4. _Androgyny and Gynandry._—Forming direct transitions from the

foregoing groups are those individuals of contrary sexuality in whom not only the character and all the feelings are in accord with the abnormal sexual instinct, but also the skeletal form, the features, voice, etc.; so that the individual approaches the opposite sex anthropologically, and in more than a psychical and psycho-sexual way. This anthropological form of the cerebral anomaly apparently represents a very high degree of degeneration; but that this variation is based on an entirely different ground than the teratological manifestation of hermaphroditism, in an anatomical sense, is clearly shown by the fact that thus far, in the domain of contrary sexuality, no transitions to hermaphroditic malformation of the genitals have been observed. The genitals of these persons always prove to be fully differentiated sexually, though not infrequently there are present anatomical signs of degeneration (epispadiasis, etc.), in the sense of arrests of development in organs that are otherwise well differentiated. There is yet wanting a sufficient record of cases belonging to this interesting group of women in masculine attire with masculine genitals, and men in feminine dress with the sexual organs of the female. Every experienced observer of his fellow-men remembers masculine persons that were very remarkable for their womanish character and type (wide hips, form rounded by abundant development of adipose tissue, absence or insufficient development of beard, feminine features, delicate complexion, falsetto voice, etc.); and, on the other hand, women that, by reason of build, pelvis, gait, attitude, heavy and decidedly masculine features, rough and deep voice, etc., had little to remind one of femininity. We have already met some indications of such an anthropological transformation in foregoing groups, as in Case 106, where the woman had the feet of a man; and in Case 112, where there was development of mammæ and production of milk during puberty. In persons belonging to the fourth group, and in certain ones in the third, forming transitions to the fourth, there seems to be a feeling of shame (sexual) toward persons of the same sex, and not toward those of the opposite sex. Case 129. _Androgyny._ Mr. v. H., aged 30, single; of neuropathic mother. Nervous and mental diseases are said not to have occurred in the patient’s family, and his only brother is said to be mentally and physically completely normal. The patient developed tardily physically, and, therefore, spent much of his time at the sea-shore and climatic resorts. From childhood he was of neuropathic constitution, and, according to the statements of his relatives, unlike other boys. His disinclination for masculine pursuits and his preference for feminine amusements were early remarked. Thus he avoided all boyish games and gymnastic exercises, while doll-play and feminine occupations were particularly pleasing to him. Thereafter he developed well physically, and escaped severe illnesses, but he remained mentally abnormal, incapable of an earnest aim in life, and decidedly feminine in thought and feeling. In his seventeenth year pollutions occurred, became more frequent, and finally took place during the day; so that the patient grew weak, and manifested various nervous disturbances. Symptoms of neurasthenia spinalis made their appearance, and have lasted up to the last few years, but they have become milder with the decrease in the number of pollutions. Onanism is denied, but is very probable. An indolent, effeminate, dreamy habit of thought has become more and more noticeable ever since puberty. All efforts to induce the patient to take up an earnest pursuit in life were vain. His intellectual functions, though formally quite undisturbed, were never equal to the motive of an independent character, and the higher ideals of life. He remained dependent, an overgrown child; and nothing more clearly indicated his original abnormal condition than an actual incapability to take care of money, and his own confession that he had no ability to use money reasonably; that as soon as he had money he wasted it for curios, toilet-articles, and the like. Incapable as he was of a reasonable use of money, the patient was no more capable of leading a social existence; indeed, he was incapable of gaining an insight into its significance and value. He learned very poorly, spending his time in _toilettes_ and artistic nothings, particularly in painting, for which he evinced a certain capability; but in this direction he accomplished nothing, since he was wanting in perseverence. He could not be brought to take up any earnest thought; he had a mind only for externals, was always distracted, and serious things quickly wearied him. Preposterous acts, senseless journeys, waste of money, and debts repeatedly occur throughout the course of his later life; and even for these positive faults in his life he was wanting in understanding. He was self-willed and intractable, and never did well as soon as an attempt was made to put him on his feet and point out to him his own interests. With these manifestations of an original abnormal and defective mind, there were notable indications of perverse sexual feeling, which were also indicated in the somatic habitus of the patient. Sexually, the patient felt like a woman toward men, and had inclinations toward people of his own sex, with indifference, if not actual disinclination, for females. In his twenty-second year it is asserted that he had sexual intercourse with women, and was able to perform the act of cohabitation normally; but, partly on account of increase of neurasthenic symptoms which was occasional after coitus, and partly on account of fear of infection,—but really by reason of a want of satisfaction,—he soon ceased to indulge in such intercourse. Concerning his abnormal sexual condition, he is not quite clear; he is conscious of an inclination toward the male sex, but confesses, only in a shame-faced way, that he has certain pleasurable feelings of friendship for masculine individuals, which, however, are not accompanied by any sensual feelings. The female sex he does not exactly abhor; he could even bring himself to marry a woman who could have an attraction for him, by means of similarity in artistic tastes, if he could but be freed from conjugal duties, which were unpleasant to him, and the performance of which made him tired and weak. He denied having had sexual intercourse with men, but his blushing and embarrassment, and, still more, an occurrence in N., where the patient, some time before, provoked a scandal by attempting to have sexual intercourse with youths, gave him the lie. Too, his external appearance, habitus, form, gestures, manners, and dress are remarkable, and decidedly recall the feminine form and characteristics. The patient, however, is over middle height, but thorax and pelvis are decidedly of feminine form. The body is rich in fat; the skin is well cared for, delicate, and soft. This impression of a woman in masculine dress is further increased by a thin growth of hair on the face, which is shaven, with the exception of a small moustache; by the mincing gait; the shy, effeminate manner; the feminine features; the swimming, neuropathic expression of the eyes; the traces of powder and paint; the curtailed cut of the clothing, with the bosom-like prominence of the upper garments; the fringed, feminine cravat; and the hair brushed down smoothly from the brow to the temples. The physical examination makes undoubted the feminine form of the body. The external genitals are well developed, though the left testicle has remained in the canal; the growth of hair on the mons veneris is thin, and the latter is unusually rich in fat and prominent. The voice is high, and without masculine timbre. Too, the occupation and manner of thought of v. H. are decidedly feminine. He has a boudoir and a well-supplied toilet-table, with which he spends many hours in all kinds of arts for beautifying himself. He abhors the chase, practice with arms, and such masculine pursuits, and calls himself an _æsthete_; speaks with preference of his paintings and attempts at poetry. He is interested in feminine occupations, which—_e.g._, embroidery—he engages in, and calls his greatest pleasure. He could spend his life in an artistic and æsthetic circle of ladies and gentlemen, in conversation, music, and æsthetics. His conversation is preferably about feminine things,—fashions, needlework, cooking, and household work. The patient is well nourished, but anæmic. He is of neuropathic constitution, and presents symptoms of neurasthenia, which are maintained by a bad manner of life, lying abed, living in-doors, and effeminateness. He complains of occasional pain and pressure in the head, and habitual obstipation. He is easily frightened; complains of occasional lassitude and fatigue, and drawing pains in the extremities, in the direction of the lumbo-abdominal nerves. After pollutions, and regularly after eating, he feels tired and relaxed; he is sensitive to pressure over the spinous processes of the dorsal vertebræ, as also to pressure along accessible nerves. He feels peculiar sympathies and antipathies for certain persons, and, when he meets people for whom he has an antipathy, he falls into a condition of peculiar fear and confusion. His pollutions, though now they occur but seldom, are pathological, in that they occur by day, and are unaccompanied by any sensual excitement. _Opinion:_ 1. Mr. v. H., according to all observations and reports, is mentally an abnormal and defective person, and that, in fact, _ab origine_. His contrary sexual instinct represents a part of his abnormal physical and mental condition.