We thus see that the ancient medico-philosophic conception of organic bisexuality put forth by the Greeks as the key to the explanation of sexual inversion, after sinking out of sight for two thousand years, was revived early in the nineteenth century by two amateur philosophers who were themselves inverted (Hössli, Ulrichs), as well as by a genuine philosopher who was not inverted (Schopenhauer). Then the conception of latent bisexuality, independently of homosexuality, was developed from the purely scientific side (by Darwin and evolutionists generally). In the next stage this conception was adopted by the psychiatric and other scientific authorities on homosexuality (Krafft-Ebing and the majority of other students). Finally, embryologists, physiologists of sex and biologists generally, not only accept the conception of bisexuality, but admit that it probably helps to account for homosexuality. In this way the idea may be said to have passed into current thought. We cannot assert that it constitutes an adequate explanation of homosexuality, but it enables us in some degree to understand what for many is a mysterious riddle, and it furnishes a useful basis for the classification not only of homosexuality, but of the other mixed or intermediate sexual anomalies in the same group. The chief of these intermediate sexual anomalies are: (1) physical hermaphroditism in its various stages; (2) gynandromorphism, or eunuchoidism, in which men possess characters resembling those of males who have been early castrated and women possess similarly masculine characters; (3) sexo-esthetic inversion, or Eonism (Hirschfeld's transvestism or cross-dressing), in which, outside the specifically sexual emotions, men possess the tastes of women and women those of men.
Hirschfeld has discussed these intermediate sexual stages in various works, especially in Geschlechtsübergänge (1905), Die Transvestiten (1910), and ch. xi of Die Homosexualität. Hermaphroditism (the reality of which has only of late been recognized and is still disputed) and pseudohermaphroditism; in their physical variations are fully dealt with in the great work, richly illustrated, Hermaphroditismus beim Menschen, by F. L. von Neugebauer, of Warsaw. Neugebauer published an earlier and briefer study of the subject in the Jahrbuch für sexuelle Zwischenstufen vol. iv, 1902, pp. 1-176, with a bibliography in vol. viii (1906) of the same Jahrbuch, pp. 685-700. Hirschfeld emphasizes the fact that neither hermaphroditism nor eunuchoidism is commonly associated with homosexuality, and that a large proportion of the cases of transvestism, as defined by him, are heterosexual. True inversion seems, however, to be not infrequently found among pseudohermaphrodites; Neugebauer records numerous cases; Magnan has published a case in a girl brought up as a youth (Gazette médical de Paris, March 31, 1911) and Lapointe a case in a man brought up as a girl (Revue de psychiatrie, 1911, p. 219). Such cases may be accounted for by the training and associations involved by the early error in recognition of sex, and perhaps still more by a really organic predisposition to homosexuality, although the sexual psychic characters are not necessarily bound up with the coexistence of corresponding sexual glands. Halban (Archiv für Gynäkologie 1903) goes so far as to class the homosexual as "real pseudohermaphrodites," exactly comparable to a man with a female breast or a woman with a beard, and proposes to term homosexuality "pseudohermaphroditus masculinus psychicus." This, however, is an unnecessary and scarcely satisfactory confusion.
To place the group of homosexual phenomena among other intermediate groups on the organic bisexual basis is a convenient classification. It can scarcely be regarded as a complete explanation. It is probable that we may ultimately find a more fundamental source of these various phenomena in the stimulating and inhibiting play of the internal secretions.[[234]] Our knowledge of the intimate association between the hormones and sexual phenomena is already sufficient to make such an explanation intelligible; the complex interaction of the glandular internal secretions and their liability to varying disturbance in balance may well suffice to account for the complexity of the phenomena. It would harmonize with what we know of the occasional delayed manifestations of homosexuality, and would not clash with their congenital nature, for we know that a disordered state of the thymus, for instance, may be hereditary, and it is held that status lymphaticus may be either inborn or acquired.[[235]] Normal sexual characters seem to depend largely upon the due co-ordination of the internal secretions, and it is reasonable to suppose that sexual deviations depend upon their inco-ordination. If a man is a man, and a woman a woman, because (in Blair Bell's phrase) of the totality of their internal secretions, the intermediate stages between the man and the woman must be due to redistribution of those internal secretions.[[236]]
We know that various internal secretions possess an influential sexual effect. Thus the atrophy of the thymus seems to be connected with sexual development at puberty; the thyroid reinforces the genital glands; adrenal overdevelopment can produce in a female the secondary characteristics of the male, as well as cause precocious development of maleness; etc. "An alteration in the metabolism," as F. H. A. Marshall suggests, "even in comparatively late life, may initiate changes in the direction of the opposite sex." Metabolic chemical processes may thus be found to furnish a key to complex and subtle sexual variations, alike somatic and psychic, although we must still regard such processes as arising on an inborn predisposition.
Whatever its ultimate explanation, sexual inversion may thus fairly be considered a "sport," or variation, one of those organic aberrations which we see throughout living nature, in plants and in animals.
It is not here asserted, as I would carefully point out, that an inverted sexual instinct, or organ for such instinct, is developed in early embryonic life; such a notion is rightly rejected as absurd. What we may reasonably regard as formed at an early stage of development is strictly a predisposition; that is to say, such a modification of the organism that it becomes more adapted than the normal or average organism to experience sexual attraction to the same sex. The sexual invert may thus be roughly compared to the congenital idiot, to the instinctive criminal, to the man of genius, who are all not strictly concordant with the usual biological variation (because this is of a less subtle character), but who become somewhat more intelligible to us if we bear in mind their affinity to variations. Symonds compared inversion to color-blindness; and such a comparison is reasonable. Just as the ordinary color-blind person is congenitally insensitive to those red-green rays which are precisely the most impressive to the normal eye, and gives an extended value to the other colors,—finding that blood is the same color as grass, and a florid complexion blue as the sky,—so the invert fails to see emotional values patent to normal persons, transferring those values to emotional associations which, for the rest of the world, are utterly distinct. Or we may compare inversion to such a phenomenon as color-hearing, in which there is not so much defect as an abnormality of nervous tracks producing new and involuntary combinations. Just as the color-hearer instinctively associates colors with sounds, like the young Japanese lady who remarked when listening to singing, "That boy's voice is red!" so the invert has his sexual sensations brought into relationship with objects that are normally without sexual appeal.[[237]] And inversion, like color-hearing is found more commonly in young subjects, tending to become less marked, or to die out, after puberty. Color-hearing, while an abnormal phenomenon, it must be added, cannot be called a diseased condition, and it is probably much less frequently associated with other abnormal or degenerative stigmata than is inversion; there is often a congenital element, shown by the tendency to hereditary transmission, while the associations are developed in very early life, and are too regular to be the simple result of suggestion.[[238]]
All such organic variations are abnormalities. It is important that we should have a clear idea as to what an abnormality is. Many people imagine that what is abnormal is necessarily diseased. That is not the case, unless we give the word disease an inconveniently and illegitimately wide extension. It is both inconvenient and inexact to speak of color-blindness, criminality, and genius as diseases in the same sense as we speak of scarlet fever or tuberculosis or general paralysis as diseases. Every congenital abnormality is doubtless due to a peculiarity in the sperm or oval elements or in their mingling, or to some disturbance in their early development. But the same may doubtless be said of the normal dissimilarities between brothers and sisters. It is quite true that any of these aberrations may be due to antenatal disease, but to call them abnormal does not beg that question. If it is thought that any authority is needed to support this view, we can scarcely find a weightier than that of Virchow, who repeatedly insisted on the right use of the word "anomaly," and who taught that, though an anomaly may constitute a predisposition to disease, the study of anomalies—pathology, as he called it, teratology as we may perhaps prefer to call it—is not the study of disease, which he termed nosology; the study of the abnormal is perfectly distinct from the study of the morbid. Virchow considers that the region of the abnormal is the region of pathology, and that the study of disease must be regarded distinctly as nosology. Whether we adopt this terminology, or whether we consider the study of the abnormal as part of teratology, is a secondary matter, not affecting the right understanding of the term "anomaly" and its due differentiation from the term "disease."
At the Innsbruck meeting of the German Anthropological Society, in 1894, Virchow thus expressed himself: "In old days an anomaly was called πάθος, and in this sense every departure from the norm is for me a pathological event. If we have ascertained such a pathological event, we are further led to investigate what pathos was the special cause of it.... This cause may be, for example, an external force, or a chemical substance, or a physical agent, producing in the normal condition of the body a change, an anomaly (πάθος). This can become hereditary under some circumstances, and then become the foundation for certain small hereditary characters which are propagated in a family; in themselves they belong to pathology, even although they produce no injury. For I must remark that pathological does not mean harmful; it does not indicate disease; disease in Greek is νὁσος, and it is nosology that is concerned with disease. The pathological under some circumstances can be advantageous" (Correspondenz-blatt Deutsch Gesellschaft für Anthropologie, 1894). These remarks are of interest when we are attempting to find the wider bearings of such an anomaly as sexual inversion.
This same distinction has more recently been emphasized by Professor Aschoff (Deutsche medizinische Wochenschrift, February 3, 1910; of. British Medical Journal, April 9, 1910, p. 892), as against Ribbert and others who would unduly narrow the conception of πάθος. Aschoff points out that, not merely for the sake of precision and uniformity of terminology but of clear thinking, it is desirable that we should retain a distinction in regard to which Galen and the ancient physicians were very definite. They used πάθος as the wider term involving affection (affectio) in general, not necessarily impairment of vital tissue; when that was involved there was νὁσος, disease. We have to recognize the distinction even if we reject the terminology.
A word may be said as to the connection between sexual inversion and degeneration. In France especially, since the days of Morel, the stigmata of degeneration are much spoken of. Sexual inversion is frequently regarded as one of them: i.e., as an episodic syndrome of a hereditary disease, taking its place beside other psychic stigmata, such as kleptomania and pyromania. Krafft-Ebing long so regarded inversion; it is the view of Magnan, one of the earliest investigators of homosexuality;[[239]] and it was adopted by Möbius. Strictly speaking, the invert is degenerate; he has fallen away from the genus. So is a color-blind person. But Morel's conception of degenerescence has unfortunately been coarsened and vulgarized.[[240]] As it now stands, we gain little or no information by being told that a person is a "degenerate." It is only, as Näcke constantly argued, when we find a complexus of well-marked abnormalities that we are fairly justified in asserting that we have to deal with a condition of degeneration. Inversion is sometimes found in such a condition. I have, indeed, already tried to suggest that a condition of diffused minor abnormality may be regarded as a basis of congenital inversion. In other words, inversion is bound up with a modification of the secondary sexual characters. But these anomalies and modifications are not invariable,[[241]] and are not usually of a serious character; inversion is rare in the profoundly degenerate. It is undesirable to call these modifications "stigmata of degeneration," a term which threatens to disappear from scientific terminology, to become a mere term of literary and journalistic abuse. So much may be said concerning a conception or a phrase of which far too much has been made in popular literature. At the best it remains vague and unfitted for scientific use. It is now widely recognized that we gain little by describing inversion as a degeneration. Näcke, who attached significance to the stigmata of degeneration when numerous, was especially active in pointing out that inverts are not degenerate, and frequently returned to this point. Löwenfeld, Freud, Hirschfeld, Bloch, Rohleder all reject the conception of sexual inversion as a degeneracy.