Psychopathia sexualis: With especial reference to contrary sexual instinct

4. Mr. v. H. is also physically ill. He presents signs of slight

5145 words  |  Chapter 35

anæmia and of neurasthenia spinalis. A rational regulation of his manner of life and a tonic regimen, and, if possible, hydro-therapeutic treatment, seem necessary. The suspicion that this trouble has its origin in early masturbation should be entertained, and the possibility of the existence of spermatorrhœa, that is of importance etiologically and therapeutically, lies near. (Personal case. _Zeitschr. f. Psychiatrie._) Case 130. Miss X., aged 38, consulted me, late in the fall of 1881, on account of severe spinal irritation and obstinate sleeplessness, in combating which she had become addicted to morphine and chloral. Her mother and sister were nervous sufferers, but the rest of the family were healthy. The trouble dated from a fall on her back in 1872, at which time the patient was terribly frightened, though, when a girl, she had been subject to muscular cramps and hysterical symptoms. Following this shock, a neurasthenic and hysterical neurosis developed, with predominating spinal irritation and sleeplessness. Episodically, hysterical paraplegia, lasting as long as eight months, and hysterical hallucinatory delirium, with convulsive attacks, occurred. In the course of this, symptoms of morphinism were added. A stay of some months in the hospital relieved the latter, and considerably improved the neurasthenic neurosis, in the treatment of which general faradization exerted a remarkably favorable influence. Even at the first meeting, the patient produced a remarkable impression by reason of her attire, features, and conduct. She wore a gentleman’s hat, her hair closely cut, eye-glasses, a gentleman’s cravat, a coat-like outer garment of masculine cut that reached well down over her gown, and boots with high heels. She had coarse, somewhat masculine features; a harsh, deep voice; and made rather the impression of a man in female attire than that of a lady, if one but overlooked the bosom and the decidedly feminine form of the pelvis. During the long time that she was observed, there were never signs of erotocism. When questioned concerning her attire, she would only respond that the style she chose suited her better. Gradually it was ascertained from her that, even when she was a small girl, she had had a preference for horses and masculine pursuits, and never any interest in feminine occupations. Later she developed a particular pleasure in reading, and prepared herself to be a teacher. Dancing had never pleased her; it had always seemed silly to her. Too, the _ballet_ had never interested her. Her greatest pleasure had always been in the circus. Until her sickness, in 1872, she had neither had inclination for persons of the opposite nor for those of her own sex. From that time she had, what was remarkable to herself, a peculiar friendship for females, particularly for young ladies; and she had a desire, and satisfied it, to wear hats and coats of masculine style. Since 1869, besides, she had worn her hair short, and parted it on the side, as men do. She asserts that she was never sensually excited in the company of men, but that her friendship and self-sacrifice for sympathetic ladies was unbounded; while from that time she also experienced repugnance for gentlemen and their society. Her relatives report that, before 1872, the patient had a proposal of marriage, which she refused; and that when she returned from a sojourn at a watering-place, in 1874, she was sexually changed, and occasionally showed that she did not regard herself as a female. Since that time she would associate only with ladies, and has had a kind of love-relation with one or another, and made remarks which indicated that she looked upon herself as a man. This predilection for women was decidedly more than mere friendship, since it expressed itself in tears, jealousy, etc. When, in 1874, she was stopping at a watering-place, a young lady, who took her for a man in disguise, fell in love with her. When this lady married, later, the patient was for a long time depressed, and spoke of unfaithfulness. Moreover, since her sickness, her relatives were struck by her desire for masculine attire, her masculine conduct, and disinclination for feminine pursuits; while previously, at least sexually, she had presented nothing unusual. Further investigations showed that the patient had a love-relation, which was not purely platonic, with the lady described in Case 118; and that she wrote her affectionate letters like those of a lover to his beloved. In 1887 I again saw the patient in a sanitarium, where she had been placed on account of hystero-epileptic attacks, spinal irritation, and morphinism. The contrary sexual feeling existed unchanged, and only by the most careful watching was the patient kept from improper advances toward her fellow-patients. Her condition remained quite unchanged until 1889. Then the patient began to fail, and she died of “exhaustion,” in August, 1889. The autopsy showed, in the vegetative organs, amyloid degeneration of the kidneys, fibroma of the uterus, and cyst of the left ovary. The frontal bone was much thickened, uneven on the inner surface, with numerous exostoses; dura adherent to vault of cranium. Long diameter of skull, 175 millimetres; lateral diameter, 148 millimetres; weight of the œdematous, but not atrophied, brain, 1175 grammes. The meninges delicate, easily removed. Cortex pale. Convolutions broad, not numerous, regularly arranged. Nothing abnormal in cerebellum and great ganglia. Case 131. _Gynandry._[117] History: On November 4, 1889, the step-father of a certain Count Sandor V. complained that the latter had swindled him out of 800f., under the pretense of requiring a bond as secretary of a stock company. It was ascertained that Sandor had entered into matrimonial contracts and escaped from the nuptials in the spring of 1889; and, more than this, that this ostensible Count Sandor was no man at all, but a woman in male attire,—Sarolta (Charlotte), Countess V. S. was arrested, and, on account of deception and forgery of public documents, brought to examination. At the first hearing S. confessed that she was born on Sept. 6, 1866; that she was a female, Catholic, single, and worked as an authoress under the name of Count Sandor V. From the autobiography of this man-woman I have gleaned the following remarkable facts that have been independently confirmed:— S. comes of an ancient, noble, and highly-respected family of Hungary, in which there have been eccentricity and family peculiarities. A sister of the maternal grandmother was hysterical, a somnambulist, and lay seventeen years in bed, on account of fancied paralysis. A second great-aunt spent seven years in bed, on account of a fancied fatal illness, and at the same time gave balls. A third had the whim that a certain table in her _salon_ was bewitched. If anything were laid on this table, she would become greatly excited and cry, “Bewitched! bewitched!” and run with the object into a room which she called the “Black Chamber,” and the key of which she never let out of her hands. After the death of this lady, there were found in this chamber a number of shawls, ornaments, bank-notes, etc. A fourth great-aunt, during two years, did not leave her room, and neither washed herself nor combed her hair; then she again made her appearance. All these ladies were, nevertheless, intellectual, finely educated, and amiable. S.’s mother was nervous, and could not bear the light of the moon. From her father’s family it is said she had a trace too much. One line of the family gave itself up almost entirely to spiritualism. Two blood-relations on the father’s side shot themselves. The majority of her male relatives are unusually talented; the females are decidedly narrow and domestic. S.’s father had a high position, which, however, on account of his eccentricity and extravagance (he wasted over a million and a half), he lost. Among many foolish things that her father encouraged in her was the fact that he brought her up as a boy, called her Sandor, allowed her to ride, drive, and hunt, admiring her muscular energy. On the other hand, this foolish father allowed his second son to go about in female attire, and had him brought up as a girl. This farce ceased in his fifteenth year, when the son was sent to a higher school. Sarolta-Sandor remained under her father’s influence till her twelfth year, and then came under the care of her eccentric maternal grandmother, in Dresden, by whom, when the masculine play became too obvious, she was placed in an Institute, and made to wear female attire. At thirteen she had a love-relation with an English girl, to whom she represented herself as a boy, and ran away with her. Sarolta returned to her mother, who, however, could do nothing, and was compelled to allow her daughter to again become Sandor, wear male clothes, and, at least once a year, to fall in love with persons of her own sex. At the same time, S. received a careful education, and made long journeys with her father,—of course, always as a young gentleman. She early became independent, and visited _cafés_, even those of doubtful character, and, indeed, boasted one day that in a brothel she had had a girl sitting on each knee. S. was often intoxicated, had a passion for masculine sports, and was a very skillful fencer. She felt herself drawn particularly toward actresses, or others of similar position, and, if possible, toward those who were not very young. She asserts that she never had any inclination for a young man, and that she has felt, from year to year, an increasing dislike for young men. “I preferred to go into the society of ladies with ugly, ill-favored men, so that none of them could put me in the shade. If I noticed that any of the men awakened the sympathies of the ladies, I felt jealous. I preferred ladies who were bright and pretty; I could not endure them if they were fat or much inclined toward men. It delighted me if the passion of a lady was disclosed under a poetic veil. All immodesty in a woman was disgusting to me. I had an indescribable aversion for female attire,—indeed, for everything feminine,—but only in as far as it concerned me; for, on the other hand, I was all enthusiasm for the beautiful sex.” During the last ten years S. had lived almost constantly away from her relatives, in the guise of a man. She had had many _liaisons_ with ladies, traveled much, spent much, and made debts. At the same time, she carried on literary work, and was a valued collaborator on two noted journals of the Capital. Her passion for ladies was very changeable; constancy in love was entirely wanting. Only once did such a _liaison_ last three years. It was years before that S., at Castle G., made the acquaintance of Emma E., who was ten years older than herself. She fell in love with her, made a marriage-contract with her, and they lived together, as man and wife, for three years at the Capital. A new love, which S. regarded as a fate, caused her to sever her matrimonial relations with E. The latter would not have it so. Only with the greatest sacrifice was S. able to purchase her freedom from E., who, it is reported, still looks upon herself as a divorced wife, and regards herself as the Countess V.! That S. also had the power to excite passion in other women is shown by the fact that when she (before her marriage with E.) had grown tired of a Miss D., after having spent thousands of guldens on her, she was threatened with shooting by D. if she should become untrue. It was in the summer of 1887, while at a watering-place, that S. made the acquaintance of a distinguished official’s family. Immediately she fell in love with the daughter, Marie, and her love was returned. Her mother and cousin tried in vain to break up this affair. During the winter, the lovers corresponded zealously. In April, 1888, Count S. paid her a visit, and in May, 1889, attained her wish; in that Marie—who, in the meantime, had given up a position as teacher—became her bride in the presence of a friend of her lover, the ceremony being performed in an arbor, by a false priest, in Hungary. S., with her friend, forged the marriage-certificate. The pair lived happily, and, without the interference of the step-father, this false marriage, probably, would have lasted much longer. It is remarkable that, during the comparatively long existence of the relation, S. was able to deceive completely the family of her bride with regard to her true sex. S. was a passionate smoker, and in all respects her tastes and passions were masculine. Her letters and even legal documents reached her under the address of “Count S.” She often spoke of having to drill. From remarks of the father-in-law, it seems that S. (and she afterward confessed it) knew how to imitate a scrotum with handkerchiefs or gloves stuffed in the trousers. The father-in-law also, on one occasion, noticed something like an erected member on his future son-in-law (probably a priapus). She also occasionally remarked that she was obliged to wear a suspensory bandage while riding. The fact is, S. wore a bandage around the body, possibly as a means of retaining a priapus. Though S. often had herself shaved _pro forma_, the servants in the hotel where she lived were convinced that she was a woman, because the chambermaids found traces of menstrual blood on her linen (which S. explained, however, as hæmorrhoidal); and, on the occasion of a bath which S. was accustomed to take, they claimed to have convinced themselves of her real sex by looking through the key-hole. The family of Marie make it seem probable that she for a long time was deceived with regard to the true sex of her false bridegroom. The following passage in a letter from Marie to S., August 26, 1889, speaks in favor of the incredible simplicity and innocence of this unfortunate girl: “I don’t like children any more, but if I had a little Bezerl or Patscherl by my Sandi,—ah, what happiness, Sandi mine!” A large number of manuscripts allow conclusions to be drawn concerning S.’s mental individuality. The chirography possesses the character of firmness and certainty. The characters are genuinely masculine. The same peculiarities repeat themselves everywhere in their contents,—wild, unbridled passion; hatred and resistance to all that opposes the heart thirsting for love; poetical love, which is not marred by one ignoble blot; enthusiasm for the beautiful and noble; appreciation of science and the arts. Her writings betray a wonderfully wide range of reading in classics of all languages, in citations from poets and prose writers of all lands. The evidence of those qualified to judge literary work shows that S.’s poetical and literary ability is by no means small. The letters and writings concerning the relation with Marie are psychologically worthy of notice. S. speaks of the happiness there was for her when by M.’s side, and expresses boundless longing to see her beloved, if only for a moment. After such a happiness, she could have but one wish,—to exchange her cell for the grave. The bitterest thing was the knowledge that now Marie, too, hated her. Hot tears, enough to drown herself in, she had shed over her lost happiness. Whole quires of paper are given up to the apotheosis of this love, and reminiscences of the time of the first love and acquaintance. S. complained of her heart, that would allow no reason to direct it; she expressed emotions which were such as only could be felt,—not simulated. Then, again, there were outbreaks of most silly passion, with the declaration that she could not live without Marie. “Thy dear, sweet voice; the voice whose tone perchance would raise me from the dead; that has been for me like the warm breath of Paradise! Thy presence alone were enough to alleviate my mental and moral anguish. It was a magnetic stream; it was a peculiar power your being exercised over mine, which I cannot quite define; and, therefore, I cling to that ever-true definition: I love you because I love you. In the night of sorrow I had but one star,—the star of Marie’s love. That star has lost its light; now there remains but its shimmer,—the sweet, sad memory which even lights with its soft ray the deepening night of death,—a ray of hope.” This writing ends with the apostrophe: “Gentlemen, you learned in the law, psychologists and pathologists, do me justice! Love led me to take the step I took; all my deeds were conditioned by it. God put it in my heart. “If He created me so, and not otherwise, am I then guilty; or is it the eternal, incomprehensible way of fate? I relied on God, that one day my emancipation would come; for my thought was only love itself, which is the foundation, the guiding principle, of His teaching and His kingdom. “O God, Thou All-pitying, Almighty One! Thou seest my distress; Thou knowest how I suffer. Incline Thyself to me; extend Thy helping hand to me, deserted by all the world. Only God is just. How beautifully does Victor Hugo describe this in his ‘Legendes du Siècle’! How sad do Mendelssohn’s words sound to me: ‘Nightly in dreams I see thee’!” Though S. knew that none of her writings reached her lover, she did not grow tired writing of her pain and delight in love, in page after page of deification of Marie. And to induce one more pure flood of tears, on one still, clear summer evening, when the lake was aglow with the setting sun like molten gold, and the bells of St. Anna and Maria-Wörth, blending in harmonious melancholy, gave tidings of rest and peace, she wrote: “For that poor soul, for this poor heart that beat for thee till the last breath.” _Personal Examination:_ The first meeting which the experts had with S. was, in a measure, a time of embarrassment to both sides; for them, because perhaps S.’s somewhat dazzling and forced masculine carriage impressed them; for her, because she thought she was to be marked with the stigma of moral insanity. She had a pleasant and intelligent face, which, in spite of a certain delicacy of features and diminutiveness of all its parts, gave a decidedly masculine impression, had it not been for the absence of a moustache. It was even difficult for the experts to realize that they were concerned with a woman, despite the fact of female attire and constant association; while, on the other hand, intercourse with the man Sandor was much more free, natural, and apparently correct. The culprit also felt this. She immediately became more open, more communicative, more free, as soon as she was treated like a man. In spite of her inclination for the female sex, which had been present from her earliest years, she asserts that in her thirteenth year she first felt a trace of sexual feeling, which expressed itself in kisses, embraces, and caresses, with sensual pleasure, and this on the occasion of her elopement with the red-haired English girl from the Dresden Institute. At that time feminine forms exclusively appeared to her in dream-pictures, and ever since, in sensual dreams, she has felt herself in the situation of a man, and occasionally, also, at such times, experienced ejaculation. She knows nothing of solitary or mutual onanism. Such a thing seemed very disgusting to her, and not conducive to manliness. She had, also, never allowed herself to be touched ad genitalia by others, because it would have revealed her great secret. The menses began at seventeen, but were always scanty, and without pain. It was plain to be seen that S. had a horror of speaking of menstruation; that it was a thing repugnant to her masculine consciousness and feeling. She recognized the abnormality of her sexual inclinations, but had no desire to have them changed, since in this perverse feeling she felt both well and happy. The idea of sexual intercourse with men disgusted her, and she also thought it would be impossible. Her modesty was so great that she would prefer to sleep among men rather than among women. Thus, when it was necessary for her to answer the calls of nature or to change her linen, it was necessary for her to ask her companion in the cell to turn her face to the window, that she might not see her. When occasionally S. came in contact with this companion,—a woman from the lower walks of life,—she experienced a sexual excitement that made her blush. Indeed, without being asked, S. related that she was overcome with actual fear when, in her cell, she was compelled to force herself into the unusual female attire. Her only comfort was, that she was at least allowed to keep a shirt. Remarkable, and what also speaks for the significance of olfactory sensations in her vita sexualis, is her statement that, on the occasions of Marie’s absence, she had sought those places on which Marie’s head was accustomed to repose, and smelled of them, in order to experience the delight of inhaling the odor of her hair. Among women, those who are beautiful, or voluptuous, or quite young do not particularly interest her. The physical charms of women she makes subordinate. As by magnetic attraction, she feels herself drawn to those between twenty-four and thirty. She found her sexual satisfaction exclusively in corpora feminæ (never in her own person), in the form of manustupration of the beloved woman, or cunnilingus. Occasionally she availed herself of a stocking stuffed with oakum as a _priapus_. These admissions were made only unwillingly by S., and with apparent shame; just as in her writings, immodesty or cynicism are never found. She is religious, has a lively interest in all that is noble and beautiful,—men excepted,—and is very sensitive to the opinion others may entertain of her morality. She deeply regrets that in her passion she made Marie unhappy, and regards her sexual feelings as perverse, and such a love of one woman for another, among normal individuals, as morally reprehensible. She has great literary talent and an extraordinary memory. Her only weakness is her great frivolity and her incapability to manage money and property reasonably. But she is conscious of this weakness, and does not care to talk about it. She is 153 centimetres tall, of delicate skeleton, thin, but remarkably muscular on the breast and thighs. Her gait in female attire is awkward. Her movements are powerful, not unpleasing, though they are somewhat masculine, and lacking in grace. She greets one with a firm pressure of the hand. Her whole carriage is decided, firm, and somewhat self-conscious. Her glance is intelligent; mien somewhat diffident. Feet and hands remarkably small, having remained in an infantile stage of development. Extensor surfaces of the extremities remarkably well covered with hair, while there is not the slightest trace of beard, in spite of all shaving experiments. The hips do not correspond in any way with those of a female. Waist is wanting. The pelvis is so slim, and so little prominent, that a line drawn from the axilla to the corresponding knee is straight,—not curved inward by a waist, or outward by the pelvis. The skull is slightly oxycephalic, and in all its measurements falls below the average of the female skull by at least one centimetre. The circumference of the head is 52 centimetres; the occipital half-circumference, 24 centimetres; the line from ear to ear, over the vertex, 23 centimetres; the anterior half-circumference, 28.5 centimetres; the line from glabella to occiput, 30 centimetres; the ear-chin line, 26.5 centimetres; long diameter, 17 centimetres; greatest lateral diameter, 13 centimetres; diameter at auditory meati, 12 centimetres; zygomatic diameter, 11.2 centimetres. The upper jaw projects strikingly, its alveolar process projecting beyond the under jaw about 0.5 centimetre. The position of the teeth is not fully normal; the right upper canine has not developed. Mouth remarkably small. Ears prominent; lobes not differentiated, passing over into the skin of the cheek. Hard palate narrow and high; voice rough and deep; mammæ fairly developed, soft, and without secretion. Mons veneris covered with thick, dark hair. Genitals completely feminine, without trace of hermaphroditic appearance, but at the stage of development of those of a ten-year-old girl. The labia majora touch each other almost completely; labia minora have a cock’s-comb-like form, and project under the labia majora. The clitoris is small, and very sensitive. Frenulum delicate; perineum very narrow; introitus vaginæ narrow; mucous membrane normal. Hymen wanting (probably congenitally); likewise, the carunculæ myrtiformes. Vagina so narrow that the insertion of a membrum virile would be impossible, and it is also very sensitive; certainly coitus had not taken place. Uterus is felt, through the rectum, to be about the size of a walnut, immovable, and retroflected. The pelvis appears generally narrowed (dwarf-pelvis), and of decidedly masculine type. The distance between anterior superior spines is 22.5 centimetres (instead of 26.3 centimetres). Distance between the crests of the ilii, 26.5 centimetres (instead of 29.3 centimetres); between the trochanters, 27.7 centimetres (31); the external conjugate diameter, 17.2 centimetres (19 to 20); therefore, presumably, the internal conjugate would be 7.7 centimetres (10.8). On account of narrowness of the pelvis, the direction of the thighs is not convergent, as in a woman, but straight. The opinion given showed that in S. there was a congenitally abnormal inversion of the sexual instinct, which, indeed, expressed itself, anthropologically, in anomalies of development of the body, depending upon great hereditary taint; further, that the criminal acts of S. had their foundation in her abnormal and irresistible sexuality. S.’s characteristic expressions—“God put love in my heart. If He created me so, and not otherwise, am I, then, guilty; or is it the eternal, incomprehensible way of fate?”—are really justified. The court granted pardon. The “countess in male attire,” as she was called in the newspapers, returned to her home, and again gave herself out as Count Sandor. Her only distress is her lost happiness with her beloved Marie. A married woman, in Brandon, Wisconsin, whose case is reported by Dr. Kiernan (_The Medical Standard_, 1888, November and December), was more fortunate. She eloped, in 1883, with a young girl, married her, and lived with her as husband undisturbed. An interesting “historical” example of androgyny is a case reported by Spitzka (_Chicago Medical Review_, August 20, 1881). It was that of Lord Cornbury, Governor of New York, who lived in the reign of Queen Anne. He was apparently affected with moral insanity; was terribly licentious, and, in spite of his high position, could not keep himself from going about in the streets in female attire, coquetting with all the allurements of a prostitute. In a picture of him that has been preserved, his narrow brow, asymmetrical face, feminine features, and sensual mouth at once attract attention. It is certain that he never actually regarded himself as a woman. * * * * * Moreover, in individuals afflicted with contrary sexual instinct, in themselves, the perverse sexual feeling and inclination may be complicated with other perverse manifestations. Thus here, with reference to the activity of the instinct, there may be acts quite analogous to acts indulged in by individuals in perverse satisfaction of the instinct, but who, at the same time, have a natural inclination toward persons of the opposite sex. Owing to the circumstance that abnormally increased sexuality is almost a regular accompaniment of contrary sexual feeling, acts of lustful cruelty in the satisfaction of libido are easily possible. A remarkable example of this is the case of Zastrow (Casper-Liman, 7. Auflage, Bd. i, p. 190; ii, p. 487), who bit one of his victims (a boy), tore his prepuce, slit the anus, and strangled the child. Z. came of a psychopathic grandfather and melancholic mother. His brother indulged in abnormal sexual pleasures, and committed suicide. Z. was a congenital urning, and in habitus and occupation masculine. There was phimosis. Mentally, he was a weak, perverse, unsocial man. He had horror feminæ, and, in his dreams, he felt himself like a woman toward a man. He was painfully conscious of his want of normal sexual feeling and his perverse instinct, and sought satisfaction in mutual onanism, with frequent desire for pederasty. Similar sadistic feelings of this kind, in those afflicted with contrary sexual instinct, are found in some of the foregoing histories (comp. Cases 107 and 108 of this edition, and Case 96 of the sixth edition). But masochism also occurs (comp. Case 43, sixth edition; Cases 111 and 114 of this edition; and Case 3, in the first edition of “Neue Forschungen”). As examples of perverse sexual satisfaction dependent on contrary sexual instinct, may be mentioned the Greek, who, as Athenäus reports, was in love with a statue of Cupid, and defiled it, in the temple of Delphi; and besides the monstrous cases reported by Tardieu (“Attentats,” p. 272), the terrible one reported by Lombroso (“L’uomo delinquente,” p. 200), of a certain Artusio, who wounded a boy in the abdomen, and abused him sexually _by means of the incisions_. Cases 86, 110, and 111, also, show that fetichism may also occur with contrary sexual instinct. DIAGNOSIS, PROGNOSIS, AND THERAPY OF CONTRARY SEXUAL INSTINCT. While up to this time contrary sexual instinct has had but an anthropological, clinical, and forensic interest for science, now, as a result of the latest investigations, there is some thought of therapy in this incurable condition, which so heavily burdens its victims, socially, morally, and mentally. A preparatory step for the application of therapeutic measures is the exact differentiation of the acquired from the congenital cases; and among the latter, again, the assignment of the concrete case to its proper position in the categories that have been established empirically. The diagnostic differentiation of the acquired from the congenital condition is made without difficulty in the early stages of the anomaly. If sexual inversion has already taken place, then the history of the development of the case will throw light upon it. The important decision, prognostically, as to whether the contrary sexual instinct is congenital or acquired, can only be made in such cases by means of the most minute details of the history. The establishment of the fact that contrary sexual instinct existed before indulgence in masturbation is of great importance with reference to deciding whether the anomaly is congenital or not. In this, however, a difficulty arises, owing to the possibility of imperfect localization of past events (illusions of memory). For the presumption of acquired contrary sexual instinct, it is important to prove the existence of hetero-sexual instinct before the beginning of solitary or mutual onanism. In general, the acquired cases are characterized in that:—

Chapters

1. Chapter 1 2. introduction of catheter, etc.). 3. 1. _Paradoxia_, _i.e._, sexual excitement occurring independently of the 4. 2. _Anæsthesia_ (absence of sexual instinct). Here all organic impulses 5. 3. _Hyperæsthesia_ (increased desire, satyriasis). In this state there 6. 4. _Paræsthesia_, (perversion of the sexual instinct, _i.e._, 7. 1. _Association of Active Cruelty and Violence with 8. 1. The patient, who had a great desire to be cured, was most strictly 9. 2. I allowed him, commanded him even, to think of nude women, because 10. 3. I sought, by means of hypnosis—which was hard to induce—and 11. 2. _The Association of Passively Endured Cruelty and Violence, with 12. 1. Masochism, according to my experience, is, under all circumstances, 13. 2. Physically and mentally I am in all respects masculine. I have a 14. 3. The foundation of all masochistic ideas is libido; and as this ebbs 15. 4. An example of masochistic ideas follows: “She” is a peasant 16. 5. In reading Sacher-Masoch, it struck me that in masochists, now and 17. episode, and he has many other and important interests; for a woman, on 18. 3. _The Association of Lust with the Idea of Certain Portions of the 19. 1. Traces of hetero-sexual, with predominating homo-sexual, instinct 20. 3. The entire mental existence is altered to correspond with the 21. 4. The form of the body approaches that which corresponds to the 22. 1. The sexual life of individuals thus organized manifests itself, as a 23. 2. The psychical love manifest in these men is, for the most part, 24. 3. By the side of the functional signs of degeneration attending 25. 4. Neuroses (hysteria, neurasthenia, epileptoid states, etc.) co-exist. 26. 5. In the majority of cases, psychical anomalies (brilliant endowment in 27. 6. In almost all cases where an examination of the physical and mental 28. 1. _Psychical Hermaphroditism._[112]—The characteristic mark of this 29. 1868. The families of both my parents are healthy; at any rate, mental 30. 3. _Effemination and Viraginity._—There are various transitions from the 31. 24. It was discovered that she was of masculine sex. E. had worn female 32. 4. _Androgyny and Gynandry._—Forming direct transitions from the 33. 2. This condition, in that it is congenital, is incurable. There 34. 3. Mr. v. H., in the legal sense of the word, is not irresponsible, 35. 4. Mr. v. H. is also physically ill. He presents signs of slight 36. 1. The homo-sexual instinct appears secondarily, and always may be 37. 2. The homo-sexual instinct, as long as inversio sexualis has not taken 38. 3. The hetero-sexual instinct long remains predominant, and the 39. 1. Prevention of onanism, and removal of other influences injurious to 40. 2. Cure of the neurosis (neurasthenia sexualis and universalis) arising 41. 3. Mental treatment, in the sense of combating homo-sexual, and 42. 2. I abhor the love for my own sex, and shall never again think men 43. 3. I shall and will become well again, fall in love with a virtuous 44. 2. The command that male-love should be felt to be disgraceful and 45. 3. The command to regard only women as beautiful; to approach them, to 46. 2. I regard the inclination for men disgusting,—horrible; and I shall 47. 3. Women alone I find enticing. Once a week I shall cohabit, with full 48. 2. I no longer have inclination toward men; for love of men is against 49. 3. I feel an inclination toward women; for woman is lovely and 50. 1. H., aged 17, imbecile, enticed a little girl into a barn, by giving 51. 2. L., aged 21; imbecile; degenerate. While he was watching cattle, 52. 3. G., aged 21, microcephalic, imbecile, has masturbated since his 53. 4. B., aged 21; imbecile. While alone in a forest with his sister of 54. 1. To oppose the normal or intensified sexual desire, there may be no 55. 2. When the sexual desire is increased (states of psychical exaltation) 56. 3. When the sexual instinct is perverse (states of psychical 57. 1. OFFENSE AGAINST MORALITY IN THE FORM OF EXHIBITION. 58. 1. Paralytic, aged 60. At the age of fifty-eight he began to exhibit 59. 2. A drinker, aged 66, suffering with folie circulaire. His exhibition 60. 3. A drinker, predisposed, aged 49. He was always very excitable 61. 4. A man, aged 64; married; father of fourteen children. Great 62. 2. RAPE AND LUST-MURDER. 63. 3. BODILY INJURY, INJURY TO PROPERTY, AND TORTURE OF ANIMALS DEPENDENT 64. 4. BODILY INJURY, ROBBERY, AND THEFT DEPENDENT ON FETICHISM. 65. 5. VIOLATION OF INDIVIDUALS UNDER THE AGE OF FOURTEEN. 66. 6. UNNATURAL ABUSE—SODOMY.[140] 67. 1. As a means of sexual gratification, in case of great sexual desire, 68. 2. In old debauchees, who have become satiated with normal sexual 69. 3. Traditionally, among certain barbarous races that are devoid of 70. 1. Upon the basis of congenital contrary sexual instinct, with 71. 2. On the basis of acquired contrary sexual instinct:— 72. 1. In individuals of the lowest class, who, having had the misfortune 73. 2. Under circumstances analogous to those of I, 1,—as a remuneration 74. 1. In individuals affected with contrary sexual instinct, with 75. 2. In urnings who feel toward men like women, out of desire and lust. 76. 1. On July 5, 1777, a woman was brought before a court in London, who, 77. 2. In 1773, another woman, dressed as a man, courted a girl, and asked 78. 3. Two women lived together as man and wife for thirty years. On her 79. 7. NECROPHILIA.[147] 80. 8. INCEST. 81. 9. IMMORAL ACTS WITH PERSONS IN THE CARE OF OTHERS; SEDUCTION 82. PART I.—THE NERVES. PART II.—THE ARTERIES. PART III.—THE VEINS. 83. PART I. The Nerves.—Gives in a clear form not only the Cranial and 84. PART II. The Arteries.—Gives a unique grouping of the Arterial system, 85. PART III. The Veins.—Shows how the blood from the periphery of the 86. 1. It is the only arrangement which combines the Three Systems, and yet 87. 2. It is the only instance of the Cranial, Spinal, and Sympathetic 88. 3. From its neat size and clear type, and being printed only upon one 89. 5. Superscripts are denoted by a caret before a single superscript

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