Psychopathia sexualis: With especial reference to contrary sexual instinct / A medico-legal study

by R. von Krafft-Ebing

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:—

1. The homo-sexual instinct appears secondarily, and always may be referred to influences (masturbatic neurasthenia, mental) which disturbed normal sexual satisfaction. It is, however, probable that here, in spite of powerful sensual libido, the feeling and inclination for the opposite sex are weak ab origine, especially in a spiritual and æsthetic sense.

2. The homo-sexual instinct, as long as inversio sexualis has not taken place, is looked upon, by the individual affected, as vicious and abnormal, and yielded to only faute de mieux.

3. The hetero-sexual instinct long remains predominant, and the impossibility of its satisfaction gives pain. It weakens in proportion as the homo-sexual feeling gains in strength.

On the other hand, in congenital cases (a) the homo-sexual instinct is the one that occurs primarily, and becomes dominant in the vita sexualis. It appears as the natural manner of satisfaction, and also dominates the dream-life of the individual. (b) The hetero-sexual instinct fails completely, or, if it should make its appearance during the life of the individual (psycho-sexual hermaphroditism), it is still but an episodical phenomenon which has no root in the mental constitution of the individual, and is essentially but a means of satisfaction of sexual desire.

The differentiation of the above groups of congenital contrary sexuality from one another, and from the cases in which the anomaly is acquired, will, after the foregoing, present no difficulties.

The prognosis of the cases of acquired contrary sexual instinct is, at all events, much more favorable than that of the congenital cases. In the former, the occurrence of effemination—the mental inversion of the individual, in the sense of perverse sexual feeling—is the limit beyond which there is no longer hope of benefit from therapy. In the congenital cases, the various categories established in this book form as many stages of psycho-sexual taint, and benefit is probable only within the category of the psychical hermaphrodites, though possible (vide the case of Schrenk-Notzing) in that of the urnings.

The prophylaxis of these conditions becomes thus the more important,—for the congenital cases, prohibition of the reproduction of such unfortunates; for the acquired cases, protection from the injurious influences which experience teaches may lead to the fatal inversion of the sexual instinct.

Numerous predisposed individuals meet this sad fate, because parents and teachers have no suspicion of the danger which masturbation brings in its train to such children.

In many schools and academies masturbation and vice are actually cultivated. At present much too little attention is given to the mental and moral peculiarities of the pupils. If only the tasks are done, nothing more is asked. That many pupils are thus ruined in body and soul is never considered. In obedience to affected prudery, the vita sexualis is veiled from the developing youth, and not the slightest attention given to the excitations of his sexual instinct. How few family physicians are ever called in, during the years of development of children, to give advice to their patients that are often so greatly predisposed!

It is thought that all must be left to Nature; in the meantime, Nature rises in her power, and leads the helpless, unprotected innocent into dangerous by-paths.

A more detailed treatment of this prophylactic side of the subject is impossible here.[^[118]]

To parents and teachers, the experiences detailed in this work, and numerous scientific works on masturbation, give suggestions.

The lines of treatment, when contrary sexual instinct exists, are the following:—

1. Prevention of onanism, and removal of other influences injurious to the vita sexualis.

2. Cure of the neurosis (neurasthenia sexualis and universalis) arising out of the unhygienic conditions of the vita sexualis.

3. Mental treatment, in the sense of combating homo-sexual, and encouraging hetero-sexual, feelings and impulses.

The most important part of the treatment lies in fulfilling the third indication, particularly with reference to onanism.

Only in very few cases, where acquired contrary sexual instinct has not progressed far, can the fulfillment of 1 and 2 be sufficient, as the following case, fully reported by the author in the Irrenfreund, 1884, No. 1, proves:—

Case 132. Count Z., aged 51, of psychopathic mother, was early sent to a military school, and there was taught onanism. He developed well, and had normal sexual feelings, but, as a result of masturbation, he became somewhat neurasthenic in his seventeenth year. He enjoyed intercourse with women, was married at twenty-five, but after a year more became neurasthenic, and absolutely lost his inclination for women. In its place came contrary sexual instinct. Involved in an accusation for high treason, he was sent to prison for two years, and then to Siberia for five years. In these seven years, under the influence of continued masturbation, neurasthenia and contrary sexual instinct constantly increased. With his freedom restored at the age of thirty-five, the patient began to visit all kinds of health-resorts on account of his great neurasthenia; and this has since been his occupation. In all these years his abnormal sexual feeling has not changed in any way. For the most part, he lived away from his wife, whom, it is true, he esteemed for her mental qualities; though he avoided her, as he did every other woman. His contrary sexual feeling is purely platonic. “Friendship,” sweet embraces, and kisses sufficed him. Pollutions, which occasionally occurred, were induced by lascivious dreams which had for subject persons of his own sex. Also, during the day, the most beautiful woman had no charm for him, while simply the sight of handsome men induced erection and ejaculation. Only athletes and male dancers in the circus and ballet interested him. At times of greater excitability, even masculine statues gave him erections. Now and again he resumed his old vice of masturbation. This man of æsthetic culture had a horror of pederasty.

He felt, always, that his perverse sexual feeling was something abnormal, without, however, in his apparently much weakened libido and virility, feeling unhappy.

The examination gave the usual findings of neurasthenia. Development, manner, and attire presented nothing remarkable. Electrical massage was unusually successful. After a few sittings the patient was mentally and physically much better. After twenty sittings libido was again awakened, not in the same way, but normally, as the patient had felt until his twenty-fifth year. Lascivious dreams were concerned only with women; and one day the patient joyfully gave the information that he had had coitus, and that he had had the same natural feeling in it that he had had twenty-six years before. He then began to live with his wife again, and hoped that he was lastingly freed from neurasthenia and contrary sexual instinct. His hope was fulfilled for the six years during which I was able to keep the patient under observation.

As a rule, physical treatment, even though it be re-inforced morally by good advice with reference to the avoidance of masturbation, the repression of homo-sexual feelings and impulses, and the encouragement of hetero-sexual desires, will not prove sufficient, even in cases of acquired contrary sexual instinct.

Here a method of mental treatment—hypnotic suggestion—is all that can bring benefit.

The following case is interesting; and it is an example of successful auto-suggestion that gives encouragement for the milder forms of the anomaly:—

Case 133. Autobiography of a Psychical Hermaphrodite. Successful Struggle against Homo-sexual Inclinations made by the Patient himself.—“My father once had a stroke, but has recovered save for paralysis of the face. My mother was very anæmic and melancholic. Both suffered severely with hæmorrhoids, and my father ascribed to this trouble the lumbar pain with which he suffered from time to time after his marriage.

“I am, if I may so express myself, a passive character. When a child, I indulged in all kinds of fancies, religious as well as others. I suffered with incontinence of urine, and it is said that in sleep I handled my genitals, so that my father fastened my hands to the bed! (I was then a mere child, and had not masturbated.) I was always very shy and embarrassed in social intercourse. When about fourteen or fifteen years old, I was seduced into onanism. The impulse and desire for women, occurring in connection with the awakening sexual feeling, were, in reality, only of a platonic nature; I was also without the society of ladies. When about eighteen, I attempted to satisfy my sexual desire in the natural way, more in obedience to a feeling of curiosity than from inner longing. Since that time, without having experienced any real inclination for women, as often as possible I have satisfied my desire by means of sexual intercourse.

“Soon after puberty I became very anæmic, and appeared much older than I really was. Then came melancholic and peculiar ideas. It was a delight to me to fancy myself humiliated in the extreme. It may be of interest to add that, at that time, I was troubled with religious doubts, and only later found the courage to rise above religions. I fell in love with young men. At first I opposed these ideas; later they became so powerful that I became a genuine urning. Women seemed to me to be human beings of the second class. I was in a state of despair. My sickened soul was filled with tædium vitæ and thoughts inimical to humanity. One day I read: ‘What will it come to?’ And ere I knew it, I was a socialist; but an ideal one. Life again had value for me, for I had an ideal,—the joyous struggle for the social elevation of the proletariat. This caused a powerful revolution in me. As in my best years (from the age of sixteen to seventeen), I took interest in art, particularly in dramatic art. I am, at the present time, writing a play and a story, and I am occupied with the grandest thoughts. I read a remark of Schlegel’s concerning Sophocles, who was indebted to his physical exercise for his energy and creative power, and to music for his artistic proportions. In another place I read: ‘The dramatist must, above all things, be mentally intact.’ This depressed me; for my contrary sexual feelings could not arise in a perfectly normal mind.

“I thought of having myself treated hypnotically; but shame held me back. Then I said to myself that I was a weakling, indeed, to have so little confidence in myself, and began in earnest to combat my abnormal desires. At the same time, I struggled against my nervousness by leading the proper kind of a life. I rowed, fenced, and was much in the open air; and I was delighted when, at last, I awoke and seemed to be an entirely different man. When I thought of the time from my twentieth to my twenty-sixth year, it seemed to me that, during those years, a strange and depressive being had been dwelling within me.

“I was astonished that the handsomest rider or the trimmest waiter excited in me almost no interest; even the muscular masons had no effect on me. I was disgusted when I thought that, at one time, such men had seemed handsome to me. My self-respect increased; I am good-natured, but my character is entirely active. Since my twentieth year my appearance has steadily improved. My appearance now corresponds perfectly with my years. There were recurrences of my abnormal inclinations, to be sure; but I struggled against them energetically. I satisfy my libido only by means of natural intercourse, and I hope that, by continuing to lead a proper life, my pleasure in natural coitus will increase.”

As a rule, only suggestion coming from a second person, and that by means of hypnosis, promises any success. In such cases, the object of post-hypnotic suggestion is to remove the impulse to masturbation and homo-sexual feelings and impulses, and to encourage hetero-sexual feelings with a sense of virility. A prerequisite is, of course, the possibility to induce hypnosis of sufficient intensity. It is, unfortunately, in these very cases of neurasthenia that this is impossible, since they are often excited, embarrassed, and in no condition to concentrate their thoughts.

Thus, in a case reported by me in the International. Centralblatt für die Physiologie und Pathologie der Harn- und Sexualorgane, Bd. i, Heft 2, p. 58, it was impossible for me to induce hypnosis, though the patient desired it, and did everything to make it successful. By reason of the great benefit that can be given to such unfortunates, and with Ladame’s case in view (v. infra), in the future, in all such cases, everything should be done to bring about hypnosis,—the only means of salvation. The result, in the three following cases, was satisfactory:—

Case 134. Contrary Sexual Instinct Acquired through Masturbation.—Mr. X., merchant, aged 29. Father’s parents healthy. Nothing nervous in father’s family. Father was an irritable, peevish old man. One brother of the father was a man-about-town, and died unmarried. Mother died in third confinement, when the patient was six years old; she had a deep, rough, masculine voice, and coarse appearance. Of the children, one brother is irritable, “melancholic,” and indifferent to women.

When a child patient had scarlet fever with delirium. Until his fourteenth year he was light-hearted and social, but, after that, quiet, solitary, and “melancholic.” The first trace of sexual feeling appeared in his tenth or eleventh year, and at that time he learned masturbation from other boys, and practiced mutual onanism with them. At the age of thirteen or fourteen, ejaculation for the first time. Patient has felt no evil results of onanism until the last three months.

In school he learned easily, but was troubled with headaches. After the age of twenty, pollutions, in spite of daily practice of onanism. With pollutions, “procreative” dreams, as man and wife might perform the act, occurred. In his seventeenth year he was seduced into mutual onanism by a man having a love for men. He found satisfaction in this, inasmuch as he was always very passionate sexually. It was a long time before the patient again sought new opportunities for intercourse with males. He did it simply to rid himself of semen. He felt no friendship or love for the person with whom he had intercourse. He felt satisfaction only when he played the passive rôle,—when manustupration was practiced on him. When the act was once completed, he had no respect for the individual. If it happened that, later, he came to respect the man, then he ceased to indulge in the act with him. Later it became indifferent to him whether he masturbated or had masturbation practiced on him. When he himself practiced onanism, he always thought of pleasing men practicing onanism on him during the act. He preferred a hard, rough hand.

The patient thought that, had he not been led astray, he would have arrived at a natural mode of satisfaction of his sexual desires. He never felt love for his own sex, though he had pleased himself with the thought of loving men. At first he had had sensual inclinations toward the opposite sex. He had taken pleasure in dancing, and he had been pleased with women, but he had taken more pleasure in the figure than the face. Too, he had had erections at the sight of women that pleased him. He had never attempted coitus, for fear of infection; whether he was potent or not with women, he did not know. He thought he could be so no longer, because his feeling for women had grown cold, especially during late years.

While previously, in his sensual dreams, he had had ideas of both men and women, of late years he had dreamed only of approaches to men; he could not remember that he had dreamed, in late years, of sensual relations with a woman. At the theatre, as well as in the circus and ballet, the feminine figure had always interested him. In museums masculine and feminine statues had affected him equally.

Patient is a great smoker, a beer-drinker, loves male society, and is a gymnast and skater. Anything dandified was repugnant to him, and he had never felt any desire to please men; he would even have preferred to please women.

He now felt his position to be painful, because onanism had obtained the upper hand. Masturbation, that had previously been practiced without evil effects, now began to disclose its bad results.

Since July, 1889, he had suffered with neuralgia of the testicles. The pain occurred particularly at night; and at night there was also trembling (increased reflex excitability).

Sleep was not refreshing, and he would wake up with pain in the testicles. He was inclined, now, to indulge more frequently in onanism. He was afraid of the consequences of the habit. He hoped that his sexual life might still be turned into normal channels. Now, he thought of the future; he had a relation with a girl, who was attractive to him, and the thought to possess her as a wife was pleasing.

For five days he had abstained from onanism, but he could scarcely believe that he would be able, with his own strength, to overcome the habit. Of late he had been very much depressed, having lost all desire for work, and become tired of life.

Patient is tall, powerful, well nourished, and has a thick growth of beard. Skull and skeleton normal. Knee-jerks very prompt; deep reflexes in upper extremities much increased. Pupils dilated, equal, and act promptly. Carotids of equal calibre; hyperæsthesia urethræ; cords and testicles not sensitive; genitals normal.

The patient was calmed, and given hope for the future, provided that he give up onanism and attempt to transfer his sexual desires from persons of his own sex to females.

Hip-baths (24° to 20° R.); ext. secal. conut. aquos., 0.5; antipyrin, 1.0 (pro die); pot. brom., 4.0 (evenings), were ordered.

December 13th. To-day the patient came, in a disturbed condition of mind, complaining that, unaided, he was unable to resist the impulse to masturbate, and he asked for help.

A trial of hypnosis induced a condition of deep lethargy in the patient.

He was given the following suggestions:—

1. I can not, must not, and will not masturbate again.

2. I abhor the love for my own sex, and shall never again think men handsome.

3. I shall and will become well again, fall in love with a virtuous woman, be happy, and make her happy.

December 14th. While out walking to-day, patient saw a handsome man, and felt himself powerfully drawn toward him.

From this time there were hypnotic sittings every second day, with the above suggestions.

December 18th (fourth sitting), somnambulism occurred; the impulse to onanism and interest in men disappear.

At the eighth sitting “complete virility” was added to the above suggestions. The patient feels himself morally elevated and physically strengthened. The neuralgia of the testicles has disappeared. He now found that he was without sexual feeling.

He now believed himself free from masturbation and contrary. sexual inclination.

After the eleventh sitting he thought that further help was unnecessary. He wished to go home, and marry. He felt well and potent. Early in January, 1890, treatment ceased.

In March, 1890, the patient wrote: “I have since had several occasions on which it has been necessary for me to use all my moral strength in order to overcome my habit, and, thank God, I have been successful in freeing myself from this vice. Several times I have had opportunity for sexual intercourse, and I have found pleasure in it. I look calmly on my happy future.”

Case 135. Acquired Contrary Sexual Instinct. Marked Improvement under Hypnotic Treatment.—Mr. P., born in 1863, official in a manufactory. He comes of a highly respected patrician family of Middle Germany, in which nervousness and insanity have been of frequent occurrence.

His great-grandfather on the father’s side and his sister died insane; the grandmother died of apoplexy; father’s brother died insane, and a daughter of the latter died of cerebral tuberculosis. The maternal grandmother was melancholic for years; maternal grandfather, insane. A maternal uncle took his life in an attack of insanity. The patient’s father is very nervous. An elder brother is very neurasthenic, and has anomalies of the vita sexualis; another is the subject of Case 155; a third is eccentric in conduct, and is said to be subject to fixed ideas. A sister suffers with convulsions, and another died of them when a little child.

The patient is constitutionally predisposed; for he was early very peculiar, irritable, irascible, and impressed those around him as being abnormal.

His vita sexualis appeared very early and in great intensity, and was satisfied, without any seductions, in onanism. From his sixteenth year the prematurely developed boy visited brothels of the Capital, using his permissions to go out on Sundays and holidays for that purpose. He took pleasure in coitus, but during the week he satisfied himself with onanism. After his twentieth year, when he became independent, the patient indulged with prostitutes excessively, and fell ill with neurasthenia sexualis, becoming relatively impotent and unsatisfied in coitus, owing to weakness of erection and premature ejaculation. His sexual libido became more powerful than ever, and was satisfied in onanism. Early in 1888 the patient made the acquaintance of a young man. “By his pleasing face, his attractive manner, and his beautiful form, he conquered me entirely. I wished to speak to him, and was happy at mere sight of him. I was completely in love with him. With this, my love for women was extinguished. Any man could excite me to such an extent that, for some moments, I would feel my memory fail, and I would stammer.

“Soon after this I made the acquaintance of a gentleman who was likewise very attractive, and who had a decided influence on my future life. He was male-loving. I confessed to him that I no longer felt anything but aversion for the female sex, and that I was attracted to men.

“When I once asked my companion how he brought it about that soldiers would surrender themselves to him, he answered that the principal thing was skill; almost any of them could be brought to it. Late in 1888, thinking of these words, I was attracted by an officer’s servant, and was intensely excited by him, but ejaculation never occurred. Since I saw that the soldier would surrender himself without trouble, I approached him. Alium quondam militem in cubiculum allectum rogavi ut veste exuta mecum in lectum concumberet. Rogatus fecit quæ volui et alter alterius penem trivit.

“Though after this success I misused many persons, I was never really in love, so to speak, with but one. He was a very handsome young fellow of seventeen. His voice was so attractive to me, and his manner was so delicately proper, that I cannot forget him. In my dreams I thought only of handsome young men, and often for whole nights I could not sleep, owing to sensual feeling.”

Early in 1889 the patient’s conduct awakened a suspicion of male-love. A threatening communication frightened him, and plunged him in deep depression, so that he contemplated suicide. At the advice of the family physician, he came to the Capital. Since the patient was unable to overcome his habitual desires by his own will, hypnotic treatment was undertaken. It induced but mild lethargy, and, in opposition to the seduction of former lovers, it had but little effect.

At that time the patient was wanting in earnest desire. There was some improvement in matters, in the face of the disgrace to relatives and the prospect of a legal examination that was actually threatening. The patient determined to attempt a cure with the author.

I found him to be a delicate, pale, very neurasthenic man, much depressed, and despairing about the future. He was without degenerative signs. He realized his perverted situation, and seemed to be willing to do anything in order to become again a decent, moral man.

He regretted exceedingly his sexual perversion, which he regarded as abnormal, but also as having been acquired. He made no attempt to conceal the fact that he could not control himself with young men, and likewise he would not say that he could abstain from onanism, to which, faute de mieux, he was driven. Only a powerful, imperious will could keep him from it.

Thus far his male-love had consisted exclusively of mutual onanism. Erections occurred only when touching men he loved; ejaculation resulted early, but simple embrace was not sufficient. He had never felt himself in any particular sexual rôle toward a man. Genitals and vegetative organs normal.

In addition to treatment directed to his neurasthenia, on April 8, 1890, hypnotic suggestion was begun. Hypnosis was easily induced by simply looking at him, with verbal suggestion. After a half-minute the patient passed into deep lethargy, with a cataleptiform state of the muscles. The awakening was brought about by suggesting it at counting three. Post-hypnotic suggestions were always successful. The intra-hypnotic suggestions were:—

1. The interdiction of onanism.

2. The command that male-love should be felt to be disgraceful and despicable, and that it should be impossible.

3. The command to regard only women as beautiful; to approach them, to dream of them, and to have libido and erection at sight of them.

The sittings occurred daily. On April 14th, the patient announced, with thankfulness and a kind of moral satisfaction, that he had had pleasure in coitus, and had ejaculated tardily. On April 16th, he felt free from inclination to masturbate, attracted to women, and perfectly indifferent to men. He dreamed of female charms and coitus with women. May 1st, the patient seemed and felt himself to be normal sexually. He has become a different man mentally, full of courage and self-confidence. He has coitus with complete satisfaction, and thinks that he is insured against relapse.

In a later letter Mr. P. writes: “As was only to be expected, I find myself lastingly freed from my errors. All that remains to remind me of my unhappy time are the dreams, which, though they are infrequent, come from my past, which I have no power to banish, and which sometimes, indeed, pleasantly occupy my thoughts. But by my own will I yet hope soon to succeed in freeing myself absolutely from them. Should I ever become weak again, the ideas you have impressed on me would, I am sure, make an energetic resistance, and I should not succumb.”

On October 20, 1890, P. wrote me: “I am completely cured of onanism, and I have no pleasure in male-love. Yet complete virility does not seem to have been re-established, notwithstanding the fact that I lead a virtuous life. Nevertheless, I feel satisfied.”

Case 136. Acquired Contrary Sexual Instinct.—Mr. Z., aged 32, divorced. He comes of a hysteropathic mother. Maternal grandmother suffered with hysteria, and her brothers and sisters were neurotic. One brother is an urning. Z. was but poorly endowed mentally, and did not learn easily. No sickness besides scarlatina. When thirteen, he was taught to masturbate by companions in a school. Sexually, he was hyperæsthetic, and, at seventeen, began to indulge in coitus, with full pleasure and power. For reasons of position and money, he married at twenty-six. The marriage was very unhappy. After a year Mrs. Z. became incapable of coitus, by reason of uterine disease. Z. satisfied his inordinate desires with other women, faute de mieux, by masturbation. Besides, he gave himself up to play, led an absolutely dissolute life, became exceedingly neurasthenic, and sought to strengthen his weakened nerves by drinking great quantities of wine and brandy. To his essential cerebral asthenia were added peripheral alcoholic cramps and globus, and he became very emotional. His libido nimia continued unabated. On account of his disgust of prostitutes and fear of infection, satisfaction by coitus was exceptional. For the most part, the patient helped himself with onanism.

Four years ago he noticed weakening of erection and decrease of libido for women. He began to feel himself drawn toward men, and his lascivious dreams were no longer concerned with women, but with men.

Three years ago, while being rubbed by a bath-attendant, he became powerfully excited sexually (the attendant also had an erection, to patient’s surprise). He could not keep from embracing and kissing the attendant, and allowing him to perform masturbation on him, the attendant doing it most willingly. From this time this mode of sexual indulgence was all that he cared for. Women became a matter of entire indifference to him; he devoted himself exclusively to men. With them he practiced mutual masturbation, and had a longing to sleep with them. He abhorred pederasty. He was entirely satisfied until (August, 1890) an anonymous letter, warning him to be careful, brought him to his senses. He was much frightened, had hysterical attacks, and became much depressed. He was embarrassed before men, seemed like a pariah in society, contemplated suicide, and finally confessed to a priest, who comforted him. He now fell into a religious state (equivalent), and, out of remorse and to cure himself of his abnormal sexual inclinations, wished to go into a cloister. While in this state, my “Psychopathia Sexualis” fell into his hands. He was frightened and filled with shame, but found a comfort in it, inasmuch as he concluded that he must have some malady. His first thought was to rehabilitate himself sexually in his own eyes. He overcame all disinclination, and visited a brothel. At first he was not successful, on account of great excitement, but he finally succeeded.

Since, however, his contrary sexual inclinations were not overcome, in spite of all his efforts to put them down, he finally came to me, asking for assistance. He felt himself to be terribly unfortunate, and very near to despair and suicide. He saw destruction before him, and would be saved at any price.

His confession was interrupted by numerous hysterical attacks. Comforting and encouraging words about his future had a calming influence.

Physically, patient presented a slightly retreating brow, with no other anatomical signs of degeneration. Spinal irritation, exaggerated deep reflexes, and a sense of pressure in the head pointed to a neurasthenic condition. No genital anomalies, though there was hyperæsthesia urethræ. Mien distressed; attitude relaxed; mind distracted and vacillating.

Hip baths, massage, ergot with antipyrin and pot. brom., ordered, with interdiction of onanism, intercourse with men, and lascivious thoughts of them.

After a few days the patient came complaining that he was not equal to the task. He said his will was too weak. In this precarious situation, it seemed that nothing but hypnotic treatment could bring improvement.

September 11, 1889. First sitting. Bernheim’s method used, in order to induce lethargy as quickly as possible.

Suggestions:—

1. I abhor onanism, and will not masturbate again.

2. I regard the inclination for men disgusting,—horrible; and I shall never think men handsome and enticing.

3. Women alone I find enticing. Once a week I shall cohabit, with full pleasure and power.

The patient received these suggestions, and repeated them in a drawling tone.

The sittings took place every second day. After the fifteenth, it was possible to induce the somnambulic stage of hypnosis with any post-hypnotic suggestions desired.

The patient improved morally and mentally, but symptoms of cerebral neurasthenia troubled him still, and, now and then, dreams of men occurred; and there were, also, in the waking state, inclinations toward men, which depressed him exceedingly.

Treatment until September 24th. Result: Free from onanism; no longer excitable to men, though impressionable to women. Normal coitus once in eight days. Hysterical symptoms absent; neurasthenic symptoms much ameliorated.

On October 6th the patient reported by letter that he was feeling well, and expressed his gratitude for his salvation; he felt as if given a new life.

December 9, 1889, patient again came for treatment. Of late he had had lascivious dreams of men twice, but had experienced no inclination toward men in the waking state. He had also resisted the impulse to masturbate, though, while living alone in the country, he had had no opportunity for coitus. He had inclinations only for the opposite sex, and, as a rule, dreamed only of females. Returned to the city, he had indulged in coitus with pleasure. The patient felt himself morally rehabilitated, being almost free from neurasthenic symptoms; and, after three more hypnotic sittings, he declared himself perfectly well, and confident that he would not relapse. Such a relapse occurred, however, in September, 1890, when, after over-exertion on an excursion into the mountains, and emotional strain with want of opportunity for coitus, he had again become neurasthenic.

Again he had dreams of men, and felt drawn toward attractive male forms; he masturbated many times, and, after returning to the city, found no real pleasure in coitus. By means of anti-neurasthenic treatment and hypnosis, it was possible soon to restore the previous condition.

In the course of the years 1890 and 1891 the patient now and then had contrary sexual feelings and dreams, but only when, as a result of emotional strain or excesses, his neurosis re-appeared. At such times satisfaction in coitus was wanting. He would then find it necessary to undergo a few hypnotic sittings, in order to restore his equilibrium—always with success.

At the end of 1891 the patient pointed with satisfaction to the fact that, since treatment, he had been able to avoid masturbation and male-intercourse, and had regained his self-confidence and self-respect.

The foregoing details of the successful results of hypnotic suggestion, in cases of acquired contrary sexual feeling, make it seem possible that those unfortunates that are afflicted with the congenital perversion may be helped in some degree by the same means.

To be sure, here the condition is entirely different, since a congenital condition must be combated, an abnormal psycho-sexual life annihilated, and a new one created. A priori this task seems impossible; at least, in the perfect urning. That the apparently impossible is artificially possible may be seen from the case of Schrenk-Notzing, which follows below. It far surpasses the case reported by me (v. infra), in which at least the homo-sexual feelings and impulses were removed by means of hypnotic suggestion.

The case of Ladame (v. infra) is an analogous one. The conditions are more favorable in psycho-sexual hermaphrodites, where at least there are rudiments of hetero-sexual feelings that may be strengthened and made operative by suggestion.

Case 137. “I was born in 1858, out of wedlock. It was only late that I was able to trace my obscure origin, and obtain knowledge of my parents; and this knowledge is, unfortunately, very obscure and imperfect. My father and mother were cousins. My father died three years ago. He had later married, and, as far as I know, had several healthy children.

“I do not think that my father had contrary sexual feelings. Without knowing him as my father, I often saw him when I was a child. He was a powerful, masculine man. As for the rest, it is said that, at the time of my birth, or before, he was sexually ill.

“I have often seen my mother on the street, but I did not then know that she was my mother. At the time of my birth she may have been about twenty-four years old. She was tall, and quick and energetic of movement, and her character was decided. At the time of my birth she is reported to have gone about much in male attire, to have worn short hair, to have smoked a long pipe, and in general to have been remarkable for her eccentric character. She was exceedingly well educated, and is said to have been beautiful in her youth. She left a fortune,—considerable even when measured by our present ideas,—but she died unmarried.

“In any case, all this would point to homo-sexual inclinations, or, at least, to abnormalities. On the other hand, several years before my birth, my mother took care of a little girl. This step-sister, whom I never knew, married young, but early in her married life, for reasons unknown to me, she poisoned herself.

“I am 1.7 metres tall, measure 92 centimetres around the waist, and 102 centimetres around hips, and, therefore, I think my pelvis is somewhat over-developed. The subcutaneous fat has always been abundant. Skeletal form is strong. The muscular system is well formed, but, from lack of exercise, perhaps owing to the influence of early, long-continued, and frequent indulgence in onanism, it is not well developed; so that I appear stronger than I really am. Hair of head and face is normal; genital hair, somewhat thin. The upper portion of the body is as good as without hair. In all other ways my appearance is fully masculine. Gait, attitude, and voice are those of a fully developed man, and other urnings have often told me that they would never have suspected my passion. I served in the army, and always found pleasure in all knightly exercises,—riding, fencing, swimming, etc.

“My early training was under a priest. I had but few real playmates. The family life of my foster-parents was faultless. In October, 1861, I entered the Institute. Here I indulged in my first perverse acts, which I shall describe more fully when I come to the development of my sexual life.

“I finished the Gymnasium, served my voluntary years in the army, and then studied forestry, being now a director of estates. During my early years my mental development was very slow. I first learned to speak in my third year, and thus the supposition that I had hydrocephalus was strengthened. From the time of beginning school, my mental development was abnormal; indeed, I learned easily, but I have never been able to concentrate my activity on any particular subject. I have a great interest in art and æsthetics, but almost none in music. In early years my character was the worst possible. Without being able to give any reason for it, during the last twelve years there has been an entire transformation. Now, there is nothing I hate more than a lie, and I never speak untruth even in jest. In financial matters, without being avaricious, I have become an economical manager.

“It is enough that, with a deep feeling of shame, I look back on my past; and, if I could be freed from my unhappy sexual perversion, or perversity, I should justly regard myself as a true gentleman. I am kind, and always ready to be charitable to the extent of my means; I am gay-spirited, and regarded with favor socially. I have no trace of that nervous irritability which is so often noticeable in others like me. Too, I am not wanting in personal courage. There is nothing in the early period of my development that points to abnormality. To be sure, as a child, I liked to lie in bed on my abdomen, and, of a morning, I often took delight in rolling about on my abdomen, much to the amusement of my foster-parents; but I cannot recall that, at such times, I ever had sensual feeling. I never sought much to play with girls, and I never played with dolls. I early heard talk about sexual matters; but I never thought anything about it. In my dreams, too, at that time, there was nothing sexual; and, in my association with boys of my own age, there was nothing of that kind. I think I may say that my vita sexualis was really first awakened after I had been seduced into mutual masturbation, in my thirteenth year, by a room-mate at the Institute. At that time ejaculation did not take place, but first about a year later. Nevertheless, I gave myself up to the vice of onanism passionately. At this time, however, the first signs of homo-sexual inclination were manifested. Youthful, powerful men, market-helpers, workmen, and soldiers took possession of my dreams, and played an important rôle in my fancy while masturbating. At this time was also first shown the tendency to pederasty, especially passive. Up to my fourteenth year I frequently made mutual attempts at pederasty with my seducer, but neither of us were successful in bringing about immissio. At the same time, there was also a weak inclination for the female sex. About a year after the first indulgence in onanism, I was once with a puella publica, but I had neither ejaculation nor any especial feeling of sensual pleasure. Thereafter, and up to my nineteenth year, I performed coitus in public houses about six times. Erection and ejaculation occurred promptly, but without marked sensual pleasure. At least onanism, particularly mutual onanism, I liked quite as much. I have never had any love for athletes. About ten years ago, while at H., a watering-place, I thought I was in love with a beautiful lady of a highly respectable family; I was happy in her presence, and thought myself happy in finding my love returned. For a time this affair kept me from masturbating; I was only afraid that, weakened by onanism that had been practiced for years, I should be incapable of performing my marital duty. When we became widely separated, my feeling quickly cooled; I found that I had deceived myself; and, after about two years, without jealousy, I was able to hear that the lady had married. My inclination for women—if, in reality, I have ever had any—grew colder and colder. Two and a half years ago, when I visited a public house with very virile friends, I last performed coitus. There was erection, but no ejaculation. Women have become indifferent to me. A prostitute who acts coarsely excites my repugnance. With intellectual women, particularly when they are elderly, I like to converse, but in their society I am often unskillful and awkward, often devoid of tact. I have never been able to find any charm in woman’s physical form.

“But, to return to the perverse inclinations. When, at the age of fourteen, I went to H., I lost sight of my lover and seducer. He was some years older than I, and was an official; and, in this capacity, when I was nineteen, I again met him once on the railway. We immediately cut the journey short, and lodged together, attempting mutual pederasty; but, on account of pain, immissio was not successful. We amused ourselves in mutual onanism. In H. I had sexual intercourse with two fellow-students, but this intercourse was confined to frequent mutual onanism, owing to the fact that they were not inclined to pederasty. During the last year of my stay (when I was nineteen), I had intercourse with another person, which likewise consisted of onanism; but our intercourse was more intimate, and we always retired, and practiced mutual onanism in bed. From Easter, 1869, until July, 1870, I had no lover. I practiced onanism alone. When the war broke out, I offered myself as a volunteer, but was not accepted. At the same time a former school-mate offered himself. He had developed into a remarkably handsome man. I had to spend one night with him in an over-crowded hotel. Though as students we had never associated sexually, he was not averse to my desire, and attempted pederasty. In this instance pain prevented success; but, in the attempt, ejaculatio ante anum meum occurred. Even now I can recall the pleasurable feeling I had in it,—a feeling previously unknown. After the war I frequently met this friend, but our intercourse was later limited to onanism. During the following eighteen years I had but two opportunities for homo-sexual intercourse. The first was in the winter of 1879, on the occasion of meeting a handsome hussar in a railway carriage. I induced him to sleep with me at an hotel. Later he confessed to me that he had previously practiced mutual masturbation with the son of a landed proprietor of his town. I could not bring him to pederasty. On the other hand, I induced ejaculation in him by receptio penis ejus in os meum. This caused me no satisfaction, but rather disgust. I have never tried it again; and, too, I have never allowed receptio penis mei in os alterius. In 1887, likewise on the railway, I made the acquaintance of a sailor, and induced him to stay with me at an hotel. He said he had never practiced pederasty, but he was ready for it. He was apparently sensually excited; he had an erection immediately, and performed the act with evident passion. It was the first time that pederasty was successfully performed. I had terrible pain, but also indescribable pleasure.

“With my sojourn here, my vita sexualis has undergone a complete change. I have learned how easy it is to find persons who, partly for money and partly from desire, yield to our inclinations. I have also not been spared annoying experiences with cheats. Until the end of the last year (since then, owing to fear of venereal infection, I have not gone beyond mutual masturbation), I enjoyed male-love to the full extent, particularly in passive pederasty. I have never practiced active pederasty, because I have found no one able to endure the pain.

“Generally, I seek my lovers among cavalrymen and sailors, and, eventually, among workmen, especially butchers and smiths. Robust forms, with healthy facial complexions, attract me especially. Leathern riding-trousers have a particular charm for me. I have no partiality for kissing and the like. I also love large, hard, and calloused hands.

“I do not wish to leave unmentioned that, under certain circumstances, I have great control of myself.

“As director of an estate, I lived in a large house. My personal servant was a very handsome young man who had served in the hussars. After once having spoken with him, in general terms, on the subject, and found that he could not be approached, for years I lived in close intimacy with him, and enjoyed his beauty, but never touched him. I think that, to this day, he knows nothing of my passion. Likewise, two and a half years ago, in C., I made the acquaintance of a sailor, who is still regarded by me and my acquaintances as one of the handsomest men we know. After an absence of more than two years, on invitation, he visited me a few weeks ago. I knew how to arrange matters so that we slept in the same room, and I burned with desire to be nearer to him. As a preliminary, however, I sounded him in confidential talk; and, when I found that he despised everything connected with male-love, I had not the heart to approach him more closely. For weeks we slept in the same room, and I took constant delight in his divine form (at first, was sexually excited, in fact); I bathed with him, in the Roman manner, in order to see his beautiful form naked,—but he never learned anything of my passion. I still have an ideal, platonic relation with this young man, who, for one of his position, has an unusual education and fine talent for poetry.

“Until my thirty-eighth year I had not a clear understanding of my condition. I always thought that, by early and frequent masturbation, I had become averse to women, and hoped always that, when the right woman came, I should be able to abandon onanism and find pleasure in her. Here it was that I first came to fully understand my condition, after making the acquaintance of others suffering and feeling like myself. At first I was frightened; later I came to look upon my fate as something not dependent on myself. Too, I made no further effort to resist temptation.

“Two or three weeks ago ‘Psychopathia Sexualis’ fell into my hands. The work has made an unexpectedly deep impression on me. At first I read the work with an interest that was undoubtedly lascivious. The description of the cultivation of mujerados, for example, excited me uncommonly. The thought of a young, powerful man being emasculated in this manner, in order, later, to be used for pederasty by a whole tribe of wild, powerful, and sensual Indians, so excited me that I masturbated five times during the next two days, fancying myself such a presumptive mujerado. The farther I read in the book, however, the more I saw its moral earnestness; the more I felt disgust with my condition; and the more I saw that I must do everything, if it were possible, to bring about a change in my condition. When I had finished the book, I was determined to seek assistance from its author.

“The reading of this work had an undoubted effect. Since then I have masturbated only twice, and have practiced onanism with cavalrymen only twice. In every instance I have had really less pleasure and satisfaction than before, and I always have the feeling: ‘Ah, if I could only be free from it!’ Nevertheless, I confess that, even now, in the society of handsome soldiers, I immediately have erection.

“In conclusion, I may add that, in spite of, or, perhaps, on account of, onanism, I have never had pollutions. The ejaculation of semen, which usually consists of only a few drops, and it has always been so, takes place only after prolonged friction. If, for any reason, I have not masturbated for a long time, the ejaculation takes place quickly, and is more abundant. About twelve years ago Hansen tried in vain to hypnotize me.”

In the spring of 1891 the writer of the foregoing autobiography visited me, with the declaration that he could live no longer in his condition; that he looked to hypnotic treatment as the only hope of salvation, for he had not strength enough to resist his impulse to masturbation and satisfaction with persons of his own sex. He felt like a pariah; like an unnatural man; like one outside the laws of nature and society, and in danger of criminal prosecution. He felt moral repugnance when he performed the act with a man, but yet the sight of any handsome soldier actually electrified him. For years he had not had the slightest sympathy with women, not even mentally.

The patient looked to be exactly the person, physically and mentally, described by himself in his autobiography. His head was exquisitely hydrocephalic, and also plagiocephalic. At first attempts at hypnosis met with difficulties. Only by Braid’s method, with the help of a little chloroform, was deep lethargy attained at the third sitting. From that time simply looking at a shining object was sufficient. The suggestions consisted of the command to avoid masturbation, the removal of homo-sexual feelings, and the assurance that the patient would have inclination for women and be virile, and have pleasure only in hetero-sexual intercourse. Masturbation was indulged in but once; after the eighth sitting the patient dreamed of a woman.

When, after the fourteenth sitting, the patient had to return, on account of pressing business, he declared that he was quite free from any inclination to masturbate or to indulge in male-love, but that he was by no means absolutely free from his partiality for men. He felt a returning interest in the female sex, and hoped to be freed finally from his unhappy condition by continuance of the treatment.

Case 138. Psychical Hermaphroditism.—Mr. von P., aged 25, single, comes of a neuropathic family. As a child he had convulsions. He recovered, but remained weak, emotional, and irritable. No severe illnesses. Before his tenth year sexuality was manifested. His earliest remembrance concerning it was that of lascivious feelings in company with the servants of the house. When older, he had sensual dreams which were of intercourse with men. In circuses the male performers alone interested him.

Youthful, powerful men were most enticing to him. Often, he could scarcely resist the longing to fall on their necks and kiss them. Of late simply the touching of such persons had become sufficient to give him pleasure and induce ejaculation. The impulse to engage in “affairs” with men he had, thus far, fortunately resisted. The patient is a psychical hermaphrodite, in so far as he is not insensitive to the charms of women, and finds men more pleasing than women. In fact, feminine nudity had never pleased him, and he can remember only to have dreamed once of coitus with a woman.

On account of his great sexual desire, and because he was ashamed to give himself up to men, after his twentieth year he began to have sexual intercourse with women. Since then, he has very seldom indulged in manual onanism, but often in mental masturbation, during which the forms of handsome men float through his fancy.

He had coitus with success, but without pleasure or sensual feeling. On account of circumstances, he was forced to abstain from his twenty-second until his twenty-fourth year. This abstinence was painful, and he relieved himself, now and then, by mental onanism.

When, a year ago, he had opportunity again for coitus, he noticed failure of libido for women, imperfect erection, and premature ejaculation. Finally he gave up coitus; then libido for men was manifested.

In the condition of irritable weakness of the ejaculatory centre, mere touching of sympathetic men was sufficient to induce ejaculation.

Patient is an only child. The circumstances of his family demand that he marry. He justly hesitates to do this, thinks he is mentally impotent, and asks for advice and help.

He points out that his feeling for men must be eradicated in order to help him.

Patient’s appearance is, in all respects, masculine. His head is slightly hydrocephalic and rhombic. Abundant growth of beard. Genitals normal; cremasteric reflex cannot be excited. No manifestations of neurasthenia. Neuropathic eyes. Pollutions infrequent. Erections occur only as a result of contact with men.

July 16, 1889, hypnotic suggestion, after Bernheim’s method, was begun. It was first at the third sitting that deep lethargy was induced.

Suggestions: “You have no longer any desire for men. Only woman is beautiful and desirable. You will love a woman, marry, be happy, and make her happy. You are fully potent; you feel that already.”

In daily hypnosis, which never goes beyond lethargy, the patient accepts the suggestions. On July 24th, he announces that he has had pleasure in coitus; and the male servants no longer interest him. At the same time, he still finds men more beautiful than women. On August 1, 1889, it was necessary to discontinue treatment. Result: Completely potent; entire indifference for men, but also for women.

The same treatment met with decided success in a case of psycho-sexual hermaphroditism, reported by me in vol. i of the Internat. Centralblatt für die Physiol. u. Path. der Harn- und Sexualorgane.

Case 139. Mr. von X., aged 25, landed proprietor. He comes of a neuropathic, passionate father. Father is said to have been normal sexually. His mother was nervous, as were her two sisters. Maternal grandmother was nervous, and his maternal grandfather was a roué, much given to venery. Patient is like his mother, and an only child. From birth he was weak, suffered much with migraine, and was nervous. He passed through several illnesses. At fifteen he began masturbation, without having been taught it.

Until his seventeenth year he says he never had feeling for men, or, in fact, any sexual inclination; but at this time desire for men arose. He fell in love with a comrade. His friend returned his love. They embraced and kissed and indulged in mutual onanism. Occasionally patient practiced coitus inter femora viri. He abhorred pederasty. Lascivious dreams were concerned only with men. In the circus and theatre males alone interested him. The inclination was for those of about twenty years. Handsome, tall forms were enticing to him. Given these conditions, he was quite indifferent to other characteristics of the men. In his sexual affairs with men his part was always that of a man.

After his eighteenth year the patient was always a source of anxiety to his highly respected parents, for he then began a love-affair with a male waiter, who fleeced him and made him an object of remark and ridicule. He was taken home. He consorted with servants and hostlers. He caused a scandal. He was sent away for travel. In London he got into a “blackmailing scrape,” but succeeded in escaping to his home.

He profited in no way by this bitter experience, and again showed disgraceful inclinations toward men. Patient was sent to me to be cured of his fatal peculiarity (December 12, 1888). Patient is a tall, stately, robust, well-nourished young man, of masculine build; large, well-formed genitals. Gait, voice, and attitude are masculine. He has no pronounced masculine passions. He smokes but little, and only cigarettes; drinks little, and is fond of confectionery. He loves music, arts, æsthetics, flowers, and moves in ladies’ society by preference. He wears a moustache, the face being otherwise cleanly shaved. His garments are in nowise remarkable. He is a soft, blasé fellow, and a do-nothing. He lies abed mornings, and can scarcely be made to rise before noon. He says he has never regarded his inclination toward his own sex as abnormal. He looks upon it as congenital; but, taught by his evil experiences, he wishes to be cured of his perversion. He has little faith in his own will. He has tried to help himself, but always begins to masturbate. This he finds injurious, inasmuch as it causes slight neurasthenic symptoms. There is no moral defect. The intelligence is a little below the average. Careful education and aristocratic manners are apparent. The exquisite neuropathic eye betrays the nervous constitution. The patient is not a complete and hopeless urning. He has hetero-sexual feelings, but his sensual inclinations toward the opposite sex are manifested weakly and infrequently. When nineteen, he was first taken to a brothel by friends. He experienced no horror feminæ, had efficient erections, and some pleasure in coitus, but not the instinctive delight he experienced while embracing men.

Since then, patient asserts that he has had coitus six times, twice sua sponte. He gives the assurance that he is always capable of it, but he does it only faute de mieux, as he does masturbation, when the sexual impulse troubles him, as a substitute for intercourse with men. He has thought of the possibility of finding a sympathetic lady and marrying her. He would regard marital cohabitation and abstinence from intercourse with men as hard duties.

Since there were rudiments of hetero-sexual feelings present, and the case could not be looked upon as hopeless, it seemed that treatment was indicated. The indications were clear enough, but there was no support for them in the will of the indolent patient, so unconscious of his own position. It lay near to seek support for the moral influence in hypnosis. The fulfillment of this hope seemed doubtful, because the famous Hansen had tried several times, in vain, to hypnotize him.

At the same time, by reason of the most important social interests of the patient, it was necessary to make another attempt. To my great surprise, Bernheim’s procedure induced immediately a condition of deep lethargy, with possibility of post-hypnotic suggestion.

At the second sitting somnambulism was induced by merely looking at him. The patient is obnoxious to suggestions of all kinds; indeed, contractures are induced by stroking him. He is awakened by counting three. Awakened, patient has amnesia for all the events of the hypnotic state. Hypnosis is induced every second or third day for the communication of hypnotic suggestions. At the same time, moral and hydro=therapeutic measures are employed.

The hypnotic suggestions were as follow:—

1. I abhor onanism, because it makes me sick and miserable.

2. I no longer have inclination toward men; for love of men is against religion, nature, and law.

3. I feel an inclination toward women; for woman is lovely and desirable, and created for man.

During the sittings the patient always repeats these suggestions. After the fourth sitting it was noticeable that, when taken into society, he paid court to ladies. Shortly after that, when a famous prima-donna sang, he was all enthusiasm for her. Some days later the patient sought the address of a brothel.

At the same time, he preferred the society of young gentlemen; but the most careful watching failed to reveal anything suspicious.

February 17th. Patient asks to be allowed to indulge in coitus, and is very well satisfied with his experience with one of the demi-monde.

March 16th. Up to this time, hypnosis twice a week. The patient always passes into deep somnambulism by simply being looked at, and, at request, repeats the suggestions. He is obnoxious to all kinds of post-hypnotic suggestion, and, in the waking state, knows not the least of the influences exerted on him in the hypnotic state. In the hypnotic condition he always gives the assurance that he is free from onanism and sexual feeling for men. Since he gives the same answers in hypnosis,—e.g., that on such and such a date he practiced onanism for the last time, and that he is too much under the will of the physician to be able to lie,—his assertions deserve belief; the more, since he looks well and is free from all neurasthenic symptoms, and, in the society of men, not the slightest suspicion rests on him. An open, free, and manly bearing is developed.

Moreover, since, of his own will, he now and then indulges in coitus with pleasure, and occasional pollutions are induced by lascivious dreams which concern women, there can be no doubt of the favorable change of his vita sexualis; and it is presumable that the hypnotic suggestions have developed into auto-suggestive inclinations, which direct his feelings, thoughts, and will. Probably the patient will always remain a natura frigida; but he more often speaks of marriage, and of his intention to win a wife as soon as he has become acquainted with a sympathetic lady.

In July, 1889, I received a letter from his father, which told me of his good health and conduct.

On May 24, 1890, by chance, I met my former patient, while on a journey. His bright, healthful appearance allowed the most favorable opinion of his condition. He told me that he still had sympathetic feeling for some men, but never anything like love. He occasionally had pleasurable coitus with women, and now thought of marriage.

I hypnotized him, in the former manner, to try him, and asked for the commands I had given him. In a deep condition of somnambulism, and in the same tone of voice as formerly, the patient repeated the suggestions he had received in December, 1888,—an excellent example of the possible duration and power of post-hypnotic suggestion.

Case 140. Psychical Hermaphroditism; Improvement with Hypnotic Treatment.—Mr. von K., aged 23; of distinguished family; well endowed mentally; scrofulous as a child. His father is said to have been dissipated. His father’s brother is said to have been subject to contrary sexuality.

The patient states that, when only seven years old, he had a peculiar inclination for male persons. It was particularly coachmen and servants having moustaches for whom he showed partiality at that time. He experienced a peculiar delightful sensation when he pressed himself against such persons.

The patient entered the cadet corps early, and there he was seduced into mutual onanism, and also learned imitatio coitus inter femora viri. At the age of seventeen he had coitus with a prostitute for the first time. He performed the act perfectly, but had not the slightest pleasure in it; and he learned that this kind of gratification amounted to nothing, or that he must be different from other young men.

Nevertheless, he often had coitus, and contracted gonorrhœa. After this he experienced an increasing aversion for the female sex, and indulged in coitus less and less frequently; in fact, only when, with intense libido, he could not gain opportunity for intercourse with men. His inclination for men predominated more and more, and he was attracted exclusively by those handsomely formed, and having as little beard as possible. He descended to the most revolting practices,—coitus buccalis, active and passive pederasty.

The patient was deeply ashamed of such depravity, and was constantly endeavoring to get into better ways by means of coitus with women. But he came to the despairing conclusion that his moral strength was insufficient, that he was indifferent about intercourse with women, or that it was repugnant to him; and that he was created for sexual intercourse with persons of his own sex. In fact, he had never dreamed of women, but always of men; and that at a time, too, when he had no suspicion of the difference between the sexes.

The patient comes for consultation, because he sees that he is jeopardizing the happiness of his whole life, and recognizes the unnaturalness and immorality of his sexual life. He does not regard his condition as hopeless; for he has no horror of women, and three weeks ago he had successful coitus with one, though it was devoid of all pleasure and mental satisfaction. He has no doubt that he was really created to love men; but, owing to acquired neurasthenia, in the sexual act with a man he experiences no such pleasure as formerly. He had given up his position as an officer, because the soldiers excited him so sexually that he feared he might compromise himself.

The patient is devoid of degenerative signs. His appearance is perfectly masculine, and his genitals are normal. Examination of the semen revealed abundance of spermatozoa. The penis is large and well developed; the growth of hair ad genitalia, as well as on the rest of the body, is abundant. The patient has masculine tastes, but has never been partial to drinking and smoking. A neuropathic eye is all that points to a nervous constitution.

In his sexual acts with men, he states that, as a rule, he has felt as a man, only now and then as a woman.

An attempt at hypnosis leads to lethargy, with cataleptic condition of the muscles, and the opportunity is used to impart suitable suggestions.

After the fourth sitting he expressed himself as satisfied, and wondered that men made no impression on him. He wished to try his fortune with women, but was afraid that he was impotent.

After the sixth sitting, without advice, he attempted coitus cum muliere. His libido was very great, but inter actum this and erection left him.

After the ninth sitting the patient was forced to discontinue treatment, owing to business that called him home. He was satisfied, in that he felt indifferent and capable of resistance to men. He felt sure that he would not relapse into his former vices. At the same time, he had not the slightest interest in the female sex.

Case 141. Mr. X., aged 31, chemist, comes of a neuropathic family, and from childhood has been nervous, emotional, and apprehensive, and afflicted with migraine. He remembers distinctly that, when a very small boy, he had a lustful feeling at the sight of the half-naked persons in the work-shop at his father’s house, and felt drawn to them. When he began school, he felt in the same way toward his companions. At the age of eleven, without teaching, he began to masturbate, during which he thought of his comrades. Later there were enthusiastic friendships. His vita sexualis gained the upper hand. As he grew up, women also interested him, but his chief interest was in men of the higher circles of society. He felt that this inclination was abnormal, and sought the acquaintance of puellis; he often had coitus, but never with any real pleasure. Thus he became more and more given to contrary sexuality, practiced mutual masturbation and coitus inter femora viri, and occasionally gave himself up to passive pederasty; but he soon abandoned this, on account of the pain it caused him.

He asserts that he feels perfectly masculine, and has never had female inclinations. Skeleton and attitude perfectly masculine; strabismus; abundant beard; genitals entirely normal. No aversion to the female sex. Occasional coitus with puellis, but without satisfaction. The patient feels exceedingly unhappy, and clearly recognizes his abnormal position; at any price, he wishes to be freed from his homo-sexual inclination, and made capable of marriage. “It is terrible to have to act a farce constantly.” At the first attempt at hypnosis, after Bernheim’s method, the patient passes into a state of deep lethargy. He proves to be very susceptible to suggestion, and suitable suggestions are imparted. After the fourth sitting, he states, with gratitude, that men become indifferent, and he begins to have pleasure in coitus; but he did not feel mentally satisfied, owing to the fact that he was limited to puellæ publicæ. After the fourteenth sitting he declared that he required no more treatment. He was in love with a young lady, and thought of marrying her. He asked for her hand, and was refused. Soon after, while he was on a journey in Italy, men interested him again. He had a relapse, and asked for further treatment. A few sittings re-established the status quo ante.

Case 142. Psychical Hermaphroditism; Successful Treatment by Hypnotic Suggestion.—Mr. von Z., aged 29. He asserts that he comes of healthy grandparents; of a healthy father, but of a nervous mother. He is an only child, and was petted by his mother. At the age of eight he was powerfully excited sexually by a male servant, who showed him pornographic pictures and his penis.

When twelve years old, Z. fell in love with his tutor. On going to sleep, the naked form of this man appeared before him. He thought of himself as in a female rôle in relation to him, and thought to marry him some time.

At the age of thirteen, at a private ball, his fancy was excited by a young governess, and, at fifteen, he fell in love with a young lady. He remained very excitable sensually; but, thereafter, exclusively so to men pleasing to him. Masturbation was not practiced.

At the age of twenty the patient became neurasthenic (ex abstinentia?). He now attempted coitus, but was not successful. On the other hand, he had intense desire on an occasion when he saw a naked man in a steam-bath. The latter noticed his excitement, approached him, and performed masturbation on him, giving the patient intense delight. He felt powerfully attracted to this man, and, thereafter, allowed him to repeat the act. In the meantime, there were attempts at coitus with females, which always ended in a fiasco. The patient was much troubled by this, and consulted physicians, who explained his impotence as due to nervousness, and thought that it would soon pass off.

Until his twenty-fifth year his sexual indulgence consisted of masturbation by the beloved man about once a month. At this time he last felt attracted to a woman. It was to a young peasant-girl. She would not accede to his wishes. Since his lover was also unattainable, the patient began to masturbate alone. With this, his neurasthenia increased. For this reason he was unable to finish his studies; he became shy, dysthymic, abulic, and now vainly tried cures at various hydropathic establishments. On account of continued severe (cerebro-spinal) neurasthenia, the patient came to me for advice, in the latter part of February, 1890.

A tall, slim man, of aristocratic and decidedly masculine manners. Neuropathic appearance; large ears, the lobes of which run into and lose themselves in the skin of the cheeks. Genitals perfectly normal. The usual picture of cerebro-spinal neurasthenia of moderate degree. Great depression; complaint of being dissatisfied with life, even to tædium vitæ; he is pained by his sexual anomaly, especially because he is urged by his family to marry.

He is interested in women only mentally, not physically. Sexually, his only interest is in men of distinction. His dreams have never been about persons of the opposite sex, but of those of his own sex. In these lascivious dreams he has always seen himself in the rôle of a woman.

The most refined woman has never been able to induce erection or even libido in him.

His sexual intercourse with men has consisted of passive or mutual masturbation. He had practiced solitary onanism only infrequently and faute de mieux. During the last five months he had abstained, and had had no male intercourse since August, 1889.

An attempt at hypnosis, after Bernheim’s method, failed; prolonged stroking of the brow induced deep lethargy, with catalepsy.

This method is used, in order to carry out suggestive treatment of this patient, who is so worthy of compassion. The hypnotic state is always the same; he cannot be brought into a state of somnambulism.

At the third sitting the patient is given the suggestions: ever despise onanism and male love; find women beautiful, and dream of them.

After the sixth sitting (March 10th) a moral transformation takes place in his mind. The patient becomes quieter, feels more free, and dreams now and then of women, and no longer of men, finding that the latter have become indifferent to him. He gratefully states that he has no more inclination to masturbation. He approaches women, but he notices that they have not the least attraction for him.

On March 19th, business called the patient home; so that the treatment had to be discontinued.

On May 17, 1890, the patient returned for treatment. He asserted that he had not masturbated in the interval, and that he had resisted his inclination to men. Too, he had not dreamed of men, but twice of women, though only platonically. His cerebral asthenia (ex abstinentia?) had increased. He apparently suffers for the want of mental and sensual satisfaction of his vita sexualis; for homo-sexual love and masturbation have become impossible for him, and intercourse with women is denied him. The patient is thus painfully depressed to the extent of tædium vitæ.

He is now subjected to anti-neurasthenic treatment (hydro-therapeutic and electro-therapeutic), and the treatment by hypnosis is resumed. Only after ten weeks of painstaking treatment did the neurasthenic symptoms disappear. Progressing parallel with this, there was a change of his mental personality.

The patient was gratified to note that he grew stronger; that his sexual life no longer played a dominating part. Though he felt more drawn toward men than women, yet he easily resisted homo-sexual desires. His former boudoir became a work-room; instead of to adornment and frivolous reading, he gave himself to walks in the mountains and forests. On account of the danger of a fiasco, the initiative in hetero-sexual attempts was left to the patient.

It was not until the fourteenth week of treatment that the patient made an attempt. It was perfectly successful. The patient became happy, and sound in body and mind, and expressed the best hope of his future, even having thoughts of marriage.

He experienced increasing pleasure in normal sexual intercourse; he occasionally had lascivious dreams of women, and no longer dreamed of men.

The patient stopped treatment at the end of September. He felt perfectly normal in hetero-sexual intercourse, devoid of neurasthenia, and had thoughts of marriage. Yet he freely confessed that he still always had erections at the sight of a naked, handsome man; though he could easily resist the desires that arose, and in dreams had exclusively “relations avec la femme.”

In April, 1891, I again saw the patient, and he was in the best of health. He regarded his vita sexualis as perfectly normal; for he had coitus regularly with pleasure and full virility, dreamed only of women, and had no inclination to masturbation. Yet he made the interesting confession that frequently, post coitum, he still had a temporary “gout pour l’homme,” which he could easily control. He thought he was lastingly cured, and was occupied with thoughts of marriage.

Case 143. Congenital Contrary Sexual Feeling. Successful Removal of Homo-Sexual Feelings by Suggestions.—L., doctor of philosophy, aged 34, German, consulted me, in the spring of 1888, on account of perversion of his vita sexualis, and asked whether he could not be freed from it by means of hypnotic treatment.

Patient came of a healthy mother, in whose family, for generations, there had been neither insanity nor nervous disease. He, like his only brother, is much like his father mentally. His brother is very sensual, and also psychically abnormal, and given to over-indulgence in drink.

His father was a neuropathic, eccentric man. Nothing is known of any abnormal sexual manifestations in him, though, like all his brothers, he had a tendency to over-indulgence in alcohol.

This vice seems to have been inherited from his mother (grandmother of patient), who was a notorious drinker. The father of this woman (great-grandfather of patient) was also a great drinker. No other ancestral history was obtainable.

Patient states that from childhood he was nervous and easily excited. He learned very easily, and had a talent for languages. He was always interested in art, particularly in music and poetry. His education was excellent, and given at home. When he was thirteen, his father told him that he should never touch his genitals, for it was wrong to do so, and to do it might bring unhappiness.

Occasionally his father showed him pictures of syphilitic diseased conditions, etc., in an anatomical museum, and the patient was disgusted and frightened. He believed that his later fear of sexual intercourse with women was partly nourished by this early erroneous teaching.

However, the patient seeks the principal cause of his sexual perversion in a defect of organization. When a small boy, he had a silly enthusiasm for companions. He also remembers that, at that time, he had a desire only for girlish games, and preferred the society of girls. When a boy, he had a passion for crocheting and embroidering. At fourteen he was still without any sexual knowledge, and fell into the hands of a pederast. He ran away, frightened, when he learned what was to be done with him. When fifteen, a sympathetic companion was accustomed to lay his head in the patient’s lap. This gave the patient a peculiar pleasurable feeling, but he knew no explanation of it. At sixteen he had the first erections—at the sight of men.

At twenty he first learned that his sexual condition was perverse, and recognized the fact that what he had taken for friendship was love. He was much frightened at the discovery, and much pained. His sympathies were directed toward young men of the upper class that were handsomely formed and of pleasing appearance.

The society of ladies had no effect on him. He was never attracted by the charms of the opposite sex. In his fifteenth year he had a sensual dream, in which he thought a girl of elegant figure sat opposite him, on a sofa.

In the theatre it was only the art of the actresses that he admired; the actors excited his real interest.

Drinking and smoking had always been very repugnant to him. Hunting and gymnastics, and other masculine occupations, had no interest for him. He did not enter the army, because his general physical weakness precluded it.

The patient has but little sexual desire. He has never had any impulse to satisfy himself with persons of his own sex. Some years ago, when he first tried to embrace a man lovingly, he had powerful erection and became greatly excited; but he was able to control himself and to repel his lover. Thereafter he always avoided such attempts. It was only seldom that he became powerfully excited sexually, and even then he was not driven to satisfy himself. He was never given to onanism. During the establishment of puberty, the patient had frequent dreams with pollutions, but these were not induced by erotic fancies of any kind.

Some years ago, for a long time, ejaculation was always induced by the embrace of a sympathetic man, but this condition of irritable weakness disappeared. As years passed, the patient, who had always had a desire for marriage and a family, became anxious on account of the conviction that the inclination toward females, for which he had hoped, would never come. It became more and more clear to him that he was abnormal, and he began to have fears about his virility and his future happiness in life.

In order to test the matter, he sought a brothel. He found a prostitute of beautiful form; he had the best will to satisfy himself that he was virile; the woman did all she could, but in vain. There was no erection, and he withdrew, ashamed. New attempts, under the most favorable circumstances, were likewise failures, though the patient brought his imagination to his aid, and thought himself to be embracing a man instead of a woman.

He now realized that his ideal—to consummate marriage—was impossible. He felt himself very unfortunate, and dissatisfied with life. Besides, it forced itself upon him that morally he was lowered, because he could not overcome his inclination for his own sex, and his friendship for respectable men of his circle was degraded by sexual feelings. In his consultation with me, the patient was unending in the description of his painful situation. His ideal was marriage. He longed for it, for purely ethical reasons. He thought of it as something holy; but the begetting of children, the sexual act, was very repugnant to him. At the same time, he saw that he could not really marry without being potent. Would not hypnotic suggestion exercise a favorable influence on his sexual life? He had not the energy of a man of normal sexual condition. He seemed to himself to be all wrong. He would endure all—to be poor and miserable—if he could but have a normal sexual inclination.

When the patient was gently told of the congenital and deep constitutional significance of his sexual anomaly, and shown that, therefore, the creation of a normal sexual condition was doubtful, he thought that he would be satisfied to remain in his condition. But he wished to know whether it were not possible to eradicate his inclination for men, without attempting to create an equivalent for women; and if, in hypnosis, it could not be suggested to him that, in the future, men be a matter of indifference to him, and that, in intercourse with his friends, he no longer be excited sexually. Such a result would elevate very much his moral feeling, and make him satisfied and unembarrassed in social relations with his friends.

The possibility of such suggestive removal of feelings by hypnosis could not be gainsaid, though he was in doubt as to whether he could be hypnotized or not, since the hypnoscope had proved to have no effect upon him.

Out of pity and scientific interest, I decided to make an immediate attempt at hypnosis, after Bernheim’s method.

The patient passed easily into a condition of deep lethargy, and, in a drawling voice, repeated the following suggestion: “I feel that, from this time, I am sexually indifferent to men; and, that a man is as sexually indifferent to me as a woman.”

When I counted three,—having suggested previously that he awake at three,—the patient came to himself, as if out of a deep sleep, and performed immediately the post-hypnotic suggestion to open the door of the stove. He said that he had not lost consciousness entirely, that he had felt as one paralyzed and without will, and that he had felt a peculiar creeping sensation in all his limbs.

After five days the patient came again. In manner he was a different person, and he said, joyfully, that he felt like another man. Energy and will-power—the loss of which he had felt so keenly—had returned. He felt, now, entirely unembarrassed toward men, and had a new joy in living.

The following seven days he was hypnotized. Hypnosis is no longer as deep as at first, though the suggestion is always accepted and repeated. However, he is quite profoundly influenced; for, the suggestion given, he sleeps on, in a state of lethargy, for ten minutes, and has to be awakened by suggestion. This always occurs as if from a deep sleep,—slowly, and through a stage of somnolence.

After the eighth sitting the patient found himself well and happy, and in possession of full self-confidence. He had the feeling and the evidence that men had no influence on him.

He thought he could dispense with hypnotic treatment, and gratefully took his leave, with the promise that, should the influence of the suggestion fade, he would come again. Since then, I have heard nothing more of this interesting patient, and I have reason to hope that he remains improved.

The patient is, in all respects, of masculine appearance; beard abundant. Physically, with the exception of slight neurasthenic symptoms, he presents nothing remarkable. Genitals normal. (Personal case. Internat. Centralblatt, etc., Bd. i, Heft 1.)

Case 144. X., aged 33; single; tall. Mentally, of small endowment; comes of tainted family. Paternal grandfather died at thirty-four with a mental disease, which is said to have developed as a result of onanism and spermatorrhœa. His father and brother suffered with disturbances of the sexual functions. There was insanity in the mother’s family; other branches of the family were noted for their irritable and eccentric character.

The patient has too small a head, a retreating brow, abnormal ears, sparse growth of hair, and a hernia, which is probably congenital. Genitals large, and normally developed.

Great impressionability; neuropathic constitution; occasional tædium vitæ. For several years, peculiar, imperative ideas: that he is a locomotive; a horse; a velocipede; and, that he must act accordingly. From his earliest youth, contrary sexual feeling (congenital). Horror feminæ; sexual inclination toward boys; satisfaction by sensual contact, and, faute de mieux, masturbation. One day he had an affair with a boy dressed in gray, which made a deep impression on him. Since then, while masturbating, the image of the boy comes into his mind; and he cannot see gray clothes without having powerful erections. On the advice of physicians whom he consulted, he attempted coitus with women, but was cold and impotent, notwithstanding the assistance of memory-pictures of the boy dressed in gray; and he finally gave up the efforts.

March 27th, first hypnotic sitting. Small result. He resists, and says his fancy keeps him from going to sleep.

In a further series of sittings he declares that he experiences unfavorable effects,—is more excited, and troubled by imperative ideas and the desire to masturbate. He makes fun of the physician and hypnotism, and offers much resistance, with the expression that hypnotism is good for nothing, and only makes people crazy.

However, gradually it became possible to induce somnambulism. After twenty-five sittings the patient confessed that he was better, and that he was less troubled with imperative ideas and onanism. The sittings were repeated every week or two. The patient felt mentally and morally well, ceased to masturbate, but, at the end of treatment, was indifferent toward the opposite sex (Dr. Ladame, Revue de l’hypnotisme, September 1, 1889).

In the two foregoing cases there was successful suggestive removal of homo-sexual feelings,—a result which, as Case 143 shows, means a great improvement for such unfortunate individuals, in that it protects them from shame and the law. An entirely different and phenomenal result is presented by the following case, reported by Dr. v. Schrenk-Notzing in the Wiener internat. klin. Rundschau, October 6, 1889, No. 40, which is a case of effemination. It discloses a new method of treatment of urnings; but it is necessary to guard against illusions. Only where hypnosis can be deepened to somnambulism, are decided and lasting results to be expected:—

Case 145. Congenital Contrary Sexual Instinct Improved by Hypnotic Suggestion.—R., official, aged 28. January 20, 1888, he sought medical advice. He is the brother of the patient who is the subject of Case 135, and, therefore, of a badly tainted family (v. supra). Toward the end of treatment, he confessed that he was the author of the autobiography which was published as Case 83 in the fifth edition of this work, and it is here reproduced:—

“In brief, my abnormality consists of this, that in sexual relations I feel myself to be completely feminine. Since my earliest youth, in my sexual acts and fancies, I have always had before my eyes only images of masculine beings and masculine genitals.

“Until I went to the University, I found nothing in this (I had never spoken with others about my fancies, but rather, while at the Gymnasium, lived a silent and retired life).

“While at the University, it struck me that female persons made not the slightest impression on me. Since then, in houses of prostitution, etc., I have attempted coitus, or only to obtain an erection, with women, but always in vain.

“Erection ceased immediately, as soon as I was in a room alone with a woman. At first I considered it impotence, though, at the same time, I was so excited sexually that I had to masturbate several times during the day in order to sleep.

“Quite different, however, has been the development of my feelings toward the masculine sex, and it has grown stronger every year. At first they expressed themselves in extraordinary, enthusiastic friendship for certain persons, under whose windows at night I would wait for hours; whom in all possible ways I would try to meet on the streets, and with whom I sought to come in contact. I wrote such persons the most passionate letters, in which, however, I was shy in expressing my feelings too plainly. Later, after my twentieth year, I came to understand the essential nature of my inclinations, particularly from the sensual pleasure I experienced as soon as I came in direct contact with any of these friends. These persons were all finely built men, with dark hair and eyes. I have never had my feelings excited by boys. Real pederasty is absolutely incomprehensible to me. About this time (twenty-second to twenty-third year) the circle of my beloved friends grew more and more extensive. Now I can scarcely see a handsome man on the street without having the wish to possess him excited in me. The fact is, I especially love persons of the lower classes, whose powerful forms attract me,—soldiers, policemen, car-drivers, etc.,—i.e., all that wear uniforms. If one of these returns my look, I feel a kind of thrill go through my whole body. I am especially excitable in the evening, and merely the heavy tread of a soldier is alone sufficient to induce the most powerful erections. I take a very peculiar pleasure in following such persons and looking at them. As soon as I learn that they are married, or that they consort with girls, my excitement very frequently ceases.

“A few months ago I became able to control my inclinations to such an extent that they were not directly noticeable. About this time I followed a soldier who seemed likely to acquiesce in my desire, and spoke to him. For money he was ready for anything. At once I was filled with a most violent longing to embrace and kiss him, and the danger of being noticed did not deter me from doing it. He had scarcely grasped my genitals when ejaculation followed. With this meeting, I had finally attained the long-desired goal of my life. I knew that my whole nature would find its happiness and satisfaction in it, and from this time I gave myself up entirely to the effort to find a person whom I could love, and from whom I should never part. For my acts I do not experience the slightest twinge of conscience.

“To be sure, in quiet moments, I very well appreciate the difference between my way of thinking and the way of the world; as a lawyer, too, I naturally recognize the dangers of a relation of the kind I desire; but, as long as my entire nature does not change, I shall not be able to give up the opportunities offered me. Nevertheless, I should be willing to undergo any cure to be freed from my abnormal condition.

“I recognize my feminine feeling, among other things, in the fact that any sensual idea in connection with a woman must be forced, and seems unnatural to me. I am also sure that my respect for a woman—I move much in the society of ladies, and enjoy it—would change immediately to repugnance, were I to notice any sensual inclination in her toward me. In my dreams and sensual fancies of men, I always think of myself in such positions with them that their faces are always toward mine. My greatest delight would be to have a powerful man, undressed, take me in his arms with a force I could not resist. In such situations I always think of myself in a passive rôle, and have to force my feelings, in order to think of myself in any other position. In this, I am truly feminine. Great as my desire may be to approach certain persons, my struggle is as great not to allow this to be noticed. Moustaches, abundance of hair, and even dirt, seem to be especially enticing. It is hardly necessary to say that, to me, my condition, with reference to society, is absolutely desperate; and, if I had not the hope of finding a being that would understand me, life would be scarcely endurable. I feel that sexual commerce with a man is the only means of successfully combating my impulse to onanism. Though this has a very bad effect on me, I cannot keep myself from it constantly, because, as I have often found, I will be even more weakened by pollutions at night and persistent erections during the day.

“Up to this time I have truly loved but two men. Both were officers, remarkably endowed mentally, handsomely and gracefully formed, and of dark skin and eyes. I became acquainted with the first at the University. I was madly in love with him, and suffered unspeakably on account of his indifference. I spent nights under his window, simply to be near him. When he was officially transferred, I was in despair.

“Soon after, I became acquainted with an officer that resembled him, who likewise enchained me at first sight. I sought every opportunity to meet him, spent the day in the streets, and at places where I hoped to get a sight of him. I knew how the blood came into my face when, unsuspected, I saw him. When I saw him friendly with others, I could scarcely contain myself for jealousy. When I sat near him, I was impelled to touch him. I could scarcely conceal my excitement when I touched his knee or thigh. I never ventured, however, to express my feelings to him; for, from his conduct, I was convinced that he would not understand them or share them.

“I am twenty-seven years old, of medium height, and well-developed, and would be considered handsome. My chest is somewhat narrow, hands and feet small, and voice weak. Mentally, I think I am well endowed; for I passed the State examination with distinction, speak several languages, and am a good painter.

“In my calling I pass for one that is industrious and conscientious. My acquaintances think me cold and peculiar. I do not smoke, do not play games, and cannot sing or whistle. My gait, like my voice, is somewhat affected. I have much taste for elegance, love adornment, sweetmeats, and perfumes, and prefer the society of ladies.”

From Dr. von Schrenk’s notes of the case, it is learned, further, that social and criminal deterrents, on the one hand, and uncontrollable desire for his own sex, on the other, caused violent mental struggles, and made life unendurable. For this reason the patient confided in the physician. January 22, 1889, hypnotic treatment, with suggestion, after the method of Nancy, was begun with the patient. Gradually it became possible to induce somnambulism.

The suggestions were made with reference to indifference to men, and ability to resist them, and to increase of interest in women; masturbation was thus forbidden, and women substituted for men in lascivious dreams. After a few sittings pleasure at sight of women was induced. At the seventh sitting successful coitus was suggested; this was fulfilled.

During the next three months the patient remained, under the influence of occasional hypnotic suggestions, in the full possession of normal sexual functions. April 22, 1889, there was a relapse, induced by a companion. At the next sitting, remorse and shame. As expiation, coitus with a woman in the presence of his seducer.

The patient complained that coitus with women below him in station did not satisfy his æsthetic feelings. He hoped to find satisfaction in a happy marriage. After forty-five sittings (May 2, 1889) the patient considered himself cured. Treatment ceased. He became engaged to a young lady some weeks later, and presented himself again, after six months, as a happy bridegroom. He thought that, in his happiness with his wife, he had a sure preventive against relapse.

The author emphasizes the fact that the hypnotic treatment had no injurious collateral effect, and leaves undecided the question as to whether the cure is permanent or not, with R.’s very bad heredity. But he expresses the conviction that, in case of relapse, renewed hypnotic treatment would not be contra-indicated.

Since the incredible result of this case interested me exceedingly, as did its further course, I wrote to the author, requesting information concerning his patient.

Dr. v. Schrenk very kindly placed at my disposal the following letter, which he had received from the patient in January, 1890:—

“By means of suggestive treatment given me by Baron Schrenk, for the first time I became possessed of the psychical condition that permitted me to have intercourse with a woman, which, up to that time, in spite of repeated efforts, I had been unable to do successfully.

“Since my æsthetic needs were unsatisfied by intercourse with prostitutes, I thought to find my real salvation in matrimony. The earlier friendly inclination toward a lady known in my youth offered me the opportunity, the more because I believed that she, of all others, would be in a position to awaken feelings for the opposite sex which were absolutely foreign to me. Her character,—i.e., our harmony,—is in such accord with my inclinations that I am fully convinced that I shall also find complete psychical satisfaction. This conviction has not changed during the eight months of my engagement.

“I intend to be married in about four weeks.

“As far as my position with respect of my own sex is concerned, my power of resistance—and this is the lasting positive result of this treatment—is absolutely changed in degree. While previously it was impossible for me to overcome an intense sexual excitation when I saw a finely formed car-driver, to-day, in the company of my former lovers, I am without sexual excitement. At the same time, I must add that now, as formerly, their society has a certain attraction for me, though it is not to be compared with my earlier passion.

“On the other hand, I have refused repeated persuasions to indulge in sexual intercourse with men, without expending much force in resistance,—persuasions which formerly I should have been unable to resist. I may say, indeed, that it is a feeling of compassion for my former lovers, that have proved their passionate devotion to me, which keeps me from directly repulsing them. My action seems to be due to a feeling of duty, rather than to inner need.

“Since the conclusion of treatment, I have not consorted with prostitutes. This circumstance, and the numerous letters and persuasions from my former lover, may well be the reason why, in the eight months that have elapsed, I have allowed him to persuade me to sexual intercourse on three or four occasions. At these times I have always been conscious of being completely master of myself, as compared with my earlier passionate condition in like situations, as the violent reproaches of my friend convinced me. I always feel a certain unconquerable repugnance, which cannot be based on moral grounds, but which, I believe, must be attributed to the treatment. I no longer feel a love for him in the former sense. Besides, since the treatment, I have sought no opportunities for sexual intercourse with men, and I feel no need of it. But, formerly, not a day passed on which I did not feel impelled to it, so that at times I was unable to think of anything else. Awake or dreaming, ideas of sexual content are very infrequent.

“I may express the belief that my marriage, that is to take place in a few weeks, and the much desired change of place that is bound to it, will entirely remove the residuum of my earlier condition. I conclude these lines with the honest assurance that, subjectively, I am another man, and that this change has restored the mental equilibrium that was previously wanting.”

The foregoing words, which Dr. v. Schrenk completes with the verbal statement of the patient that he had not practiced onanism again, are a brilliant proof of the lasting effect of post-hypnotic suggestion. I consider the hetero-sexual instinct of the patient to be the artificial creation of his excellent physician; and the patient himself seems to recognize this, in that he speaks of a repugnance which “does not rest on moral grounds, but which depends on the treatment.”

The further fate of this interesting patient may be learned from the following letter, kindly submitted by Dr. v. Schrenk:—

“Honored Sir: Having been home some days from my wedding-journey, I wish to send you a short report of my present condition. During the week before my wedding I was in great excitement, because I feared that I should be unable to perform certain duties. The impelling thoughts of my friend, who wished another meeting with me, at any price, had no effect on me. We had not seen each other since I heard from you last. [Receipt of the professor’s letter.] However, I was much troubled with the thought that my marriage must be unhappy. Now, however, I have no anxiety. To be sure, on the first night, success was difficult,—to induce sexual excitation in myself,—but on the following night, and since, the influences needed for a normal man, I believe, would have been sufficient for me. I am also convinced that the harmony between us, which, of course, is mentally of long standing, will become more and more complete. A relapse to the former condition seems impossible. It is, perhaps, significant for my present condition, that I one night dreamed of my former lover, and that the dream was not sensual, and did not excite me sensually.

“I am satisfied with my present circumstances. I am, of course, well aware that my present inclinations are far from being of a degree equal to what they formerly were. I believe, however, that they will daily grow stronger. Already my former life is incomprehensible, and I cannot understand why I did not earlier think to overcome the abnormal sexual instinct by normal sexual indulgence. A relapse would now be possible only with an entire change of my mental life; and, in a word, it seems impossible.

“Your obedient servant, ——d.”

From a letter of Dr. v. Schrenk’s, of December 7th, I extract the following:—

“In this case the cure seems to be of longer duration than I expected; for, on speaking with the patient, some months ago, he said that he was perfectly happy in marriage, and, as I hear, he expects soon the happiness of a father.”

Dr. v. Schrenk has reported in the Wiener internationalen klinischen Rundschau, 1891, No. 26, later and very interesting facts concerning his patient, which, therapeutically, are very satisfactory.

IV. SPECIAL PATHOLOGY.
THE MANIFESTATIONS OF ABNORMAL SEXUAL LIFE IN THE VARIOUS FORMS AND STATES OF MENTAL DISTURBANCE.