C. is forty-five years old, married, father of one child. He does not know what diseases his parents or other members of his family have had. In childhood he was weak and neuropathic. At the age of five his head was injured by a blow with a hoe. A scar one-half cm. broad by one cm. long, situated on the right parietal and frontal bones, dates from that injury. The bone is here somewhat depressed. The overlying skin is united to the bone. Pressure at this point causes pain, which radiates along the lower branch of the trigeminus. This spot is also frequently spontaneously painful. In his youth he had frequent attacks of “fainting”; before puberty, pneumonia, rheumatism, and intestinal catarrh. At the age of seven he experienced a peculiar inclination for men,—i.e., for a certain superior. Whenever he saw this man he had a peculiar feeling in his heart; kissed the ground he walked on. At ten he fell in love with a certain deputy. Later he had an enthusiasm for men, though it was entirely platonic. He began to masturbate at the age of fourteen; first intercourse at seventeen. Then the earlier manifestations of contrary sexual feeling disappeared entirely. At that time he passed through a peculiar acute psychopathic condition, which he described as a kind of clairvoyance. From fifteen, hæmorrhoids, with symptoms of plethora abdominalis. When he had profuse hæmorrhoidal hæmorrhage, which occurred usually every three or four weeks, he was better. At other times he was constantly in a condition of painful sexual excitement, which he satisfied partly by means of onanism and partly by coitus. Every woman he met excited him; even when he was among female relatives he was impelled to make indecent proposals. Sometimes it was possible for him to master his desire; sometimes he was driven to indecent acts. If, after these, he was kicked out-of-doors, it seemed perfectly right to him; for he thought that he needed such correction and support against his powerful impulse, which was a burden to him. No periodicity in this sexual excitement was recognizable.
Until 1861 he committed excesses in venery and was several times infected with gonorrhœa and chancres. In 1861, marriage. He was sexually satisfied, but became a burden to his wife on account of his great sensuality. In 1864 he passed through an attack of mania in the hospital at Fiume, and in the same year he again fell ill, and was taken to the insane asylum at Ybbs, where he remained until 1867. There he suffered with recurrent mania accompanied by great sexual excitement. He says that intestinal catarrh and anxiety were the cause of his illness at that time.
Thereafter he was well, but he suffered much on account of his excessive sexual desire. If he were absent from his wife but a short time, the impulse became so powerful that man or animal was indifferent to him for the satisfaction of his lust. In summer these impulses were much stronger, and were always accompanied by abdominal plethora. Something that he remembered in medical reading, made him think that in his case the ganglionic system was more powerful than the cerebral. In October, 1873, on account of business, he had to leave his wife. From that time until Easter, with the exception of occasional masturbation, there was no sexual indulgence. After that he made use of women and bitches. From the middle of June until July 7, he had no opportunity for sexual indulgence. He felt nervously excited, relaxed, and as if he were going crazy. Of late he had slept badly. A longing for his wife, who lived in Vienna, drove him to leave his business. He obtained leave of absence. The heat and the noise of the train confused him, and he could no longer hold out against his sexual excitement and the pressure of blood in his abdomen. Everything danced before his eyes. He left the car at Bruck, and was absolutely confused, not knowing where he went; and for a moment the thought came to him to throw himself in the water; all was like a mist before his eyes. Then he saw a woman, exposed his genitals, and tried to embrace her. She cried for help, and thus he was arrested.
After the attempt it suddenly became clear to him what he had done. He openly confessed his crime, which he remembered in all its details, but which seemed to him to be something abnormal. He could not help it. For some days after this, C. suffered with headache and congestions, and was now and then excited and restless, and slept badly. His mental functions are undisturbed, but he is, nevertheless, a congenitally peculiar man, with a character weak and devoid of energy. The facial expression has something lascivious and peculiar about it. He suffers with hæmorrhoids. The genitals present nothing abnormal. The cranium is narrow and retreating at the forehead. Body large and well nourished. With the exception of diarrhœa, there is no disturbance of the vegetative functions.
Case 12. Mrs. E., aged 47. Uncle on father’s side was insane; father was sanguine, and given to excess in venery. Patient’s brother died of an acute cerebral affection. Patient from childhood has been nervous, eccentric, and romantic; and while little more than a child manifested excessive sexual desire, and at ten began sexual indulgence. At nineteen, marriage. Unhappy married life; her husband, who was normal, did not satisfy her, and until recent years she constantly had other friends besides her husband. She was well aware of the immorality of her life, but felt her powerlessness against her insatiable desire, which she sought to keep, at least outwardly, a secret. Later she thought that she had suffered with a “mania for men.” Patient has borne six children. Six years ago she was thrown from a wagon and received a severe cerebral concussion. Following this there was melancholia, with delusions of persecution, which sent her to the asylum. She is approaching the climacterium, and of late the menses have been profuse and too frequent. Since this period she is pleased to note that the previously powerful sexual impulse has declined. Proper behavior. Slight degree of descensus uteri and prolapsus ani.
Hyperæsthesia sexualis may be continuously present with exacerbations, or it may be intermittent or periodic. In the latter case it is a cerebral neurosis per se (vide “Special Pathology”), or an accompanying symptom of a condition of general psychical excitement (mania; episodically in dementia paralytica, dementia senilis, etc.).
Lentz has published a remarkable case of intermittent satyriasis (Bulletin de la société de méd. légale de Belgique, Nr. 21):—
Case 13. For three years the generally respected farmer D., married, aged 35, has manifested states of sexual excitement, with increasing frequency and severity, which, during the past year, have become true paroxysms of satyriasis. It was impossible to discover hereditary or other organic cause. D. was compelled, at times when his sexual excitement was excessive, to perform the sexual act from ten to fifteen times in twenty-four hours, without deriving any feeling of satisfaction. Gradually he developed a condition of general nervous hyper-irritability (éréthisme général) with increased emotional irritability to the extent of pathological outbreaks of anger, and impulse to over-indulgence in alcohol, which induced symptoms of alcoholism. His attacks of satyriasis became so violent that consciousness was interfered with, and the patient raged about in blind impulse to sexual acts. He demanded that his wife give herself to other men or to animals in his presence; that she allow copulation with him, presentibus filiabus, because this would afford him greater enjoyment. Memory for the events at the height of these attacks, in which the extreme irritability even led to outbreaks of maniacal rage, was entirely wanting. D. himself thought that he must have had moments in which he no longer had control of his senses, and without satisfaction from his wife would have been compelled to seize the next best female. After an attack of violent emotion, these attacks of sexual excitement suddenly disappeared entirely.
The two following cases show how powerful, dangerous, and painful sexual hyperæsthesia may become in those afflicted with this anomaly:—
Case 14. Hyperæsthesia Sexualis—Delirium Acutum ex Abstinentia.—On May 29, 1882, F., aged 29, single, shoemaker, was received at the clinic. Father was of passionate temper; mother neuropathic, and had an insane brother. Patient had never been seriously ill previously, and was not a drinker, but had always been sexually very passionate. Five days before, he was taken acutely ill mentally. He made two attempts at rape in broad daylight, before witnesses, and when arrested talked in delirium only of obscene things, and masturbated without stint, and for three days had been raving mad. On admission he presented the picture of a severe acute delirium, with violent motor symptoms of irritation, and fever. Under treatment with ergotin a cure was effected.