f1 o9 . . . SEXUAL PERVERSION, SATYRIASIS AND NYMPHOMANIA. BY S. Trank Lydstgn, M. D„ CHICAGO. Repri?n from Phila. Med. and Surg. Reporter. McCJupr Ptg. Co., 53 Dearborn St., Chicago. A LECTURE OM SEXUAL PERVERSION, SATYRIASIS AND NYMPHOMANIA.1 BY G. KR.ANK LYDSTON, ML D. CHICAGO. Gentlemen : The subject of sexual perversion (Con- trare Sexualempfindimg), although a disagreeable one for discussion, is one well worthy the attention of the scientific physician, and is of great importance in its social, medical and legal relations.2 The subject has been until a recent date studied solely from the standpoint of the moralist, and from the indisposition of the scientific physician to study the subject, the unfortunate class of individuals who are characterized by perverted sexuality have been viewed in the light of their moral responsibility rather than as the victims of a physical and incidentally of a mental defect. It is certainly much less humiliating ’Phila. Med. & Surg. Rep., Sept. 7, 1889. 2 In a recent article, Dr. J. G. Kiernan, of Chicago, in discuss- ing the hypothetical dependence of the Whitechapel murders up- on sexual perversion, says : “The present subject may seem to trench on the ‘ prurient,’ which in medicine does not exist, ‘science, like fire, purifies everything,' and what Macaulay calls ‘ the mightiest of human instincts ’ is too intimately related to the physical basis of human weal and woe for any physician prudishly to ignore any of its phases.” 2 to us as atoms of the social fabric to be able to at- tribute the degradation of these poor unfortunates to a physical cause, than to a willful viciousness over which they have, or ought to have, volitional control. Even to the moralist there should be much satisfac- tion in the thought that a large class of sexual per- verts are physically abnormal rather than morally leprous. It is often difficult to draw the line of de- marcation between physical and moral perversion. Indeed, the one is so often dependent upon the other that it is doubtful whether it were wise to attempt the distinction in many instances. But this does not af- fect the cogency of the argument that the sexual per- vert is generally a physical aberration—a lusus nat- zirtz. Krafft-Ebing1 expresses himself upon this point as follows: “In former }rears I considered contrare Sex- u'alempfindung as a result of neuro-psychical degenera- tion, and I believe this view is warranted by more re- cent investigations. As we study into the abnormal and diseased conditions from which this malady re- sults, the ideas of horror and criminality connected with it disappear, and there arises in our minds the sense of duty to investigate what at first sight seems so repulsive, and to distinguish, it may be, between a perversion of natural instincts which is the result of disease, and the criminal offenses of a perverted mind against the laws of morality and social decency. By so doing the investigations of science will become the means of rescuing the honor and re-establishing the social position (sic) of many an unfortunate whom unthinking prejudice and ignorance would class among depraved criminals. It would not be the first time that science has rendered a service to justice and to society by teaching that what seem to be immoral conditions and actions are but the results of disease.” There is in every community of any size a colony of 1 Journ. Psychiatry and Neurology, Vol. IX, No. 4, p. 505. 3 male sexual perverts; they are usually known to each other, and are likely to congregate together. At times they operate in accordance with some definite and concerted plan in quest of subjects wherewith to grat- ify their abnormal sexual impulses. Often they are characterized by effeminacy of voice, dress and man- ner. In a general way, their physique is apt to be in- ferior—a defective physical make-up being quite gen- eral among them, although exceptions to this rule are numerous. Sexual perversion is more frequent in the male; women usually fall into perverted sexual habits for the purpose of pandering to the depraved tastes of their patrons rather than from instinctive impulses. Ex- ceptions to this rule are occasionally seen. For ex- ample, I know of an instance of a woman of perfect physique, who is not a professional prostitute, but moves in good society, who has a fondness for women, being never attracted to men for the purpose of ordi- nary sexual indulgence, but for perverted methods. The physician rarely has his attention called to these things, and when evidence of their existence is placed before him, he is apt to receive it with skepticism. He regards the subject as something verging onMun- chausenism, or, if the matter seem at all credible, he sets it aside as something unholy with which he is not or should not be concerned. It is indeed not to be wondered at that the doctor, who sees so much to disgust hini with the human animal, should be reluc- tant to add to his store of contempt. The man about town is very often au fait in these matters, and can give very valuable information. Indeed, witnesses enough can be found to convince the most skeptical. Sexual perversion may be best defined in a general way as the possession of impulses to sexual gratifica- tion in an abnormal manner, with a partial or a com- plete apathy toward the normal method. The affection presents itself in several forms, which may be tabulated as follows: 4 I. Congenital and per- haps hereditary < sexual perver- sion. a. Sexual perversion without defect of structure of sexual organs. b. Sexual perversion with defect of gen- ital structure, e. g., hermaphroditism. c. Sexual perversion with obvious defect of cerebral development, e. g., idiocy. a. Sexual perversion from pregnancy, the meno-pause, ovarian disease, hysteria, etc. b. Sexual perversion from acquired cere- bral disease, with or without recog- nized insanity. c. Sexual perversion (?) from vice. d. Sexual perversion from over stimula- tion of the nerves of sexual sensibility and the receptive sexual centers, inci- dental to sexual excesses and mastur- bation. II. Acquired sexual per- version. As regards the clinical manifestations of the disease sexual perverts may be classified as : (a) Those hav- ing a predilection (affinity) for their own sex; (b) those having a predilection for abnormal methods of gratification with the opposite sex; (c) those affected with bestiality. Instances of all these different vari- eties have been observed. The Precise Causes of sexual perversion are obscure. The explanation of the phenomenon is in a general way much more definite. Just as we may have varia- tions of physical form, and of mental attributes, in gen- eral, so we may have variations and perversions of that intangible entity : sexual affinity. In some cases, per- haps, sexual differentiation has been imperfect, and there is a reversion of type; as Kiernan remarks:1 “The original bi-sexuality of the ancestors of the race, shown in the rudimentary female organs of the male, could not fail to occasion functional, if not or- ganic, reversions when mental or physical manifesta- tions were interfered with by disease or congenital defect. The inhibitions on excessive action to ac- complish a given purpose, which the race has acquired through centuries of evolution, being removed, the 1 Medical Standard, November, 1888. 5 animal in man springs to the surface. Removal of these inhibitions produces, among other results, sex- ual perversions.” Reasoning back to celi life we see many variations of sexual affinity and the function of reproduction, be- tween the primal segmentation of the cell—the lowest type of procreative action—and that complete and perfect differentiation of the sexes which requires a definite act of sexual congress as a manifestation of the acme of sexual affinity, and for the purpose of reproduction. The variations in the methods of sexual gratification—or to attribute it to instinct, of perpetuat- ing the species—which are presented to the students of natural history., are numerous and striking. It is not my intention, however, to give this matter more than passing notice. The method of sexual gratification— i. e., procreation—of fishes, is a curious phenomenon. It is difficult to appreciate the sexual gratification in- volved in the deposition of the milt of the male fish upon the spawn of the female, yet that the so-called instinctive act of the male is unattended by gratifica- tion is improbable. Indeed, it is an argument as ap- plicable to the lower animals as to man, that, were the act of procreation divested of its pleasurable fea- tures, the species would speedily become extinct; for the act of procreation per se is possessed of no features of attractiveness, but of many that are repulsive and in themselves productive of discomfort. It is puzzling to the healthy man and woman, to understand how the practices of the sexual pervert can afford gratification. If considered in the light of reversion of type, however, the subject is much less perplexing. That mal-development, or arrested de- velopment, of the sexual organs should be associated with sexual perversion is not at all surprising ; and the more nearly the individual approximates the type of foetal development which exists prior to the com- mencement of sexual differentiation, the more marked is the aberrance of sexuality. 6 There is one element in the study of sexual perversion that deserves especial attention. It is probable that few bodily attributes are more readily transmitted to posterity than peculiarities of sexual physiology. The offspring of the abnormally carnal individual is likely to be possessed of the same inordinate sexual appe- tite that characterizes the parent. The child of vice has within it, in many instances, the germ of vicious impulse, and no purifying influence can save it from following its own inherent inclinations. Men and women who seek, from mere satiety, variations of the normal method of sexual gratification, stamp their nervous systems with a malign influence which in the next generation may present itself as true sexual per- version. Acquired sexual perversion in one genera- tion may be a true constitutional and irradicable vice in the next, and this independently of gross physical abberations. Carelessness on the part of parents is responsible for some cases of acquired sexual perver- sion. Boys who are allowed to associate intimately, are apt to turn their inventive genius to account by inventing novel means of sexual stimulation, with the result of ever after diminishing the natural sexual appetite. Any powerful impression made upon the sexual system at or near puberty, when the sexual apparatus is just maturing and very active, although as yet weak and impressionable, is apt to leave an imprint in the form of sexual peculiarities that will haunt the patient throughout his after life. Sexual congress at an early period, often leaves its impres- sion in a similar manner. Many an individual has had reason to regret the indulgences of his youth be- cause of its moral effect upon his after life. The im- pression made upon him in the height of his youthful sensibility is never eradicated, but remains in his memory as his ideal of sexual matters; for—if you will pardon the metaphor—there is a physical as well as an intellectual memory. As he grows older and less impressionable, he seeks vainly for an experience 7 similar to that of his youth, and so joins the ranks of the sexual monomaniacs, who vainly chase the Will- o’-the-wisp : sexual gratification, all their lives. Vari- ations of circumstance may determine sexual perver- sion rather than abnormally powerful desire. Let the physician who has the confidence of his patients in- quire into this matter, and he will be surprised at the result. Only a short time since, one of my patients, a man of exceptional intellect, volunteered a similar explanation for his own excesses. Satiety also brings in its train a deterioration of normal sexual sensibility, with an increase, if anything, in the sexual appetite. As a result, the deluded and unfortunate being seeks for new and varied means of gratification, often de- grading in the extreme. Add to this condition, intem- perance or disease, and the individual may become the lowest type of sexual pervert. As Hammond con- cisely puts it, regarding one of the most disgusting forms of sexual perversion-: “Pederasty is generally a vice resorted to by debauchees who exhaust the re- sources of the normal stimulus of the sexual act, and who for a while find in this new procedure the pleasure which they can no longer obtain from intercourse with women.” When the differentiation of sex is complete from a gross physical standpoint, it is still possible that the receptive and generative centers of sexual sensibility may fail to become perfectly differentiated. The re- sult under such circumstances might be, upon the one hand, sexual apathy, and upon the other, an approxi- mation to the female or male type, as the case may be. Such a failure of development and imperfect dif- ferentiation of structure, would necessarily be too occult for discovery by any physical means at our command. It is, however, but too readily recognized by its results. There exists in every great city so large a number of sexual perverts, that seemingly their depraved tastes have been commercially appreciated by the 8 demi-monde. This has resulted in the formation of establishments whose principal business it is to cater to the perverted sexual tastes of a numerous class of patrons. Were the names and social positions of these patrons made public in the case of our own city, society would be regaled with something fully as disgusting, and coming much nearer home, than the Pall Mall Gazette exposure.1 The individuals alluded to would undoubtedly re- sent the appellation of “sexual pervert;” but, never- theless, in many instances they present the disease in its most inexcusable form : that from vicious impulse. Personally, I fail to see any difference, from a moral standpoint, between the individual who is gratified sexually only by oral masturbation performed by the opposite sex, and those unfortunate mortals whose passions can be gratified only by performing the active role in the same disgusting performance. One is to be pitied for his constitutional fault; the other to be despised for his deliberately acquired debasement. In the case of the professional prostitute who panders to the depraved sexual tastes of certain male speci- mens of the genus homo, she has, at least, the question- able excuse of commercial instinct, and in some cases the more valid one of essential sexual perver- sion. These excuses the majority of her patrons cer- tainly do not have. An interesting theory, bearing upon the question of sexual perversion in its relations to evolutionary re- version, is advanced by Professor S. V. Clevenger.2 This is well worthy of repetition and I will therefore quote it verbatum : “A paper on Researches into the 1 Since the above was written the world has been regaled with the exposure of an establishment in London patronized by the aristocracy, which was devoted to the procurement of young boys for the purpose of passive pederasty. I have also obtained posi- tive knowledge of a physician in this city who has presented dis- gusting manifestations of sexual perversion to his female patients. a Physiology and Psychology, 1885. 9 Life History of the Monads, by W. H. Dallinger, F. R. M. S., and J. Drysdale, M. D., was read before the Royal Microscopical Society, Dec. 3, 1873, wherein fission of the monad was described as being preceded b}? the absorption of one form by another. One monad would fix on the sarcode of another, and the substance of the lesser or under one would pass into the upper one. In about two hours the merest trace of the lower one was left, and in four hours fission and mul- tiplication of the larger monad began. A full descrip- tion of this interesting phenomenon may be found in the Monthly Microscopical Journal (London), for Octo- ber, 1877. Professor Leidy has asserted that the amoeba is a cannibal, whereupon Mr. Michels, in the American Journal oj Microscopy, July, 1877, calls atten- tion to Dallinger and Drysdale’s contribution, and draws therefrom the inference that each cannibalistic act of the amoeba is a reproductive, or copulative one, if the term is admissible. The editor (Dr. Henry Lawson) of the English journal agrees with Michels.” “Among the numerous speculations upon the origin of the sexual appetite, such as Maudsley’s altruistic conclusion, which always seemed to me to be far- fetched, I have encountered none that referred its de- rivation to hunger. At first glance such a suggestion seems ludicrous enough, but a little consideration will show that in thus fusing two desires, we have still to get at the meaning and derivation of the primary one, desire for food. The cannibalistic amoeba may, as Dal- linger’s monad certainly does, impregnate itself by eat- ing one of its own kind, and we have innumerable in- stances, among algae and protozoa, of this sexual fusion appearing very much like ingestion. Crabs have been seen to confuse the two desires by actually eating por- tions of each other while copulating ; and in a recent number of the Scientific American, a Texan details the mantis religiosa female eating off the head of the male mantis during conjugation. Some of the female arach- nidcs find it necessary to finish the marital repast by 10 devouring the male, who tries to scamper away from his fate. The bitings and even the embrace of the higher animals appears to have reference to this deri- vation. It is a physiological fact that association oft- en transfers an instinct in an apparently outrageous manner. With quadrapeds it is most clearly olfac- tion that is most related to sexual desire and its re- flexes; but not so in man. Terrier diligently searches the region of the temporal lobe near its connection with the olfactory nerve for the seat of sexuality; but with the diminished importance of the smelling sense in man, the faculty of sight has grown to vicariate ol- faction; certainly the Must of the eyes’ is greater than that of other special sense organs among Bi- mana. “ In all animal life multiplication proceeds from growth, and until a certain stage of growth, puberty, is reached, reproduction does not occur. The com- plementary nature of growth and reproduction is ob- servable in the large size obtained by some animals after castration. Could we stop the division of an amoeba, a comparable increase in size would be ef- fected. The grotesqueness of these views is due to their novelty, not to their being unjustifiable. While it must thus seem apparent that a primeval origin for both ingestive and sexual desire existed, and that each is a true hunger, the one being repressible, and in higher animal life being subjected to more control than the other, the question then presents itself: What is hun- ger ? It requires but little reflection to convince us of its potency in determining the destiny of nations and individuals, and what a stimulus it is in animated creation. It seems likely that it has its origin in the atomic affinities of inanimate nature, a view monistic enough to please Haeckel and Tyndall.” Dr. Spitzka,1 in commenting on the foregoing, says: “There are some observations made by alienists 1 Science, June 25, 1881. 11 which strongly tend to confirm Dr. Clevenger’s the- ory. It is well known that, under pathological cir- cumstances, relations, obliterated in higher develop- ment and absent in health, return and simulate con- ditions found in lower and even in primitive forms. An instance of this is the pica or morbid appetite of pregnant women and hysterical girls for chalk, slate- pencils and other articles of an earthy nature. To some extent this has been claimed to constitute a sort of reversion to the oviparous ancestry, which, like the birds of our day, sought the calcerous mate- rial required for the shell structure in their food. There are forms of mental perversion properly classed under the head of the degenerative mental states with which a close relation between the hunger appetite and sexual appetite becomes manifest. Under the heading ‘ Wallust, Mordlust, Anthropophagie,’ Krafft- Ebing describes a form of sexual perversion where the sufferer fails to find gratification unless he or she can bite, eat, murder or mutilate the mate. He refers to the old Hindoo myth: Civa and Durga, as showing that such observations in the sexual sphere were not unknown to the ancient races. He gives an instance where, after the act, the ravisher butchered his victim and would have eaten a piede of the viscera; another where the criminal drank the blood and ate the heart; still another where certain parts of the body were cooked and eaten.” 1 Nature (London), commenting on my article, quotes Ovid: “ Mulieres in coitu non- nemque genas cervicemque maris mordant." Illustra- tions of the varying types of sexual perversion are of late years finding their way into literature. A very 1Ueber gewisse Anomalien des Geschlechtstriebes. Von Krafft-Ebing, Archiv. fur Psychiatre, VII. It is unnecessary to call attention to the logic of Dr. Kiernan’s deductions from the above as applied to the Whitechapel horrors. (“ Sexual Perver- sion and the Whitechapel Murders.” Dr. J. G. Kiernan, Medical StandardNovember, 1888.) 12 interesting series of cases is related by Professor von Krafft-Ebing. Journal of Neurology and Psychiatry. Hammond, quoting from Tardieu,1 chronicles the following interesting points with regard to one form of sexual perversion: “ I do not pretend to explain that which is incomprehensible, and thus to penetrate into the causes of pederasty. We can nevertheless ask if there is not something else in this vice than a moral perversion, than one of the forms of psychopathia sexualis, of which Kaan has traced the history. Un- bridled debauchery, exhausted sensuality, can alone account for pederastic habits as they exist in married men and fathers of families, and reconcile with a de- sire for women the existence of these impulses to un- natural acts. We can form some idea on the subject from a perusal of the writings of pederasts containing the expression of their depraved passions. Casper has had in his possession a journal in which a man, member of an old family, had recorded, day by day, and for several years, his adventures, his passions, and his feelings. In this diary he had, with unex- ampled cynicism, avowed his shameful habits,which had extended through more than thirty years, and which had succeeded to an ardent love for the oth- er sex. He had been initiated into these new pleas- ures by a procuress, and the description which he gives of his feelings is startling in its intensity. The pen refuses to write of the orgies depicted in this journal, or to repeat the names which he gave to the objects of his love.” “ I have had frequent occasion to read the corre- spondence of known pederasts, and have found them applying to each other, under the forms of the most passionate language, idealistic names which legiti- mately belong to the diction of the truest and most ardent love. But it is difficult not to admit the ex- istence in some cases of a real pathological alteration 1 “ Sur les attentats aux moeurs. Paris, 1858, p. 125. 13 of the moral faculties. When we witness the pro- found degradation, the revolting salacity of the indi- viduals who seek for and admit to their disgusted fa- vors men who are gifted both with education and for- tune, we might well be tempted to think that their sensations and reason are altered; but we can enter- tain no doubt on the subject, when we call to mind facts such as those I have had related to me by a magistrate, who has displayed both ability and ener- gy in the pursuit of pederasts. One of these men, who had fallen from a high position to one of the low- est depravity, gathered about him the dirty children of the streets, knelt before them and kissed their feet with passionate submission before asking them to yield themselves to his infamous propositions. Anoth- er ‘experienced singularly voluptuous sensations by having a vile wretch administer violent kicks on his gluteal region. What other idea can we entertain of such horrors than that those guilty of them are actu- ated by the most pitiable and shameful insanity?” Some of the manifestations of sexual perversion, quoted by various authorities, are very extraordinary, and it is difficult to associate them with titillations of the sexual sensibility. Perhaps the most familiar of these cases is that of Sprague, who was committed in Brooklyn a number of years ago for highway rob- bery. 1 It is unnecessary to present this case in detail, but an outline of it may prove interesting. Sprague was arrested immediately after having assaulted a young lady by throwing her down violently, removing one of her shoes and running away with it. He made no attempt to steal anything else, although she had on valuable jewelry. When the trial came on, insan- ity was alleged as a defense. Numerous witnesses, the principal of whom was the father of the defendant, a clergyman of the highest respectability, testified to the erratic conduct of the prisoner. A family history Medical Jurisprudence, Vol. I, 1860, p. 732. 14 was elicited which bore most pertinently upon Sprague’s case. His grandfather, grandmother, great- grand-uncle, three great-aunts, and a cousin having been insane. He had himself in his youth received numerous blows and falls upon the head, and within a year from the last head injury he had developed se- vere headaches, associated with which his friends noticed a bulging of the eyes. About this time the prisoner developed a fondness for stealing and hiding the shoes of females about the house, and it was found necessary by his relatives and the female domestics to carefully conceal or lock up their shoes to prevent his abstracting them. Upon investigation it was dis- covered that the act of stealing or handling the shoes produced in him sexual gratification.” Wharton1 several years ago chronicled a most pe- culiar case of sexual perversion. In this instance the morbid sexual desire impelled the individual to as- sault young girls upon the streets of Leipzig by grasp- ing them and plunging a small lancet into their arms above the elbow. . The fact was developed after his arrest that these peculiar acts of assault were accom- panied by seminal emissions. This authentic case gives a vivid coloring to the rational hypothesis that the now famous Whitechapel assassin is a sexual per- vert, a theory which Kiernan in particular has sup- ported, and which I believe has suggested itself to the minds of the majority of medical men who have given the murders even slight consideration. Many cases of sexual perversion manifest them- selves only under the influence of disease or of drunk- enness. Ovarian irritation, and those more obscure cases of hysteria in women which we are unable to trace to a definite physical cause, are frequently as- sociated with sexual perversion. The physiological(P) disturbance incidental to pregnancy is, in certain neu- rotic patients, productive of similar aberration. !A Treatise on Mental Unsoundness, etc., Philadelphia, 1873. 15 Whether the influence of liquor obtunds the moral faculties, or develops an inherent defect of sexual physiology in any given case, is of course difficult to determine. I know of an individual who conducts himself with perfect propriety when sober, and who is a man of exceptional intellect, but who, when under the influence of alcohol, is too low for consort with the human species. The association of sexual perversion with malform- ations of the sexual organs with or without associated close approximation to the general physique of the opposite sex, male or female, as the case may be, is certainly not surprising. I have met, in my own ex- perience, with a most peculiar illustration of this form of sexual perversion, in the form of a young mulatto hypospadiac. This man had marked hypospadias, and had, it seems, an affinity for women, as illustrated by the fact that he contracted a gonorrhoea in the nor- mal manner. That he also had a predilection for the passive role in the act of copulation was demonstrated by the fact that a number of young lads, ranging from ten to seventeen years of age, who lived in the neigh- borhood in which the spurious hermaphrodite was employed in the capacity of cook, contracted from him typical gonorrhoea, for which several of them came under my care. A peculiar case was recently reported to the Chi- cago Medical Society by Dr. A. R. Reynolds, of this city, of a man who had a love affair with a woman whose right lower extremity had been amputated at the thigh, and became so much attached to her that he was afterward impotent with perfectly formed women, it being necessary for him to secure females who had undergone mutilation similar to that of his former attachment in order that he might be sexually gratified.1 A peculiar phase of sexual perversion is occasionally seen among masturbators, male and fe- 1 Western Medical Reporter, Nov., 1888. 16 male. The individuals suffering from this have a pe- culiar predilection for titillating the sexual organs in the most outlandish fashion. Such patients are in many instances particularly fond of introducing for- eign bodies of various kinds into the uretlia and thus gratifying their sexual desires. Such cases occur even among persons who have opportunities for nor- mal gratification. Thus an interesting case is re- ported by Poulet1 of a married woman, the mother of three children, who failed to receive gratification from ordinary intercourse, and practiced masturbation with a blunt piece of wood fastened to a wire. Her unfortu- nate failing was exposed through the slipping of the foreign body from her grasp into the bladder. Kier- nan reports a somewhat similar case of an insane girl who was admitted into his service at the Cook County Insane Asylum. In this instance the physical appear- ance of the sexual organs and anus led to a suspicion of pederasty which was confirmed upon investigation.2 I have already directed attention to forms of sexual perversion which do not conform to Westphal’s definition of Contrare Sexualempfindimg, which implies a sexual predilection on the part of an individual for those of his or her own sex with an inversion for sex- ual intimacy with those of the opposite sex. In my opinion certain other cases of disease, the principal manifestation of which is excessive sexual desire, are really forms of sexual perversion. Such cases are often met with in both the male and the female. Satyriasis is a disease that occurs in the male, with or without insanity, the principal manifestation of which is an abnormally excessive and unreasonable sexual desire. It is not a frequent disease as brought to the attention of the physician, probably because the opportunities for gratification of the male are rela- tively numerous. 1 Foreign Bodies.” 2 Western Medical Reporter, Nov., 1888. 17 The disease consists of a constant desire, attended with vigorous erections, which no amount of sex- ual intercourse in some instances will gratify. It has been termed “erotic delirium,” and it may or may not be due to coarse disease of the brain. In the worst cases of the disease the unfortunate individual maybe the subject of mania and delirium of a violent form. Acton1 relates to the case of an old man, suffering from satyriasis, whose desire was so extreme that he would masturbate whenever he was brought in the presence of women. After his death a small tumor was found in the pons varolii. Shocks and injuries involving the cerebellum are peculiarly apt to be followed by persistent erections. This phenomenon has been noticed in connection with executions by hanging. Injuries of the spinal cord, although in the majority of instances inhibiting the sexual function by producing complete paralysis of that portion of the cord which seems to bear an inti- mate relation to sexual sensibility, produce in some instances from irritation of the same nervous struct- ure, persistent erection. Cases of this kind are re- lated by Lallemand.2 The following case is one which has been most frequently quoted: “This man was a soldier, who, in climbing over the walls of the garrison, fell upon his sacrum. Following this injury he became paraplegic and suffered with per- sistent priapism. This lasted for some time, and could not be relieved by intercourse. All pleasurable sensa- tions and the power of ejaculation were destroyed, al- though sexual desire was very ardent. During sleep, however, the unfortunate subject had lascivious dreams, accompanied by slight sensation and ejaculation.” The causes of satyriasis, as enumerated by different authorities, are : masturbation, diseases of the brain, particularly those affecting the cerebellum, injuries 1 On the Reproductive Organs, 2 On Spermatorrhoea. 18 and diseases of the spinal cord, sexual excesses and the administration of poisonous doses of cantharides. Prolonged continuance is another rare and dubious cause to which sat3?riasis has been ascribed. J. W. Howe,1 quoting from Blandet, describes a case of this kind. The patient was an earnest, hard- working and zealous missionary. He was unfortunate in the possession of an intensely passionate nature, although he had gratified himself in a vicious manner. So intense was his excitement in the presence of women that it became necessary to seclude himself from them as far as possible. This plan proved a failure, for he became so much worse that he suffered from satyriasis in an extreme degree. A cure was fi- nally accomplished by the normal indulgence of his passion. The mild form of excessive sexual desire called pri- apism, may be due to local irritation. In some instances such irritation will produce severe priapism without sexual desire. I have at present under my charge a gentleman who is suffering in this manner. Pie is about 50 years of age, and has been somewhat dissipated and a high liver, as a consequence of which he has gout in an extreme degree. He has suffered for several years from vesical irritation, attributed by him to stricture of long standing. The urethra on examination presents no abnormality; the urine is highly concentrated and strongly acid. As soon as the patient retires for the night, he begins to be troubled with severe erections, which are so marked as to be quite painful, and which persist during the entire night. Sexual intercourse gives no relief. I can only attribute this case to sexual hyperaesthesia, incidental to long continued gout and irritation of the genito-urinary tract. This does not manifest itself during the daytime, but during the night; when, as is well known, the spinal cord is relatively hyperaemic 1 Excessive Venery. 19 and in a condition of increased functional activity. The same explanation holds good here that prevails in nocturnal emissions. Nymphomania (erotomania, furor uterinus) is a dis- ease analogous to satyriasis, occurring in the female. It is characterized by excessive and inordinate sexual desire, and often by the most pronounced lewdness and vulgarity of speech and action. In the most se- vere forms, it is apt to be associated with, and de- pendent upon, other forms of insanity, with or with- out gross brain disease. In some instances the disease is a reflex manifestation of irritative affections of the sexual apparatus. Thus, ovarian and uterine diseases are apt to be associated with it. Any irrita- tion about the external genital organs in a female of hysterical temperament may produce the affection; all that is necessary being a nervous and excitable state of the nervous system, a passionate disposition, and the existence of local irritation of the sensitive sexual apparatus. Some of the recorded cases of nymphomania are very pitiful. It has been known to be associated with the cerebral distuabance inci- dental to pulmonary consumption. Thus, a case has been recorded of a woman who, in the last stages of this disease, exhibited the most inordinate sexual desire, and but a short time before her death impor- tuned her husband to have intercourse with her. The association of hysteria with this unfortunate condition of the mind and sexual organs is one with which nearly every gynecologist of experience is per- fectly familiar. Nymphomania is also known to occur as a result of masturbation and sexual excess. In women of a highly erethistic temperament, it has been developed as a consequence of sudden cessation of the normal method of sexual indulgence. A knowledge of sexual matters is by no means nec- essary to the development of nymphomania, for it has been known to occur in individuals who had neither masturbated nor indulged in sexual intercourse. Some 20 of the most painful cases of the disease have occurred during pregnancy. The principal astonishing feature of such unfortunate cases is the acquirement of lewd actions and expressions on the part of women previ- ously and naturally pure-minded and refined. Such women may use expressions and commit actions that lead the physician to wonder where they they possibly have acquired a knowledge of them. The gynecologist is compelled to be on his guard with reference to a not infrequent form of nympho- mania, but one which is little suspected by those sur- rounding the patient, in which the woman develops a fondness for gynecological manipulations. The sub- terfuges and devices of such patients to induce hand- ling of the sexual organs on part of the physician are something remarkable. Perhaps one of the most fre- quent forms of this malingering is the pretense of retention of urine ; although every disease which they may have heard of will be complained of by such patients in their insane endeavors to obtain manipula- tions at the hands of gynecologists. Howe relates an interesting case of this kind occur- ring under his observation at Bellevue Hospital : “A girl, set. 18, was admitted, supposed to be suffer- ing from retention of urine. She was thin; her eyes were deep set, but bright and staring, and were found filled with tears. Her statement was that she had passed no water for three days; that she wTas subject to these attacks, and was treated by having her water drawn off. I introduced the catheter, and found only a few ounces of urine in her bladder—not enough, in- deed, to corroborate her history. The next morning, as she had not urinated during the night, I drew off the urine again. While doing so I noticed by a se- ries of peculiar convulsive movements, that she was under the influence of strong excitement. Further examination showed that the labia minora, clitoris and adjacent parts were red and swollen and bathed in a profuse mucous secretion. I then remembered that 21 on the previous evening she had shown a somewhat similar state of excitement, and gave the nurse orders to watch her closely all day. In the evening the nurse informed me that the patient kept up a constant fric- tion of the genitals when she supposed no one was watching, and even when eyes were on her she en- deavored, by uneasy movements in the bed, to con- tinue the titillation. Knowing then what I had to deal with, the patient was given a sedative, and was told that she must empty her bladder without assistance. For thirty-six hours subsequently she obstinately in- sisted on her inability to urinate. When she was told no catheter would be employed again there was no further retention. Soon after she left the hospital I learned that a physician friend of mine was treating her for uterine disorder, but he, too, soon found out the true nature of the case, and advised her to get married.” Several cases of a similar nature have come under my own observation, one during my hospital experi- ence, and two others in private practice. The treatment of satyriasis and nymphomania con- sists chiefly in the removal of irritation of the sexual apparatus, the administration of anaphrodisiac reme- dies to be hereafter considered, and attempts to re- strain sexual excesses, or to break the habit of mas- turbation, as the case may be. Where there is actual organic disease the case is likely to be found to be in- curable in the majority of instances, particularly if the structural disease involves the nervous centers. In women, the extirpation of the ovaries, or the proced- ure of Mr. Baker Brown—clitoridectomy may be per- formed. Howe recommends the application of the actual cautery to the back of the neck. Basing this treatment upon the theory that the disease takes its origin in over-excitation of the nerve fibers of the cer- ebellum or some of the ganglia in the neighborhood, he also suggests blisters and setons to answer Jdie same purpose. Dry cupping to the nucha is also ser- 22 vicable. Means to restore the general health are al- ways indicated. In the severe cases of the maniacal form of excessive sexual desire, the asylum is usually our only recourse.