The following cases show the development of the interesting neuro-psychological process to its height:—
Case 100. K., aged 36, single, servant, received at the clinic on February 26, 1889, is a typical case of paranoia persecutoria, resulting from neurasthenia sexualis, with olfactory hallucinations, sensations, etc. He comes of a predisposed family. Several brothers and sisters were psychopathic. Patient has an hydrocephalic skull, depressed in the region of the right fontanelle; eyes neuropathic. He has always been very sensual; began to masturbate at nineteen; had coitus at twenty-three; begat three illegitimate children. He gave up further sexual intercourse, on account of fear of begetting more children, and of being unable to provide for them. Abstinence proved very painful to him. He also gave up masturbation, and was then troubled with pollutions. A year and a half ago he became sexually neurasthenic, had diurnal pollutions, became thereafter ill and miserable, and, after a time, generally neurasthenic, finally developing paranoia. A year ago he began to have paræsthetic sensations,—as if there were a great coil in the place of his genitals; and then he felt that his scrotum and penis were gone, and that his genitals were changed into those of a female. He felt the growth of his breasts; that his hair was that of a woman; and that feminine garments were on his body. He thought himself a woman. The people in the street gave utterance to corresponding remarks: “Look at the woman! The old blowhard!” In a half dreamy state, he had the feeling as if he played the part of a woman in coitus with a man. During it he had the most lively feelings of pleasure. During his stay at the clinic, a remission of the paranoia occurred, and, at the same time, a marked improvement of the neurasthenia. Then the feelings and ideas due to a developing metamorphosis sexualis disappeared.
A more advanced case of eviration, on the way to a transformatio sexus paranoica, is the following:—
Case 101. Franz St., aged 33; school-teacher; single; probably of tainted family; always neuropathic; emotional, timid, intolerant of alcohol; began to masturbate at eighteen. At thirty there were manifestations of neurasthenia sexualis (pollutions with consequent fatigue, which at last began to occur during the day; pain in the region of the sacral plexus, etc.). Gradually, spinal irritation, pressure in the head, and cerebral neurasthenia were added. Since the beginning of 1885 the patient had given up coitus, in which he no longer experienced pleasurable feeling. He masturbated frequently.
In 1888 he began to have delusions of suspicion. He noticed that he was avoided, and that he had unpleasant odors about him (olfactory hallucinations). In this way he explained the altered attitude of people, and their sneezing, coughing, etc. He smelled corpses and foul urine. He recognized the cause of his bad smells in inward pollutions. He recognized these in a feeling he had as if a fluid flowed up from the symphysis toward the breast. Patient soon left the clinic.
In 1889 he was again received in an advanced stage of paranoia masturbatoria persecutoria (delusions of physical persecution).
In the beginning of May, 1889, the patient attracted notice, in that he was cross when he was addressed as “mister.” He protested against it, because he was a woman. Voices told him this. He noticed that his breasts were growing. Some weeks before, others had touched him in a sensual manner. He heard it said that he was a whore. Of late, dreams of pregnancy. He dreamed that, as a woman, he indulged in coitus. He felt the immissio penis, and, during the hallucinatory act, also a feeling of ejaculation.
Head straight; facial form long and narrow; parietal eminences prominent; genitals normally developed.
The following case, observed in the asylum at Illenau, is a pertinent example of lasting delusional alteration of sexual consciousness:—
Case 102. Metamorphosis Sexualis Paranoica.—N., aged 23, single, pianist, was received in the asylum at Illenau in the last part of October, 1865. He came of a family in which there was said to be no hereditary taint; but it was tuberculous (father and brother died of pulmonary tuberculosis). Patient, as a child, was weakly and dull, though especially talented in music. He was always of abnormal character; silent, retiring, unsocial, and sullen. He practiced masturbation after fifteen. After a few years neurasthenic symptoms (palpitation of the heart, lassitude, occasional pressure in the head, etc.), and also hypochondriacal symptoms, were manifested. During the last year he had worked with great difficulty. For about six months neurasthenia had increased. He complained of palpitation of the heart, pressure in the head, and sleeplessness; was very irritable, and seemed to be sexually excited. He declared that he must marry for his health. He fell in love with an artist, but almost at the same time (September, 1865) he fell ill with paranoia persecutoria (ideas of enemies, derision in the street, poison in food; obstacles were placed on the bridges to keep him from going to his inamorata). On account of increasing excitement and conflicts with those about him that he considered inimical to him, he was taken to the asylum. At first he presented the picture of a typical paranoia persecutoria with symptoms of sexual, and later general, neurasthenia, though the delusions of persecution did not rest upon this neurotic foundation. It was only occasionally that the patient heard such sentences as this: “Now the semen will be drawn out of him. Now the bladder will be cut out.”