“This man followed me, and made strange proposals which I did not understand, and repelled. He did not give me any rest. I learned the secrets of male love for males, and felt that my sexuality was excited by it. But I resisted the shameful passion (as I then regarded it), and, for the next three years, I remained free from it. During this time I repeatedly attempted coitus with girls in vain. My attempts to free myself of my impotence by means of medical treatment were also vain. Once, when my libido sexualis was troubling me again, I recalled what the old man had told me: that male-loving men were accustomed to meet on the E. Promenade.
“After a hard struggle, and with beating heart, I went there, made the acquaintance of a blonde man, and allowed myself to be seduced. The first step was taken. This kind of sexual love was satisfactory to me. I always preferred to be in the arms of a strong man. The satisfaction consisted of mutual manustupration; occasionally in osculum ad penem alterius. I was then twenty-three years old. Sitting, together with my comrades, on the beds of patients in the clinic during the lectures, excited me so intensely that I could scarcely listen to the lectures. In the same year I entered into a formal love-relation with a merchant of thirty-four. We lived as man and wife. X. played the man, and fell more and more in love. I gave up to him, but now and then I had to play the man. After a time I grew tired of him, became unfaithful, and he became jealous. There were terrible scenes, which led to temporary separation, and finally to actual rupture. (The merchant afterward became insane, and died by suicide.)
“I made many acquaintances, and loved the most ordinary people. I preferred those having a full beard, and who were tall and of middle age, and able to play the active rôle well. I developed a proctitis. The professor thought it was the result of sitting too much while preparing for examinations. I developed a fistula, and had to undergo an operation; but this did not cure me of my desire to allow myself to be used passively. I became a physician, and went to a provincial city, where I had to live like a nun. I developed a desire to move in ladies’ society, and was gladly welcomed there; because it was found that I was not so one-sided as most men, and was interested in toilettes and such feminine things. However, I felt very unhappy and lonesome. Fortunately, in this town, I made the acquaintance of a man, a ‘sister,’ who felt like me. For some time I was taken care of by him. When he had to leave, I had an attack of despair, with depression, which was accompanied by thoughts of suicide.
“When it became impossible for me to longer endure the town, I became a military surgeon in the Capital. There I began to live again, and often made two or three acquaintances in one day. I had never loved boys or young people; only fully-developed men. The thought of falling into the hands of the police was frightful. Thus I have escaped the clutches of the blackmailer. At the same time, I could not keep myself from the satisfaction of my impulse. After some months I fell in love with an official of forty. I remained true to him for a year, and we lived like a pair of lovers. I was the wife, and was formally courted by the lover. One day I was transferred to a small town. We were in despair. The last night was spent in continually kissing and caressing one another.
“In T. I was unspeakably unhappy, in spite of some ‘sisters’ whom I found. I could not forget my lover. In order to satisfy my sexual desire, which cried for satisfaction, I chose soldiers. Money obtained men; but they remained cold, and I had no enjoyment with them. I was successful in being re-transferred to the Capital. There, there was a new love-relation, but much jealousy; because my lover liked to go into the society of ‘sisters,’ and was proud and coquettish. There was a rupture. I was very unhappy and very glad to be transferred from the Capital. I now stayed in C., alone and in despair. Two infantry privates were brought into service, but with the same unsatisfactory result. When shall I ever find true love again?
“I am over medium height, well developed, and look somewhat aged; and, therefore, when I wish to make conquests I use the arts of the toilet. My manner, movements, and face are masculine. Physically I feel as youthful as a boy of twenty. I love the theatre, and especially art. My interest in the stage is in the actresses, whose every movement and gesture I notice and criticise.
“In the society of gentlemen I am silent and embarrassed, while in the society of those like myself I am free, witty, and as fawning as a cat, if a man is sympathetic. If I am without love, I become deeply melancholic; but the favors of the first handsome man dispel my depression. In other ways I am frivolous; anything but ambitious. My profession is nothing to me. Masculine pursuits do not interest me. I prefer novels and going to the theatre. I am effeminate, sensitive, easily moved, easily injured, and nervous. A sudden noise makes my whole body tremble, and I have to collect myself in order to keep from crying out.”
Remarks: The foregoing case is certainly one of acquired contrary sexual instinct, since the sexual instinct and impulse were originally directed toward the female sex. Sch. became neurasthenic through masturbation.
As an accompanying manifestation of the neurasthenic neurosis, lessened impressionability of the erection-centre and consequent relative impotence came on. As a result of this, sexual sensibility toward the opposite sex was lessened, with simultaneous persistence of libido sexualis. The acquired contrary sexual instinct must be abnormal, since the first touch by a person of the same sex is an adequate stimulus for the erection-centre. The perverse sexual feeling became complete. At first Sch. felt like a man in the sexual act; but more and more, as the change progressed, the feeling and desire of satisfaction changed to the form which, as a rule, characterizes the (congenital) urning.
This eviration induces a desire for the passive rôle, and, further, for (passive) pederasty. It makes a deeper impress on the character. The character becomes feminine, inasmuch as Sch. now prefers to move in the society of actual females, has an increasing desire for feminine occupations, and, indeed, makes use of the arts of the toilet in order to improve his fading charms and make “conquests.”
The foregoing facts, concerning acquired contrary sexual instinct and effemination, find an interesting confirmation in the following ethnological data:—
Even Herodotus describes a peculiar disease which frequently affected the Scythians. The disease consisted in this: that men became effeminate in character, put on female garments, did the work of women, and even became effeminate in appearance. As an explanation of this insanity of the Scythians,[103] Herodotus relates the myth that the goddess Venus, angered by the plundering of the temple at Ascalon by the Scythians, had made women of these plunderers and their posterity.
Hippocrates, not believing in supernatural diseases, recognized that impotence was here a causative factor, and explained it, though incorrectly, as due to the custom of the Scythians, by attributing it to disease of the jugular veins induced by excessive riding. He thought that these veins were of great importance in the preservation of the sexual powers, and that when they were severed, impotence was induced. Since the Scythians considered their impotence due to divine punishment, and incurable, they put on the clothing of females, and lived as women among women.
It is worthy of note that, according to Klaproth (“Reise in den Kaukasus,” Berlin, 1812, v, p. 285) and Chotomski, even at the present time impotence is very frequent among the Tartars, as a result of riding unsaddled horses. The same is observed among the Apaches and Navajos of the Western Continent, who ride excessively, scarcely ever going on foot, and are remarkable for small genitals and mild libido and virility. Sprengel, Lallemand, and Nysten recognized the fact that excessive riding may be injurious to the sexual organs.
Hammond reports analogous observations of great interest concerning the Pueblo Indians of New Mexico. These descendants of the Aztecs cultivate so-called “mujerados,” of which every Pueblo tribe requires one in the religious ceremonies (actual orgies in the spring), in which pederasty plays an important part. In order to cultivate a “mujerado,” a very powerful man is chosen, and he is made to masturbate excessively and ride constantly. Gradually such irritable weakness of the genital organs is engendered that, in riding, great loss of semen is induced. This condition of irritability passes into paralytic impotence. Then the testicles and penis atrophy, the hair of the beard falls out, the voice loses its depth and compass, and physical strength and energy decrease. Inclinations and disposition become feminine. The “mujerado” loses his position in society as a man. He takes on feminine manners and customs, and associates with women. Yet, for religious reasons, he is held in honor. It is probable that, at other times than during the festivals, he is used by the chiefs for pederasty. Hammond had an opportunity to examine two “mujerados.” One had become such seven years before, and was thirty-five years old at the time. Seven years before, he was entirely masculine and potent. He had noticed gradual atrophy of the testicles and penis. At the same time he lost libido and the power of erection. He differed in nowise, in dress and manner, from the women among whom Hammond found him. The genital hair was wanting, the penis was shrunken, the scrotum lax and pendulous, and the testicles were very much atrophied and no longer sensitive to pressure. The “mujerado” had large mammæ like a pregnant woman, and asserted that he had nursed several children whose mothers had died. A second “mujerado,” aged thirty-six, after he had been ten years in the condition, presented the same peculiarities, though with less development of mammæ. Like the first, the voice was high and thin. The body was plump.[104]
A further degree of development is represented by those cases in which bodily sensation is also transformed in the sense of a transmutatio sexus. In this respect the following case is unique:—
Case 99. Autobiography. “Born in Hungary in 1844, for many years I was the only child of my parents; for the other children died for the most part of general weakness. A brother came late, who is still living.
“I come of a family in which nervous and mental diseases have been numerous. It is said that I was very pretty as a little child, with blonde locks and transparent skin; very obedient, quiet, and modest, so that I was taken everywhere in the society of ladies without any offense on my part.
“With a very active imagination—my enemy through life—my talents developed rapidly. I could read and write at the age of four; my memory reaches back to my third year. I played with everything that fell into my hands,—with leaden soldiers, or stones, or ribbons from a children’s store; but a machine for working in wood, that was given to me as a present, I did not like. I liked best to be at home with my mother, who was everything to me. I had two or three friends, with whom I got on good-naturedly; but I liked to play with their sisters quite as well, who always treated me like a girl, which at first did not embarrass me. I must have already been on the road to become just like a girl; at least, I can still well remember how it was always said: ‘He is not intended for a boy.’ At this I tried to play the boy,—imitated my companions in everything, and tried to surpass them in wildness. In this I succeeded. There was no tree or building too high for me to reach its top. I took great delight in soldiers. I avoided girls more, because I did not wish to play with their play-things; and it always annoyed me that they treated me so much like one of themselves.
“In the society of mature people, however, I was always modest, and, also, always regarded with favor. Fantastic dreams about wild animals—which once drove me out of bed without waking me—frequently troubled me. I was always very simply, but very elegantly, dressed, and thus developed a taste for beautiful clothing. It seems peculiar to me that, from the time of my school-days, I had a partiality for ladies’ gloves, which I put on secretly as often as I could. Thus, when once my mother was about to give away a pair of gloves, I made great opposition to it, and told her, when she asked why I acted so, that I wanted them myself. I was laughed at; and from that time I took good care not to display my preference for female things. Yet my delight in them was very great. I took especial pleasure in masquerade costumes,—i.e., only in female attire. If I saw them, I envied their owners. What seemed to me the prettiest sight was: two young men, beautifully dressed as white ladies, with masks on; and yet I would not have shown myself to others as a girl for anything; I was so afraid of being ridiculed. At school I worked very hard, and was always among the first. From childhood my parents taught me that duty came first; and they always set me an example. It was also a pleasure for me to attend school; for the teachers were kind, and the elder scholars did not plague the younger ones. We left my first home; for my father was compelled, on account of his business,—which was dear to him,—to separate from his family for a year. We moved to Germany. Here there was a stricter, rougher manner, partly in teachers and partly in scholars; and I was again ridiculed on account of my girlishness. My school-mates went so far as to give a girl, who had exactly my features, my name, and me hers; so that I hated the girl. But I later came to be on terms of friendship with her after her marriage. My mother tried to dress me elegantly; but this was repugnant to me, because it made me the object of joke. So, finally, I was delighted when I had correct trousers and coats. But with these came a new annoyance. They irritated my genitals, particularly when the cloth was rough; and the touch of tailors while measuring me, on account of their tickling, which almost convulsed me, was unendurable, particularly about the genitals. Then I had to practice gymnastics; and I simply could do nothing at all, or only indifferently the things that girls cannot do easily. While bathing I was troubled by feeling ashamed to undress; but I liked to bathe. Until my twelfth year I had a great weakness in my back. I learned to swim late, but ultimately so well that I took long swims. At thirteen I had pubic hair, and was about six feet tall; but my face was feminine until my eighteenth year, when my beard came in abundance and gave me rest from resemblance to woman. An inguinal hernia that was acquired in my twelfth year, and cured when I was twenty, gave me much trouble, particularly in gymnastics. Besides, from my twelfth year on, I had, after sitting long, and particularly while working at night, an itching, burning, and twitching, extending from the penis to my back, which the acts of sitting and standing increased, and which was made worse by catching cold. But I had no suspicion whatever that this could be connected with the genitals. Since none of my friends suffered in this way, it seemed strange to me; and it required the greatest patience to endure it; the more owing to the fact that my abdomen troubled me.
“In sexualibus I was still perfectly innocent; but now, as at the age of twelve or thirteen, I had a definite feeling of preferring to be a young lady. A young lady’s form was more pleasing to me; her quiet manner, her deportment, but particularly her attire, attracted me. But I was careful not to allow this to be noticed; and yet, I am sure that I should not have shrunk from the castration-knife, could I have thus attained my desire. If I had been asked to say why I preferred female attire, I could have said nothing more than that it attracted me powerfully; perhaps, too, I seemed to myself, on account of my uncommonly white skin, more like a girl. The skin of my face and hands, particularly, was very sensitive. Girls liked my society; and, though I should have preferred to have been with them constantly, I avoided them when I could; for I had to exaggerate in order not to appear feminine. In my heart I always envied them. I was particularly envious when one of my young girl friends got long dresses and wore gloves and veils. When, at the age of fifteen, I was on a journey, a young lady, with whom I was boarding, proposed that I mask as a lady and go out with her; but, owing to the fact that she was not alone, I did not acquiesce, much as I should have liked it. Others stood on very little ceremony with me. While on this journey, I was pleased at seeing boys in one city wearing blouses with short sleeves, and the arms bare. A lady elaborately dressed was like a goddess to me; and if even her hand touched me coldly I was happy and envious, and only too gladly would have put myself in her place in the beautiful garments and lovely form. Nevertheless, I studied assiduously, and passed through the Realschule and the Gymnasium in nine years, passing a good final examination. I remember, when fifteen, to have first expressed to a friend the wish to be a girl. In answer to his question, I could not give the reason why. At seventeen I got into fast society; I drank beer, smoked, and tried to joke with waiter-girls. The latter liked my society, but they always treated me as if I wore petticoats. I could not take dancing lessons, they repelled me so; but if I could have gone as a mask, it would have been different. My friends loved me dearly; I hated only one, who seduced me into onanism. Shame on those days, which injured me for life! I practiced it quite frequently, but in it seemed to myself like a double man. I cannot describe the feeling; I think it was masculine, but mixed with feminine elements. I could not approach girls; I feared them, but they were not strange to me. They impressed me as being more like myself; I envied them. I would have denied myself all pleasures if, after my classes, at home I could have been a girl and thus have gone out. Crinoline and a smoothly-fitting glove were my ideals. With every lady’s gown I saw I fancied how I should feel in it,—i.e., as a lady. I had no inclination toward men. But I remember that I was somewhat lovingly attached to a very handsome friend with a girl’s face and dark hair, though I think I had no other wish than that we both might be girls.
“At the high-school I finally once had coitus; hoc modo sensi, me libentius sub puella concubuisse et penem meum cum cunno mutatum maluisse. To my astonishment, too, the girl had to treat me as a girl, and did it willingly; but she treated me as if I were she (she was still quite inexperienced, and, therefore, did not laugh at me).
“When a student, at times I was wild, but I always felt that I assumed this wildness as a mask. I drank and duelled, but I could not take lessons in dancing, because I was afraid of betraying myself. My friendships were close, but without other thoughts. It pleased me most to have a friend masked as a lady, or to study the ladies’ costumes at a ball. I understood such things perfectly. Gradually I began to feel like a girl.
“On account of unhappy circumstances, I twice attempted suicide. Without any cause I once slept fourteen days, had many hallucinations (visual and auditory at the same time), and was with both the living and the dead. The latter habit of thought remains. I also had a friend (a lady) who knew my hobby and put on my gloves for me; but she always looked upon me as a girl. Thus I understood women better than other men did, and in what they differed from men; so I was always treated more feminarum,—as if they had found in me a female friend. On the whole, I could not endure obscenity, and indulged in it myself only out of braggadocio when it was necessary. I soon overcame my aversion to foul odors and blood, and even liked them. I was wanting in only one respect: I could not understand my own condition. I knew that I had feminine inclinations, but believed that I was a man. Yet I doubt whether, with the exception of the attempts at coitus, which never gave me pleasure (which I ascribe to onanism), I ever admired a woman without wishing I were she; or without asking myself whether I should not like to be the woman, or be in her attire. Obstetrics I learned with difficulty (I was ashamed for the exposed girls, and had a feeling of pity for them); and even now I have to overcome a feeling of fright in obstetrical cases; indeed, it has happened that I thought I felt the traction myself. After filling several positions successfully as a physician, I went through a military campaign as a volunteer surgeon. Riding, which, while a student, was painful to me, because in it the genitals had more of a feminine feeling, was difficult for me (it would have been easier in the female style).
“Still, I always thought I was a man with obscure masculine feeling; and whenever I associated with ladies, I was still soon treated as an inexperienced lady. When I wore a uniform for the first time, I should have much preferred to have slipped into a lady’s costume, with a veil; I was disturbed when the stately uniform attracted attention. In private practice I was successful in the three principal branches. Then I made another military campaign; and during this I came to understand my nature; for I think that, since the first ass, no beast of burden has ever had to endure with so much patience as I have. Decorations were not wanting, but I was indifferent to them.
“Thus I went through life, such as it was, never satisfied with myself, full of dissatisfaction with the world, and vacillating between sentimentality and a wildness that was for the most part affected.
“My experience as a candidate for matrimony was very peculiar. I should have preferred not to marry, but family circumstances and practice forced me to it. I married an energetic, amiable lady, of a family in which female government was rampant. I was in love with her as much as one of us can be in love,—i.e., what we love we love with our whole hearts, and live in it, even though we do not show it as much as a genuine man does. We love our brides with all the love of a woman, almost as a woman might love her bridegroom. But I cannot say this for myself; for I still believed that I was but a depressed man, who would come to himself, and find himself out by marriage. But, even on my marriage-night, I felt that I was only a woman in man’s form; sub femina locum meum esse mihi visum est. On the whole, we lived contented and happy, and for two years were childless. After a difficult pregnancy, during which I was in mortal fear of death, the first boy was born in a difficult labor,—a boy on whom a melancholy nature still hangs; who is still of melancholy disposition. Then came a second, who is very quiet; a third, full of peculiarities; a fourth, a fifth; and all have predisposition to neurasthenia. Since I always felt out of my own place, I went much in gay society; but I always worked as much as human strength would allow. I studied and operated; and I experimented with many drugs and methods of cure, always on myself. I left the regulation of the house to my wife, as she understood house-keeping very well. My marital duties I performed as well as I could, but without personal satisfaction. Since the first coitus, the masculine position in it has been repugnant, and, too, difficult for me. I should have much preferred to have the other rôle. When I had to deliver my wife, it almost broke my heart; for I knew how to appreciate her pain. Thus we lived long together, until severe gout drove me to various baths, and made me neurasthenic. At the same time, I became so anæmic that every few months I had to take iron for some time; otherwise I would be almost chlorotic or hysterical, or both. Stenocardia often troubled me; then came unilateral cramps of chin, nose, neck, and larynx; hemicrania and cramps of the diaphragm and chest-muscles. For about three years I had a feeling as if the prostate were enlarged,—a bearing-down feeling, as if giving birth to something; and, also, pain in the hips, constant pain in the back, and the like. Yet, with the strength of despair, I fought against these complaints, which impressed me as being female or effeminate, until three years ago, when a severe attack of arthritis completely broke me down.
“But before this terrible attack of gout occurred, in despair, to lessen the pain of gout, I had taken hot baths, as near the temperature of the body as possible. On one of these occasions it happened that I suddenly changed, and seemed to be near death. I sprang with all my remaining strength out of the bath: I had felt exactly like a woman with libido. Too, at the time when the extract of Indian hemp came into vogue, and was highly prized, in a state of fear of a threatened attack of gout (feeling perfectly indifferent about life), I took three or four times the usual dose of it, and almost died of haschisch poisoning. Convulsive laughter, a feeling of unheard of strength and swiftness, a peculiar feeling in brain and eyes, millions of sparks streaming from the brain through the skin,—all these feelings occurred. But I could not force myself to speak. All at once I saw myself a woman from my toes to my breast; I felt, as before while in the bath, that the genitals had shrunken, the pelvis broadened, the breasts swollen out; a feeling of unspeakable delight came over me. I closed my eyes, so that at least I did not see the face changed. My physician looked as if he had a gigantic potatoe instead of a head; my wife had the full moon on her nates. And yet I was strong enough to briefly record my will in my note-book when both left the room for a short time.
“But who could describe my fright, when, on the next morning, I awoke and found myself feeling as if completely changed into a woman; and when, on standing and walking, I felt vulva and mammæ! When at last I raised myself out of bed, I felt that a complete transformation had taken place in me. During my sickness a visitor said: ‘He is too patient for a man.’ And the visitor gave me a plant in bloom, which seemed strange, but pleased me. From that time I was patient, and would do nothing in a hurry; but I became tenacious, like a cat, though, at the same time, mild, forgiving, and no longer bearing enmity,—in short, I had a woman’s disposition. During the last sickness I had many visual and auditory hallucinations,—spoke with the dead, etc.; saw and heard familiar spirits; felt like a double person; but, while lying ill, I did not notice that the man in me had been extinguished. The change in my disposition was a piece of good fortune which came over me like lightning, and which, had it come with me feeling as I formerly did, would have killed me; but now I gave myself up to it, and no longer recognized myself. Owing to the fact that I still often confounded neurasthenic symptoms with the gout, I took many baths, until an itching of the skin with the feeling of scabies, instead of being diminished, was so increased that I gave up all external treatment (I was made more and more anæmic by the baths), and hardened myself as best I could. But the imperative female feeling remained, and became so strong that I wear only the mask of a man, and in everything else feel like a woman; and gradually I have lost memory of the former individuality. What was left of me from the gout, the influenza ruined entirely.
“Present Condition: I am tall, slightly bald, and the beard is growing gray. I begin to stoop. Since having the influenza, I have lost about a quarter of my strength. Owing to a valvular lesion, my face looks somewhat red; full beard; chronic conjunctivitis; more muscular than fat. The left foot seems to be developing varicose veins, and it often goes to sleep; but it is not really thickened, though it seems to be.
“The mammary region, though small, swells out perceptibly. The abdomen is feminine in form; the feet are placed like a woman’s, and the calves, etc., are feminine; and it is the same with arms and hands. I can wear ladies’ hose, and gloves, 7½ to 7¾ in size. I also wear a corset without annoyance. My weight varies between 168 and 184 pounds. Urine without albumen or sugar, but it contains an excess of uric acid. But if there is not too much uric acid in it, it is clear, and almost as clear as water after any excitement. Bowels usually regular; but should they not be, then come all the symptoms of female obstipation. Sleep is poor,—for weeks at a time only two or three hours long. Appetite quite good; but, on the whole, my stomach will not bear more than that of a strong woman, and reacts to irritating food with cutaneous eruption and burning in the urethra. The skin is white, and, for the most part, feels quite smooth; there has been unbearable cutaneous itching for the last two years; but during the last few weeks it has diminished, and is now present only in the popliteal spaces and on the scrotum.
“Tendency to perspire. Perspiration was previously as good as wanting, but now there are all the odious peculiarities of the female perspiration, particularly about the lower part of the body; so that I have to keep myself cleaner than a woman. (I perfume my handkerchief, and use perfumed soap and eau-de-Cologne.)
“General Feeling: I feel like a woman in a man’s form; and even though I often am sensible of the man’s form, yet it is always in a feminine sense. Thus, for example, I feel the penis as clitoris; the urethra as urethra and vaginal orifice, which always feels a little wet, even when it is actually dry; the scrotum as labia majora; in short, I always feel the vulva. And all that that means one alone can know who feels or has felt so. But the skin all over my body feels feminine; it receives all impressions, whether of touch, of warmth, or whether unfriendly, as feminine, and I have the sensations of a woman. I cannot go with bare hands, as both heat and cold trouble me. When the time is past when we men are permitted to carry sun-umbrellas, I have to endure great sensitiveness of the skin of my face, until sun-umbrellas can again be used. On awaking in the morning, I am confused for a few moments, as if I were seeking for myself; then the imperative feeling of being a woman awakens. I feel the sense of the vulva (that one is there), and always greet the day with a soft or loud sigh; for I have fear again of the play that must be carried on throughout the day. I had to learn everything anew; the knife—apparatus, everything—has felt different for the last three years; and with the change of muscular sense I had to learn everything over again. I have been successful, and only the use of the saw and bone-chisel are difficult; it is almost as if my strength were not quite sufficient. On the other hand, I have a keener sense of touch in working with the curette in the soft parts. It is unpleasant that, in examining ladies, I often feel their sensations; but this, indeed, does not repel them. The most unpleasant thing I experience is fœtal movement. For a long time—several months—I was troubled by reading the thoughts of both sexes, and I still have to fight against it. I can endure it better with women; with men it is repugnant. Three years ago I had not yet consciously seen the world with a woman’s eyes; this change in the relation of the eyes to the brain came almost suddenly, with violent headache. I was with a lady whose sexual feeling was reversed, when suddenly I saw her changed in the sense I now feel myself,—viz., she as man,—and I felt myself a woman in contrast with her; so that I left her with ill-concealed vexation. At that time she had not yet come to understand her own condition perfectly.
“Since then, all my sensory impressions are as if they were feminine in form and relation. The cerebral system almost immediately adjusted itself to the vegetative; so that all my ailments were manifested in a feminine way. The sensitiveness of all nerves, particularly that of the auditory and olfactory and trigeminal, increased to a condition of nervousness. If only a window slammed, I was frightened inwardly; for a man dare not tremble at such things. If food is not absolutely fresh, I perceive a cadaverous odor. I could never depend on the trigeminus; for the pain would jump whimsically from one branch of it to another; from a tooth to an eye. But, since my transformation, I bear toothache and migraine more easily, and have less feeling of fear with stenocardia. It seems to me a strange fact that I feel myself to be a fearful, weak being, and yet, when danger threatens, I am much rather cool and collected; and this is true in dangerous operations. The stomach rebels against the slightest indiscretion (in female diet) that is committed without thought of the female nature, either by ructus or other symptoms; but particularly against abuse of alcoholics. The indisposition after intoxication that a man who feels like a woman experiences is much worse than any a student could get up. It seems to me almost as if one feeling like a woman were entirely controlled by the vegetative system.
“Small as my nipples are, they demand room, and I feel them as mammæ; just as during the beginning of puberty, the nipples swelled and pained. On this account, the white shirt, the waistcoat, and the coat trouble me. I feel as though the pelvis were female; and it is the same with the anus and nates. At first the sense of a female abdomen was troublesome to me; for it cannot bear trousers, and it always possesses or induces the feminine feeling. I also have the imperative feeling of a waist. It is as if I were robbed of my own skin, and put in a woman’s skin that fitted me perfectly, but which felt everything as if it covered a woman; and whose sensations passed through the man’s body, and exterminated the masculine element. The testes, even though not atrophied or degenerated, are still no longer testes, and often cause me pain, with the feeling that they belong in the abdomen, and should be fastened there; and their mobility often bothers me.
“Every four weeks, at the time of the full moon, I have the molimen of a woman for five days, physically and mentally, only I do not bleed; but I have the feeling of a loss of fluid; a feeling that the genitals and abdomen are (internally) swollen. A very pleasant period comes when, afterward and later in the interval for a day or two, the physiological desire for procreation comes, which with all power permeates the woman. My whole body is then filled with this sensation, as an immersed piece of sugar is filled with water, or as full as a soaked sponge. It is like this: first, a woman longing for love, and then, for a man; and, in fact, the desire, as it seems to me, is more a longing to be possessed than a wish for coitus. The intense natural instinct or the feminine concupiscence overcomes the feeling of modesty, so that indirectly coitus is desired. I have never felt coitus in a masculine way more than three times in my life; and even if it were so in general, I was always indifferent about it. But, during the last three years, I have experienced it passively, like a woman; in fact, oftentimes with the feeling of feminine ejaculation; and I always feel that I am impregnated. I am always fatigued as a woman is after it, and often feel ill, as a man never does. Sometimes it caused me so great pleasure that there is nothing with which I can compare it; it is the most blissful and powerful feeling in the world; at that moment the woman is simply a vulva that has devoured the whole person.
“During the last three years I have never lost for an instant the feeling of being a woman, and now, owing to habit, this is no longer annoying to me, though during this period I have felt debased; for a man could endure to feel like a woman without a desire for enjoyment; but when desires come! The happiness ceases; then come the burning, the heat, the feeling of turgor of the genitals (when the penis is not in a state of erection the genitals do not play any part). In case of intense desire, the feeling of sucking in the vagina and vulva is really terrible—a hellish pain of lust hardly to be endured. If I then have opportunity to perform coitus, it is better; but, owing to defective sense of being possessed by the other, it does not afford complete satisfaction; the feeling of sterility comes with its weight of shame, added to the feeling of passive copulation and injured modesty. I seem almost like a prostitute. Reason does not give any help; the imperative feeling of femininity dominates and rules everything. The difficulty in carrying on one’s occupation, under such circumstances, is easily appreciated; but it is possible to force one’s self to it. Of course, it is almost impossible to sit, walk, or lie down; at least, any one of these cannot be endured long; and with the constant touch of the trousers, etc., it is unendurable.
“Marriage then, except during coitus, where the man has to feel himself a woman, is like two women living together, one of whom regards herself as in the mask of a man. If the periodical molimen fail to occur, then come the feelings of pregnancy or of sexual satiety, which a man never experiences, but which take possession of the whole being, just as the feeling of femininity does, and are repugnant in themselves; and, therefore, I gladly welcome the regular molimen again. When erotic dreams or ideas occur, I see myself in the form I have as a woman, and see erected organs presenting. Since the anus feels feminine, it would not be hard to become a passive pederast; only positive religious command prevents it, as all other deterrent ideas would be overcome. Since such conditions are repugnant, as they would be to any one, I have a desire to be sexless, or to make myself sexless. If I had been single, I should long ago have taken leave of testes, scrotum, and penis.
“Of what use is female pleasure, when one does not conceive? What good comes from excitation of female love, when one has only a wife for gratification, even though copulation is felt as though it were with a man? What a terrible feeling of shame is caused by the feminine perspiration! How the feeling for dress and ornament lowers a man! Even in his changed form, even when he can no longer recall the masculine sexual feeling, he would not wish to be forced to feel like a woman. He still knows very well that, before, he did not constantly feel sexually; that he was merely a human being uninfluenced by sex. Now, suddenly, he has to regard his former individuality as a mask, and constantly feel like a woman, only having a change when, every four weeks, he has his periodical sickness, and in the intervals his insatiable female desire. If he could but awake without immediately being forced to feel like a woman! At last he longs for a moment in which he might raise his mask; but that moment does not come. He can only find amelioration of his misery when he can put on some bit of female attire or finery, an under-garment, etc.; for he dare not go about as a woman. To be compelled to fulfill all the duties of a calling with the feeling of being a woman costumed as a man, and to see no end of it, is no trifle. Religion alone saves from a great lapse; but it does not prevent the pain when temptation affects the man who feels as a woman; and so it must be felt and endured! When a respectable man who enjoys an unusual degree of public confidence, and possesses authority, must go about with his vulva—imaginary though it be; when one, leaving his arduous daily task, is compelled to examine the toilette of the first lady he meets, and criticise her with feminine eyes, and read her thoughts in her face; when a journal of fashions possesses an interest equal to that of a scientific work (I felt this as a child); when one must conceal his condition from his wife, whose thoughts, the moment he feels like a woman, he can read in her face, while it becomes perfectly clear to her that he has changed in body and soul,—what must all this be? The misery caused by the feminine gentleness that must be overcome! Oftentimes, of course, when I am away alone, it is possible to live for a time more like a woman; for example, to wear female attire, especially at night, to keep gloves on, or to wear a veil or a mask in my room, so that thus there is rest from excessive libido. But when the feminine feeling has once gained an entrance, it imperatively demands recognition. It is often satisfied with a moderate concession, such as the wearing of a bracelet above the cuff; but it imperatively demands some concession. My only happiness is to see myself dressed as a woman without a feeling of shame; indeed, when my face is veiled or masked, I prefer it so, and thus think of myself. Like every one of Fashion’s fools, I have a taste for the prevailing mode; so greatly am I transformed. To become accustomed to the thought of feeling only like a woman, and only to remember the previous manner of thought to a certain extent in contrast with it; and, at the same time, to express one’s self as a man,—it requires a long time and an infinite amount of persistence.
“Nevertheless, in spite of everything, it will happen that I betray myself by some expression of feminine feeling, either in sexualibus, when I say that I feel so and so, expressing what a man without the female feeling cannot know; or when I accidentally betray that female attire is my talent. Before women, of course, this does not amount to anything; for a woman is greatly flattered when a man understands something of her matters; but this must not be displayed to my own wife. How frightened I once was when my wife said to a friend that I had great taste in ladies’ dress! How a haughty, stylish lady was astonished when, as she was about to make a great error in the education of her little daughter, I described to her in writing and verbally all the feminine feelings! To be sure, I lied to her, saying that my knowledge had been gleaned from letters. But her confidence in me is as great as ever; and the child, who was on the road to insanity, is rational and happy. She had confessed all the feminine inclinations as sins; now she knows what, as a girl, she must bear and control by will and religion; and she feels that she is human. Both ladies would laugh heartily, if they knew that I had only drawn on my own sad experience. I must also add that I now have a finer sense of temperature and, besides, a sense of the elasticity of the skin and tension of the intestines, etc., in patients, that was unknown to me before; that in operations and autopsies, poisonous fluids more readily penetrate my (uninjured) skin. Every autopsy causes me pain; examination of a prostitute, or a woman having a discharge, a cancerous odor, or the like, is actually repugnant to me. In all respects I am now under the influence of antipathy and sympathy, from the sense of color to my judgment of a person. Women usually see in each other the periodical sexual disposition; and, therefore, a lady wears a veil, if she is not always accustomed to wear one, and usually she perfumes herself, even though it be only with handkerchief or gloves; for her olfactory sense in relation to her own sex is intense. Odors have an incredible effect on the female organism; thus, for example, the odors of violets and roses quiet me, while others disgust me; and with ihlang-ihlang I cannot contain myself for sexual excitement. Contact with a woman seems homogeneous to me; coitus with my wife seems possible to me because she is somewhat masculine, and has a firm skin; and yet it is more an amor lesbicus.
“Besides, I always feel passive. Often at night, when I cannot sleep for excitement, it is finally accomplished, si femora mea distensa habeo, sicut mulier cum viro concumbens, or if I lie on my side; but an arm or the bed-clothing must not touch the mammæ, or there is no sleep; and there must be no pressure on the abdomen. I sleep best in a chemise and night-robe, and with gloves on; for my hands easily get cold. I am also comfortable in female drawers and petticoats, because they do not touch the genitals. I liked female dresses best when crinoline was worn. Female dresses do not annoy the feminine-feeling man; for he, like every woman, feels them as belonging to his person, and not as something foreign.
“My dearest associate is a lady suffering with neurasthenia, who, since her last confinement, feels like a man, but who, since I explained these feelings to her, coitu abstinet as much as possible, a thing I, as a husband, dare not do. She, by her example, helps me to endure my condition. She has a more perfect memory of the female feelings, and has often given me good advice. Were she a man and I a young girl, I should seek to win her; for her I should be glad to endure the fate of a woman. But her present appearance is quite different from what it formerly was. She is a very elegantly dressed gentleman, notwithstanding bosom and hair; she also speaks quickly and concisely, and no longer takes pleasure in the things that please me. She has a kind of melancholy dissatisfaction with the world, but she bears her fate worthily and with resignation, finding her comfort only in religion and the fulfillment of duty. At the time of the menses, she almost dies. She no longer likes female society and conversation, and has no liking for delicacies.
“A youthful friend felt like a girl from the very first, but he had inclinations toward the male sex. His sister had the opposite condition; and when the uterus demanded its right, and she saw herself as a loving woman, in spite of her masculinity, she cut the matter short, and committed suicide by drowning.
“Since complete effemination, the principal changes I have observed in myself are:—
“1. The constant feeling of being a woman from top to toe.
“2. The constant feeling of having female genitals.
“3. The periodicity of the monthly molimen.
“4. The regular occurrence of female desire, though not directed to any particular man.
“5. The passive female feeling in coitus.
“6. After that, the feeling of impregnation.
“7. The female feeling in thought of coitus.
“8. At the sight of women, the feeling of being of their kind, and the feminine interest in them.
“9. At the sight of men, the feminine interest in them.
“10. At the sight of children, the same feeling.
“11. The changed disposition and much greater patience.
“12. The final resignation to my fate, for which I have nothing to thank but positive religion; without it I should have long ago committed suicide.
“To be a man and to be compelled to feel that chaque femme est futuée ou elle désire d’être, is hardly to be endured.”
The foregoing autobiography, scientifically so important, was accompanied by the following no less interesting letter:—
“Sir: I must next beg your indulgence for troubling you with my communication. I lost all control, and thought of myself only as a monster before which I myself shuddered. Then your work gave me courage again; and I determined to go to the bottom of the matter, and examine my past life, let the result be what it might. It seemed a duty of gratitude to you to tell you the result of my recollection and observation, since I had not seen any description by you of an analogous case; and, finally, I also thought it might perhaps interest you to learn, from the pen of a physician, how such a worthless human, or masculine, being thinks and feels under the weight of the imperative idea of being a woman.
“It is not perfect; but I no longer have the strength to reflect more upon it, and have no desire to go into the matter more deeply. Much is repeated; but I beg you to remember that any mask may be allowed to fall off, particularly when it is not voluntarily worn, but enforced.
“After reading your work, I hope that, if I fulfill my duties as physician, citizen, father, and husband, I may still count myself among human beings who do not deserve merely to be despised.
“Finally, I wished to lay the result of my recollection and reflection before you, in order to show that one thinking and feeling like a woman can still be a physician. I consider it a great injustice to debar woman from Medicine. A woman, through her feeling, gets on the track of many ailments which, in spite of all skill in diagnosis, remain obscure to a man; at least, in the diseases of women and children. If I could have my way, I should have every physician live the life of a woman for three months; then he would have a better understanding and more consideration in matters affecting the half of humanity from which he comes; then he would learn to value the greatness of women, and appreciate the difficulty of their lot.”
Remarks: The badly-tainted patient is originally psycho-sexually abnormal, in that, in character and in the sexual act, he feels as a female. This abnormal feeling remained purely a psychical anomaly until three years ago, when, owing to severe neurasthenia, it received overmastering support in imperative bodily sensations of a transmutatio sexus, which now dominate consciousness. Then, to the patient’s horror, he felt bodily like a woman; and, under the impulse of his imperative feminine sensations, he experienced a complete transformation of his former masculine feeling, thought, and will; in fact, of his whole vita sexualis, in the sense of eviration. At the same time, his ego is able to control these abnormal psycho-physical manifestations, and prevent descent to paranoia,—a remarkable example of imperative feelings and ideas on the basis of neurotic taint, which is of great value for a comprehension of the way in which the psycho-sexual transformation may be accomplished.
IV. Degree: Metamorphosis Sexualis Paranoica.—A final possible stage in this disease-process is the delusion of a transformation of sex. It arises on the basis of sexual neurasthenia that has developed into neurasthenia universalis, resulting in a mental disease,—paranoia.
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.”
In the course of the years 1866–68, the delusions of persecution became less and less apparent, and were for the most part replaced by erotic ideas. The somatic and mental basis was a lasting and powerful excitation of the sexual sphere. The patient fell in love with every woman he saw, heard voices which told him to approach her, and begged to be allowed to marry, declaring that, if he was not given a wife, he would waste away. With continuance of masturbation, in 1869, signs of future effemination made themselves manifest. “He would, if he should get a wife, love her only platonically.” The patient grows more and more peculiar, lives in a circle of erotic ideas, sees prostitution practiced in the asylum, and now and then hears voices which impute immoral conduct with women to him. For this reason he avoids the society of women, and only associates with them for the sake of music when two witnesses are with him.
In the course of the year 1872, the neurasthenic condition became markedly increased. Now paranoia persecutoria again comes into the foreground, and takes on a clinical coloring from the neurotic basis. Olfactory hallucinations occur. Magnetic influences are at work on him (false interpretation of sensations due to spinal asthenia). With continued and intense sexual excitement and excess in masturbation, the process of effemination constantly progresses. Only episodically is he a man and inclined toward a woman, complaining that the shameless prostitution of the men in the house makes it impossible for a lady to come to him. He is dying of magnetically poisoned air and unsatisfied love. Without love he cannot live. He is poisoned by lewd poison that affects his sexual desire. The lady that he loves is sunk in the lowest vice. The prostitutes in the house have fortune-chains; that is, chains in which, without moving, a man can indulge in lustful pleasure. He is ready now to satisfy himself with prostitutes. He is possessed of a wonderful ray of thought that emanates from his eyes, which is worth twenty millions. His compositions are worth 500,000 francs. With these indications of delusions of grandeur, there are also those of persecution—the food is poisoned by venereal excrement; he tastes and smells poison, hears infamous accusations, and asks for instruments to close his ears. From August, 1872, however, the signs of effemination become more and more frequent. He acts somewhat affected, declaring that he can no longer live among men that drink and smoke. He thinks and feels like a woman. He must thenceforth be treated like a woman and transferred to a female ward. He asks for confections and delicate desserts. Occasionally, on account of tenesmus and cystospasm, he asks to be transferred to a lying-in hospital and treated as a woman very ill in pregnancy. The abnormal magnetism of masculine attendants has an unfavorable effect on him. At times he still feels himself to be a man, but in a way which indicates his abnormally altered sexual feeling. He pleads only for satisfaction by means of masturbation, or for marriage without coitus. Marriage is a sensual institution. The girl that he would take for a wife must be a masturbator. About the end of December, 1872, his personality became completely feminine. From that time he remained a woman. He had always been a woman, but in his babyhood a French Quaker, an artist, had put masculine genitals on him, and by rubbing and distorting his thorax had prevented the development of his breasts. After this he demanded to be transferred to the female department, protection from men that wished to violate him, and asked for female clothing. Eventually he also desired to be given employment in a toy-shop, with crocheting and embroidery work to do, or a place in a dress-making establishment with female work. From the time of the transformatio sexus, the patient begins a new reckoning of time. He conceives his previous personality in memory as that of a cousin.
He always speaks of himself in the third person, and calls himself the Countess V., the dearest friend of the Empress Eugenie; asks for perfumes, corsets, etc. He takes the other men of the ward for girls, tries to raise a head of hair, and demands “Oriental Hair-Remover,” in order that no one may doubt his gender. He takes delight in praising onanism, for “she had been an onanist from fifteen, and had never desired any other kind of sexual satisfaction.” Occasionally neurasthenic symptoms, olfactory hallucinations, and persecutory delusions are observed. All the events up to the time of December, 1872, belong to the personality of the cousin.
The patient’s delusion that he is the Countess V. can no longer be corrected. She proves her identity by the fact that the nurse has examined her, and finds her to be a lady. The countess will not marry, because she hates men. Since he is not provided with female clothing and shoes, he spends the greatest part of the day in bed, acts like an invalid lady of position, affectedly and modestly, and asks for bon-bons and the like. His hair is done, up in a knot as well as it allows, and the beard is pulled out. Breasts are made out of biscuits.
In 1874 caries began in the left knee-joint, to which pulmonary tuberculosis was soon added. Death on December 2, 1874. Skull normal. Frontal lobes atrophic. Brain anæmic. Microscopical (Dr. Schüle): In the superior layer of the frontal lobe, ganglion cells somewhat shrunken; in the adventitia of the vessels, numerous fat-corpuscles; glia unchanged; isolated pigment particles and colloid bodies. The lower layers of the cortex normal. Genitals very large; testicles small, lax, and show no change macroscopically on section.
The delusion of sexual transformation, displayed, in its conditions and phases of development, in the foregoing case, is a manifestation remarkably infrequent in the pathology of the human mind. Besides the foregoing cases, personally observed, I have seen such a case, as an episodical phenomenon, in a lady having contrary sexuality (Case 92 of the sixth edition of this work), one in a girl affected with original paranoia, and another in a lady suffering with original paranoia.
Save for a case briefly reported by Arndt, in his text-book (p. 172), and one quite superficially described by Sérieux (“Recherches Clinique,” p. 33), and the two cases known to Esquirol, I cannot recall any cases of delusion of sexual transformation in literature. Arndt’s case may be briefly given here, though, like Esquirol’s cases, it gives nothing concerning the genesis of the delusion:—
Case 103. A middle-aged woman in the asylum at Greifswald thought she was a man, and acted out her belief. She cut her hair short, and parted it on one side in the military fashion. A sharply-cut profile, a nose somewhat large, and a certain heaviness of all the features gave the face something characteristic, and, in combination with the short hair combed smoothly over the ears, gave the whole head a decidedly masculine appearance. She was tall and lean; her voice low and rough; the larynx angularly prominent; her attitude erect; her gait, like all her movements, heavy, but not awkward. She looked like a man in female dress. Asked how she had come to think she was a man, she would almost always cry excitedly: “Just look at me! Don’t I look like a man? I feel like a man, too. I have always felt so, but I only gradually came to understand it clearly. The man who should be my husband is not a real man. I raised my children myself. I always felt somewhat like this, but I came to understand later. Did I not always work like a man? The man who passed for my husband only helped. He did what I planned. From my youth I have been more masculine than feminine. I have always had more liking for the garden and farm than for work in the house and kitchen. But I never understood the reason. Now I know I am a man, and I shall bear myself like one. It is a shame to make me always wear women’s clothes.”
Case 104. X., aged 26, tall, and of handsome appearance. Since his earliest youth he has loved to wear female attire. As he grew up, he managed it so that, when he was a participant in theatricals, he always had a female part. After an attack of mental excitement, he imagined that he was actually a woman, and tried to convince others of it.
He liked to undress himself, and dress his hair and put on female clothing. In this state he wished to go out on the street. In other respects he was perfectly reasonable. He would spend the whole day arranging his hair and looking at himself in the glass, costuming himself in a night-dress as much like a woman as possible. In walking he imitated women. One day, when Esquirol acted as if about to lift up his dress, he flew into a passion and upbraided him for his want of modesty (Esquirol).
Case 105. Mrs. X., widow. Owing to the death of her husband and loss of fortune, she had been greatly troubled in mind. She became disturbed mentally, and was admitted to the Salpêtrière after attempting suicide.
Mrs. X., lean, thin; constantly maniacal; she believes herself a man, and flies angry if she is addressed as “madam.” Once, when male clothing was placed at her disposal, she was beside herself with joy. She died, in 1802, of a consumptive malady; and she expressed her delusion of being a man until shortly before her death (Esquirol).
I have already mentioned the interesting relations existing between the facts of delusional transformation of sex and the so-called insanity of the Scythians.
Marandon (“Annales médico-psychologiques,” 1877, p. 161), like others, has erroneously presumed that with the ancient Scythians there was an actual delusion, and that the condition was not merely that of eviration. According to the law of empirical actuality, the delusion, so infrequent to-day, must also have been very infrequent in ancient times. Since it can only be conceived as arising on the basis of a paranoia, there can be no thought of its endemic occurrence; it can only be regarded as a superstitious manifestation of eviration (the result of anger of the goddess), as is also evident from the statements of Hippocrates.
The facts of the so-called Scythian insanity, as well as the facts lately learned about the Pueblo Indians, are also noteworthy anthropologically, in that atrophy of the testes and genitals in general, and approximation to the female type, physically and mentally, were observed. This is the more remarkable, since, in men who have lost their procreative organs, such a reversal of instinct is quite as unusual as in women, mutatis mutandis, after the natural or artificial climacteric.
B. Homo-Sexual Feeling as an Abnormal Congenital Manifestation.[105]—The essential feature of this strange manifestation of the sexual life is the want of sexual sensibility for the opposite sex, even to the extent of horror, while sexual inclination and impulse toward the same sex are present. At the same time, the genitals are normally developed, the sexual glands perform their functions properly, and the sexual type is completely differentiated.
Feeling, thought, will, and the whole character, in cases of the complete development of the anomaly, correspond with the peculiar sexual instinct, but not with the sex which the individual represents anatomically and physiologically. This abnormal mode of feeling may not infrequently be recognized in the manner, dress, and calling of the individuals, who may go so far as to yield to an impulse to don the distinctive clothing corresponding with the sexual rôle in which they feel themselves to be.
Anthropologically and clinically, this abnormal manifestation presents various degrees of development:—
1. Traces of hetero-sexual, with predominating homo-sexual, instinct (psycho-sexual hermaphroditism).
2. There exists inclination only toward the same sex (homo-sexuality).
3. The entire mental existence is altered to correspond with the abnormal sexual instinct (effemination and viraginity).
4. The form of the body approaches that which corresponds to the abnormal sexual instinct. However, actual transitions to hermaphrodites never occur, but, on the contrary, completely differentiated genitals; so that, just as in all pathological perversions of the sexual life, the cause must be sought in the brain (androgyny and gynandry).
The first definite communications[106] concerning this enigmatical phenomenon of Nature are made by Caspar (“Ueber Nothzucht und Päderastie,” Caspar’s Vierteljahrsschrift, 1852, i), who, it is true, classes it with pederasty, but makes the pertinent remark that this anomaly is, in most cases, congenital, and, at the same time, to be regarded as a mental hermaphroditism. There exists here an actual disgust of sexual contact with women, while the imagination is filled with beautiful young men, and with statues and pictures of them. It did not escape Casper that in such cases emissio penis in anum (pederasty) is not the rule, but that, by means of other sexual acts (mutual onanism), sexual satisfaction is sought and obtained.
In his “Clinical Novels” (1863, p. 33) Casper gives the interesting confession of a man showing this perversion of the sexual instinct, and does not hesitate to assert that, aside from vicious imagination and vice, as a result of over-indulgence in normal sexual intercourse, there are numerous cases in which pederasty has its origin in a remarkable, obscure impulse, which is congenital and inexplicable. About the middle of the “sixties,” a certain assessor, Ulrichs, himself subject to this perverse instinct, came out and declared, in numerous articles,[107] that the sexual mental life was not connected with the bodily sex; that there were male individuals that felt like women toward men (“anima muliebris in corpore virili inclusa”). He called these people “urnings,” and demanded nothing less than the legal and social recognition of this sexual love of the urnings as congenital and, therefore, as right; and the permission of marriage among them. Ulrichs failed, however, to prove that this certainly congenital and paradoxical sexual feeling was physiological, and not pathological.
Griesinger (Archiv f. Psychiatrie, i, p. 651) threw the first ray of light on these facts, anthropologically and clinically, by pointing out the marked hereditary taint of the individual, in a case which came under his own observation.
We have Westphal (Archiv f. Psychiatrie, ii, p. 73) to thank for the first systematic consideration of the manifestation in question, which he defined as “congenital reversal of the sexual feeling, with consciousness of the abnormality of the manifestation,” and designated with the name, since generally accepted, of contrary sexual instinct. At the same time, he began a series of cases,[108] which, up to this time, has reached ninety-three, those reported in this monograph not being included.
Westphal leaves it undecided as to whether contrary sexual feeling is a symptom of a neuropathic or of a psychopathic condition, or whether it may occur as an isolated manifestation. He holds fast to the opinion that the condition is congenital.
From the cases published up to 1877, I have designated this peculiar sexual feeling as a functional sign of degeneration, and as a partial manifestation of a neuro-psychopathic state, in most cases hereditary,—a supposition which has found renewed confirmation in a consideration of additional cases. The following peculiarities may be given as the signs of this neuro-psychopathic taint:—
1. The sexual life of individuals thus organized manifests itself, as a rule, abnormally early, and thereafter with abnormal power. Not infrequently still other perverse manifestations are presented besides the abnormal method of sexual satisfaction, which in itself is conditioned by the peculiar sexual feeling.