Bleeding of the nose is specially apt to occur at puberty and during adolescence, while in women it may take the place of menstruation and is sometimes more apt to occur at the menstrual periods; disorders of the nose have also been found to be aggravated at these periods. It has even been possible to control bleeding of the nose, both in men and women, by applying ice to the sexual regions. In both men and women, again, cases have been recorded in which sexual excitement, whether of coitus or masturbation, has been followed by bleeding of the nose. In numerous cases it is followed by slight congestive conditions of the nasal passages and especially by sneezing. Various authors have referred to this phenomenon; I am acquainted with a lady in whom it is fairly constant.[[41]] Féré records the case of a lady, a nervous subject, who began to experience intense spontaneous sexual excitement shortly after marriage, accompanied by much secretion from the nose.[[42]] J. N. Mackenzie is acquainted with a number of such cases, and he considers that the popular expression "bride's cold" indicates that this effect of strong sexual excitement is widely recognized.
The late Professor Hack, of Freiburg, in 1884, called general medical attention to the intimate connection between the nose and states of nervous hyperexcitability in various parts of the body, although such a connection had been recognized for many centuries in medical literature. While Hack and his disciples thus gave prominence to this association, they undoubtedly greatly exaggerated its importance and significance. (Sir Felix Semon, British Medical Journal, November 9, 1901.) Even many workers who have more recently further added to our knowledge have also, as sometimes happens with enthusiasts, unduly strained their own data. Starting from the fact that in women during menstruation examination of the nose reveals a degree of congestion not found during the rest of the month, Fliess (Die Beziehungen zwischen Nase und Weiblichen Geschlechtsorganen, 1897), with the help of a number of elaborate and prolonged observations, has reached conclusions which, while they seem to be hazardous at some points, have certainly contributed to build up our knowledge of this obscure subject. Schiff (Wiener klinische Wochenschrift, 1900, p. 58, summarized in British Medical Journal, February 16, 1901), starting from a skeptical standpoint, has confirmed some of Fliess's results, and in a large number of cases controlled painful menstruation by painting with cocaine the so-called "genital spots" in the nose, all possibility of suggestion being avoided. Ries, of Chicago, has been similarly successful with the method of Fliess (American Gynæcology, vol. iii, No. 4, 1903). Benedikt (Wiener medicinische Wochenschrift, No. 8, 1901, summarized in Journal of Medical Science, October, 1901), while pointing out that the nose is not the only organ in sympathetic relation with the sexual sphere, suggests that the mechanism of the relationship is involved in the larger problem of the harmony in growth and in nutrition of the different parts of the organism. In this way, probably, we may attach considerable significance to the existence of a kind of erectile tissue in the nose.
An interesting example of a reflex influence from the nose affecting the genital sphere has been brought forward by Dr. E. S. Talbot, of Chicago: "A 56-year-old man was operated on (September 1, 1903) for the removal of the left cartilage of the septum of the nose owing to a previous traumatic fracture at the sixteenth year. No pain was experienced until two years ago, when a continual soreness occurred at the apical end of the fracture during the winter months. The operation was decided upon fearing more serious complications. The parts were cocainized. No pain was experienced in the operation except at one point at the lower posterior portion near the floor of the nose. A profound shock to the general system followed. The reflex influence of the pain upon the genital organs caused semen to flow continually for three weeks. Treatment of general motor irritability with camphor monobromate and conium, on consultation with Dr. Kiernan, checked the flow. The discharge produced spinal neurasthenia. The legs and feet felt heavy. Erythromelalgia caused uneasiness. The patient walked with difficulty. The tired feeling in the feet and limbs was quite noticeable four months after the operation, although the pain had, to a great extent diminished." (Chicago Academy of Medicine, January, 1904, and private letter.)
J. N. Mackenzie has brought together a great many original observations, together with interesting quotations from old medical literature, in his two papers: "The Pathological Nasal Reflex" (New York Medical Journal, August 20, 1887) and "The Physiological and Pathological Relations between the Nose and the Sexual Apparatus of Man" (Johns Hopkins Hospital Bulletin, January 1, 1898). A number of cases have also been brought together from the literature by G. Endriss in his Inaugural Dissertation, Die bisherigen Beobachtungen von Physiologischen und Pathologischen Beziehungen der oberen Luftwege zu den Sexualorganen, Teil. II, Würzburg, 1892.
The intimate association between the sexual centers and the olfactory tract is well illustrated by the fact that this primitive and ancient association tends to come to the surface in insanity. It is recognized by many alienists that insanity of a sexual character is specially liable to be associated with hallucinations of smell.
Many eminent alienists in various countries are very decidedly of the opinion that there is a special tendency to the association of olfactory hallucinations with sexual manifestations, and, although one or two authorities have expressed doubt on the matter, the available evidence clearly indicates such an association. Hallucinations of smell are comparatively rare as compared to hallucinations of sight and hearing; they are commoner in women than in men and they not infrequently occur at periods of sexual disturbance, at adolescence, in puerperal fever, at the change of life, in women with ovarian troubles, and in old people troubled with sexual desires or remorse for such desires. They have often been noted as specially frequent in cases of excessive masturbation.
Krafft-Ebing, who found olfactory hallucinations common in various sexual states, considers that they are directly dependent on sexual excitement (Allgemeine Zeitschrift für Psychiatrie, bd. 34, ht. 4, 1877). Conolly Norman believes in a distinct and frequent association between olfactory hallucinations and sexual disturbance (Journal of Mental Science, July, 1899, p. 532). Savage is also impressed by the close association between sexual disturbance or changes in the reproductive organs and hallucinations of smell as well as of touch. He has found that persistent hallucinations of smell disappeared when a diseased ovary was removed, although the patient remained insane. He considers that such hallucinations of smell are allied to reversions. (G. H. Savage, "Smell, Hallucinations of," Tuke's Dictionary of Psychological Medicine; cf. the same author's manual of Insanity and Allied Neuroses.) Matusch, while not finding olfactory hallucinations common at the climacteric, states that when they are present they are connected with uterine trouble and sexual craving. He finds them more common in young women. (Matusch, "Der Einfluss des Climacterium auf Entstchung und Form der Geistesstörung," Allgemeine Zeitschrift für Psychiatrie, vol. xlvi, ht. 4). Féré has related a significant case of a young man in whom hallucinations of smell accompanied the sexual orgasm; he subsequently developed epilepsy, to which the hallucination then constituted the aura (Comptes Rendus de la Société de Biologie, December, 1896). The prevalence of a sexual element in olfactory hallucinations has been investigated by Bullen, who examined into 95 cases of hallucinations of smell among the patients in several asylums. (In a few cases there were reasons for believing that peripheral conditions existed which would render these hallucinations more strictly illusions.) Of these, 64 were women. Sixteen of the women were climacteric cases, and 3 of them had sexual hallucinations or delusions. Fourteen other women (chiefly cases of chronic delusional insanity) had sexual delusions. Altogether, 31 men and women had sexual delusions. This is a large proportion. Bullen is not, however, inclined to admit any direct connection between the reproductive system and the sense of smell. He finds that other hallucinations are very frequently associated with the olfactory hallucinations, and considers that the co-existence of olfactory and sexual troubles simply indicates a very deep and widespread nervous disturbance. (F. St. John Bullen, "Olfactory Hallucinations in the Insane," Journal of Mental Science, July, 1899.) In order to elucidate the matter fully we require further precise inquiries on the lines Bullen has laid down.
It may be of interest to note, in this connection, that smell and taste hallucinations appear to be specially frequent in forms of religious insanity. Thus, Dr. Zurcher, in her inaugural dissertation on Joan of Arc (Jeanne d'Arc, Leipzig, 1895, p. 72), estimates that on the average in such insanity nearly 50 per cent, of the hallucinations affect smell and taste; she refers also to the olfactory hallucinations of great religious leaders, Francis of Assisi, Katherina Emmerich, Lazzaretti, and the Anabaptists.
It may well be, as Zwaardemaker has suggested in his Physiologie des Geruchs, that the nasal congestion at menstruation and similar phenomena are connected with that association of smell and sexuality which is observable throughout the whole animal world, and that the congestion brings about a temporary increase of olfactory sensitiveness during the stage of sexual excitation.[[43]] Careful investigation of olfactory acuteness would reveal the existence of such menstrual heightening of its acuity.
In a few exceptional, but still quite healthy people, smell would appear to possess an emotional predominance which it cannot be said to possess in the average person. These exceptional people are of what Binet in his study of sexual fetichism calls olfactive type; such persons form a group which, though of smaller size and less importance, is fairly comparable to the well-known groups of visual type, of auditory type, and of psychomotor type. Such people would be more attentive to odors, more moved by olfactory sympathies and antipathies, than are ordinary people. For these, it may well be, the supremacy accorded to olfactory influences in Jäger's Entdeckung der Seele, though extravagantly incorrect for ordinary persons, may appear quite reasonable.