Too, the occupation and manner of thought of v. H. are decidedly feminine. He has a boudoir and a well-supplied toilet-table, with which he spends many hours in all kinds of arts for beautifying himself. He abhors the chase, practice with arms, and such masculine pursuits, and calls himself an æsthete; speaks with preference of his paintings and attempts at poetry. He is interested in feminine occupations, which—e.g., embroidery—he engages in, and calls his greatest pleasure. He could spend his life in an artistic and æsthetic circle of ladies and gentlemen, in conversation, music, and æsthetics. His conversation is preferably about feminine things,—fashions, needlework, cooking, and household work.
The patient is well nourished, but anæmic. He is of neuropathic constitution, and presents symptoms of neurasthenia, which are maintained by a bad manner of life, lying abed, living in-doors, and effeminateness. He complains of occasional pain and pressure in the head, and habitual obstipation. He is easily frightened; complains of occasional lassitude and fatigue, and drawing pains in the extremities, in the direction of the lumbo-abdominal nerves. After pollutions, and regularly after eating, he feels tired and relaxed; he is sensitive to pressure over the spinous processes of the dorsal vertebræ, as also to pressure along accessible nerves. He feels peculiar sympathies and antipathies for certain persons, and, when he meets people for whom he has an antipathy, he falls into a condition of peculiar fear and confusion. His pollutions, though now they occur but seldom, are pathological, in that they occur by day, and are unaccompanied by any sensual excitement.
Opinion: 1. Mr. v. H., according to all observations and reports, is mentally an abnormal and defective person, and that, in fact, ab origine. His contrary sexual instinct represents a part of his abnormal physical and mental condition.
2. This condition, in that it is congenital, is incurable. There exists defective organization of the highest cerebral centres, which renders him incapable of leading an independent life, and of obtaining a position in life. His perverse sexual instinct prevents him from exercising normal sexual functions; and this is attended by all the social consequences of such an anomaly, and the danger of satisfaction of perverse impulses arising out of his abnormal organization, with consequent social and legal conflicts. Fear of the latter, however, cannot be great, since the (perverse) sexual impulse of the patient is weak.
3. Mr. v. H., in the legal sense of the word, is not irresponsible, and neither fit for, or in need of, treatment in a hospital for the insane. It is possible for him—though but an overgrown child, and incapable of personal independence—to live in society, though under the care and guidance of normal individuals. Too, to a certain extent, it is possible for him to respect the laws and restrictions of society, and to judge his own acts; but, with respect of possible sexual errors and conflicts with criminal laws, it must be emphasized that his sexual instinct is abnormal, having its origin in organic pathological conditions; and this circumstance should eventually be used in his favor. On account of his notorious lack of independence, he cannot be discharged from parental care or guardianship, inasmuch as otherwise he would be ruined financially.
4. Mr. v. H. is also physically ill. He presents signs of slight anæmia and of neurasthenia spinalis. A rational regulation of his manner of life and a tonic regimen, and, if possible, hydro-therapeutic treatment, seem necessary. The suspicion that this trouble has its origin in early masturbation should be entertained, and the possibility of the existence of spermatorrhœa, that is of importance etiologically and therapeutically, lies near. (Personal case. Zeitschr. f. Psychiatrie.)
Case 130. Miss X., aged 38, consulted me, late in the fall of 1881, on account of severe spinal irritation and obstinate sleeplessness, in combating which she had become addicted to morphine and chloral. Her mother and sister were nervous sufferers, but the rest of the family were healthy. The trouble dated from a fall on her back in 1872, at which time the patient was terribly frightened, though, when a girl, she had been subject to muscular cramps and hysterical symptoms. Following this shock, a neurasthenic and hysterical neurosis developed, with predominating spinal irritation and sleeplessness. Episodically, hysterical paraplegia, lasting as long as eight months, and hysterical hallucinatory delirium, with convulsive attacks, occurred. In the course of this, symptoms of morphinism were added. A stay of some months in the hospital relieved the latter, and considerably improved the neurasthenic neurosis, in the treatment of which general faradization exerted a remarkably favorable influence.
Even at the first meeting, the patient produced a remarkable impression by reason of her attire, features, and conduct. She wore a gentleman’s hat, her hair closely cut, eye-glasses, a gentleman’s cravat, a coat-like outer garment of masculine cut that reached well down over her gown, and boots with high heels. She had coarse, somewhat masculine features; a harsh, deep voice; and made rather the impression of a man in female attire than that of a lady, if one but overlooked the bosom and the decidedly feminine form of the pelvis. During the long time that she was observed, there were never signs of erotocism. When questioned concerning her attire, she would only respond that the style she chose suited her better. Gradually it was ascertained from her that, even when she was a small girl, she had had a preference for horses and masculine pursuits, and never any interest in feminine occupations. Later she developed a particular pleasure in reading, and prepared herself to be a teacher. Dancing had never pleased her; it had always seemed silly to her. Too, the ballet had never interested her. Her greatest pleasure had always been in the circus. Until her sickness, in 1872, she had neither had inclination for persons of the opposite nor for those of her own sex. From that time she had, what was remarkable to herself, a peculiar friendship for females, particularly for young ladies; and she had a desire, and satisfied it, to wear hats and coats of masculine style. Since 1869, besides, she had worn her hair short, and parted it on the side, as men do. She asserts that she was never sensually excited in the company of men, but that her friendship and self-sacrifice for sympathetic ladies was unbounded; while from that time she also experienced repugnance for gentlemen and their society.
Her relatives report that, before 1872, the patient had a proposal of marriage, which she refused; and that when she returned from a sojourn at a watering-place, in 1874, she was sexually changed, and occasionally showed that she did not regard herself as a female.
Since that time she would associate only with ladies, and has had a kind of love-relation with one or another, and made remarks which indicated that she looked upon herself as a man. This predilection for women was decidedly more than mere friendship, since it expressed itself in tears, jealousy, etc.