On a Case of Female Impotency 
By R. W. SHufeldt, 
CAPTAIN MEDICAL CORPS, UNITED STATES ARMY. 
Member of the Medico-Legal Society of New York City; British and American 
Societies for Psychical Research; Fellow of the American 
Association for the Advancement of Science, 
etc., etc., etc. 
Washington, D. C. 
1896. INTRODUCTION. 
In the spring of 3 896 the author submitted to the 
Medico-Legal Society, of New York, a paper entitled, 
“On the Medico-Legal Aspects of Impotency in 
Women.” This paper was, at a regular meeting of the 
society, duly submitted to a committee for a “ Report,” 
prior to its acceptance for publication. The paper con- 
tained, among other causes for impotency in women, a 
complete abstract of the case treated in the present 
brochure. The committee consisted of three members of 
the society, being no less distinguished ones than its 
honored President, Dr. S. B. W. McLeod ; Judge Abram 
H. Dailey, of Brooklyn, N. Y., Senior Vice President of 
the Medico-Legal Congress, of New York ; and Albert 
Bach, Esq., its Secretary. 
A copy of the report of this committee is now before 
me, and from it I make the following extracts : As to 
the object of the paper, they are pleased to say, that if it be 
“to summarize in a plain, logical, and scientific manner 
the main facts of the subject of which he treats, then in- 
deed he is to be congratulated on the presentation of this 
dissertation, and the society on the addition of another 
useful paper to its present file.” ****** 
“ The illustrations given by Dr. Shufeldt in the form 
of cases are most aptly chosen, and the entire paper 
merit a careful perusal. The author concluded with a 
reference to existing statute laws on the subject, and sug- 
gests valuable and important changes therein, chiefly in 
the interest of protection to those who are suffering from 
the infelicity endured in their marital relations as the 
result of impotency or sterility. The whole paper is 
practical, suggestive, and we believe in accord with a con- 
sensus of opinion in the medical and legal professions.” 2 
This paper and report will appear in some of the future 
publications of the society. 
Here in America, cases of this nature are unfortunately 
but very rarely printed. Intelligent physicians, how- 
ever, with a far-reaching knowledge of their profession, 
will read what I have here written without surprise 
Such cases are plenty enough, but their very nature mili- 
tates against record being made of them, or even their 
being discussed. So my chief object in publishing this 
case is to place in the hands of such medico-legal jurists 
as may be inconveniently situated with respect to large 
libraries of medical works, or even the opportunity to 
consult directly with those expert in such subjects, the 
leading facts in a disease and disability of this kind, with 
reference foot-notes to its literature. 
R. W. S. 3 
ON A CASE OF FEMALE IMPOTENCY. 
By Dr. R. W. Shufeldt, U. S. Army. 
Member of the Medico-Legal Society of New York City. 
Ill the present account it is proposed to discuss the 
medical aspects attending the cause of separation of a 
widower with three children, who had married his second 
wife. 
The man, living upon very slender means, was in his 
45th year; the woman, two years his junior, had never 
married before, was living in comfortable circumstances, 
and had a large expectancy in the near future. 
The parties on both sides are from distinguished fami- 
lies, and the man married to gain a wife and mother for 
his home. 
Both before and immediately after marriage the union 
seemed to offer everything that could be desired, when 
in about two months & separation suddenly took place and 
the wife left her husband to reside elsewhere. 
A little later the wife filed a suit for divorce, against 
the advice of many of her friends; this suit had the 
effect of compelling the husband to file his cross-bill, 
that up to the time had been withheld. 
In this counter-suit the husband claims that his wife 
is impotent, and as the claim presents many features of 
both medical and legal interest, an account of them will 
here be entered upon. 
The claim sets forth that when the husband came to 
consummate the marriage he was defeated, after many 
attempts, owing to the fact that he found the vaginal 
secretions of his wife so acid in their reaction that from 
the discomfort thus engendered he was rendered power- 
less to effect the act of coitus by reason of his inability 4 
to have an erection. It is further claimed that his wife 
became repugnant to him, inasmuch as he, as a physi- 
cian, was soon convinced that this acidity of the genital 
secretions in her case was due to onanism. 
The condition not only prevented his having sexual 
intercourse with her, but it also rendered her sterile, and 
the husband greatly desired a son by this marriage. 
During the first month or more, and before the pair 
ceased to occupy the same bed and bedroom, a state of 
affairs that subsequently existed, the husband discovered 
that the wife was without hymen at the time of mar- 
riage ; that she was largely lacking in sexual passion ; 
that her menses appeared at least once after marriage ; 
that shortly following this event, after an imperfect at- 
tempt at copulation, he further discovered that no erec- 
tion of the clitoris took place, and the wife informed him 
that she felt that she could not satisfy him or bear him 
children, and suggested that he seek other women. She 
was also unchaste in bed, and on one occasion aroused 
the husband from sleep by handling his genitals, and 
he, when thought by her to be asleep, discovered, in one 
instance at least, that she resorted to masturbation. 
To assuage the pain and discomfort caused by his 
attempts to fulfill his marital obligations, the husband 
was compelled to bathe the parts in cold water after 
each attempt. By this means any inflammation was 
prevented, though the sexual act became more and 
more impossible for him, and, for the reasons given, 
never proved successful. 
From this it would appear that the wife in this case 
was not only impotent, but likewise sterile, in so far as 
her husband was concerned. 
Leaving out of the question, however, the matter of 
sterility, a condition often confounded both by physi- 
cians and jurists with the allied disability of impotence, 
the latter only, as affecting this case, will here be dealt 5 
with ; and it becomes necessary at the outstart to define, 
from a medico-legal standpoint, exactly what is meant 
by impotence. 
One of the best definitions given for impotency in fe- 
males has been rendered by Dr. John J. Caldwell, of 
Baltimore, Md.,* and according to that authority “ impo- 
tence may be applied to any morbid state which may 
impair or destroy the vitality of the ova or spermatozoa 
after their secretion, or which may prevent that contact 
necessary to fecundation.” 
In other words, the old opinion formerly entertained, 
that a woman to be impotent must present some anatom- 
ical defect, is no longer adhered to, while on the other 
hand the ground is covered completely by the definition 
just given. 
That this is so is amply supported by the opinions 
rendered in the latest and authoritative works upon 
legal medicine. For example, Simeon E. Baldwin, LL. D., 
when treating of “Marriage and Divorce,” in the second 
volume of “ A System of Legal Medicine ” (p. 518,1894), 
remarks, “If while sexual intercourse is not physically 
impossible, it is practically so, because possible only 
under conditions to which the other party ought not to 
be expected to submit, the case would be one of legal 
impotence, furnishing a sufficient ground for divorce.” 
The husband in the case now being considered had, 
up to a few years since, a large and varied practice in 
medicine, and had treated not a few cases of both impo- 
tence and masturbation in men and women. His expe- 
rience is quite in keeping with what is found throughout 
all medical literature for all time; that is, the detection 
of masturbation in many females, when the latter are of 
a mind to conceal it, is one of the most difficult tasks 
that can confront the practitioner. It is only when a 
* Neuroses of the Genito-urinary System—Impotence and Sterility in 
Man and Women. Virginia Med. Monthly. Vol. 8, Art. IV, p. 668. 6 
sufficient number of general symptoms are established 
as due to this cause that diagnosis can no longer remain 
a matter of doubt. Even then the patient will fre- 
quently, and with great indignation, deny the charge 
amidst tears and temper. 
On this point Dr. Dayton, of New York, has said, 
“ Unfortunately the sexual instinct in polite life is too 
little thought of as a source of irritation; whereas it is 
not infrequently abused, often furnishing a practitioner 
with mysterious cases of the origin of which he knows 
nothing, and into which it might he considered by inter- 
ested parties, at least, improper to inquire.” (New York 
Med. Record, XX, 1881, p. 596.) And the eminent Ger - 
man authority, Schrenck-Notzing, remarks, “ Another 
of my patients had practiced onanism eight years, and 
completely destroyed her nervous system before the phy- 
sician discovered the cause of the trouble.” * 
Again, in a very recent paper contributed to The Daily 
Lancet, of Philadelphia (Tuesday, July 28, 1896, p. 612), 
Dr. Hiram Elliott says, in the course of his excellent 
remarks upon the “ Insanity of Pubescence,” we must 
“remember that this habit maybe carried on without 
manipulation, and may exist, lack of evidence on physi- 
cal examination, failure of the attendant to observe it, 
and the denial of the patient notwithstanding. One 
patient of mine, seventeen years old, whom I brought 
through a severe attack of insanity, in whom no evi- 
dence of this habit could be found, afterward boasted to 
me that she had masturbated all through her sickness.” 
Even as early as 1849, Dr. W. D. Purple pointed out 
in his excellent article, entitled, “ On the Morbid Condi- 
tion of the Generative Organs,” the difficulty in discover- 
ing the practice of masturbation in females, and explain- 
ing the symptoms it gives rise to (New York Medical 
* Suggestive Therapeutics in Psychopathia Sexualis. Trans, by Chad- 
dock, 1895, p. 26. 7 
Journal, 1849, III, 207-218); and any number of equally 
good authorities might here be quoted to the same end. 
This is the more remarkable in face of what Dr. Howe 
has made clear when he says: “ Masturbation is a univer- 
sal vice in civilized countries. A very large majority ol 
human beings of both sexes indulge in the habit from 
early childhood.” 
“ In savage lands it is of rare occurrence. Savages 
live in a state of nature. No moral obligations exist 
which compel them to abstain from a natural gratifica- 
tion of their passions. There is no social law which pre- 
vents them from following the dictates of their lower 
nature. Hence, they have no reason for adopting onan- 
ism as an outlet for passions.” 
“ The moral trammels of civilized society and ignor- 
ance of physiological laws give origin to the vice. The 
dread of the consequences of sexual intercourse begets 
continual indulgence in the other sin because it is less 
liable to be found out.” * 
Bearing in mind, then, what really constitutes impo- 
tence in the female; the nature of legal impotence; the 
universality of the vice of masturbation; the fact that it 
occurs largely in those representing the highest social 
planes ; and also what the husband in the present case 
claims as set forth above, it becomes necessary next to 
inquire into the question of the cause and effects of an 
acid condition of the genital secretions in the female. 
That this condition is frequently found to be the case 
admits of no doubt, and physicians well know that it is 
at least one of the causes of sterility in prostitutes, and 
frequently gives rise to painful coitus for men attempt- 
ing the act with them. 
This acidity is due to a long practiced excitation and 
abuse of the genital apparatus—either from undue coitus 
* Mown. Jos. W., Excessive Venery, Masturbation, and Continence. New 
York and London, 1883. P. 62. 8 
or from onanism. The husband in the present case, 
when a student of medicine in 1876, killed, as a matter 
of experimentation, living human spermatozoa with a 
\ per cent, solution of acetic acid, and that in a few 
seconds. The same solution when applied to the distal 
entrance of the urethea caused a very active smarting 
that required cold water bathing to alleviate'. The dis- 
tinguished gynecologist, P. Muller, remarks : “ The in- 
fluence of the vaginal mucus in causing sterility is but 
little understood. * * * Still, under certain patho- 
logical conditions, the secretion may become so acid in 
reaction, that it acts as any other acid and induces ster- 
ility. It is furthermore proven that under such circum- 
stances, after cohabitation, spermatozoa are found rigid 
and dead.” * 
And the eminent medico-legal jurist, Dr. F. R. Stur- 
gis, has recently pointed out that “ Another source of 
sterility in the female seems to be due to an exceedingly 
acid condition of the uterine and vaginal secretions, in 
which the spermatozoa are killed almost immediately, 
or shortly after being deposited in the vagina and in the 
cervical canal, and so fail either to find their way into 
the body of the uterus, or else if they do find a lodgment 
there, practically arrive in a dead or dying condition.” 
(Sterility in the Female.) f 
Dr. Sturgis further believes that such cases constitute 
“ a bar to matrimony, and a just reason for divorce.” 
In the event of a court ordering a medical examina- 
tion to seek the proof of the presence or absence of such 
a condition, which is the usual legal procedure, there 
may be some difficulty in the way of obtaining that 
proof. In the first place,the conditions are so utterly 
*Cyclop. of Obstet. and Gynecology. Vol. II. Sterility. P. 116 
| A system of Legal Medicine. Hamilton and Godkin, vol. II, pp. 504, 
505. Article by Dr. Sturgis, Genito-Urinary and Venereal Affections in 
their Medico-Legal Relations, p. 49V. 9 
and entirely different—for in the first case we would 
have the vaginal and uterine glands giving up their 
secretions under the act of sexual excitement, while in 
the second we would have all that checked under the 
emotions arising from everything attending and depend- 
ing upon a medico-legal examination. Under the latter 
circumstances the two glands of Bartholin would in all 
probability not yield up their secretion, and these, in 
acidity of the vaginal secretions, are the ones largely at 
fault. Moreover, this acidity may be intermittent both 
in presence as well as in intensity. That in cases of 
female masturbation other local symptoms, such as con- 
gestion, ulcers, or elongation of the labia3, and the like, 
may be practically absent in women past forty, there is 
no manner of a doubt. Any number of cases, in both 
men and women, are met with by the physician where 
neither the face, the general physique, or the local ap- 
pearances of the genitals betray any very marked 
change, and the patient had practiced the vice for years. 
In females, frequent cold bathing and local cleanliness 
will do much towards keeping down the various evi- 
dences of congestion and hypertrophy of parts, and the 
type of the onanism will also have to be taken into con- 
sideration, and the recent French writer, Dr. Pouillet, 
has much to say upon this point in his work. (L’Onan- 
isme chez le femme.) 
However this may be, there sooner or later comes a 
time in the life of every female masturbator, when the 
general and special symptoms presented by the case 
leaves no doubt in the mind of the intelligent physician 
as to its nature. 
For, in the first place, if the examiner can get at the 
family history of the patient, and this shows a decided 
record of a neuropathic taint, then a long step has been 
taken towards a correct diagnosis, especially if this is 
sustained by the presentation of psychopathic sexual 10 
symptoms oil the part of the Woman herself. Now, the 
family and personal history of the case here being consid- 
ered are both very bad. 
A partial examination of the former goes to show that 
she is either connected with, or descended from, a stock 
exhibiting both erotic and neurotic constitutions in the 
highest degree. Her father’s brother died a drunkard, 
and was while living a man of passion; his insane son, 
still living, exhibits the same disease, with a mind given 
over to lewdness. He is at present the inmate of an 
asylum. His daughter never married, and was a great 
coquette in early life. The patient’s half sister had 
a child five months after marriage, and her daughter 
committed the same indiscretion. Her own sister was 
intensely erotic in passing the period of the menopause. 
She was declared partially insane by New York physi- 
cians, and at the time of her sister’s (the patient’s) en- 
gagement, or only twenty-four hours thereafter, would 
talk to her about little else save the “ horrors of copula- 
tion,” the “ pangs of labor,” etc., and later on desired her 
to read works upon “The age of consent,” “ Prostitution 
within the bond of marriage,” etc. She is a maiden 
sister, fifty-four years of age). Another unmarried 
half-sister is filled with peculiarities, and among others 
a certain uncontrollable fascination for shoes. She de- 
lights in new shoes, and changes her shoes all day long 
at regular intervals of exactly three hours each. She 
keeps this row of shoes out in plain sight in her apart- 
ment. Such an instinct as this exhibited in a woman, 
the member of a neuropathic family, is, from a psycho- 
medical point of view at least, interesting—especially 
when taken in connection with the extraordinary chapter 
on “ shoe-fetichism ” among male masturbators, found in 
Chaddock’s translation of Kraftt-Ebing’s Psychopathia 
sexualis. Finally, one of tlie patient’s brothers was 
a peripatetic drunkard, and rambled in a meaningless way, all over the country, until the day of his death, 
and the patient, when once laboring under powerful 
emotion, told her husband that “ no [mentioning the 
name of her family] woman had ever succeeded yet in 
making a man happy, and she believed the family to be 
sexually accursed.” The family is of French extraction, 
and of the very type in which we would look for erotics, 
especially as the family has produced one or two mem- 
bers of eminent musical and artistic abilities, but these 
have been far outnumbered by its neuropaths. 
This much for the family history, and it is far worse 
than many a family history given by Ivraftt-Ebing as 
forming a part of the record of some of his most incura- 
ble cases. 
The personal history of the patient is equally bad, and it 
is a fact well worthy of not ice that just prior to her mar- 
riage to her present husband she was engaged to another 
man for a period extending over twelve years. The disas- 
trous effects of long engagements upon the minds of a 
certain class of females is too well known and appreciated 
to require especial comment here. To those predisposed 
to onanism, the man in time is setup in the mind of the 
woman as her sexual fetich, that excites her passion while 
she gives way to the masturbatic act, being unable to re- 
ceive satisfaction by the natural method. (The only safe- 
guard for such women is to marry early.) 
In physique and appearance the patient is inclined 
to be stout in person, with a severe, determined cast of 
countenance, overspread by one of profound melancholy. 
She talks much of morality, and pretends to know little 
or nothing of sexual matters. Often when conversing 
with people she has that peculiar blank stare so graphi- 
cally described bv the French wrriter, Pouillet, in his 
history of onanism among females. 
She, during her engagement to her present husband, 
wrote him upwards of two hundred letters, and these are 12 
of great value in throwing additional light upon her 
case. They show her to be of a low order intellectually; 
that she has been melancholic from girlhood ; has led 
largely a monotonous life, mostly in one place, and had 
a room to herself. The effect of all of which would, in 
any case, be extremely unfortunate, or undesirable for a 
woman predisposed, by virtue of her hereditary taint, 
to onanism. Moreover, both in her letters and in her 
conversation it is evident that at all times she is deeply 
imbued with religion, and possesses an uncontrollable 
fascination for church ceremonies and forms. This con- 
stitutes one of the distinct characteristics of both male 
and female onanists. 
Dr. Howe, in his work on “ Excessive Venery,” says of 
the typical masturbator, quoting Dr. Richie, “that these 
cases chiefly occur in members of families of strictly re- 
ligious education, and those who from this cause become 
insane generally, to all appearances have been of strictly 
moral life and recognized as persons who paid much 
attention to the forms of religion.” Rosse remarks in 
his “ Sexual Hypochondriasis and Perversion of the 
Genesic Instinct,” that “ many hypochondriacs pass for 
religious when they are only suffering from sexual neu- 
rasthenia; and it is a fact known to physicians that so- 
called religious and erotic debauchery often go together 
(pp. 18,19); and the eminent authority Kraftt-Ebing 
speaks of “ the motley mixture of religious and sexual 
delusions that is so frequently observed in psychoses, but 
particularly in masturbatic insanity.” (Psychopathia 
Sexualis, p. 8.) Every well-read physician knows that 
any number of authorities could be quoted to sustain 
this conspicuous character in the majority of both male 
and female onanists. 
Those who have been addicted to self-abuse also suffer 
from anaemia, functional disorder of the heart, vertigo, 
and other symptoms referable to the nervous and eircu- 13 
latory systems. At various times this patient has suf- 
fered from these affections, and her husband is informed, 
in a letter from her family physician, that he had treated 
the patient for “ anaemia,” and relieved her, and the 
patient herself admits in a letter (March 26,1895), speak- 
ing of herself, that “ she has suffered from a great variety 
of ailments.” From personal experience, her husband 
knows her to be a victim of pronounced insomnia, and 
Howe, in his work, says, on page 73, that “ Sleeplessness 
* * * and palpitation of the heart are common 
accompaniments of sexual as well as of solitary indul- 
gence,” and she also presents the symptom of a tendency 
to relaxation of the 'perspiratory system. 
In a great many onanists of both sexes the desire to 
resort to alcoholic stimulants to sustain the marked depres- 
sion from which they frequently suffer is seen, and this is 
most decidedly marked in the present case, for the patient 
drank quantities of whiskey during the time she lived 
with her husband, and, usually, when he was not present. 
It has been stated above that she was at times addicted 
to unchaste practices, and this was first observed by 
the husband on the evening of the day of their engage- 
ment, when alone with her, at the place where she 
resided, and between the hours of 10 and 11 p. m. 
When the patient came to kiss her intended hus- 
band good night upon that occasion she was standing 
up, and, passionately throwing her arms about him, 
forced her tongue into his mouth, and before he could re- 
cover from his surprise, resorted to a rapid bucco-lingual 
copulation so graphically described by many authors in 
medical works. In a few moments her lover departed, 
but after the street door was closed, and he was descend- 
ing the steps to the street, he returned, with the purpose 
in his mind of breaking off the engagement—but the 
door was locked, the patient was probably retiring, and 
the intent passed, though the suspicion never did. A 14 
few days afterwards she writes him a letter in which she 
distinctly refers to this occurrence, and expresses regret 
at her “ boldness,” and concern as to what he might have 
thought of it. 
After this unfortunate marriage had taken place, 
husband states that when his wife desired to kiss him 
.he was obliged to keep his lips tightly compressed in 
order to defeat her constant desire to resort to this 
revolting practice. That bucco-lingual copulation has 
been, and is resorted to, by erotics, ever since the dawn 
of history, is attested to by simply hundreds of works by 
hundreds of authors, and requires no comment in the 
present connection. It is mentioned in the old theologi- 
cal works as the oscula more columbino, and was ruled 
against at least one of the Christian sects. 
No capable physician who had so much of the history 
of this patient known to him, as has been set forth 
above, would in any way be surprised if told, in addition, 
that he had under observation a female who had prac- 
ticed masturbation ; indeed, he would look for some- 
thing of that very nature. But now we come to a class 
of symptoms, exhibited on the part of the patient, that 
are not only objective, but positively diagnostic of some 
neurotic condition. 
It is a well-known fact that those who have long been 
victims of self-abuse, whether there be any local evi- 
dences of it in the genitals or not, suffer, when greatly 
worried, from nervous twitchings of the hands, that 
more or less completely incapacitate them for work. 
In a number of her letters to her intended husband the 
patient had referred to and described this disability, and 
it was very noticeable by every one after she was mar- 
ried. Howe remarks (p. 73) that those given to solitary 
indulgence exhibit nervous twitching of the muscles, 
especially those of the extremities, and the husband of 
the patient has treated cases of female masturbators 15 
wherein this was a marked feature, and corresponded 
exactly to the form of it presented on the part of the 
case now being described. 
The patient likewise suffers from a distinct and well- 
marked type of melancholia, that under certain condi- 
tions takes on a suicidal tendency. Both of these affections 
are symptomatic of the vast majority of cases exhibiting 
the general effects of masturbation. 
The melancholia in the present case is absolutely typi- 
cal of that form of the disease found in these cases, and 
described in a great many works devoted to such sub- 
jects. It is also associated in this patient with deficient 
memory, of which she often complained; an inability to 
keep the mind upon one subject for any length of time; 
and with a very slight regard for the truth. That it oc- 
casionally had a suicidal impulse was evident from the 
fact that she tried to secure chloroform from her stepson 
after marriage, upon several occasions, distinctly stating 
that she intended taking her life, as she was “being 
cruelly treated.” Her fancied notions of “ cruelty ” were 
simply the emanations from her demented brain, and 
purely illusionary. But the nature of her dementia 
amply explains her extraordinary melancholic letters— 
nearly two hundred in number—written to her intended 
husband during the eight months preceding her mar- 
riage. It was then that she claimed that she suffered 
from insomnia, intense nervousness, shaky hands, and 
melancholia on account of the annoyance caused her by 
her demented sister with whom she lived. She upon 
many, many occasions in those letters deceived the man 
she intended to marry by having him believe that her 
melancholia was but temporary, and that she would be 
all right after marriage. But that day never came, and 
when the terrible cause of her wrecked mind and nervous 
system became at last evident to her husband, when it 
was too late, then her real nature asserted itself, and she 16 
tried to carry further ruin into a home already nearly 
destroyed by her brief residence in it. 
Still another symptom is to be added to this melan- 
cholia with suicidal impulse. 
It has been stated above that the vaginal secretions in 
this patient have, at various times, been more or less 
acid. In those cases where this acid secretion is present, 
it will, unconsciously, at times reach the anal orifice, 
and, sooner or later, give rise to an anal fissure, or an 
anal ulcer. Prior to marriage the patient on one oc- 
casion informed her husband-to-be that she had suf- 
fered from anal fissure, and to cure it was obliged to be 
operated upon by a surgeon. The British surgeon, Dr. 
Holmes, in his work on “ Surgery, its Principles and Prac- 
tice ” (p. 660), says of “ Fissure of the Anus,” that “ It is 
more common in women than in men, and may be 
produced by the irritation of discharges.” Anal fissure 
differs materially from anal fistula, though masturbators 
may also suffer from the latter trouble. 
In female masturbators it is by no means an uncom- 
mon thing to find an anal fissure present, or the results 
of a surgical operation to cure one. In making the med- 
ical examination in these cases, either the anal ulcer or 
fissure must be looked for, or else the cicatrix resulting 
from the use of the knife. This latter must be done with 
great care and skill, for if it were a superficial ulcer alone 
that the acid secretion had caused, the attending surgeon 
may have cured it by the application of a caustic only, in 
which case the eschar resulting therefrom would be su- 
perficial and leave no visible cicatrix ; but on the other 
hand, were the knife used, a definite scar, if carefully 
searched for, would doubtless be revealed. If much 
pigmentation existed around the orifice of the anus 
another difficulty would be added to the search, while, 
again, the cicatricial furrow resulting from the operation 
may at once be evident upon examination. 17 
The symptoms present in this case at once relegate it 
to the catagory of neurotic diseases, and by the methods 
of differential diagnosis there is no difficulty in distin- 
guishing which one it is. The family and personal his- 
tory, age, and erotic practices, associated in the patient 
with religious exaltation, prudism, alcholism, insomnia, 
cardiac palpitation, ansemia, occasional vertigo, muscular 
twitchings of the hands, deficient memory and lack of mental 
concentration, marked melancholia with suicidal impulse, 
anal fissure, and acidity of the vaginal secretions, would 
alone be sufficient to establish the fact that at some time 
in the life of the patient masturbation had been prac- 
ticed, and for a long time carried to excess. 
Taking the age of the patient into account, it is clear 
that the act of copulation, even were it possible for the 
husband to perform it, can now only aggravate the con- 
dition she is in, and so marriage can in her case only 
prove to be a detriment. Consequently the prognosis in 
her case is bad, and unless for the latter half of her life 
her surroundings are favorable, either the insane asylum 
or else suicide will surely be her fate. 
From such manual examination as the husband could 
make, he is of the opinion that this practice in the 
patient has not been as active during recent years as it was 
doubtless during earlier life, so the local evidences may 
be more or less subordinated. This is most frequently 
the case, as the practice in women commonly extends be- 
tween the age of puberty to thirty or thirty-five years of 
age, or during the most passionate period of life. After 
this, and after the nervous system has to a greater or less 
extent been destroyed, then the fires of passion grow less 
in intensity, and the indulgence is only occasionally 
resorted to, and local evidences of the damage done, 
subside. Even the acidity of the vaginal secretions may 
be intermittent, but normal copulation would surely in 
time reinstate this symptom, and, under the circumstan- 18 
ces, with the growing repugnance for her as a compan- 
ion that this patient’s husband has for her, she is, in so 
far as he is concerned, quite as impotent to satisfy his 
sexual demands as though she were a victim of the 
worse type of atresia vaginae. 
The presence of such a person in a true home simply 
means its ruin in very short order. She is not fit to be 
a mother at the head of a household of children, nor can 
she expect to command their love and respect. In both 
of these particulars this woman utterly failed in the few 
weeks she occupied her new home. She brought only 
profound unhappiness, where happiness and prosperity 
formerly reigned. 
In closing this paper the writer desires to thank his 
friends for many useful suggestions offered, as well as for 
calling his attention to many points touching the litera- 
ture of the subject. Chief among these are Dr. Irving C. 
Rosse, Vice President of the International Congress of 
Medico-Legal Jurists, etc.; Dr. Jos. Taber Johnson, the 
distinguished gynecologist of Washington, D. C.; Dr. IT. 
Witmar, of the United States Government Asylum for 
the Insane; and Dr. D. S. Lamb, the pathologist of the 
United States Medical Museum.