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The Sexual Question - A Scientific, psychological, hygienic and sociological study
by August Forel
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The last is still very weak in man, while some animal species, such as the bees and ants, have developed it in a more complete manner, on the basis of instinct. According to this natural law, all social organization naturally develops altruism or the sentiment of duty. The history of humanity proves that our social union is only developed slowly and laboriously through innumerable contests, and that it is derived, directly or indirectly, from the family union of individuals. Extension of communication on the surface of the earth causes the artificial development of social organization to advance much more rapidly than the natural phylogenetic development by evolution of the sentiments or social instincts. The latter are, however, forced to follow the movement, resting first on the deep roots of family and friendly altruism, as well as on that of caste or clan (patriotism); i.e., on sentiments of sympathy and duty toward certain individuals who are more closely connected with us, sentiments which are hereditary in man. A vague general humanitarian sentiment, a hothouse flower which is still feeble, has already commenced to grow on this natural basis. Let us hope that it will live.

It would be a fundamental error to try and found social solidarity solely on our phylogenetic sentiments of sympathy, or on our ideal faculty of devotion and self-sacrifice; but to try and take egoism as a basis for this solidarity is a still greater error. We must not make an antinomy of egoism and altruism, but regard them as two elements inseparable from all human society, as well as the individuals who compose it. We cannot deny that the altruist, endowed with strong sentiments of sympathy and duty, is an excellent social worker, while the pure egoist constitutes an element of decomposition for society. It is, therefore, a social duty to proceed by the sexual route to a selection which will cause the first to multiply and eliminate the second as far as possible by sterilizing his germs.



CHAPTER VIII

SEXUAL PATHOLOGY

On this subject we refer the reader to the well-known work of Krafft-Ebing, "Psychopathia Sexualis,"[4] in which will be found a number of observations, the details of which we cannot enter into here. We may first of all say that with the exception of venereal diseases the genital organs by themselves only play a very small part in sexual pathology. The brain is the true domain of nearly all sexual anomalies.

In the second place, we may remark that the disorders of sexual life only rarely belong to acute affections which the physician can treat with pharmaceutical or other common remedies. They almost exclusively originate in the mental constitution, i.e., in the hereditary dispositions of the brain of the individual. But the pathology of mental or cerebral conditions offers an extremely vast field, capable of so much extension that no definite limit can be fixed between the normal state and morbid states, which are themselves connected by numerous transitions. A great number of acts due to mental conditions which the public and even learned theologians, jurists and physicians not initiated in psychiatry, consider as criminal, sinful, or infamous, are only the product of pathological aberrations due to hereditary dispositions. I was recently consulted by a patient of this kind, otherwise possessed of noble sentiments, who told me that a physician in Germany to whom he related his troubles, turned on him furiously and said, "These things are filthy; you are a pig; hold your tongue and get away from here!" As a matter of fact this unfortunate patient was sustaining a heroic struggle against his perverted pathological sexual appetites. Knowing little or nothing of these matters human society, with few exceptions, is of the same opinion as the ignorant doctor mentioned above. For this reason I think it necessary at least to give an outline of phenomena which, although very repulsive in themselves, throw much light on the sexual question.

PATHOLOGY OF THE SEXUAL ORGANS

Every deformity, disease or operation which destroys the sexual glands in the child, or prevents them from developing, gives rise to the phenomena which we have described when speaking of castration. This is the case, for instance, with cryptorchidism in which the testicles remain in the inguinal canal and become atrophied, instead of descending into the scrotum. The following case is an example, and is interesting in other respects:

A young man was affected with imbecility and congenital cryptorchidism with atrophy of the testicles. A eunuch from birth, he developed no sexual appetite and no correlative masculine character. To make a man of him, his too eager aunts married him to a strong girl, who was anything but innocent. She attempted by all kinds of manipulations to cure the sexual blindness of her husband; but this was a waste of labor, as the unhappy wretch only regarded the performance as disgusting and filthy. He was violently excited and became somnambulistic.

Soon afterwards the wife consoled herself with a lover of normal sexual power, and they both overwhelmed the poor eunuch with raillery. The latter, becoming furious, offered his wife a cake poisoned with arsenic on her birthday, but she saw through the stratagem. The poor wretch was sent for trial and condemned to a long term of imprisonment for attempted poisoning. I consider this judgment as a legal crime. In spite of my protests, imbecility was not admitted, and the somnambulism was looked upon as simulated.

On the other hand, the same lesions when they occur in the adult neither destroy the correlative sexual characters, nor the power of coitus, nor the voluptuous sensation of the orgasm.

In man, aspermia sometimes occurs; the testicles appear to be well formed, but the semen contains no spermatozoa. In spite of this the aspermatic individual generally has erections, a certain amount of sexual power and orgasm, and is capable of amorous feelings, although his sexual functions are generally feeble. But he is incapable of fecundating a woman.

Some women who have never menstruated possess normal ovaries and may become pregnant.

Tuberculosis, tumors and inflammations of the testicles and ovaries may cause sterility.

The erection of the penis is often rendered impossible by certain deformities, such as hypospadias and epispadias, in which the urethral canal opens respectively below or above the penis.

Involuntary emissions of semen without erection, with or without voluptuous sensation, is called spermatorrhea. This is often a result of onanism, nervousness or constipation. Too much importance has been attached to it. In hypochondriacs spermatorrhea becomes a bugbear, which often makes them the dupes of charlatans. The less attention is paid to it the quicker it disappears; especially when it is of purely nervous origin, as is usually the case.

Phimosis, or narrowness of the opening of the prepuce is nearly always of embryonic origin. It prevents the glans penis from becoming exposed, at least during erection. It is a very common condition and very disagreeable. If the prepuce is forcibly drawn back behind the glans penis before erection, as is often the case in masturbation, the penis is gripped by the prepuce so that it cannot sometimes be drawn forward and inflammation with oedema results; this condition is called paraphimosis, and may become dangerous. Secretions, urine and semen accumulate and decompose in a phimosed prepuce, cause irritation and lead to masturbation. All cases of phimosis should be operated upon in infancy, by complete or partial circumcision.

In women, the number of diseases which prevent conception is much greater than in man. The ovary may undergo cystic degeneration or become the seat of a tumor; but affections of the uterus and vagina cause more sterility than ovarian affections. This results chiefly from catarrh and inflammation which destroy the spermatozoa before they can reach the egg during its descent. Disorders of menstruation have much less influence on fecundity. The womb sometimes remains in an infantile state, which may also cause sterility. Other diseases of the female sexual organs have a more general pathological character and hardly influence sexual intercourse.

A method of rendering women sterile without castration (removal of the ovaries) consists in interrupting the communication between the ovaries and the womb by dislocation of the Fallopian tubes: this avoids all the evil effects of castration.

Certain inflammations and displacements of the uterus and ovaries are often the origin of pains, indispositions and nervous disorders in women. Irregularity and pain in menstruation are a frequent cause of neuroticism.

The hymen is seldom so strongly developed as to offer a serious obstacle to coitus; but when this occurs it may be removed by a slight operation. Young women often suffer from vaginismus, or painful spasms occurring when an object, such as the finger or penis, is introduced into the vagina.

Hermaphrodism in man is always pathological, extremely rare, and when it exists nearly always incomplete. These cases are generally incomplete mixtures concerning principally the correlative characters. A double function only exists in legends. I have myself seen a celebrated hermaphrodite named Catherine Hohmann who had a well-formed testicle on the left side enclosed in a fold of skin which resembled the larger lip of the vulva, while the penis was very short and resembled a clitoris. This individual, who was baptized as a woman, was certainly male on one side; on the other hand, the feminine nature was more than problematical. Menstruation was alleged to have occurred but was not established with certainty, any more than an ovary or uterus.

Much more frequent are inverted correlative sexual characters, such as bearded women, men with breasts; also mental sexual inversions, of which we shall speak later.

VENEREAL DISEASES[5]

We cannot give here a complete description of the venereal diseases, which constitute a terrible evil for humanity, by bringing a great deal of misfortunes and decadence into family and social life. Let us first point out the common error which attributes to sexual excess the evil effects which are really due to venereal disease. Although it may be uncommon, one may be infected by these diseases after an innocent kiss, a cut finger, by sitting on a privy contaminated by a person suffering from venereal disease, by the use of contaminated linen, etc., etc. A pachydermatous Don Juan, on the contrary, may abandon himself to the wildest sexual excess without being infected, if he is prudent and has good luck. On the other hand, young men may be infected after having been with a prostitute only once in their lives, and thus ruin their whole existence.

There are three kinds of venereal disease, which we will describe in a few words. To these may be added certain parasites, such as crab-lice and the itch, which are easily communicated by sexual intercourse with infected persons, but also in other ways.

Gonorrhea or Clap.—This disease consists in a purulent inflammation of the urethra caused by a microbe called the gonococcus. When treated properly it may be cured in a few weeks, but very often the inflammation becomes chronic and attacks the neighboring organs. Chronic clap, or "morning-drop," may lead in the male to permanent stricture of the urethra, which in turn may produce retention of urine, catarrh of the bladder and disease of the kidneys, which may be fatal. One attack of gonorrhea in no way protects against a second infection, but rather predisposes to it, and when this disease becomes chronic exacerbations or relapses of the acute stage often occur without fresh infection.

In women the results of gonorrhea are, if possible, still worse than in men, because it is more difficult to cure. A prostitute affected with gonorrhea may infect an enormous number of men, and in this case medical inspection of brothels is no guarantee. The gonococci are concealed in all the corners and folds of the internal genital organs of woman, where they set up inflammation of the womb, the Fallopian tubes and even the ovaries, which may lead to adhesions between the abdominal organs. Women affected with chronic gonorrhea generally become sterile. When the womb and the ovaries are affected there is much suffering and the woman may be confined to bed for some years. Stricture of the urethra and inflammation of the bladder are more rare in women than in men, as the result of gonorrhea.

But gonorrhea is not confined to the adults of both sexes. The innocent child, who at birth has to pass through its mother's vulva, when this is affected with gonorrhea, undergoes a baptism of gonococci which attack the conjunctiva of the eyes and set up a severe purulent inflammation, called ophthalmia of the newly born (ophthalmia neonatorum). This is one of the chief causes of total blindness, and if the child is not entirely blind, there are often large white patches left on the cornea which considerably interfere with sight. Gonorrheal ophthalmia may also occur in adults by conveying pus from the urethra to the eyes by the fingers.

Syphilis.—This disease is still more formidable than gonorrhea. It is caused by a microbe which has been recently discovered (Spirochaeta pallida). Syphilis is much more chronic than gonorrhea and commences with a small sore indurated at its base and called the hard chancre. This is situated on the genital organs or elsewhere; in the mouth, for instance, when this has been in contact with the buccal or genital organs of a person infected with syphilis. The syphilitic poison spreads through the body by means of the blood and lymph. At the end of a few weeks eruptions appear on the body and face, and then commences a series of disasters the cause of which may be suspended over the victim for his whole life, like the sword of Damocles, even when he believes himself cured; for the cure of syphilis is often uncertain. This disease may remain latent for months and years, to reappear later on in different organs and cause fresh lesions.

Syphilis causes ulcers of the skin and mucous membranes; it sometimes causes decay of the bones; it may cause disease of the internal organs, such as the liver and lungs; it affects the walls of the blood vessels, causing them to become hard and brittle (atheroma); it causes disease of the eyes, especially of the iris and retina, tumors (or gummata) in the brain, paralysis etc. In fact, it spares none of the organs of the body.

Among the most terrible results of syphilis we must mention locomotor ataxy (sclerosis of the posterior columns of the spinal cord), with its lightning pains and paralysis of the legs and arms; also general paralysis of the insane, which by causing gradual atrophy of the brain, destroys one after the other, sensations, movements and all the mental faculties. These two diseases, which are so common at the present day, only occur in old syphilitics, five to twenty years, or more often ten to fifteen years after infection, and as a rule in persons who think they have been completely cured. Both these diseases are fatal. Before causing death, locomotor ataxy causes intolerable pain for several years. General paralysis first gives rise to grandiose ideas, and after disintegrating the human personality bit by bit, ends by transforming the individual into a being much inferior to animals, and of an aspect as miserable as it is repulsive. A general paralytic in his last stage is little more than a vegetating ruin, in whom the nervous activities are decomposed little by little, after the gradual disappearance of all the mental faculties. This is the result of slow atrophy of the brain and gradual destruction of its microscopic elements, or neurones.

The early stages of syphilis may easily pass unnoticed owing to their partly latent and completely painless character. Small eruptions may be mistaken for other affections, and mercurial treatment generally disperses the symptoms of primary and secondary syphilis. But syphilitics who are apparently cured are never safe from being attacked, after perhaps many years, with locomotor ataxy, general paralysis or the tertiary or quaternary manifestations of syphilis, such as disease of the bones, internal organs, eyes, brain, etc. The sores of the first two or three years of syphilis are contagious but painless, and hence do not prevent coitus when they occur in the genitals. After three years syphilis becomes less contagious, but there is no definite time limit and cases have been recorded in which contagious lesions occurred ten or fifteen years after the onset of the disease.

A syphilitic man may transmit the disease to his children without infecting his wife, and these children may die before birth or may be born with congenital syphilis. This is due to the spermatozoa being infected with syphilis. However, this is fortunately not always the case, for many cured syphilitics have healthy children. A child affected with congenital syphilis (from the father) may infect the mother during pregnancy; this is called "syphilis by conception." Congenital syphilis may also cause locomotor ataxy and general paralysis.

It is difficult to enumerate all the infirmities which syphilis in the parents may transmit to the children. Syphilis often renders marriage sterile. It is more frequent in men than in women, because the number of prostitutes is small compared with the number of men who go with them; a single prostitute may contaminate a whole regiment. On their part, the clients of prostitutes convey gonorrhea and syphilis to their wives, thus spreading in society this abominable plague and all the evils resulting from it.

Soft Chancre.—The third kind of venereal disease is the soft chancre, thus called in distinction to hard chancre, which is the primary sore of syphilis. Soft chancre is the least dangerous and the least common of the three diseases. It consists of an ulcer which remains localized to the genital organs (unless it is complicated with syphilis, which is frequent). The ulcerated parts are destroyed, but the sore heals generally without trouble.

Venereal diseases constitute one of the worst satellites of the sexual appetite. If men were not so ignorant and careless, it would be on the whole easy to avoid them and cause their gradual disappearance. One of the most absurd and infamous organizations which can be imagined is that of the State regulation of prostitution which, under the pretext of hygiene, compels prostitutes to be registered by the police or to live in brothels. They then undergo regular medical examination, the object of which is to prevent those who are diseased from practicing their trade, and compel them to be treated in hospital. We shall see later on that this system absolutely fails in its object, for the simple reason that the treatment of venereal diseases is by no means the panacea which many people imagine.

The first attack of gonorrhea in man is very often spontaneously cured, while unskillful treatment often aggravates it. The relapses of this disease, on the other hand, especially in their chronic form, often resist all kinds of treatment and sometimes become incurable. The gonococci become hidden in the folds of the deep parts of the mucous membrane, both in men and women, and cannot all be destroyed. With regard to syphilis, mercurial treatment, although remarkable in its immediate effect, requires prolonged administration. And it is by such means that it is proposed to make prostitutes clean! There is only one radical cure for venereal diseases; that is not to contract them! However, this does not prevent us from recommending all those who are affected with them to seek immediate treatment by a skilled specialist.

It is sad to see ladies of high position defending such barbarous institutions as proxenetism (the business of keeping brothels) and the regulation of prostitution, imagining that they thereby protect their daughters against seduction. Such aberration can only be explained by suggestive influence on the part of men. Among men, and especially among many physicians, the belief in the efficacy of regulation depends on a mixture of blind routine, faith in authority and want of judgment, combined perhaps with more or less unconscious eroticism. We shall consider this point in detail later on.

One of the most tragic effects of venereal disease is the contamination of an innocent wife, whose whole life, hitherto chaste and pure, becomes brutally deprived of its fruits, and whose dreams of the ideal and hopes of happiness become swamped in the mire with which prostitution has contaminated her. Is it surprising that love in such cases becomes replaced by bitterness and despair? Some modern authors, such as Brieux (Les Avaries) and Andre Couvreur (La Graine), have pictured in their dramas and novels the tragic effects of venereal disease and heredity in the family, as well as their social consequences. What is deplorable, is the enormous proportion of persons who are infected with venereal diseases.

SEXUAL PSYCHOPATHOLOGY

With the exception of what is called sexual inversion and pathological love of the insane, sexual psychopathology (i.e., sexual pathology of mind) is chiefly limited to the domain of the sexual appetite, and originates mainly in fetichism (see Chapter V), to which it is closely allied. Let us first examine certain anomalies which partly concern the lower nervous functions.

First of all a general question presents itself. Hereditary or congenital sexual anomalies have been distinguished from those which are said to result from vicious habits. Krafft-Ebing, in his celebrated book which we have already quoted, makes a capital difference between these two causes, and stigmatizes the acquired vices with great indignation. I do not deny that there is reason for the distinction, but we must take exception to two fundamental errors in the manner in which the facts are presented.

In the first place, the difference between hereditary and acquired sexual anomalies is only relative and gradual, so that it is necessary to avoid opposing one against the other. When an anomaly arrives spontaneously in the first sexual glimmer of the child's mind during its development, it is obvious that it is the expression of a profound hereditary taint, the result of blastophthoria or of unfortunate combinations of ancestral energies which have been associated by the conjugation of the two procreative germs. In such a case it is comparatively easy to prove that this is a pathological symptom independent of the will of the individual. But a continuous series of degrees in the intensity of a hereditary predisposition to a certain sexual anomaly, or to other anomalies or peculiarities apt to provoke this anomaly, insensibly connects the purely hereditary pathological appetite with that which is simply the effect of acquired vicious habits. In this way a strong hereditary predisposition may exaggerate a moderate normal sexual appetite, or may give it a pathological direction under influences which would have had no effect in a less predisposed individual. Again, a slightly marked tendency to homosexuality in a man may increase under the seductive influence of a passionate invert, when the same individual would have lost this tendency if he had fallen seriously in love with a woman. On the other hand, the invert would have no influence on an individual who was not predisposed.

If the hereditary disposition is very strong, it is developed spontaneously or under the influence of very slight circumstances. If it is mediocre, it may remain latent and even become extinct when favorable circumstances do not awaken it. When it is entirely absent the most powerful seduction and the most evil influence cannot give rise to the corresponding anomaly. These facts are sufficient to show what abuse is made of the term acquired vice. Under this heading are designated a number of peculiarities the roots of which are to a great extent contained in the germ of heredity.

The power of words on the human mind produces antinomies which do not really exist; such is the case with the terms vice and disease. Vices depend on a hereditary mnemic disposition, of varying strength and more or less pathological, or at any rate unilateral (i.e., developed in one direction only, or connected with a single group of objects); according to the good or evil influence of the environment they may develop, become limited or even fail to appear. Inversely, we may say that many diseases, especially of the brain, are the source of vices.

In the second place, it follows from this fundamental principle, that the vicious and apparently acquired conduct of certain individuals should not be considered as the product of perverted free will, but rather as the unfortunate and destructive result of a bad hereditary disposition developed under the influence of the bad habits of a corrupt environment. This environment being itself composed of men, there is a vicious circle of cause and effect which will not escape the mind of the thoughtful reader. Bad habits are made by hereditary forces, and bad habits develop in their turn by custom, and may even create, by blastophthoria, vicious hereditary dispositions. The indignation of the moralists who condemn vicious persons are very like the temper of a child who strikes the fire which burnt him.

REFLEX ANOMALIES

We have already mentioned vaginismus, which is often produced in women by the first coitus. Priapism in man is somewhat analogous to vaginismus. It is produced by an exaggerated reflex irritability of the nerve centers for erection, and results in continual and painful erections, which sometimes end in ejaculation without sensation. Another anomaly, more or less reflex and very frequent, produces voluptuous sensations and premature ejaculation after short and incomplete erections. In some nervous women also, the venereal orgasm occurs very rapidly and briefly. These anomalies belong to the domain of medicine and are of little importance for our subject.

PSYCHIC IMPOTENCE

Psychic impotence is a symptom which occurs accidentally in the normal state and very frequently in psychopathological conditions.

A representation or idea of any kind, may suddenly paralyze by suggestive action the normal reflex mechanism of the center for erection. The blood ceases to accumulate in the corpora cavernosa and erection is either arrested or not produced at all. For example, a very excited lover, who has had strong erections at the moment when he prepared to copulate, may be suddenly overcome with the idea that he will fail, or by some other thought which paralyzes erection and renders coitus impossible. The remembrance of such a failure and the distress and shame attached to it, even efforts to produce erection indirectly for another attempt, constitute further causes of inhibition of the cerebro-spinal activity; they temporarily extinguish the sexual appetite, and prevent by their interference the automatic mechanism of erection which they strive to produce. The greater the fear of failure, the more the psychic impotence increases. This phenomenon may be limited to a certain woman, but it is more often general. Sometimes an incomplete erection is produced, which is insufficient.

This condition, which depends on auto-suggestion, is best treated by hypnotic suggestion. The sentiment of impotence powerfully depresses a man, and the depression increases his impotence. This condition often, however, disappears by itself.

A special variety of psychic impotence is that in which erection takes place, but the idea of ejaculation predominates so much that it paralyzes the voluptuous sensations, and causes ejaculation to occur without pleasure, or even erection to cease.

Impotence may occur at the first coitus, or may come on gradually. It is often produced suddenly at the time of marriage in persons who have hitherto been very capable, even in Don Juans. Men may have normal erections and pollutions, but these may be stopped by counter-suggestions at each attempt at coitus. Habitual masturbation may in some cases contribute to produce impotence, but we must not generalize from such cases, nor construct a dogma from them, for continence may also be a cause of impotence.

All these details, which are combined in all kinds of ways with other sexual troubles, but which are also produced alone in men who are otherwise normal, throw much light on the relation of the momentary mental state of man to his sexual appetite and the accomplishment of coitus.

I do not know under what heading the following case should be placed:

A young man of steady habits, and normal sexual appetite, had always abstained from sexual connection and masturbation. He only had emissions during sleep. The latter were accompanied by erotic dreams, but never produced an orgasm, while disagreeable sensations occurred on waking. He married for love a woman in whom the hymen was resistant, and vaginismus occurred on each attempt at coitus. These attempts failed constantly in spite of the most intense love and the most ardent desire for children on both sides. The husband's erections were incomplete, and he never had an ejaculation except when asleep. By the aid of hypnotism I succeeded in strengthening his erections, and an operation on the hymen cured his wife's vaginismus. The first attempts at coitus were not immediately successful, but suggestion acted after a time; finally the attempts were crowned with success, and followed by a first and second pregnancy. The children were healthy.

In this case, the impotence, which had lasted about eighteen months, did not affect the mutual love and respect of the couple, because the husband's affection combined with his sexual appetite had sufficed for the happiness of a woman who was on the whole normal.

This case is very instructive in several ways, for it gives a good example of the nature of the sexual instinct in woman; it also shows how the auto-suggestion of emissions occurring only during sleep may hinder copulation in the waking state. But such phenomena are extremely rare.

It is hardly necessary to say that there is no true impotence in woman; but the same mental paralysis may occur as in man, preventing orgasm and often causing disgust.

SEXUAL PARADOXY

By this term is understood the appearance of the sexual appetite, or even of love, at an abnormal age. Infantile paradoxy is, however, very different to senile paradoxy.

Infantile paradoxy must not be confounded with certain forms of masturbation, to which we shall return. Some races, especially in the tropics, have a much earlier sexual development than others; depending more on race than climate. In some, sexual maturity occurs in boys between the age of twelve and fourteen, and in girls between nine and ten years, while in others the former are hardly mature at twenty and the latter before seventeen or eighteen. Again, individual variations may be very great in the same race. But, owing to hereditary satyriasis or nymphomania, we sometimes in our own country see sexual appetite appear in children of eight, seven, or even three or four years of age, in a spontaneous manner without any external excitation. Lombroso mentions the case of a girl three years old who had an irresistible tendency to onanism. I have myself observed the two following cases:

(1). A boy of seven years, the son of a brothel keeper, and a kind of satyr who committed great excesses, began spontaneously to attack little girls of his own age or even younger. He was so artful that all means failed in curing him of this habit, and he was sent to an asylum of which I was superintendent. He then tried to renew his exploits with a boy older than himself. He was also idle and disposed to all kinds of folly. He did not, however, attempt to copulate with adult women or men. His sexual organs were absolutely infantile, without any abnormal development. His paradoxy was thus of cerebral origin.

(2). A girl of nine years was brought to my office addicted to self-abuse. Upon examination, I found this child highly neurotic, the major part of her life had been under unhygienic atmosphere, case history, father psychopathic, had been in an insane asylum, mother aenemic. The child was sent to a state institution for girls and improved remarkably.

In this case I was told that there was no hereditary taint, but such statements prove nothing. Individuals of this kind generally become criminals, or else give themselves up to masturbation or prostitution.

Occasionally, the sexual appetite may be preserved for a long time in old men, or reappear for a time, with or without sexual power, but as a rule, the paradoxy of old men is the initial symptom of senile dementia. As this disorder is only commencing when sexual excitation occurs, it is not noticed, and the patient is regarded as an immoral, vicious or criminal individual. I have seen a patient of this kind masturbate openly in an asylum, so great was his sexual excitation.

In most old men affected with senile sexual paradoxy, the sexual appetite is directed toward very young girls or even children, which aggravates their case from the legal point of view. Very often this appetite is perverted and assumes one of the forms we shall speak of later. Some of these old men are still capable, but others are not, and then their excitation only manifests itself in manipulations of the genital organs, etc. Such cases play a considerable part in law scandals. The patient (for so he must be called) often becomes the victim of blackmail on the part of vicious girls or children, incited by unnatural parents. One often sees also, at the onset of senile dementia, an old man become enamored of some prostitute or adventuress who makes him marry her and thus takes possession of his fortune. The law generally makes the matter valid, under the pretext that individual liberty must be respected. Such sanction consists in reality in sacrificing a patient for the profit of a female swindler.

SEXUAL ANAESTHESIA OR CONGENITAL ABSENCE OF THE SEXUAL SENSE AND APPETITE

Sexual sensations are so intimately connected with the sexual appetite that it is difficult to separate them. No doubt in the adult a certain degree of sexual appetite may exist without any voluptuous sensation, but this is a secondary phenomenon.

Complete sexual anaesthesia is very rare in man; it is not a special form of anomaly, but the reduction to zero of a normal sensation and the appetite which corresponds to it. The characteristic feature of these cases is that, contrary to what occurs in eunuchs and cryptorchids, not only the testicles, but all the correlative sexual attributes (the beard, voice, character, etc.) are normally developed, and are in no way inverted as in homosexual individuals. Sexual anaesthesia causes no more suffering than color-blindness, but like the latter it occasions individual troubles resulting from misunderstanding. The sexual anaesthetic, having a more or less false idea of marriage, often marries in complete ignorance, and the results are then disastrous, thanks to our laws and customs.

In women, sexual anaesthesia is very common. Krafft-Ebing is wrong in maintaining that in all such cases the women are always neurotic. A number of absolutely normal and intelligent women remain all their life completely cold from the sexual point of view, apart from the normally passive character of the female sex in coitus. It is rather the very libidinous woman who is pathological.

We have seen that the normal sexual sentiment of woman is developed rather in the direction of love, and desire for children. Erotic men often complain of the sexual coldness of their wives, which is disagreeable to them; for pleasure in one sex excites and completes that of the other. Cold women submit to coitus as a duty, or at any rate only mentally enjoy their husband's caresses.

Sexual anaesthesia occurs normally in old age. It may occur at an earlier age, owing to destruction or atrophy of the sexual glands, great excesses, or on the contrary, extreme continence. Certain diseases and psychoses may also cause it.

The following are a few examples of sexual anaesthesia:

(1). A normally built man, of high culture and moral sense, was affected with complete sexual anaesthesia since birth. He occasionally had nocturnal emissions, and also matutinal erections, but no erotic images. When he arrived at mature age he had no idea of sexual intercourse, and was completely indifferent to everything concerning sexuality. He did not even comprehend anything relating to sexual affairs, and his replies reminded me of conversations with color-blind persons on the distinction between red and green! According to his ideas, marriage was an intellectual and sentimental union in which children came by themselves!

He eventually married a young girl, well educated but extremely prudish. One can imagine the revelations which followed! The wife, who had a strong desire for children, soon perceived the sexual blindness of her husband. She became very unhappy and bitterly reproached him. The husband then became aware that there should be something in marriage which he had not taken into account; but the explanations of coitus by the medical man were useless, and hypnotic suggestion was incapable of producing the least sexual sensation.

In spite of all this, the husband was full of respect and affection for his wife, but was incapable of simulating the least sexual appetite. As regards the wife, what she required was not coitus, which was simply a means to an end, but children. However, her prudery made her prefer this state of things to a divorce, which would create scandal. We may notice that in such cases erections are only produced mechanically during sleep, which renders coitus impossible.

(2). A timid but vain young man of retiring habits, sexually cold, had occasional nocturnal emissions sometimes accompanied by slightly erotic dreams. Although better informed than the preceding case on sexual relations, his sexual appetite was almost entirely absent, and he regarded marriage as a purely intellectual alliance. He married an intelligent and passionate young girl whose sexual appetite was strongly developed, and at once began to treat her with great coldness, as a kind of domestic servant.

The wife's family were in favor of divorce, but having pity on the husband, sent him to me for advice. I explained the matter to him, made him understand that the fault was entirely on his side, and that his first duty was to show affection for his wife, or if not, to accept divorce. The effect was purely psychical, and from this moment he became amiable and affectionate toward his wife. This was sufficient to cause the wife to give up the idea of divorce. I then told her that, on account of her husband's timidity and anomaly, the only thing to do was to reverse their roles, and for her to make the sexual advances. I have not heard anything more from this singular couple.

(3). A young man who had never had sexual connection before marriage, in spite of a strong sexual appetite, made the acquaintance of an intelligent young girl of excellent character. Marriage followed, and the wife was loyal to her husband, but remained sexually cold. She was insensible to coitus and only regarded it as a disagreeable complement of love. In spite of this she was fond of caresses, devoted to her husband, and had several children.

(4). An intelligent and cultured man, normal from the sexual point of view, who had frequented prostitutes in his youth, but not excessively, married a rather nervous but apparently very amorous young woman. The marriage night produced on her the effect of a cold douche, and coitus offended and horrified her. The husband in his discomfiture took patience; but his love, which was never very strong, became shattered. To avoid all scandal each of the conjoints practiced dissimulation and adapted themselves more or less to each other. The wife allowed coitus, the husband tolerated her coldness. Several children were born, but the family was unhappy, and after a few years divorce put an end to it.

SEXUAL HYPERAESTHESIA, OR EXAGGERATION OF THE SEXUAL APPETITE

This anomaly may be congenital, for example, in the sexual paradoxy of children. Every one knows the Don Juans and Messalinas with their insatiable appetites. These types of sexual hyperaesthesia are certainly less frequent and more abnormal in women than in men, but the intensity is as great or greater.

Sexual hyperaesthesia manifests itself by desires excited by every sensorial perception relating to the opposite sex, or simply by objects which recall it to the imagination; so that fetichism plays a great part in this condition. The feeling of satiety is hardly experienced at all, or only for a short time after each orgasm. Nymphomaniacs and satyrs are possessed by an insatiable sexual desire, often associated with certain sensations of anguish. This hyperaesthesia, even when it is not hereditary, may be developed up to a certain point by continued or repeated artificial excitations.

In women it is during or after menstruation that the sexual appetite and consequently sexual hyperaesthesia are generally strongest, but there are many individual variations in this respect, and sometimes the opposite occurs.

The effect of sexual hyperaesthesia is to direct the appetite toward any object capable of satisfying it. When the other sex is wanting, masturbation is generally resorted to. All mucous membranes (anus, mouth, etc.) and even inanimate objects may serve to satisfy the pathologically exalted appetite of such individuals. Men most distinguished in other respects may abandon themselves to the most foolish or abominable practices.

Animals are often used to satisfy the hyperaesthetic sexual appetite in both sexes. The healthy woman is not prone to such desires, unless of psychopathic taint. Men visit prostitutes, and become excited at the sight of every woman who is neither too old nor too repulsive. Some individuals of this kind are pursued night and day by erotic images, which may even become an obsession and a veritable torment.

A further degree of sexual hyperaesthesia is called Satyriasis in man, and nymphomania in woman. I have observed in women two very different varieties of sexual hyperaesthesia. In one, true nymphomania, the subjects are attracted toward man bodily and mentally with an elementary force; in these the whole brain follows the appetite in quite a feminine manner. Other women, on the contrary, are driven to masturbation by a purely peripheral excitation; they have erotic dreams with venereal orgasms which torment rather than please them; but they do not fall in love easily, and may have difficulty in the choice of a husband. Their mind alone remains feminine, full of tact and delicacy in its sentiments, while their lower nerve centers react in a more masculine and at the same time more pathological manner. There are many transitional forms between these two extremes.

Sexual hyperaesthetics are often unhappy, and consult the physician for relief from the perpetual excitation which torments them. They attempt to master themselves and check their appetite in all ways, and are sometimes affected with nervous or mental depression. It is important, however, to recognize the fact, that many sexual hyperaesthetics remain quite fresh and active, and attain an advanced age, provided they escape alcohol and venereal disease.

When sexual hyperaesthesia results chiefly from artificially acquired habits it may often be cured by hypnotic suggestion, and establishing self-control; but when it is hereditary and very intense, and especially when it is connected with infantile paradoxy or other anomalies, castration may be the only efficient remedy. When it is chiefly acquired, any strong diversion which turns the mind from sexual preoccupation to other subjects may have an excellent curative effect. The most intense hereditary cases may constitute a plague for the individual and for society, and it is then that castration may become a blessing by calming the obsessed patient, by giving him the opportunity for useful occupation, and by preventing him from abusing his fellows and procreating beings similar to himself.

Nymphomaniacs often have polyandrous instincts, and they then become more insatiable than men. Several cases of this kind have been published in the press, and examples of such women are not rare in history. When a woman is possessed by passion she often loses all sense of shame, all moral sense and all discretion, as regards the object of her desires. She pays no attention to anything which is opposed to her passion, but may be full of reserve, tact and good-feeling in all other respects. Cases of this kind, however, have always a more or less marked pathological character.

In man, satyriasis is very frequent. It often happens that a husband continually forces his wife to coitus, even during menstruation. We have mentioned already the case of an old peasant of seventy who thus abused his poor old wife. In such cases conjugal infidelity very commonly occurs. The cynicism of such individuals may go so far that they have intercourse with prostitutes or servants in the presence of their wives, or even abuse their own children. The wife behaves in these cases in different ways according to her character. Many tolerate everything and do not complain, for the sake of their children; others leave the husband or divorce him; some commit suicide.

It would seem quite natural for nymphomaniacs to marry satyrs, but we must bear in mind the evil results for posterity from such an accumulation of the sexual appetite.

MASTURBATION OR ONANISM

The term onanism is derived from the name of Onan, son of Juda and Suah and grandson of Israel. According to the Old Testament, Onan's father wished him to marry his brother's widow and have children by her; but this did not please Onan, and he provoked ejaculation of semen by friction, in order to avoid having children by his sister-in-law. "This offended God who slew him."

We have already shown that in the child the sexual appetite manifests itself in a kind of obscure presentiment and vague sensations in the genital organs. If a young man cannot satisfy his sexual appetite naturally, the latter when it increases in strength provokes erotic dreams and nocturnal emissions; or artificial excitation of the penis may be practiced to produce orgasms: the latter phenomenon is called masturbation.

Masturbation in man is performed by friction of the penis with the hand or against some soft body. In the latter case especially erotic images of naked women or female sexual organs is associated with onanism. This kind of masturbation may be called compensatory, because it does not depend on an anomaly of the sexual appetite, but serves to satisfy a natural want by compensation. There are a whole series of manipulations employed for the same object, which constitute the psychic equivalent of compensating masturbation. In remote garrisons and in boys' schools the more libidinous individuals, usually those mentally tainted, often practice mutual masturbation or sodomy. This is the sex complex of the degenerate individual and in an effort to exterminate these pathological manifestations, they are being penalized by law, throughout the civilized world. It is unnecessary to prolong this enumeration. Those we have mentioned are the most common and it is agreed that men who are addicted to these practices are decidedly psychopathic, whether it may be caused by faulty heredity or anomaly in the psychology of the individual, this still remains to be proven. In reality they are often normal in other respects, but simply affected with sexual hyperaesthesia. Sometimes they are feeble-minded individuals who have recourse to such practices because they are derided by women. Others are cynics, more or less vicious in other respects.

Compensatory masturbation is extremely widespread, but it is as a rule neither recognized nor admitted because it is easy to conceal. Although depressing for those whose will power is overcome by an excitation which they cannot conquer, it is relatively the least dangerous form of onanism. At the most it leads to a certain amount of nervous and mental exhaustion by abuse of the facility of thus procuring a venereal orgasm. The loss of substance from frequent seminal ejaculations is also more or less weakening, although the secretion from the prostate plays a much greater part than the semen. But what especially affects the nervous system, is the repeated loss of the will, and the failure of resolutions made many times to overcome the desire for orgasm.

Here, as elsewhere, effect is too often confounded with cause. Because men of feeble will power are addicted to onanism, it is imagined that the latter is the cause of the weakness of will. In itself, a seminal ejaculation provoked by masturbation is no more dangerous than a nocturnal emission; both are often accompanied by nervous sensations which are more disagreeable and exhausting than normal coitus. I must, however, point out that the effects of moderate masturbation in the adult have been greatly exaggerated, either by confounding the effect with its cause, or for mercenary objects, by driving timid persons to charlatans or to prostitutes.

The active sexual appetite of man, increased by the accumulation of semen, is absent in woman. She does not have nocturnal emissions accompanied by voluptuous sensations which spontaneously awaken sexual desire. For this reason a pathological sexual excitability is necessary to spontaneously provoke in woman voluptuous dreams or masturbation. For the same reason we cannot speak of compensatory masturbation in woman. Onanism, however, is not uncommon among women, although less frequent than in men. It results either from artificial and local excitations, from bad example, or from pathological hyperaesthesia. When once the habit is acquired, repetition is produced by the difficulty of resisting voluptuous desires.

Women perform masturbation by friction of the clitoris with the finger, or by introducing various hard and rounded objects into the vagina and imitating the movements of coitus; often also by rubbing the crossed thighs against each other. In the insane, masturbation is sometimes practiced to an excessive extent. Some hysterical women introduce objects into the urethra during masturbation and cause severe inflammation of the bladder.

Another variety of sexual excitation which is often substituted for coitus among women, is the practice of mutual licking of the clitoris with the tongue (cunnilingus). Although not so dangerous as has been maintained, these habits are aberrations of the sexual appetite, and it is needless to say that every human being should abstain from them out of self-respect.

The man who, for some reason or another, cannot obtain normal coitus should content himself with nocturnal emissions, and the woman with voluptuous dreams, and should both abstain from active and voluntary excitations. For my part, I consider prostitution, or "love" which is bought, as a variety of compensatory masturbation, and not as normal copulation. Coitus with a prostitute, generally infected with venereal disease, who receives new clients continually, has as little affinity with love as with the normal object of the sexual appetite—reproduction; and its moral value is certainly inferior to that of onanism.

A second form of masturbation occurs in very young children from accidental irritation; in boys from phimosis; in girls from itching due to worms (oxyuris) about the anus and vulva. Innocent as regards its cause, this form of onanism may become dangerous by habit. Attention should therefore be paid to phimosis and worms, and the former treated by circumcision and the latter by the usual remedies.

A third kind of masturbation is caused by example and imitation. This often occurs in schools and among children in general; and in this way very precocious sexual excitation may develop and become a habit difficult to suppress. The onanism of young children is certainly worse than that which begins after puberty; it not only renders the child idle and bashful, or increases these faults; but it also interferes with nutrition and digestion and develops a tendency to sexual perversion and to impotence. It often ceases, however, after careful supervision, combined with physical exercise and fresh air, and direction of the attention to other things. On the whole, the danger of this form of onanism has also been exaggerated. In most cases it is cured, when it is not based on abnormal predispositions or on an indolent and feeble character. Love and normal sexual intercourse are naturally the best remedies for masturbation due to seduction and habit, as soon as the subject has reached sexual maturity.

We may include as a fourth form of masturbation the cases of paradoxy which we have mentioned previously. In this case onanism is produced spontaneously as the result of psycho-sexual precocity or hereditary pathological satyriasis.

With the exception of the last paradoxical form which is based on incurable satyriasis, all the kinds of onanism which we have mentioned hitherto can only be successfully treated by kindness and confidence, combined with work and direction of the mind to wholesome and attractive subjects; not by threats or punishment. The new reformatory schools called Landerziehungsheime (Vide Chapter XVII) are an excellent remedy for onanism, for they keep the child occupied from morning to night and hardly leave him any time for bad habits; when he goes to bed he is too tired to do anything but sleep. However, great prudence and active supervision is required in these cases.

The fifth class is constituted by the onanism of sexual inverts, and may be called essential onanism. This concerns men whose sexual appetite is directed toward their own sex instead of the other. They are called homosexual, and mutual onanism is, so to speak, the normal satisfaction of their inverted appetite. We shall refer to this again later on. While normal sexual intercourse is the best and most rational remedy for compensatory masturbation, there is no question of it here. Marriage is the worst and most scandalous remedy in such cases. It is therefore of the greatest importance in order to judge of the nature of the masturbation, to inquire into the kind of erotic images with which it is associated. If, in the case of a man, the images are those of women, it is simply a case of compensatory masturbation; but if the images are masculine, it is a case of sexual inversion. If masturbation is not accompanied by any images, the question remains doubtful. In young children this is explained by the fact that the psycho-sexual irradiations are not yet developed; but after puberty the absence of images as an object of eroticism suggests a certain anomaly and sometimes depends on a latent tendency to inversion.

Relation of Masturbation to Hypochondriasis.—Some onanists become much distressed, and reproach themselves for having spoilt their lives by their bad habit. They give way to lamentations before their doctor and their acquaintances, wring their hands with despair, and beg every one to come to their aid. They look upon themselves as poor sinners whose lives have been ruined, either by their own fault or by others. They have read Lamert's "Personal Preservation," or other sensational books which excite both the fear and the sexual desire of weak characters, whom they are intended to exploit. These poor devils believe themselves lost, and are truly pitiable objects. These form the types which are paraded as terrible examples in books on onanism which make timid persons' hair stand on end.

When these unfortunate onanists are questioned on all the circumstances of the act of which they accuse themselves, we generally arrive at the following results:

We recognize that we have to deal with psychopathic or neurotic subjects more or less tainted by heredity, timid and shunning their fellows, easily impressed by imagination, possessed of unhealthy sentiments and ideas; in fact, hypochondriacs, predisposed to look upon every sensation or slight indisposition as a grave disorder threatening their health or life. They thus live in perpetual anxiety. This mental anomaly has for a long time preceded the onanism, even if they have masturbated, which is often even not the case.

Among the numerous patients of this kind that I have treated, there were many who had simply had nocturnal emissions since puberty, but they regarded themselves as lost men through masturbation! Many others no doubt practice compensatory masturbation, generally because their timid nature prevents them from frequenting prostitutes, or committing other sexual excesses, while the way in which they analyze their sensations easily leads them to onanism. On the other hand, they are generally so afraid that they do not give way to excessive masturbation, perhaps only once or twice a week or even less often, so that the normal frequency of coitus, according to Luther, is often not attained and seldom exceeded. Among these persons we find few precocious or excessive onanists. I admit, however, that a hypochondriacal constitution predisposes somewhat to onanism.

But, what I wish to lay stress upon, is that the onanists who are full of lamentation and self-reproach are neither the most numerous nor those who commit the greatest excess. The worst onanists, those who provoke several ejaculations daily, belong to the category of sexual hyperaesthetics. These have not the classical aspect attributed to them by tradition; they are not pale and terrified creatures, but rather lewd individuals who are early transformed into impudent Don Juans. They may be as courageous, as clever and as strong as others and yet be disposed to all kinds of evil tricks and follies. It is, therefore, not true, as is so often said, that it is possible to recognize a masturbator by his face or manner.

These excessive onanists no doubt do themselves harm in various ways, but the great error of taking sexual hypochondriasis for the type of onanists, is to confound cause with effect. Sexual hypochondriasis is in no way the effect of onanism, but precedes it, and onanism is rather its effect, or is simply associated with it. It is obvious that onanism, by its depressing effect, aggravates a mind beset with hypochondriacal anxieties.

It results from these facts, first, that a sexual hypochondriac should be treated as a hypochondriac and not as an onanist; secondly, that the worst slaves of masturbation are not to be looked for among pale and dejected individuals.

Among women, especially young girls, hypochondriasis is not common and cases of sexual hypochondriacs who accuse themselves of masturbating are rare among them. Women who masturbate generally keep their secret and are apparently very little affected by it. However, onanism does them nearly as much harm as men; it is true they have no loss of semen, but the repetition and intensity of the nervous irritation are greater than in man, and it is this which causes most exhaustion. In spite of this, it is curious to observe that women who masturbate are generally less ashamed than men, and are apparently less depressed by it. We must bear in mind that the loss of semen by masturbation has in man a peculiarly depressing effect, for it lacks its object and represents an absolutely abnormal satisfaction of the sexual appetite.

It may be objected that this difference is due to another cause, that women who masturbate have less moral tone and are especially depraved individuals. I agree that this is often the case, but far from always. The intensity of the sexual excitability in women has nothing in common with their character; it may be associated with high intelligence, with high moral and aesthetic qualities, and even with a strong will. On the other hand, deficiency in moral sense and will may occur with sexual frigidity, and, as we have already seen, may lead to sexual excess without any voluptuous sensation, in accordance with the peculiarities of feminine sentiment. These facts show how complex are the causes of a given effect in the sexual domain.

PERVERSIONS OF THE SEXUAL APPETITE OR PARAESTHESIA OF THE SEXUAL SENSATION

We are here concerned with sexual appetite provoked by inadequate objects. Krafft-Ebing having made a profound study of this question we shall follow his subdivisions in the main.

Perverted Sexual Appetite Directed Toward the Opposite Sex.—(A.) Sadism (association of sexual desire with cruelty and violence). History shows us a number of celebrated persons who satisfied their sexual desire by making martyrs of their victims, up to complete butchery. The most atrocious types of this kind are perhaps assassins such as "Jack the Ripper," who lie in wait for their victims like cats, pounce on them, revel in their terror, assassinate them by inches, and wallow voluptuously in their blood.

The term sadism is derived from the celebrated Marquis de Sade, a French author, whose obscene romances overflow with cruel voluptuousness. Certain reminiscences of sadism are common both in man and woman. At the moment of highest excitation in coitus it is not uncommon for one or other of the couple to bite or scratch in the ecstasy of their amorous embraces. Lombroso remarks on the brutal excesses of soldiers when excited after battle. This is so to speak an inversion of sadism as regards cause and effect. After the exaltation of combat, that of desire possesses the mind, as in the inverse direction exaltation of desire gives rise in certain cases to that of violence and thirst for blood.

Krafft-Ebing draws attention to the fact that love and anger are the two most violent effective conditions, and are at the same time the two powers which provoke the most motor discharges. This explains why they may be associated in the delirium of unbridled passions. To these facts is added an atavistic relic of the instinct of man's ancestors, the males of whom fought furiously to conquer the females by violence, which provoked desire in them, after the subjection of the object of their sexual appetite. True sadism can, however, only become effective by the combination of two causes: (1) by an exalted and absolutely pathological association of sexual desire with a sanguinary instinct, and with the desire to illtreat and overcome a victim; (2) by an almost absolute absence of moral sense and sympathy, combined with a violent and egoistic sexual passion. It is evident that the slight more or less sadic impulses which may involuntarily occur in the performance of normal coitus, are quite exempt from the second of these causes.

Krafft-Ebing maintains that sadism is usually, if not always, congenital and hereditary. Sadism is for a long time restrained by fear, education or moral sentiments. It is only gradually, when normal coitus cannot procure for the perverted sexual appetite the satisfaction it requires, that the sadist gives way to his passion; this gives the latter a false appearance of acquired vice.

The highest degree of sadism leads to assassination. In this way human tigers entice young girls into a wood and cut them to pieces. Some begin by forcing them to coitus, after frightening them, or half strangling them; others masturbate in their ripped up entrails. But some others have no desire for coitus, nor anything resembling it, their desire being satisfied only by the sight of the terror, suffering and blood of their victim, whom they torture before killing. Others again associate desire with the rage of a wild beast to such a point that they swallow parts of their victim's body and drink the blood.

Sadists become experts in the art of assassination without discovery. The cynicism with which some of them have described their sensations shows their cold indifference toward the tragic and the horrible. Krafft-Ebing describes a series of atrocious types of this kind, and unfortunately the press and the criminal law courts continually give us fresh examples. Some sadists assassinate children, others men, when their perversion is complicated with pederasty or sexual inversion. (The story of Bluebeard is probably based on the successive crimes of a sadic.)

Sadists do not always confine their attacks to living people; some of them are necrophiles, who violate dead bodies and cut them in pieces: others again kill animals, whose sufferings and blood serve to satisfy their desires.

Some sadists satisfy themselves by flogging prostitutes or pricking them till they bleed, while others prefer to martyrize their victims slowly, and thus procure the maximum of pleasure. Others again are contented with scenes symbolical of servitude, in which women are compelled to adore and supplicate them, etc. The humiliation of women takes part in the sadist appetite of man and often degenerates into fetichism. Simple imagination in which he plays the part of a tyrant, and which are complicated with onanism or normal coitus, often suffice to satisfy the sadist. Some sadists soil themselves with the excrements of the woman they "love!" When sadism assumes the character of a symbol or a fetich, seminal ejaculation and sensation generally occur without contact with the woman's body.

Sadism is more common in men, but occurs also in women. Messalina and Catherine de Medici are historical examples. The latter had her maids of honor flogged before her eyes, and said she was bathing in roses when she witnessed the massacre of the Huguenots. Women in whom sadism takes a milder form are contented with biting a man till he bleeds, during coitus.

Sadism appears to be most often an effect of hereditary alcoholic blastophthoria.

(B). Masochism (association of sexual desire with submission to cruelty and violence). The term masochism is applied by Krafft-Ebing to a form of sexual perversion described by Sacher-Masoch in several of his romances. Masochism is exactly the converse of sadism. The desire of the masochist is excited by humiliation, submission, and even blows; the pain he feels when he is flogged gives him intense pleasure. Like sadism, this perversion may be incomplete. When it is complete the masochist is affected with psychic impotence and is incapable of normal coitus. Ill-treatment and humiliation are alone capable of causing him erections, seminal ejaculations and pleasure. However, comedies representing his humiliation, or corresponding efforts of his imagination may succeed in replacing the reality and procure the desired effect.

Like sadism, masochism is hereditary and congenital. When the first sexual sensations are produced, the masochist child sighs for a dominating woman who will illtreat him and make him her slave. His imagination is transported by the idea of being on his knees, of being trodden under foot, or bound in chains by her, etc. The cruel heroine of his heart must ridicule and humiliate him as much as possible. Corporal punishment with a beneficial object does not satisfy the true masochist. Rousseau, in his "Confessions," reveals the sexual feelings of the masochist.

It is remarkable how far poetic conceptions are combined with the perversion of sexual sensations in masochists, leading them to dream of an imperious and cruel woman to whom they devote a love as humble as it is exalted, while normal coitus causes them no pleasure, and can sometimes only be accomplished with the aid of masochistic images. These images may also be accompanied by onanism. It is very common for masochists to become flagellants, and to be flogged or trampled on by prostitutes. But it often happens that they only feel pain instead of pleasure, when the comedy which they have started appears revealed in all its absurdity, showing them a woman paid to illtreat them, and not doing it for her own enjoyment. Some masochists take pleasure in imagining themselves assassinated by a woman, or even cut in pieces. Others organize theatrical performances in which imperious women play the part of judges, before whom they appear naked and are flogged and condemned to death. Others again are contented with imagining these performances, combining them sometimes with coitus or masturbation.

Krafft-Ebing is no doubt right in considering the lucubrations of the poet Baudelaire, and his necrophile imagination of his own carrion hung on a gibbet and devoured by vultures, as a mixture of sadism and masochism. He sought out the most repulsive women of all races, Chinese, negresses, dwarfs, giants, or modern women as artificial as possible, to satisfy his pathological instinct. The following case quoted by Krafft-Ebing from Hammond, is typical:

A married man and father of several children was sometimes subject to attacks during which he visited a brothel, where he chose two or three of the fattest women. He stripped the upper part of his body, lay on the floor, crossed his hands, shut his eyes and ordered the women to tread with all their force on his chest, neck and face. Sometimes he required a still heavier woman or more cruel manipulations. After two or three hours he was satisfied, paid the women liberally and regaled them with wine, rubbed his bruises, dressed himself and returned to his office, to repeat this singular performance a week later.

Krafft-Ebing describes, as masked masochism, certain cases of fetichism in which the nature of the fetich which causes sexual excitation and the manner in which it is used prove a desire for maltreatment and humiliation by a woman. This is especially the case with shoe and foot fetichism. Among those who are affected with this pathological specialty, voluptuous sensations are produced when they are trodden on by a woman's shoes or feet. They even dream of women's shoes and feet. Some of them put nails in their shoes, the pain of which gives them voluptuous sensations. Lastly, the shoes alone, especially when they touch the penis, are sufficient to excite their sexual desire. Other masked masochists are excited by the secretions or even excrements of women.

I have been consulted by a typical masochist, who, being very religious, was convinced that his perverted sexual appetite was a sin. He therefore married, thinking that God and repentance would change him. But when married he naturally found himself absolutely impotent and incapable of coitus.

If masochism is common in men, it is produced in women rather as an exaggeration in the domain of her normal sexual sensations, for it is to a great extent in harmony with her passive sexual role. Woman does not like the weak man who submits to her. She prefers a master on whom she can lean. In fact, normal women do not like their husbands to ask advice from them too often, nor to be wanting in decision and self-confidence. On the contrary they like them to be firm and even somewhat imperious, provided they are not unkind. It is notorious that many women like to be beaten by their husbands, and are not content unless this is done. This appears to be especially common in Russia. Accentuated forms of pathological masochism are, however, rare in women.

Masochism presents a certain analogy with the religious ecstasy of fakirs and flagellants who flog themselves. These individuals appear to become exalted in a kind of ecstatic convulsion with the idea of pleasing God or gaining Heaven by their martyrdom. We may add that, like sadism, masochism occurs in sexual inverts, but always having the same sex for its object. I know an old gentleman whose only pleasure consisted in receiving a shower of blows: as a boy, like Rousseau he tried by all kinds of ruses to obtain corporal punishment: when he grew up this became impossible and he devised tricks to urge schoolboys to fight each other, pretending to be angry and exciting their spirit of contradiction: the boys then pretended to fight him, and this sufficed for the rest of his life to excite erections and seminal ejaculations. This gentleman was a lawyer and told me his history, hoping that suggestion might cure him.

The eroticism produced by submission to pain and humiliation is often blended with that produced by performing acts of cruelty. These mixtures of sadism and masochism have been investigated by Schrenk Notzing, who concludes that they are intimately related.

Fetichism (production of voluptuous sensations by contact with or by the sight of certain portions of the body or clothes of woman). We have already mentioned this symptom and have seen the part it plays in some forms of masochism. A masked form of fetichism forms part of the normal sexual appetite, in the sense that certain parts of the body or clothes, certain odors, etc., especially excite the sexual desire of many people by recalling the individual to whom they belong. Therefore, parts of the body which normally excite sexual desire—the breasts, sexual organs, or other parts of the body usually covered—cannot be regarded as pathological fetiches.

The true fetichist is a very pathological being, whose entire sexual appetite, often with all its irradiations in the higher sphere of love, if we can speak of love in such cases, is limited to certain objects connected with woman. The most common fetiches are women's handkerchiefs, gloves, velvet or shoes; or their hair, hands or feet, etc. In these cases the fetich plays the essential part, and is in no way associated with the image of a woman. The fetich is the sole object of "love." The sight or touch of the fetich, the pleasure of pressing it against the heart or the genital organs, are alone capable of producing erections and ejaculations. There are even fetichists whose sexual desire is only excited by the sight of certain feminine deformities, such as clubfoot, squint, etc. Hairdressers, who masturbate after dressing women's hair, are well-known examples of fetichism.

Certain feminine costumes may serve as fetiches, and these are kept in some brothels to satisfy certain customers. Shoe fetichism is more common than that of clothes or handkerchiefs. Krafft-Ebing mentions a typical case of the psychic irradiation of fetichism; the individual in question thought it immoral and scandalous that women's shoes should be exposed in shop windows. Others blush when they see such things in the windows. Fetichism is essentially a masculine perversion. I have been consulted by a fetichist who all his life had only felt erotic at the sight of shoes; later on he married, and his sexual desire becoming more and more concentrated on pointed and fashionable shoes, especially women's, but also men's, he could only obtain pleasure with his wife when she put on the shoes he was in love with, or when he put them on himself. The sight of shoes in shop windows always made him blush, while the female body made no impression on him. He could not buy the shoes he desired most, owing to a sentiment of shame, and the sight of them was often sufficient to produce erection and ejaculation.

Exhibitionism. There is a class of individuals, especially men, whose sole sexual desire consists in masturbating in the presence of women. They lie in wait behind some wall or bush, and masturbate openly when women pass that way. In these subjects an orgasm is only produced when they are observed by women. As soon as ejaculation has occurred they fly to avoid the police. They never attempt to molest the women whose presence excites them to this performance.

These cases are not uncommon and naturally cause much scandal, so that the poor wretches seldom escape the police. These unfortunate persons who sometimes hold high social positions, have often been previously convicted, but cannot as a rule overcome their passion, which has much worse consequences for them than for the women and children whom they frighten or annoy.

Exhibitionism is not rare among insane women and I have myself treated two typical cases. I do not know whether it occurs in women of sound mind, but at all events they cannot be addicted to it without running great risk.

Sexual Inversion or Homosexual Love.—However shocking or absurd the aberrations of the sexual appetite and its irradiations may be, of which we have spoken hitherto, they are at any rate derived from originally normal intercourse with adults of the opposite sex. Those we have now to deal with are distinguished by the fact that, not only the appetite itself, but all its psychic irradiations are directed to the same sex as the perverted individual, the latter being horrified at the idea of genital contact with the opposite sex, quite as much as a normal man is horrified at the idea of homosexual union. This horror is, however, confined to sexual matters, and in no way concerns those of social life. It is therefore a question of sexual desire of man for man, and woman for woman.

What we have to deal with here has no connection with compensation as in cases of compensatory masturbation or pederasty, which are practiced, for want of anything better, by individuals whose normal sexual appetite cannot be satisfied otherwise. When excitation and desire become too strong, the purely animal (spinal) irritation of the sexual appetite may drive a man or woman to satisfy themselves by means which would otherwise disgust them.

A. Homosexual love in man. It seems absurd that the whole sexual appetite and amorous ideals of a man can be directed all his life to persons of his own sex. This pathological phenomenon, however, is as common as it is certain, although its psychological and normal import has long been misapprehended, as much in judicial circles as by the general public. It is the inverts themselves, aided by psychiatrists, who have finally thrown light on the subject. An invert, named Ulrich, announced himself publicly as the apostle of homosexual love, describing inverts under the name of Urnings, a name which is still used in Germany. Ulrich and his disciples endeavored to prove an absurdity by maintaining that homosexuals are a special kind of normal men, and by attempting to obtain legal sanction for this kind of love. Ulrich gives the name Dionings to men whose sexual appetite is normal, i.e., directed toward women. Such a pretension appears necessarily ridiculous to every man whose sexual sense is normal, and it is obviously absurd to apply the term "normal" to a sexual appetite absolutely devoid of its natural object, procreation. But this is quite characteristic of the sentiments of inverts.

Hirschfeld, of Berlin, has recently attempted to show that homosexuals constitute a variety of normal man; but he plays with words and facts, invoking the names of celebrated inverts, and wrongly asserts that inversion is not hereditary.

From the first dawn of sexual feeling in youth, male inverts have the same feelings as girls toward other boys. They feel the need for passive submission, they become easily enraptured over novels and dress, they like to occupy themselves with feminine pursuits, to dress like girls and to frequent women's societies. They regard women as friends, as persons with whom they have a fellow-feeling. They generally, but not always, have a banal sentimentalism, they are fond of religious forms and ceremonies, they admire fine clothes and luxurious apartments; they dress their hair and "fake" themselves with a coquetry which often exceeds that of women. They are not all like this, but one or other of these traits predominates in different individuals.

Their sexual appetite, usually very strong and precocious, begins with an exalted love for some male friend. I have treated a great number of inverts and have always been struck with the intensity of their passion. Among other cases, I may mention that of an invert hospital attendant, who fell madly in love with one of his comrades and covered ten meters of white tape with the name of his beloved. The most passionate love letters, vows of fidelity till death, the most ferocious jealousy toward other friends of their beloved, and even ceremonies symbolical of marriage, are daily events among the homosexuals.

The invert does not so easily become enamored of another invert as of normal men. These have a special attraction for him, but as they generally repulse him with disgust, or threaten to expose or exploit him, he is often obliged to content himself with his fellows. These gentlemen form among themselves a secret brotherhood, a kind of freemasonry which is recognized by signs.

The first appearance of the homosexual appetite with its youthful impulses, causes love and happiness to appear to the invert in a special aspect, determined by the inverted irradiation of his sexual appetite. It represents the aim of his life as an amorous union with his beloved, and shapes his idylls, his romance and his ideal to this end. But later on, when his sexual desire increases and when he discovers that the majority of men feel differently to him, that the human race is reproduced by the union of men and women, etc., he becomes unhappy. He perceives that it would be both ridiculous and dangerous to reveal his inner feelings, and generally gives way to masturbation. But all social barriers which oppose his appetite only increase his desire, and he becomes less and less able to dominate his passion for certain young men. The disgust and indignation of the latter, when they discover that they are not the object of simple affection but of perverted sexual love, are expressed only too clearly, and the poor invert sees himself condemned to perpetual torment in trying to hide his most violent desires and his most intimate and ideal aspirations, and finally to live in continual dread of being betrayed and prosecuted. It is thus easy to understand that he is happy in the discovery that his fellows form a secret society, and he associates with them immediately, when his moral sense and will are not strong enough to be proof against it.

If the invert succeeds in finding a male to his liking and with a similar degenerative state of mind to his own, he will pay him the attention that the normal man would to a woman. It is therefore reasonable to believe that this mode of inversion is likewise an expression of pathological manifestation of the individual; usually accompanied by neurosis and a like corresponding deficiency in the physical makeup of the individual.

The invert's ideal would be to obtain a legal license for marriage between men; but they are not very constant in their love and are much inclined to polyandry. Sexual love for women inspires them with contempt; they regard it as low and disgusting, at the most only good for the production of young inverts!

Homosexual love has played a much greater part in the world's history than is generally believed. The Count de Platen and Sapho were inverts. The inverts themselves maintain that it was the same with Plato, Frederick the Great, Socrates, etc.; but this is not proved. In the East and in Brazil, homosexual love is very common.

My experience agrees with that of Krafft-Ebing, that homosexual love is pathological in nature, and that nearly all inverts are in a more or less marked degree psychopaths or neurotics, whose sexual appetite is not only abnormal but usually also exalted. Insane inverts, such as King Louis II of Bavaria, a great number of the insane, affected, for example, with Pseudologia phantastica (pathological swindlers), and who are also homosexual, show the intimate relationship which exists between sexual inversion (also called "uranism") and the psychoses.

I agree with Rudin that the psycho-pathological phenomena presented by the majority of inverts are primitive and hereditary, and that they are hardly ever the effect of their tormented life, as Hirschfeld, Ulrich and their disciples maintain. The vexations, anxieties and other torments that they suffer may no doubt play a part in developing certain nervous conditions previously latent, but they can never create hereditary taints. We may admit that sexual inversion corresponds to a kind of partial hermaphrodism, in which the sexual glands and copulatory organs have the characters of one of the sexes, while the brain has, to a great extent, those of the other sex; but the phenomenon is none the less pathological.

The inverts with whom we have most to do, especially in public asylums and at the courts of justice, are cynics and debauchees in spite of the ideal which they parade; but we should be wrong in concluding that this is always the case. The cynics make themselves heard because they do not restrain themselves. In my private practice I have known many very well-conducted inverts, possessing the most delicate sentiments, who had become pessimists owing to the shame and grief of a state of mind which they hid from the world.

Inverts of this class often commit suicide, after having carried on in silence a desperate struggle against their morbid appetite, because they prefer death to defeat, which they consider a dishonor. The victims of these tragedies deserve all our pity, and sometimes our respect. Such individuals generally hold aloof from the brotherhood of inverts which they look upon with fear or disgust.

In the picture of homosexuals there are two lamentable shadows, which are largely due to the severity with which most legislations track and condemn these unfortunate beings.

(1). As soon as an invert realizes his abnormal and dangerous situation in society, in which he feels a pariah, he often makes up his mind to follow the advice of ignorant friends, and even, alas, of ignorant doctors, and try and cure himself by marriage. Sometimes he begins by visiting a brothel to see if he is capable of normal coitus with a woman. In this he often succeeds, if he is able to picture to himself a man in the person of the prostitute. He tries to persuade himself that the disgust which he felt at this experimental coitus was due to the fact that the "love" was bought; and he then decides to enter into conjugal life. This is at the same time the greatest absurdity and the worst action possible for him to commit, for his wife becomes a martyr and soon feels herself deceived, abandoned and despised. The invert treats her as a servant; he rarely has sexual intercourse with her, sometimes not at all, and only performs it with repugnance with a view to the procreation of young inverts, who will rise to his ideal. He invites his male lovers to his house and they indulge in orgies, especially when the wife, despised and neglected, has separated from him. Such marriages, which are fortunately less common since this question has been better understood, generally end in divorce, preceded by bitter and mutual deceptions. It is really criminal to favor them when we know what they lead to. (It is against such unions, and against sexual indulgence of this nature, that the law ought to exert itself.)

(2). A second very grave result of homosexual love is the continual blackmail which is levied on inverts by all kinds of scamps. Public urinals are common meeting places for inverts. The blackmailers, who know this very well, follow them there and offer themselves for money; but as soon as they find out the name of their victim and his financial position, they begin to extort hush-money, threatening to prosecute him if he does not pay what they ask. If the invert is rich or of high position he has only to yield to the extortion, emigrate or commit suicide. In this way the life of most well-to-do inverts is ruined by perpetual anxieties, emotions and torments, because their morbid appetite instinctively urges them to abandon themselves to men who feel differently to themselves.

Moll, Krafft-Ebing and Hirschfeld have written at great length on sexual inversion. The law takes a just point of view and is generally severe as regards this anomaly, especially in Germanic countries. Even homosexual love that does not affect minors nor insane persons, is a sign of degeneracy, but produces no offspring and consequently dies out by means of selection. We hope, therefore, that this type may be extinct some day, although it is still decidedly numerous, principally in the larger cities of the world. When a normal man is tormented by an invert, it is much easier to get rid of him than for a young girl to protect herself against the importunities of a man.

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