female style). “Still, I always thought I was a man with obscure masculine feeling; and whenever I associated with ladies, I was still soon treated as an inexperienced lady. When I wore a uniform for the first time, I should have much preferred to have slipped into a lady’s costume, with a veil; I was disturbed when the stately uniform attracted attention. In private practice I was successful in the three principal branches. Then I made another military campaign; and during this I came to understand my nature; for I think that, since the first ass, no beast of burden has ever had to endure with so much patience as I have. Decorations were not wanting, but I was indifferent to them. “Thus I went through life, such as it was, never satisfied with myself, full of dissatisfaction with the world, and vacillating between sentimentality and a wildness that was for the most part affected. “My experience as a candidate for matrimony was very peculiar. I should have preferred not to marry, but family circumstances and practice forced me to it. I married an energetic, amiable lady, of a family in which female government was rampant. I was in love with her as much as one of us can be in love,—_i.e._, what we love we love with our whole hearts, and live in it, even though we do not show it as much as a genuine man does. We love our brides with all the love of a woman, almost as a woman might love her bridegroom. But I cannot say this for myself; for I still believed that I was but a depressed man, who would come to himself, and find himself out by marriage. But, even on my marriage-night, I felt that I was only a woman in man’s form; sub femina locum meum esse mihi visum est. On the whole, we lived contented and happy, and for two years were childless. After a difficult pregnancy, during which I was in mortal fear of death, the first boy was born in a difficult labor,—a boy on whom a melancholy nature still hangs; who is still of melancholy disposition. Then came a second, who is very quiet; a third, full of peculiarities; a fourth, a fifth; and all have predisposition to neurasthenia. Since I always felt out of my own place, I went much in gay society; but I always worked as much as human strength would allow. I studied and operated; and I experimented with many drugs and methods of cure, always on myself. I left the regulation of the house to my wife, as she understood house-keeping very well. My marital duties I performed as well as I could, but without personal satisfaction. Since the first coitus, the masculine position in it has been repugnant, and, too, difficult for me. I should have much preferred to have the other _rôle_. When I had to deliver my wife, it almost broke my heart; for I knew how to appreciate her pain. Thus we lived long together, until severe gout drove me to various baths, and made me neurasthenic. At the same time, I became so anæmic that every few months I had to take iron for some time; otherwise I would be almost chlorotic or hysterical, or both. Stenocardia often troubled me; then came unilateral cramps of chin, nose, neck, and larynx; hemicrania and cramps of the diaphragm and chest-muscles. For about three years I had a feeling as if the prostate were enlarged,—a bearing-down feeling, as if giving birth to something; and, also, pain in the hips, constant pain in the back, and the like. Yet, with the strength of despair, I fought against these complaints, which impressed me as being female or effeminate, until three years ago, when a severe attack of arthritis completely broke me down. “But before this terrible attack of gout occurred, in despair, to lessen the pain of gout, I had taken hot baths, as near the temperature of the body as possible. On one of these occasions it happened that I suddenly changed, and seemed to be near death. I sprang with all my remaining strength out of the bath: I had felt exactly like a woman with libido. Too, at the time when the extract of Indian hemp came into vogue, and was highly prized, in a state of fear of a threatened attack of gout (feeling perfectly indifferent about life), I took three or four times the usual dose of it, and almost died of haschisch poisoning. Convulsive laughter, a feeling of unheard of strength and swiftness, a peculiar feeling in brain and eyes, millions of sparks streaming from the brain through the skin,—all these feelings occurred. But I could not force myself to speak. All at once I saw myself a woman from my toes to my breast; I felt, as before while in the bath, that the genitals had shrunken, the pelvis broadened, the breasts swollen out; a feeling of unspeakable delight came over me. I closed my eyes, so that at least I did not see the face changed. My physician looked as if he had a gigantic potatoe instead of a head; my wife had the full moon on her nates. And yet I was strong enough to briefly record my will in my note-book when both left the room for a short time. “But who could describe my fright, when, on the next morning, I awoke and found myself feeling as if completely changed into a woman; and when, on standing and walking, I felt vulva and mammæ! When at last I raised myself out of bed, I felt that a complete transformation had taken place in me. During my sickness a visitor said: ‘He is too patient for a man.’ And the visitor gave me a plant in bloom, which seemed strange, but pleased me. From that time I was patient, and would do nothing in a hurry; but I became tenacious, like a cat, though, at the same time, mild, forgiving, and no longer bearing enmity,—in short, I had a woman’s disposition. During the last sickness I had many visual and auditory hallucinations,—spoke with the dead, etc.; saw and heard familiar spirits; felt like a double person; but, while lying ill, I did not notice that the man in me had been extinguished. The change in my disposition was a piece of good fortune which came over me like lightning, and which, had it come with me feeling as I formerly did, would have killed me; but now I gave myself up to it, and no longer recognized myself. Owing to the fact that I still often confounded neurasthenic symptoms with the gout, I took many baths, until an itching of the skin with the feeling of scabies, instead of being diminished, was so increased that I gave up all external treatment (I was made more and more anæmic by the baths), and hardened myself as best I could. But the imperative female feeling remained, and became so strong that I wear only the mask of a man, and in everything else feel like a woman; and gradually I have lost memory of the former individuality. What was left of me from the gout, the influenza ruined entirely. “_Present Condition_: I am tall, slightly bald, and the beard is growing gray. I begin to stoop. Since having the influenza, I have lost about a quarter of my strength. Owing to a valvular lesion, my face looks somewhat red; full beard; chronic conjunctivitis; more muscular than fat. The left foot seems to be developing varicose veins, and it often goes to sleep; but it is not really thickened, though it seems to be. “The mammary region, though small, swells out perceptibly. The abdomen is feminine in form; the feet are placed like a woman’s, and the calves, etc., are feminine; and it is the same with arms and hands. I can wear ladies’ hose, and gloves, 7½ to 7¾ in size. I also wear a corset without annoyance. My weight varies between 168 and 184 pounds. Urine without albumen or sugar, but it contains an excess of uric acid. But if there is not too much uric acid in it, it is clear, and almost as clear as water after any excitement. Bowels usually regular; but should they not be, then come all the symptoms of female obstipation. Sleep is poor,—for weeks at a time only two or three hours long. Appetite quite good; but, on the whole, my stomach will not bear more than that of a strong woman, and reacts to irritating food with cutaneous eruption and burning in the urethra. The skin is white, and, for the most part, feels quite smooth; there has been unbearable cutaneous itching for the last two years; but during the last few weeks it has diminished, and is now present only in the popliteal spaces and on the scrotum. “Tendency to perspire. Perspiration was previously as good as wanting, but now there are all the odious peculiarities of the female perspiration, particularly about the lower part of the body; so that I have to keep myself cleaner than a woman. (I perfume my handkerchief, and use perfumed soap and _eau-de-Cologne_.) “_General Feeling_: I feel like a woman in a man’s form; and even though I often am sensible of the man’s form, yet it is always in a feminine sense. Thus, for example, I feel the penis as clitoris; the urethra as urethra and vaginal orifice, which always feels a little wet, even when it is actually dry; the scrotum as labia majora; in short, I always feel the vulva. And all that that means one alone can know who feels or has felt so. But the skin all over my body feels feminine; it receives all impressions, whether of touch, of warmth, or whether unfriendly, as feminine, and I have the sensations of a woman. I cannot go with bare hands, as both heat and cold trouble me. When the time is past when we men are permitted to carry sun-umbrellas, I have to endure great sensitiveness of the skin of my face, until sun-umbrellas can again be used. On awaking in the morning, I am confused for a few moments, as if I were seeking for myself; then the imperative feeling of being a woman awakens. I feel the sense of the vulva (that one is there), and always greet the day with a soft or loud sigh; for I have fear again of the play that must be carried on throughout the day. I had to learn everything anew; the knife—apparatus, everything—has felt different for the last three years; and with the change of muscular sense I had to learn everything over again. I have been successful, and only the use of the saw and bone-chisel are difficult; it is almost as if my strength were not quite sufficient. On the other hand, I have a keener sense of touch in working with the curette in the soft parts. It is unpleasant that, in examining ladies, I often feel their sensations; but this, indeed, does not repel them. The most unpleasant thing I experience is fœtal movement. For a long time—several months—I was troubled by reading the thoughts of both sexes, and I still have to fight against it. I can endure it better with women; with men it is repugnant. Three years ago I had not yet consciously seen the world with a woman’s eyes; this change in the relation of the eyes to the brain came almost suddenly, with violent headache. I was with a lady whose sexual feeling was reversed, when suddenly I saw her changed in the sense I now feel myself,—viz., she as man,—and I felt myself a woman in contrast with her; so that I left her with ill-concealed vexation. At that time she had not yet come to understand her own condition perfectly. “Since then, all my sensory impressions are as if they were feminine in form and relation. The cerebral system almost immediately adjusted itself to the vegetative; so that all my ailments were manifested in a feminine way. The sensitiveness of all nerves, particularly that of the auditory and olfactory and trigeminal, increased to a condition of nervousness. If only a window slammed, I was frightened inwardly; for a man dare not tremble at such things. If food is not absolutely fresh, I perceive a cadaverous odor. I could never depend on the trigeminus; for the pain would jump whimsically from one branch of it to another; from a tooth to an eye. But, since my transformation, I bear toothache and migraine more easily, and have less feeling of fear with stenocardia. It seems to me a strange fact that I feel myself to be a fearful, weak being, and yet, when danger threatens, I am much rather cool and collected; and this is true in dangerous operations. The stomach rebels against the slightest indiscretion (in female diet) that is committed without thought of the female nature, either by ructus or other symptoms; but particularly against abuse of alcoholics. The indisposition after intoxication that a man who feels like a woman experiences is much worse than any a student could get up. It seems to me almost as if one feeling like a woman were entirely controlled by the vegetative system. “Small as my nipples are, they demand room, and I feel them as mammæ; just as during the beginning of puberty, the nipples swelled and pained. On this account, the white shirt, the waistcoat, and the coat trouble me. I feel as though the pelvis were female; and it is the same with the anus and nates. At first the sense of a female abdomen was troublesome to me; for it cannot bear trousers, and it always possesses or induces the feminine feeling. I also have the imperative feeling of a waist. It is as if I were robbed of my own skin, and put in a woman’s skin that fitted me perfectly, but which felt everything as if it covered a woman; and whose sensations passed through the man’s body, and exterminated the masculine element. The testes, even though not atrophied or degenerated, are still no longer testes, and often cause me pain, with the feeling that they belong in the abdomen, and should be fastened there; and their mobility often bothers me. “Every four weeks, at the time of the full moon, I have the molimen of a woman for five days, physically and mentally, only I do not bleed; but I have the feeling of a loss of fluid; a feeling that the genitals and abdomen are (internally) swollen. A very pleasant period comes when, afterward and later in the interval for a day or two, the physiological desire for procreation comes, which with all power permeates the woman. My whole body is then filled with this sensation, as an immersed piece of sugar is filled with water, or as full as a soaked sponge. It is like this: first, a woman longing for love, and then, for a man; and, in fact, the desire, as it seems to me, is more a longing to be possessed than a wish for coitus. The intense natural instinct or the feminine concupiscence overcomes the feeling of modesty, so that indirectly coitus is desired. I have never felt coitus in a masculine way more than three times in my life; and even if it were so in general, I was always indifferent about it. But, during the last three years, I have experienced it passively, like a woman; in fact, oftentimes with the feeling of feminine ejaculation; and I always feel that I am impregnated. I am always fatigued as a woman is after it, and often feel ill, as a man never does. Sometimes it caused me so great pleasure that there is nothing with which I can compare it; it is the most blissful and powerful feeling in the world; at that moment the woman is simply a vulva that has devoured the whole person. “During the last three years I have never lost for an instant the feeling of being a woman, and now, owing to habit, this is no longer annoying to me, though during this period I have felt debased; for a man could endure to feel like a woman without a desire for enjoyment; but when desires come! The happiness ceases; then come the burning, the heat, the feeling of turgor of the genitals (when the penis is not in a state of erection the genitals do not play any part). In case of intense desire, the feeling of sucking in the vagina and vulva is really terrible—a hellish pain of lust hardly to be endured. If I then have opportunity to perform coitus, it is better; but, owing to defective sense of being possessed by the other, it does not afford complete satisfaction; the feeling of sterility comes with its weight of shame, added to the feeling of passive copulation and injured modesty. I seem almost like a prostitute. Reason does not give any help; the imperative feeling of femininity dominates and rules everything. The difficulty in carrying on one’s occupation, under such circumstances, is easily appreciated; but it is possible to force one’s self to it. Of course, it is almost impossible to sit, walk, or lie down; at least, any one of these cannot be endured long; and with the constant touch of the trousers, etc., it is unendurable. “Marriage then, except during coitus, where the man has to feel himself a woman, is like two women living together, one of whom regards herself as in the mask of a man. If the periodical molimen fail to occur, then come the feelings of pregnancy or of sexual satiety, which a man never experiences, but which take possession of the whole being, just as the feeling of femininity does, and are repugnant in themselves; and, therefore, I gladly welcome the regular molimen again. When erotic dreams or ideas occur, I see myself in the form I have as a woman, and see erected organs presenting. Since the anus feels feminine, it would not be hard to become a passive pederast; only positive religious command prevents it, as all other deterrent ideas would be overcome. Since such conditions are repugnant, as they would be to any one, I have a desire to be sexless, or to make myself sexless. If I had been single, I should long ago have taken leave of testes, scrotum, and penis. “Of what use is female pleasure, when one does not conceive? What good comes from excitation of female love, when one has only a wife for gratification, even though copulation is felt as though it were with a man? What a terrible feeling of shame is caused by the feminine perspiration! How the feeling for dress and ornament lowers a man! Even in his changed form, even when he can no longer recall the masculine sexual feeling, he would not wish to be forced to feel like a woman. He still knows very well that, before, he did not constantly feel sexually; that he was merely a human being uninfluenced by sex. Now, suddenly, he has to regard his former individuality as a mask, and constantly feel like a woman, only having a change when, every four weeks, he has his periodical sickness, and in the intervals his insatiable female desire. If he could but awake without immediately being forced to feel like a woman! At last he longs for a moment in which he might raise his mask; but that moment does not come. He can only find amelioration of his misery when he can put on some bit of female attire or finery, an under-garment, etc.; for he dare not go about as a woman. To be compelled to fulfill all the duties of a calling with the feeling of being a woman costumed as a man, and to see no end of it, is no trifle. Religion alone saves from a great lapse; but it does not prevent the pain when temptation affects the man who feels as a woman; and so it must be felt and endured! When a respectable man who enjoys an unusual degree of public confidence, and possesses authority, must go about with his vulva—imaginary though it be; when one, leaving his arduous daily task, is compelled to examine the _toilette_ of the first lady he meets, and criticise her with feminine eyes, and read her thoughts in her face; when a journal of fashions possesses an interest equal to that of a scientific work (I felt this as a child); when one must conceal his condition from his wife, whose thoughts, the moment he feels like a woman, he can read in her face, while it becomes perfectly clear to her that he has changed in body and soul,—what must all this be? The misery caused by the feminine gentleness that must be overcome! Oftentimes, of course, when I am away alone, it is possible to live for a time more like a woman; for example, to wear female attire, especially at night, to keep gloves on, or to wear a veil or a mask in my room, so that thus there is rest from excessive libido. But when the feminine feeling has once gained an entrance, it imperatively demands recognition. It is often satisfied with a moderate concession, such as the wearing of a bracelet above the cuff; but it imperatively demands some concession. My only happiness is to see myself dressed as a woman without a feeling of shame; indeed, when my face is veiled or masked, I prefer it so, and thus think of myself. Like every one of Fashion’s fools, I have a taste for the prevailing mode; so greatly am I transformed. To become accustomed to the thought of feeling only like a woman, and only to remember the previous manner of thought to a certain extent in contrast with it; and, at the same time, to express one’s self as a man,—it requires a long time and an infinite amount of persistence. “Nevertheless, in spite of everything, it will happen that I betray myself by some expression of feminine feeling, either in _sexualibus_, when I say that I feel so and so, expressing what a man without the female feeling cannot know; or when I accidentally betray that female attire is my talent. Before women, of course, this does not amount to anything; for a woman is greatly flattered when a man understands something of her matters; but this must not be displayed to my own wife. How frightened I once was when my wife said to a friend that I had great taste in ladies’ dress! How a haughty, stylish lady was astonished when, as she was about to make a great error in the education of her little daughter, I described to her in writing and verbally all the feminine feelings! To be sure, I lied to her, saying that my knowledge had been gleaned from letters. But her confidence in me is as great as ever; and the child, who was on the road to insanity, is rational and happy. She had confessed all the feminine inclinations as sins; now she knows what, as a girl, she must bear and control by will and religion; and she feels that she is human. Both ladies would laugh heartily, if they knew that I had only drawn on my own sad experience. I must also add that I now have a finer sense of temperature and, besides, a sense of the elasticity of the skin and tension of the intestines, etc., in patients, that was unknown to me before; that in operations and autopsies, poisonous fluids more readily penetrate my (uninjured) skin. Every autopsy causes me pain; examination of a prostitute, or a woman having a discharge, a cancerous odor, or the like, is actually repugnant to me. In all respects I am now under the influence of antipathy and sympathy, from the sense of color to my judgment of a person. Women usually see in each other the periodical sexual disposition; and, therefore, a lady wears a veil, if she is not always accustomed to wear one, and usually she perfumes herself, even though it be only with handkerchief or gloves; for her olfactory sense in relation to her own sex is intense. Odors have an incredible effect on the female organism; thus, for example, the odors of violets and roses quiet me, while others disgust me; and with ihlang-ihlang I cannot contain myself for sexual excitement. Contact with a woman seems homogeneous to me; coitus with my wife seems possible to me because she is somewhat masculine, and has a firm skin; and yet it is more an _amor lesbicus_. “Besides, I always feel passive. Often at night, when I cannot sleep for excitement, it is finally accomplished, si femora mea distensa habeo, sicut mulier cum viro concumbens, or if I lie on my side; but an arm or the bed-clothing must not touch the mammæ, or there is no sleep; and there must be no pressure on the abdomen. I sleep best in a chemise and night-robe, and with gloves on; for my hands easily get cold. I am also comfortable in female drawers and petticoats, because they do not touch the genitals. I liked female dresses best when crinoline was worn. Female dresses do not annoy the feminine-feeling man; for he, like every woman, feels them as belonging to his person, and not as something foreign. “My dearest associate is a lady suffering with neurasthenia, who, since her last confinement, feels like a man, but who, since I explained these feelings to her, coitu abstinet as much as possible, a thing I, as a husband, dare not do. She, by her example, helps me to endure my condition. She has a more perfect memory of the female feelings, and has often given me good advice. Were she a man and I a young girl, I should seek to win her; for her I should be glad to endure the fate of a woman. But her present appearance is quite different from what it formerly was. She is a very elegantly dressed gentleman, notwithstanding bosom and hair; she also speaks quickly and concisely, and no longer takes pleasure in the things that please me. She has a kind of melancholy dissatisfaction with the world, but she bears her fate worthily and with resignation, finding her comfort only in religion and the fulfillment of duty. At the time of the menses, she almost dies. She no longer likes female society and conversation, and has no liking for delicacies. “A youthful friend felt like a girl from the very first, but he had inclinations toward the male sex. His sister had the opposite condition; and when the uterus demanded its right, and she saw herself as a loving woman, in spite of her masculinity, she cut the matter short, and committed suicide by drowning. “Since complete effemination, the principal changes I have observed in myself are:— “1. The constant feeling of being a woman from top to toe. “2. The constant feeling of having female genitals. “3. The periodicity of the monthly molimen. “4. The regular occurrence of female desire, though not directed to any particular man. “5. The passive female feeling in coitus. “6. After that, the feeling of impregnation. “7. The female feeling in thought of coitus. “8. At the sight of women, the feeling of being of their kind, and the feminine interest in them. “9. At the sight of men, the feminine interest in them. “10. At the sight of children, the same feeling. “11. The changed disposition and much greater patience. “12. The final resignation to my fate, for which I have nothing to thank but positive religion; without it I should have long ago committed suicide. “To be a man and to be compelled to feel that chaque femme est futuée ou elle désire d’être, is hardly to be endured.” The foregoing autobiography, scientifically so important, was accompanied by the following no less interesting letter:— “SIR: I must next beg your indulgence for troubling you with my communication. I lost all control, and thought of myself only as a monster before which I myself shuddered. Then your work gave me courage again; and I determined to go to the bottom of the matter, and examine my past life, let the result be what it might. It seemed a duty of gratitude to you to tell you the result of my recollection and observation, since I had not seen any description by you of an analogous case; and, finally, I also thought it might perhaps interest you to learn, from the pen of a physician, how such a worthless human, or masculine, being thinks and feels under the weight of the imperative idea of being a woman. “It is not perfect; but I no longer have the strength to reflect more upon it, and have no desire to go into the matter more deeply. Much is repeated; but I beg you to remember that any mask may be allowed to fall off, particularly when it is not voluntarily worn, but enforced. “After reading your work, I hope that, if I fulfill my duties as physician, citizen, father, and husband, I may still count myself among human beings who do not deserve merely to be despised. “Finally, I wished to lay the result of my recollection and reflection before you, in order to show that one thinking and feeling like a woman can still be a physician. I consider it a great injustice to debar woman from Medicine. A woman, through her feeling, gets on the track of many ailments which, in spite of all skill in diagnosis, remain obscure to a man; at least, in the diseases of women and children. If I could have my way, I should have every physician live the life of a woman for three months; then he would have a better understanding and more consideration in matters affecting the half of humanity from which he comes; then he would learn to value the greatness of women, and appreciate the difficulty of their lot.” _Remarks_: The badly-tainted patient is originally psycho-sexually abnormal, in that, in character and in the sexual act, he feels as a female. This abnormal feeling remained purely a psychical anomaly until three years ago, when, owing to severe neurasthenia, it received overmastering support in imperative bodily sensations of a _transmutatio sexus_, which now dominate consciousness. Then, to the patient’s horror, he felt bodily like a woman; and, under the impulse of his imperative feminine sensations, he experienced a complete transformation of his former masculine feeling, thought, and will; in fact, of his whole vita sexualis, in the sense of eviration. At the same time, his ego is able to control these abnormal psycho-physical manifestations, and prevent descent to paranoia,—a remarkable example of imperative feelings and ideas on the basis of neurotic taint, which is of great value for a comprehension of the way in which the psycho-sexual transformation may be accomplished. _IV. Degree: Metamorphosis Sexualis Paranoica._—A final possible stage in this disease-process is the delusion of a transformation of sex. It arises on the basis of sexual neurasthenia that has developed into neurasthenia universalis, resulting in a mental disease,—paranoia. The following cases show the development of the interesting neuro-psychological process to its height:— Case 100. K., aged 36, single, servant, received at the clinic on February 26, 1889, is a typical case of paranoia persecutoria, resulting from neurasthenia sexualis, with olfactory hallucinations, sensations, etc. He comes of a predisposed family. Several brothers and sisters were psychopathic. Patient has an hydrocephalic skull, depressed in the region of the right fontanelle; eyes neuropathic. He has always been very sensual; began to masturbate at nineteen; had coitus at twenty-three; begat three illegitimate children. He gave up further sexual intercourse, on account of fear of begetting more children, and of being unable to provide for them. Abstinence proved very painful to him. He also gave up masturbation, and was then troubled with pollutions. A year and a half ago he became sexually neurasthenic, had diurnal pollutions, became thereafter ill and miserable, and, after a time, generally neurasthenic, finally developing paranoia. A year ago he began to have paræsthetic sensations,—as if there were a great coil in the place of his genitals; and then he felt that his scrotum and penis were gone, and that his genitals were changed into those of a female. He felt the growth of his breasts; that his hair was that of a woman; and that feminine garments were on his body. He thought himself a woman. The people in the street gave utterance to corresponding remarks: “Look at the woman! The old blowhard!” In a half dreamy state, he had the feeling as if he played the part of a woman in coitus with a man. During it he had the most lively feelings of pleasure. During his stay at the clinic, a remission of the paranoia occurred, and, at the same time, a marked improvement of the neurasthenia. Then the feelings and ideas due to a developing metamorphosis sexualis disappeared. A more advanced case of eviration, on the way to a transformatio sexus paranoica, is the following:— Case 101. Franz St., aged 33; school-teacher; single; probably of tainted family; always neuropathic; emotional, timid, intolerant of alcohol; began to masturbate at eighteen. At thirty there were manifestations of neurasthenia sexualis (pollutions with consequent fatigue, which at last began to occur during the day; pain in the region of the sacral plexus, etc.). Gradually, spinal irritation, pressure in the head, and cerebral neurasthenia were added. Since the beginning of 1885 the patient had given up coitus, in which he no longer experienced pleasurable feeling. He masturbated frequently. In 1888 he began to have delusions of suspicion. He noticed that he was avoided, and that he had unpleasant odors about him (olfactory hallucinations). In this way he explained the altered attitude of people, and their sneezing, coughing, etc. He smelled corpses and foul urine. He recognized the cause of his bad smells in inward pollutions. He recognized these in a feeling he had as if a fluid flowed up from the symphysis toward the breast. Patient soon left the clinic. In 1889 he was again received in an advanced stage of paranoia masturbatoria persecutoria (delusions of physical persecution). In the beginning of May, 1889, the patient attracted notice, in that he was cross when he was addressed as “mister.” He protested against it, because he was a woman. Voices told him this. He noticed that his breasts were growing. Some weeks before, others had touched him in a sensual manner. He heard it said that he was a whore. Of late, dreams of pregnancy. He dreamed that, as a woman, he indulged in coitus. He felt the immissio penis, and, during the hallucinatory act, also a feeling of ejaculation. Head straight; facial form long and narrow; parietal eminences prominent; genitals normally developed. The following case, observed in the asylum at Illenau, is a pertinent example of lasting delusional alteration of sexual consciousness:— Case 102. _Metamorphosis Sexualis Paranoica._—N., aged 23, single, pianist, was received in the asylum at Illenau in the last part of October, 1865. He came of a family in which there was said to be no hereditary taint; but it was tuberculous (father and brother died of pulmonary tuberculosis). Patient, as a child, was weakly and dull, though especially talented in music. He was always of abnormal character; silent, retiring, unsocial, and sullen. He practiced masturbation after fifteen. After a few years neurasthenic symptoms (palpitation of the heart, lassitude, occasional pressure in the head, etc.), and also hypochondriacal symptoms, were manifested. During the last year he had worked with great difficulty. For about six months neurasthenia had increased. He complained of palpitation of the heart, pressure in the head, and sleeplessness; was very irritable, and seemed to be sexually excited. He declared that he must marry for his health. He fell in love with an artist, but almost at the same time (September, 1865) he fell ill with paranoia persecutoria (ideas of enemies, derision in the street, poison in food; obstacles were placed on the bridges to keep him from going to his _inamorata_). On account of increasing excitement and conflicts with those about him that he considered inimical to him, he was taken to the asylum. At first he presented the picture of a typical paranoia persecutoria with symptoms of sexual, and later general, neurasthenia, though the delusions of persecution did not rest upon this neurotic foundation. It was only occasionally that the patient heard such sentences as this: “Now the semen will be drawn out of him. Now the bladder will be cut out.” In the course of the years 1866–68, the delusions of persecution became less and less apparent, and were for the most part replaced by erotic ideas. The somatic and mental basis was a lasting and powerful excitation of the sexual sphere. The patient fell in love with every woman he saw, heard voices which told him to approach her, and begged to be allowed to marry, declaring that, if he was not given a wife, he would waste away. With continuance of masturbation, in 1869, signs of future effemination made themselves manifest. “He would, if he should get a wife, love her only platonically.” The patient grows more and more peculiar, lives in a circle of erotic ideas, sees prostitution practiced in the asylum, and now and then hears voices which impute immoral conduct with women to him. For this reason he avoids the society of women, and only associates with them for the sake of music when two witnesses are with him. In the course of the year 1872, the neurasthenic condition became markedly increased. Now paranoia persecutoria again comes into the foreground, and takes on a clinical coloring from the neurotic basis. Olfactory hallucinations occur. Magnetic influences are at work on him (false interpretation of sensations due to spinal asthenia). With continued and intense sexual excitement and excess in masturbation, the process of effemination constantly progresses. Only episodically is he a man and inclined toward a woman, complaining that the shameless prostitution of the men in the house makes it impossible for a lady to come to him. He is dying of magnetically poisoned air and unsatisfied love. Without love he cannot live. He is poisoned by lewd poison that affects his sexual desire. The lady that he loves is sunk in the lowest vice. The prostitutes in the house have fortune-chains; that is, chains in which, without moving, a man can indulge in lustful pleasure. He is ready now to satisfy himself with prostitutes. He is possessed of a wonderful ray of thought that emanates from his eyes, which is worth twenty millions. His compositions are worth 500,000 francs. With these indications of delusions of grandeur, there are also those of persecution—the food is poisoned by venereal excrement; he tastes and smells poison, hears infamous accusations, and asks for instruments to close his ears. From August, 1872, however, the signs of effemination become more and more frequent. He acts somewhat affected, declaring that he can no longer live among men that drink and smoke. He thinks and feels like a woman. He must thenceforth be treated like a woman and transferred to a female ward. He asks for confections and delicate desserts. Occasionally, on account of tenesmus and cystospasm, he asks to be transferred to a lying-in hospital and treated as a woman very ill in pregnancy. The abnormal magnetism of masculine attendants has an unfavorable effect on him. At times he still feels himself to be a man, but in a way which indicates his abnormally altered sexual feeling. He pleads only for satisfaction by means of masturbation, or for marriage without coitus. Marriage is a sensual institution. The girl that he would take for a wife must be a masturbator. About the end of December, 1872, his personality became completely feminine. From that time he remained a woman. He had always been a woman, but in his babyhood a French Quaker, an artist, had put masculine genitals on him, and by rubbing and distorting his thorax had prevented the development of his breasts. After this he demanded to be transferred to the female department, protection from men that wished to violate him, and asked for female clothing. Eventually he also desired to be given employment in a toy-shop, with crocheting and embroidery work to do, or a place in a dress-making establishment with female work. From the time of the transformatio sexus, the patient begins a new reckoning of time. He conceives his previous personality in memory as that of a cousin. He always speaks of himself in the third person, and calls himself the Countess V., the dearest friend of the Empress Eugenie; asks for perfumes, corsets, etc. He takes the other men of the ward for girls, tries to raise a head of hair, and demands “Oriental Hair-Remover,” in order that no one may doubt his gender. He takes delight in praising onanism, for “she had been an onanist from fifteen, and had never desired any other kind of sexual satisfaction.” Occasionally neurasthenic symptoms, olfactory hallucinations, and persecutory delusions are observed. All the events up to the time of December, 1872, belong to the personality of the cousin. The patient’s delusion that he is the Countess V. can no longer be corrected. She proves her identity by the fact that the nurse has examined her, and finds her to be a lady. The countess will not marry, because she hates men. Since he is not provided with female clothing and shoes, he spends the greatest part of the day in bed, acts like an invalid lady of position, affectedly and modestly, and asks for bon-bons and the like. His hair is done, up in a knot as well as it allows, and the beard is pulled out. Breasts are made out of biscuits. In 1874 caries began in the left knee-joint, to which pulmonary tuberculosis was soon added. Death on December 2, 1874. Skull normal. Frontal lobes atrophic. Brain anæmic. Microscopical (Dr. Schüle): In the superior layer of the frontal lobe, ganglion cells somewhat shrunken; in the adventitia of the vessels, numerous fat-corpuscles; glia unchanged; isolated pigment particles and colloid bodies. The lower layers of the cortex normal. Genitals very large; testicles small, lax, and show no change macroscopically on section. The delusion of sexual transformation, displayed, in its conditions and phases of development, in the foregoing case, is a manifestation remarkably infrequent in the pathology of the human mind. Besides the foregoing cases, personally observed, I have seen such a case, as an episodical phenomenon, in a lady having contrary sexuality (Case 92 of the sixth edition of this work), one in a girl affected with original paranoia, and another in a lady suffering with original paranoia. Save for a case briefly reported by Arndt, in his text-book (p. 172), and one quite superficially described by Sérieux (“Recherches Clinique,” p. 33), and the two cases known to Esquirol, I cannot recall any cases of delusion of sexual transformation in literature. Arndt’s case may be briefly given here, though, like Esquirol’s cases, it gives nothing concerning the genesis of the delusion:— Case 103. A middle-aged woman in the asylum at Greifswald thought she was a man, and acted out her belief. She cut her hair short, and parted it on one side in the military fashion. A sharply-cut profile, a nose somewhat large, and a certain heaviness of all the features gave the face something characteristic, and, in combination with the short hair combed smoothly over the ears, gave the whole head a decidedly masculine appearance. She was tall and lean; her voice low and rough; the larynx angularly prominent; her attitude erect; her gait, like all her movements, heavy, but not awkward. She looked like a man in female dress. Asked how she had come to think she was a man, she would almost always cry excitedly: “Just look at me! Don’t I look like a man? I feel like a man, too. I have always felt so, but I only gradually came to understand it clearly. The man who should be my husband is not a real man. I raised my children myself. I always felt somewhat like this, but I came to understand later. Did I not always work like a man? The man who passed for my husband only helped. He did what I planned. From my youth I have been more masculine than feminine. I have always had more liking for the garden and farm than for work in the house and kitchen. But I never understood the reason. Now I know I am a man, and I shall bear myself like one. It is a shame to make me always wear women’s clothes.” Case 104. X., aged 26, tall, and of handsome appearance. Since his earliest youth he has loved to wear female attire. As he grew up, he managed it so that, when he was a participant in theatricals, he always had a female part. After an attack of mental excitement, he imagined that he was actually a woman, and tried to convince others of it. He liked to undress himself, and dress his hair and put on female clothing. In this state he wished to go out on the street. In other respects he was perfectly reasonable. He would spend the whole day arranging his hair and looking at himself in the glass, costuming himself in a night-dress as much like a woman as possible. In walking he imitated women. One day, when Esquirol acted as if about to lift up his dress, he flew into a passion and upbraided him for his want of modesty (Esquirol). Case 105. Mrs. X., widow. Owing to the death of her husband and loss of fortune, she had been greatly troubled in mind. She became disturbed mentally, and was admitted to the Salpêtrière after attempting suicide. Mrs. X., lean, thin; constantly maniacal; she believes herself a man, and flies angry if she is addressed as “madam.” Once, when male clothing was placed at her disposal, she was beside herself with joy. She died, in 1802, of a consumptive malady; and she expressed her delusion of being a man until shortly before her death (Esquirol). I have already mentioned the interesting relations existing between the facts of delusional transformation of sex and the so-called insanity of the Scythians. Marandon (“Annales médico-psychologiques,” 1877, p. 161), like others, has erroneously presumed that with the ancient Scythians there was an actual delusion, and that the condition was not merely that of eviration. According to the law of empirical actuality, the delusion, so infrequent to-day, must also have been very infrequent in ancient times. Since it can only be conceived as arising on the basis of a paranoia, there can be no thought of its endemic occurrence; it can only be regarded as a superstitious manifestation of eviration (the result of anger of the goddess), as is also evident from the statements of Hippocrates. The facts of the so-called Scythian insanity, as well as the facts lately learned about the Pueblo Indians, are also noteworthy anthropologically, in that atrophy of the testes and genitals in general, and approximation to the female type, physically and mentally, were observed. This is the more remarkable, since, in men who have lost their procreative organs, such a reversal of instinct is quite as unusual as in women, mutatis mutandis, after the natural or artificial climacteric. B. _Homo-Sexual Feeling as an Abnormal Congenital Manifestation._[105]—The essential feature of this strange manifestation of the sexual life is the want of sexual sensibility for the opposite sex, even to the extent of horror, while sexual inclination and impulse toward the same sex are present. At the same time, the genitals are normally developed, the sexual glands perform their functions properly, and the sexual type is completely differentiated. Feeling, thought, will, and the whole character, in cases of the complete development of the anomaly, correspond with the peculiar sexual instinct, but not with the sex which the individual represents anatomically and physiologically. This abnormal mode of feeling may not infrequently be recognized in the manner, dress, and calling of the individuals, who may go so far as to yield to an impulse to don the distinctive clothing corresponding with the sexual _rôle_ in which they feel themselves to be. Anthropologically and clinically, this abnormal manifestation presents various degrees of development:—