THE PHYSIOLOGICAL AND PATHOLOGICAL RELATIONS BE- 
TWEEN THE NOSE AND THE SEXUAL 
APPARATUS OF MAN. 
By John Noland Mackenzie, M. D., of Baltimore. 
Clinical Professor of Laryngology ancl Phinology in the Johns Hopkins Medical 
School and Laryngologist to the Johns Hopkins Hospital. 
[From The Johns Hopkins Hospital Bulletin,.No. 82, January, 1898.] [From The Johns Hopkins Hospital Bulletin, No. 82, Januarj', 1898.J 
THE PHYSIOLOGICAL AND PATHOLOGICAL RELATIONS BE- 
TWEEN THE NOSE AND THE SEXUAL 
APPARATUS OF MAN.* 
By John Noland Mackenzie, M. D., of Baltimore. 
Clinical Professor of Laryngology and Bhinology in the Johns Hopkins Medical 
School and Laryngologist to the Johns Hopkins Hospital. 
" Balnea, vina, Venus corrumpunt corpora nostra, 
Set vitam faciunt, b(alnea), v(ina), V(enus)."t 
OZvof Kal ra /metpa Kal 7 mpl Kv~piv epuij 
o^vrepr/v wepirei rijv odov elf 
Mr. President and Gentlemen.-The limited, time at my 
disposal this morning precludes an elaborate discussion of the 
propositions which form the text for these remarks. I shall, 
therefore, content myself with a brief statement of the con- 
clusions which I have reached after a careful study of the 
subject, and shall not weary you with the arid narrative of 
individual cases. 
The injurious effects of undue excitation or disease of the 
generative apparatus upon the organs of sight and. hearing 
are matters of ancient recognition. That immoderate indul- 
gence in venery may lead to derangements of the former was 
familiar to Aristotle,§ and that the fathers of medicine recog- 
* Remarks made before the British Medical Association at its 
Montreal meeting, September, 1897. 
t An old inscription found in the Campus Florae in Rome. See 
Buecheler's Antholog. Latin. Carmen. Epigraphic., Ease. II, p. 
705, No. 1499, Teubner edition, 1897. Also Corpus Inscript. Latin. 
VI, 15258, Gruter 615, 11, Orelli 4816, etc. It is attributed, how- 
ever, by Scaliger to a modern poet. 
| The supposed Greek original. See Antholog. Palatin. X, 112. 
§ Aristot. Opera omnia graeco-latin. Parisiis, 1854. De animal- 
ium generatione, lib. ii, cap. 7. 2 
nized some mysterious connection between the ear and the 
reproductive functions is evident from the testimony of Hip- 
pocrates.* Over two centuries ago Rolfincf wrote: "Qua 
partibus genitalibus abutitur, et sexto praecepto vim infert, male 
audit," a proposition which has been fully established by the 
clinical experience of to-day. 
The intimate relationship between the genital organs and 
those of the throat and neck seems to have attracted the 
special attention of the ancients. Thus AristotleJ clearly 
defines the changes in the voice at puberty, and the effect of 
castration on its qualities.§ Its harsh, irregular and discordant 
character during the maturation of the sexual functions was 
furthermore affirmed to be more conspicuous in those who 
attempted the early gratification of the sexual appetite. The 
observation that, during coitus, the voice becomes rougher 
and less acute, led the phonasci or voice-trainers to infibulate 
their pupils, or confine the penis with bands and fetters, to 
preclude indulgence in wantonness,|| whilst the popular idea 
* Opera omnia. Ed. Kuhn, Lipsiae, 1827, tom. i, p. 562. 
t Ordo et methodus generatione dicatarum partium, per anato- 
men, cognoscendi fabricam. Jenae, 1664, part i, cap. vii, p. 32. 
J Op. cit., De animal, historia, lib. vii, cap. i. 
Choking sensations in the throat and other hysterical manifes- 
tations have from time immemorial been regarded as signs of preg- 
nancy. Shakespeare, in King Lear (sc. ii, act iv) thus gives 
expression to this idea : 
" O, how this mother swells up towards my heart! 
Hysterica passio! down, thou climbing sorrow, 
Thy element's below." 
§ Op. cit., De animal, generatione, lib. v, cap. 7. 
|| J. Riolani Antbropographiae, lib. ii, cap. 34, p. 303, Franco- 
furti, 1626. Riolanus quotes from the Musaeum of Albertus Magnus 
the case of a girl, sent to fetch wine from a public house, who was 
seized and ravished on the road, and who found in attempting to 
sing on her return that her voice had changed from acute to grave. 
See also Martial (lib. ix, Epig. 28) : 
"Jam paedegogo liberatus etcujus 
Refibulavit turgidum faber penem." 
Also lib. xiv, Epig. 215 : 
" Die mihi, simplicitur, comoedis et cithaedis 
Fibula quid praestet ? Carius ut futuant." 
See also Juvenal, sat. vi, 73. 
The gladiators and athletes were also subjected to infibulation : 
" Dum ludit media, populo spectante, palaestra, 
Delapsa est misero fibula ; verpus erat." 
Martial, lib. viii, Epig. Ixxxii. 3 
of the injurious effect of repeated coition upon the singing 
voice is reflected in the epigram of the Roman satirist: 
" Cantasti male, dum fututa es, Aegle, 
Jam cantas bene ; basianda non es."* 
The supposed influence of sexual excitement upon the 
external throat is likewise apparent from the ancient nuptial 
ceremonial. Before the virgin retired on the. wedding night 
it was customary to measure her neck with a tape and again 
on the following morning. If the neck showed an increase 
in size it was taken as a certain indication of defloration, 
whilst if the two measurements were equal she was supposed 
to have retained her virginity. This curious test, which has 
also been utilized to establish the fact of adultery, has been 
transmitted to us in the Epithalamium of Catullus: 
" Non illamnutrix, oriente luce revisens, 
Hesterno collum poterit circumdare fllo."t 
Whilst, therefore, the above historical facts point to the 
early recognition of the relationship between over-indulgence 
of the sexual powers and morbid conditions of the eye, ear 
and throat, the special part which it plays in the production 
of nasal disease seems to have been heretofore overlooked. 
My attention was first attracted to the investigation of the 
physiological and pathological relations between the nose and 
the genital organs by the case of a patient in London, in 1879, 
who invariably suffered from coryza after sexual indulgence. 
Stimulated by this observation I began the study of the 
subject, and five years later published the results of my inves- 
tigations in the American Journal of the Medical Sciences for 
April, 1884, in an essay entitled " Irritation of the Sexual 
Apparatus as an Etiological Factor in the Production of 
Nasal Disease." In this thesis, which was the first attempt 
* Martial, Epig. lib. i, xcv, ad Aeglen fellatricem. 
fEpithal. Pelei et Thetidos, Ixiv. Catulli op, omn., Lond., 
1882, p. 230. This phenomenon was variously attributed to the 
dilatation of the vessels of the neck by the semen, a portion of 
which, according to the Hippocratic doctrine, flowed down from 
the brain during intercourse, and to the general agitation of the 
vascular system, and especially the arterial and venous trunks of 
the throat, during the excitement of the sexual act. 4 
to reduce this curious relationship to, as far as possible, a 
scientific basis, I advanced the series of propositions which 
you will find embodied in the text of these remarks. 
Several years later there appeared in France a thesis by 
Arviset,* a critical review by Isch-Wallf and an excellent 
article by Joal,| which dealt in a most interesting way with 
the topic under consideration. In Germany, Peyer§ in Munich, 
Endriss|| in Goeppingen, and, in the present year, Fliess^ in 
Berlin, have enriched its literature with their contributions. 
Fliess's elaborate monograph, written in apparent ignorance 
of the work done by me in this special field before him, is a 
model of painstaking labor, and is valuable as an independent 
contribution to the study of this important subject. 
Before submitting for discussion the propositions which 
form the text for these remarks, let me briefly call attention 
to certain matters of historical interest which have seemed in 
olden times to have foreshadowed the physiological relation- 
ship between the nose and the genital apparatus. 
In the Ayurveda, the sacred medical classic of the ancient 
Hindus, a work of fabulous antiquity, the causes of common 
catarrh are thus tersely defined: 
"Uxoris concubitus, capitis dolor, fumus, pulvis, frigus, 
Vehemens calor, retentio urinae soecumque statim 
Catarrhi causae dictae sunt."** 
* Contribution a 1'etude du tissu erectile des fosses nasales. 
These de Lyon, aout, 1887. 
t Progres medical, Sept. 10 et 17,1887. Du tissu erectile des fosses 
nasales. 
t Revue mensuelle de laryngologie, d'otologie et de rhinologie, 
fevr. et mars, 1888. De I'epistaxis genitale. 
§ Ueber nervos. Schnupfen u. Speicbelfluss u. den atiologischen 
Zusammenhang derselben mit Erkrankungen desSexualapparates. 
Miinchener Med. Wochenschrift, Jahrgang 1889, No. 4. 
|| Ueber die bisherigen Beobachtungen von physiologischen u. 
pathologischen Beziehungen der Oberen Luftwege zu den Sexual- 
organen. Inaug. Diss. Wurzburg, 1892. 
TfDie Beziehungen zwischen Nase u. weiblichen Geschlecbts- 
organen. Berlin, 1897. 
**Susrutas Ayurvedas: id est Medicinae Systema, a venerabili 
D'hanvantare demonstratum a suo discipulo compositum. Trans- 
lated from the Sanscrit into Latin byFranciscus Hessler, Erlangen, 
tom. iii, cap. xxiv, p. 44, 1850. 5 
Although indulgence in venery heads the list, it is highly 
probable that its real influence was unrecognized, and that it 
is given as an etiological factor simply in accordance with the 
seemingly prevalent idea that pervades the Indian Shastras, 
that venery and confinement of the bowels lay at the root of 
most diseases. 
The earlier physiognomists laid great stress upon the size 
and form of the nose as an indication of corresponding pecu- 
liarities in the penis.* The nose, for example, that was large 
and firm was looked upon as an index of a penis acceptable to 
women, and hence it was that the licentious Emperor Helio- 
gabalus only admitted those who were nasuti, i. e. who pos- 
sessed a certain comeliness of that feature, to the companion- 
ship of his lustful practices.^ 
Johanna, Queen of Naples, a woman of insatiable lust, 
seems also to have selected, as her male companions, men with 
large noses, with a similar end in view.J Sterne, in Tristram 
Shandy, depicts with consummate humor the supposed sexu- 
ality of the nose in " Slawkenbergius's Tale," in which the 
city of Strasburg was captured by a handsome nose. Every 
one remembers the closing lines of that intensely amusing 
production: "Alas! alas 1 cries Slawkenbergius, making an 
exclamation-it is not the first, and I feai' will not be the last 
fortress that has been either won-or lost by noses." 
While the efforts of those who have selected men who were 
nasuti for sexual purposes were doubtless often crowned with 
success, history, alas! records some cases of bitter disappoint- 
ment. Thus Henry Salmutb§ relates with great solemnity a 
case in point. 
Christian Francis Paullini in his curious work|| devotes a 
* See especially Ludwig Septalius : De Naevis tractatus, sect. 26, 
p. 18, in Bonet's Labarynthi medic, extricati, etc. Genevae, 
1687. 
j-Vide Aelius Lampridius in vita Antonii Heliogabilis, in Hist. 
August, etc. Beponti. 
JGuidonis Pancirolli rerum memorabilium sive deperditarum 
pars prior, etc. Francofurti, 1646, lib. 2, tit. 10, p. m. 176. 
§Ibid. p. 177. 
llObservat. medico-physiog. Cent, i, obs. xcvii, p. m. 141 ; Lip- 
siae, 1706. 6 
chapter, under the caption Nasuti non semper bene vasati* to 
the subject. After alluding to the prevalent impression that 
a large nose indicated a corresponding increase in volume of 
the virile organ, he goes on gravely to state that he has known 
several "noble and pious" men in whom the rule did not 
hold good, and relates the following mournful tale: " Nobilis- 
sima ac venustissima Virgo, sed valde petulca, duos simul 
habebat procos, alterum bonae vitae, fortunataeque hominum, 
sed macilentum; alterum quadratum, et insigni naso conspi- 
cuum, hirconem, ac fruges consumere natum. Illa, temto 
isto, hunc sibi elegit ob peculium, quod sperabat, magnum et 
conditionem strenuam. Sed egregie decepta est. Hine domi 
jurgia, foris rixae et summa viri aversio, ob sterilitatem quae 
thorum perpetuo comitatur." 
It was possibly, the supposed influence of an elegant and 
handsome nose as an incentive to illicit amours that led to the 
well-known custom of amputation of that organ in adulterers, 
"truncas inhonesto vulnere nares"\ whilst in women detected 
in the act| the disfigurement thereby produced was intended 
as a perpetual reminder of their shame. 
In astrology Venus was supposed to govern the nose. 
According to all the astrologers, the gentry who 
" . .. feel the pulses of the stars, 
To find out agues, coughs, catarrhs," 
Venus presides over generation and all the parts pertaining 
thereto. De la Chambre in his work L'Art de Connoistre les 
Hommes,§ in alluding to this supposed influence, says that 
nothing is more convincing, at least to those who admit the 
influence of planets on the affairs of men, than that there is 
an intimate relationship (astrological] y) between the genital 
organs and the nose. As the result of this sympathy the 
nose must receive the same influence which the planet Venus 
*Vasatus, post-classical. 
f Virgil, Aeneid, vi, 497. 
jVide Diodorus Siculus in Bibliothecae Historicae, Paris edi- 
tion, 1854, tom. i, lib. i, cap. Ixxvii (5), p. 64. On the customs and 
laws of the Egyptians. 
§ L'Art de Connoistre les Hommes. Amsterdam, chez Jacques 
le Jeune, 1660. De la metoposcopie, p. 259. 7 
communicates to the genital organs and must submit to the 
same empire to which they are subjected. The astrological 
signs of the nose are reproduced in the genital organs, which, 
like the nose, occupy a prominent part in the center of the 
body. 
The charlatans of those days pretended to establish the fact 
of virginity or defloration by astrological signs. William 
Lilly, the celebrated English astrologer and impostor of the 
seventeenth century, claimed never to have made a mistake.* 
It was doubtless this method of imposture that inspired the 
line of Butlei' in Hudibras, "detect lost maidenheads by sneez- 
ing,"! in the famous poem in which he smiled the pretensions 
of this fraternity of quacks away. 
The idea of some occult relationship between the nose and 
the virile member seems, in days gone by, to have crept even 
into the darkness of teratology. Thus we find PalfynJ 
describing cases in which in place of the nose were found 
masses resembling the male organs of generation. 
To render the relationship to which I wish to call attention 
more intelligible it is necessary to recall the anatomical fact 
that in man, covering the whole of .the inferior, the under 
surface of the middle, the posterior ends of the middle and 
superior, and, what is not sufficiently insisted upon by many 
writers, a portion of the septum, is a structure which is 
essentially the anatomical analogue of the erectile tissue of 
the penis. Like it, this body is composed of irregular spaces, 
or so-called erectile cells, separated by trabeculae of connec- 
tive tissue containing elastic and muscular fibers, the latter 
element being not as prominent and well-marked as in the 
cavernous bodies of the generative organs. Under a multi- 
tude of various impressions erection of this tissue takes place, 
* Life and Times of William Lilly, written by himself. London, 
1629. 
tPart ii, canto iii, 285. Bartholini (Anatomica Reformata, de 
naso ; also Lond. ed., bk. iii, chap, x, p. 150) tells us that Michael 
Scotus pretended to be able to diagnosticate virginity by touching 
the cartilage of the nose. 
fFortunus Licetus (Jean Palfyn), Description anatomique des 
parties de la femme, etc., avec un traite des monstresr Leiden, 
1708, lib. ii, chap. 30, p. 142 and 144. 8 
the dilatation of its cells being, in all probability, under the 
direct dominion of vaso-motor nerves derived through the 
spheno-palatine ganglion. It is the temporary dilatation of 
these bodies that constitutes the anatomical explanation of 
the stoppage of the nostrils in coryza and allied conditions, 
and their permanent enlargement is the distinctive feature of 
chronic inflammatory states of the nasal passages. This 
erectile area is, moreover, especially concerned in the evolu- 
tion of the many curious "reflex" phenomena which are 
observed in connection with nasal affections. Indeed, the 
changes which it undergoes seem to lie at the foundation of 
nasal pathology, and furnish the key not only to the correct 
interpretation of nasal disease, but also to many obscure affec- 
tions in other and remote organs of the body. For practical 
purposes we may consider this erectile, or contractile, area, 
consisting, as it does, of myriad blood-vessels and blood spaces 
in wonderfully exquisite correlationship, bounded on the one 
side by mucous membrane, and on the other by periosteum, 
as an important organ, certainly of respiration and probably 
of other physiological functions, using the term organ in its 
highest physiological sense. Call these bodies by whatever 
name we may, erectile bodies, corpora cavernosa, nasal lungs, 
we have a definite, peculiar anatomical arrangement of tissues 
endowed with specific physiological function and serving a 
manifest and manifold destiny in the organism. 
Physiological. 
That an intimate physiological relationship exists between 
the sexual apparatus and the nose, and especially the intra- 
nasal erectile tissue, is sufficiently evident from the following 
facts: 
I.-(a) In a certain proportion of women whose nUsal organs 
are healthy, engorgement of the nasal cavernous tissue occurs 
with unvarying regularity during the menstrual epoch, the 
swelling of the membrane subsiding with the cessation of the 
catamenial flow. 
(5) In some cases of irregular menstruation, in which the 
individual occasionally omits a menstrual period without 
external flow, at such times the nasal erectile bodies become 
swollen and turgid as in the periods when all the external 
evidences of menstruation are present. 9 
(c) The monthly turgescence of the nasal corpora cavernosa 
may be bilateral, or confined, to one side, the swelling appear- 
ing at first in one side and then in the other, the alternation 
varying with the epoch. 
{cl} The periodical erection may be inconsiderable and give 
rise to little or no inconvenience, or, on the other hand, the 
swollen bodies may occlude the nostril and awaken phenomena 
of a so-called reflex nature, such as coughing, sneezing, etc. 
{e} In some cases there seems to be a direct relationship 
between this periodical engorgement of the nasal erectile 
bodies and the phenomena referable to the head that so often 
accompany the consummation of the menstrual act. 
(/) As a natural consequence of the phenomena above 
described, the nasal mucous membrane becomes, at such 
periods, more susceptible to reflex-producing impressions, and 
is therefore more easily influenced by mechanical, electrical, 
thermic and chemical irritation. 
{g} The conditions (engorgement and increased irritability 
of the nasal mucous membrane) indicated above, together 
with the phenomena that accompany them, are also found 
during pregnancy at periods corresponding to those of the 
menstrual flow. There is also reason to believe that similar 
phenomena occur during lactation and the menopause. 
During the period of my original investigations I was 
unable, from poverty of material, to come to any definite con- 
clusions in regard to the behavior of the nasal apparatus dur- 
ing pregnancy. I was familiar with the fact that in some 
women the presence of pregnancy was proclaimed by a cold 
in the head. Isolated cases, too, had led me to the belief that 
the changes such as I described in my first article occurred in 
some women, at least, during that period at intervals corre- 
sponding to those of the menstrual flow, but at the time of 
publication of my essay I was not as sure of the fact as I 
am now. Since my work first appeared I have been so busied 
with other things that I have given little or no time to the 
subject. Several cases have, however, offered themselves to 
me which have confirmed me in the belief that sometimes, at 
least, the phenomena described by me as occurring during 
menstruation also occur in pregnancy at periods correspond- 
ing to those of the monthly flux. Not to mention others, I 10 
have, for example, at present under my care a young pregnant 
married woman, without any disease of the nasal passages, 
who with great regularity during the time at which her 
menses are due (from the 13th to the 17th of every month) 
suffers from acute and complete obstruction of both nostrils, 
intense sensitiveness of the nasal mucosa and violent paroxysms 
of sneezing. These phenomena commence on the 13th, reach 
their acme by the 15th, and gradually subside, to disappear on 
the 17th of the month. During the intervals between the 
periods there is no abnormal condition of the nose present. 
Indeed, it was for this peculiar, disagreeable feature of her 
pregnancy that she consulted me, with a very accurate volun- 
tary description of her symptoms. This condition of affairs 
has continued during three pregnancies. If other proof were 
wanting of the fact that menstrual phenomena referable to 
the nose occur during pregnancy, the question has been defi- 
nitely settled by Fliess, who has shown that they not only 
occur during that period, but also during lactation. This 
author also reports several cases in which abortion was acci- 
dentally produced by galvano-caustic operations on the nose. 
In this connection I would call attention to the fact that 
Pliny* observes that the smell of a lamp which has been 
extinguished will often cause abortion, and that the latter 
ensues should the female happen to sneeze just after the 
sexual congress. 
II.-The presence of vicarious nasal menstruation. 
(«) It is a familiar fact that women are occasionally 
found in whom the menstrual function is heralded or estab- 
lished by a discharge of blood from the nostrils. This hem- 
orrhage, which may be accompanied by other phenomena 
referable to the nose, such as sneezing, etc., may be replaced 
afterwards by the uterine flow, but sometimes continues 
throughout the menstrual life of the individual. In the 
latter case, some malformation or derangement of the sexual 
apparatus seems to be, usually, though not always, responsible 
for the nasal flow. 
(b) Epistaxis also occurs, now and then, from the suppres- 
sion of the normal flux. This was considered as a favorable 
*Nat. His. lib. vii, cap. 7. 11 
sign by Hippocrates,* and by Celsus,f who followed closely in 
his footsteps. 
(c) Hemorrhage from the nose may occur as the vicarious 
representative of menstruation during pregnancy; towards 
the close of menstrual life as the premature or normal herald 
of the menopause; or it may be observed as a recurring phe- 
nomenon after the establishment of the change of life or after 
the removal of the uterus or its appendages. 
(d) These vicarious hemorrhages are, moreover, not confined 
to women, but make their appearance not infrequently in boys 
at or near the age of puberty, upon the full development of 
their sexual powers. 
HI.- The well-known sympathy between the erectile portions of 
the generative tract and other erectile structures of the body. 
There is no reason why the sexual excitement that leads to 
congestion and erection of these organs, as for example in the 
case of the nipple, may not, under similar circumstances, cause 
engorgement of the nasal erectile spaces. 
IV.-The occasional dependence of phenomena referable to 
the nose during sexual excitement (such as, for example, nose 
bleed, stoppage of the nostrils, sneezing and other reflex acts), 
either from the operation of a physiological process, the ereth- 
ism produced by amorous contact with the opposite sex or 
during the consummation of the copulative act. 
The nasal symptoms most commonly found associated with 
sexual excitement are sternutation, occlusion of the nasal pas- 
sages (from erection of the corpora cavernosa), and epistaxis. 
Sneezing is sufficiently common, particularly during coitus. 
Quite a number of such cases have come under my personal 
observation in persons in robust health and whose nasal organs 
were apparently free from disease. The reflex may occur 
before (from erotic thoughts), during, or after the consum- 
mation of the act. Many like cases have been since reported 
to me. Thus one physician of large practice, who became 
interested in the subject, found twelve cases among his clien- 
tele. It may be interesting to know that this form of sexual 
consensus, or sympathy, has been recognized for centuries. 
*0p. omn. Ed. Kiihn. Lipsiae, 1827, tom. ii, p. 174. De 
morbis lib. i, and Aph. sect. 5, art. 33. 
f De medicina. Rotterodami, 1750, lib. ii, cap. 8. 12 
Thus in the sixteenth century, Amatus Lusitanus* reports a 
case of sneezing from the sight of a pretty girl; Bonetf and 
Thomas Bartholini,J and later, Stalpart VanderwieL§ relate 
cases of sneezing during coitus. In the last centuryXchurigl| 
following Bartholini, and at the commencement qf'the present, 
Grun er,T[ give sneezing as one of the signs of pregnancy. 
Gruner** states that the nose becomes warm..antTred in the 
*Curationum medicinalium cept. iv, cur. 4, Venet. 1557. See 
also Rahn. Exercit. phys. de cparSiS physicis mirae illiustuminhom- 
ine, turn inter homines, denique inter cetera naturae corpora 
sympathia, xvii, Tuprfl788. 
fSepulchretupr" L. I, s. xx. 
t HistormXfm anatomic. et medic, rariorum, cent, v et vi, ed. 
Hafni^efu61, v, p. 184. 
§<€ynaecologia historico-medica, etc. Dresden and Leipsic, 1730, 
p. 429. 
^jX5bservations rares de medecine etc. (quoted by Deschamps, 
Traite des maladies des fosses nasales et leur sinus. Paris, 1804, 
p. 88.) 
UPhysiologische u. pathologische Zeichenlehre, etc. Jena, 1801, 
p. 122. 
**Ibid., p. 327. Several of the older writers refer to a case of 
" pituitous and serous catarrh " from coitus, reported by Georg 
Wolfgang Wedel (see Schurig, Spermatologia historico-medica 
etc., Francofurti ad Moenum., 1720, p. 280), but I have been unable 
to obtain the original account of the case. John Jacob Wepfer, Ob- 
servationes medico-practicae de affectibus capitis internis et exter- 
nis, Schaphusii, 1728, obs. Ivii (see my essay, The Pathological 
Nasal Reflex, an Historical Study. Transactions of the American 
Laryngological Association, 1887; also N. Y. Medical Journal, 
August 20th, 1887), mentions a case of hemicrania, tinnitus aurium 
and vertigo associated with uterine trouble, sneezing and a nasal 
discharge, but few particulars are given. 
It is interesting in this connection to recall the admonition of 
Celsus to abstain from warmth and women at the commencement 
of an ordinary catarrh. (Op. cit., lib. iv, cap. 2, § 4, " ubi aliquid 
ejusmodi sentimus, protinus abstinere a sole, a balneo, a venere 
debemus.") Hippocrates, on the other hand, relates the following 
case : " Timochari hieme distillatione in nares praecipue vexato, 
post veneris usum cuncta ressicata sunt, lassitudo, calor et capitis 
gravitas successit, sudor ex capite multus manabat." Op. cit., De 
morbis vulgaribus, lib. v (tom. iii, p. 574). The expression 
"bride's cold" would seem to indicate on the part of the laity the 
suspicion of a causal connection between repeated sexual excite- 
ment and coryza. 13 
hysterical, in women at the menstrual period and in the vic- 
tims of onanism. 
Isolated cases of sneezing at the menstrual period are found 
scattered here and there in older medical literature. Thus 
Garmanus* and Lanzonusf report cases of this kind, DeliusJ 
a case of sneezing following the suppression of the menses, 
while Petzold§ relates one in which sneezing occurred every 
day during the whole of pregnancy. Paullini|| records a case 
in which the menses were brought on by sternutatories, and 
quotes Fabricius Hildanus as having noted copious menstrua- 
tion follow violent and immoderate sneezing. 
Sudden and complete occlusion of both nostrils sometimes 
occurs with regularity during coitus. This phenomenon, 
which may be accompanied by so-called "reflex" phenomena, 
such as, for example, asthmatic attacks, is doubtless due to 
sudden dilatation of the erectile bodies from paralysis of their 
vaso-motor nerves; for as Anjel^f has shown, during coitus 
the nervous shock is distributed to the whole vaso-motor sys- 
tem of nerves and is not confined to the erection center. 
Cases have also been reported in which the act of coitus 
was accompanied by hemorrhage from the nose (Isch-Wall, 
Joal). 
V.-The reciprocal relationship between the genital organs 
and the nasal apparatus is furthermore illustrated by the 
occasional dependence of genito-urinary irritation upon affec- 
tions of the nasal passages. Retarded sexual development, 
too, may possibly depend upon the co-existence of nasal 
defect.** Unfortunately there are no authentic cases in litera- 
ture in support of this latter hypothesis, but in this connec- 
tion I would like to call attention to the remarkable case 
reported by Heschel (Wiener Zeitschrift fur pract. Heil- 
kunde, Marz 22, 1861), in which imperfectly developed 
*Ephemerid. nat. cur. Dec. ii, An. viii, obs. 152. 
flbid., Dec. iii, An. ii, obs. 32. 
| Act. nat. cur., vol. viii, obs. 198. 
§Ephem. nat. cur. Dec. iii, An. v, vi, obs. 183. See also Rahn, 
op. cit., p. 34. 
II Op. cit., cent, iv, cap. xlviii. 
IT Archiv fur Psych., Bd. viii, Heft 2. 
** See Elsberg, Archives of Laryngology, Oct., 1883. 14 
genital organs were associated with absence of both olfactory 
lobes. The man was well developed, with the exception of 
the testes, which were the size of beans and contained no sem- 
inal canals, and the larynx, which was of feminine dimen- 
sions. All trace of olfactory nerves was absent, as were also 
the trigona olfactoria and the furrow on the under surface of 
the anterior lobes. There was scant perforation of the cribri- 
form plate which transmitted the nerveless processes of the 
dura mater. There was also an absence of nerves in the nasal 
mucosa. 
VI.-It is, finally, quite possible that irritation and conges- 
tion of the nasal mucous membrane precede, or are the exci- 
tants of, the olfactory impression that forms the connecting 
link between the sense of smell and erethism of the reproduc- 
tive organs exhibited in the lower animals and in those indi- 
viduals whose amorous propensities are aroused by certain 
odors that emanate from the person of the opposite sex. 
Through all the centuries the season of flowers-the spring- 
time-has been celebrated in amatory song and story as the 
season of love and of sexual delight. This conceit, handed 
down to us from the poets of antiquity, finds modern expres- 
sion in the glorious verse of Tennyson: 
" In the Spring a fuller crimson comes upon the robin's breast; 
In the Spring the wanton lapwing gets himself another crest; 
In the Spring a livelier iris changes on the burnish'd dove ; 
In the Spring a young man's fancy lightly turns to thoughts of 
love." 
Woman, in all the ages, from the perfumed courtesan of 
ancient Babylon to her reflected image in the harem of the 
Sultan to-day, has appealed to the olfactory sense to bring man 
under her sexual dominion and to fire his passionate desire. 
In the Song of Solomon, in the Artes amoris of the older 
writers, in the fetich worship of odor, in the picture of Riche- 
lieu surrounded by an atmosphere of dense perfume in order 
to stimulate his amorous feeling, is reflected the idea of the 
possible power of olfactory perception in awakening sexual 
thoughts. If you doubt that modern man has not forsaken 
this idea, read Zola,* Lombroso, Tolstoi, Nordau. 
* See especially a work by Leopold Bernard, Les odeurs dans les 
romans de Zola. Montpellier, 1889. 15 
Rousseau has aptly termed olfaction the sense of the imagi- 
nation, and if we reflect how intimately related it is to the 
impressions we form of external objects, how it affects our 
emotions and influences our judgment, the clever definition 
of the French philosopher becomes all the more striking and 
felicitous.* 
While it is undoubtedly true that olfactory impression in 
man, under natural conditions, plays a subordinate part in the 
excitation of sexual feeling, while it may be also true that such 
intensification or perversion of the odor sense may indicate an 
abnormal condition and a reversion to the purely animal type, 
still the fact is incontestable that many persons are attracted 
sexually to each other through the sense of smell. Both his- 
tory and fiction are full of such examples. 
In connection with this part of the subject it is interesting 
to note the extraordinary degree of nervous sympathy that 
may be developed through the sense of smell. Millingen,f for 
example, relates the case of a pensioner in the Hospital for 
the Blind in Paris, called Les quinze Vingt, who by the touch 
*0f great interest is the influence which civilization exerts upon 
the development and impressibility of the olfactory sense. "With- 
out enumerating, much less elaborating, the myriad conditions 
that conspire to produce such a result, we may safely lay down the 
general proposition that the physical and moral forces of civiliza- 
tion-the social and intellectual environment of the subject-exert 
a marked effect upon the olfactory faculty by inviting or encourag- 
ing disturbance of the sentient and perceptive apparatus ; that the 
higher we ascend in the social scale, the more readily our judg- 
ments are unnaturally influenced or perverted by impressions 
derived through the sense of smell, and that the more we recede 
from the inferior orders, the less perfect and acute this faculty 
becomes, the more susceptible to irritation and the more predis- 
posed to disease. In view, therefore, of the importance of olfac- 
tion as an avenue through which our mental impressibility is 
influenced-our imagination perverted-and in view of the rela- 
tions of civilization to the sense of smell, we can readily under- 
stand why it is that this faculty is found more frequently deranged 
among the superior orders than in those lower down in the social 
scale and in the savage state. 
tMillingen. The Passions, or Mind and Matter, etc. London, 
1848, p. 102. 16 
of a woman's hands and nails and their odor could infallibly 
assert if she were a virgin. A number of tricks were played 
on him and wedding rings were put on the fingers of young 
girls, but he never was at fault. 
As in the lower animals it is possible or even probable that 
the alternate inflation and collapse of the erectile bodies is, to 
some extent at least, the means by which the grateful or 
ungrateful odorous particles are excluded from, or admitted 
to contact with, the apparatus of special sense, so in men in 
whom this sense is sexually excited or perverted, either norm- 
ally, or from defect in the subjects themselves, the reception 
or rejection of the sensuous odors may be accomplished by a 
similar mechanism. 
These facts point conclusively to an intimate physiological 
association between the nasal and reproductive apparatus, 
which may be partially explicable on the theory of reflex or 
correlated action, partially by the bond of sympathy which 
exists between the various erectile structures of the body. 
That a relationship exists by virtue of tvhich irritation of the 
one reacts upon the circulation and possibly nutrition of the 
other, is accordingly rendered highly probable by the evidence 
of clinical observation. 
If this excitation be carried beyond its physiological limits 
there comes a time sooner or later when that which is a 
normal process becomes translated into a pathological state, 
according to a well-known law of the economy. Hence it is 
a priori conceivable and eminently probable, not only that 
stimulation of the generative organs, when carried to excess, 
may become an etiological factor in the production of conges- 
tion and transient inflammation of the nasal passages, and 
especially of their cavernous tissue, but that repeated and 
prolonged abuse of the function of these organs may, by con- 
stant irritative influence on the turbinated tissue, become the 
starting point of chronic changes in that structure. 
Pathological. 
The following data, derived from personal clinical observa- 
tion, may possibly throw some light upon the subject. 
I.-In a fair proportion of women suffering from nasal 
affections, the disease is greatly aggravated during the men- 17 
strual epoch or when under the influence of sexual excite- 
ment. 
IL-Cases are also met with in which congestion or inflam- 
matory conditions of the nasal passages make their appearance 
only at the menstrual period, or, at least, are only sufficiently 
annoying at that time to call for medical attention. 
III.-Occasionally the discharge from a nasal catarrh will 
become offensive at the menstrual epoch, losing its disagree- 
able odor during the decline of the ovarian disturbance. In 
many cases of ozoena, the fetor is much more pronounced at 
times corresponding to those of the menstrual flow. 
IV.-Excessive indulgence in venery sometimes seems to 
have a tendency to initiate inflammation of the nasal mucous 
membrane, or to aggravate existing disease of that structure. 
There are those, for example, who suffer from coryza after a 
night's indulgence in venereal excesses, and the common 
catarrhal affections of the nose are undoubtedly exaggerated 
by repeated and unnatural coition. 
V.-The same is true in regard to the habit of masturba- 
tion. The victims of this vice in its later stages are constantly 
subject to nose-bleed, watery or mucous discharge from the 
nostrils, and perversion of the olfactory sense. 
VI.-The co-existence of uterine or ovarian disease exerts 
sometimes an important influence on the clinical history of 
nasal disease. This fact has been shown in practice in cases 
in which the nasal affection has resisted stubbornly all treat- 
ment and in which it has only been relieved upon the recog- 
nition and appropriate treatment of the disease of the genera- 
tive apparatus. 
The recent researches of Fliess seem to indicate that the 
converse of this proposition is true. 
The most commonly found conditions of the nasal appa- 
ratus following perverted sexual excitement, either from 
excessive venery or onanism, are: (1) coryza (generally of 
vaso-motor type), with or without reflex manifestations, such 
as asthma, paroxysmal sneezing, etc., (2) epistaxis, and (3) 
various forms of perversion of the sense of smell. In addition 
to these, Peyei' has observed abnormal dryness of the nasal 
and pharyngeal mucous membrane, indicated by a feeling of 
dryness and burning in these regions and by complete cessa- 
tion of secretion. 18 
The coryza that follows intemperate venery resembles in 
character that seen in the disease falsely called " hay fever," 
and, like it, is generally associated with more or less pro- 
nounced neurasthenia, or shall we say, localized hysteria. In 
other cases the nervous system is not apparently involved. 
The predominant temperament, however, in individuals thus 
affected is the neurotic. While they may not necessarily in 
some instances belong to the so-called "nervous " or "hysteri- 
cal" individual, while they may give no outward and visible 
sign of a deranged nervous system, there will generally be 
found, on careful examination, a delicacy or sensitiveness of 
the nervous apparatus either in whole or in part. 
It is conceivable that this sexual coryza may be associated 
with almost any of the so-called nasal reflex neuroses. In 
one of my cases asthma was the central symptom. A young 
married woman, twenty-three years old, in otherwise appa- 
rently perfect health, consulted me for the relief of attacks 
of asthmatic breathing associated with stoppage of the nos- 
trils. I could find nothing wrong at the time of con- 
sultation with the respiratory apparatus, and her other 
organs were in perfect condition. Reluctantly she confessed 
that every night for five years she and her husband had 
indulged in intemperate venery. Moderation 'in their sexual 
relations caused rapid disappearance of the symptoms, and in 
the nine years that have elapsed since she consulted me there 
has been no return of the disorder. 
Interesting cases of asthma of nasal origin associated with, 
and due to sexual excitement have also been reported by Joal 
and Peyer. In this connection I would recall a case of peri- 
odic vaso-motor coryza reported by me at length elsewhere,* 
in which the attacks invariably appeared and were most severe 
at the menstrual period, appearing sometimes at its com- 
mencement, sometimes at its close. In the attacks coming on 
in the interval between the monthly periods pain was always 
felt in the left ovary. Residence at the seashore invariably 
gave relief, except during menstruation, when the attacks 
were as bad as when at home. The outbreak of the disease at 
*A contribution to the study of coryza vasomotoria periodica, or 
so-called " hay fever." N. Y. Med. Rec., July 19, 1884. 19 
the menstrual epoch in this case is readily explained by the 
physiological erection of the corpora carvernosa which occurs 
at that period. In this particular case the chief, and under 
certain circumstances the sole excitant of the paroxysm was 
the utero-ovarian excitement of the menstrual epoch. 
Nose-bleed is not infrequently the result of onanism. Years 
ago Du Saulsay* called attention to the fact that enormous 
quantities of blood can be lost from the nose from the practice 
of this vice, and the accuracy of his observation is borne out 
by the experience of subsequent observers. Among others, 
Joalf has collected several such cases and reports three of his 
own. One of his patients informed him that he masturbated 
to excess to provoke nose-bleed, which relieved him from vio- 
lent headaches from which he suffered. 
Whether the hemorrhages in these cases-which by the way 
are not confined to the male sex^-come from simple acute 
distension of the intra-nasal blood-vessels, or whether definite 
chronic structural changes have taken place in the mucous 
membrane and in the vessel walls, are points which are as yet 
undetermined. The probability is that some intra-nasal lesion 
is responsible for them, for, as I have pointed out elsewhere,§ 
the discharge from the nostrils and the perverted olfactory 
sense found in the later stages of onanism are often simply 
the outward expression of chronic nasal inflammation. 
The nature of the perversion of the olfactory sense in onan- 
ists will vary with the character of the nervous condition pro- 
duced by the vice-hyperosmia, hyposmia, parosmia andallot- 
riosmia have all been observed in cases of immoderate sexual 
excitement. 
The investigations of Fliess would seem to indicate that 
painful, profuse and irregular menstruation may in some 
instances depend upon an intra-nasal cause. He cites a num- 
ber of cases to show that the pain of certain forms of dys- 
* Comment, de rebus in med. etc., vol. xviii, p. 213. Michell, 
in Schlegel's "Sylloge selectiorum opusc. de mirabile sympathiae 
quae partes inter diversas corporis humani intercedit." Lipsiae, 
1787. 
th c. 
t See case of Lemarchand de Trigon (girl of 16), quoted by Joal. 
§1- c. 20 
menorrhcea may be temporarily dissipated by the application 
of cocaine to the nasal mucous membrane, or permanently 
controlled by cauterization. According to him, only the infe- 
rior turbinated body and the tuberculum septi possess a special 
relation to the dysmenorrhoeic pains. These two localities he 
accordingly designates as zar' genital zones (Genitalstel- 
len). If the tuberculum septi be cocainized, the sacral, if the 
inferior turbinated bodies be cocainized, the hypogastric, pains 
disappear. Cocainization of the right nostril causes disap- 
pearance of the pain on the left side of the body and vice 
versa. 
In answer to the objection that these phenomena may be 
due to the general anaesthetic action of the drug, he points out 
the fact that cocaine absorbed into the blood does not produce 
a general analgesic effect, as is produced in the case, for exam- 
ple, of morphia. On the contrary, in small doses it acts as a 
stimulant. The fact that the pain ceases only when the geni- 
tal zones are cocainized and that it may be permanently dissi- 
pated by cauterization of this area, does away, he thinks, with 
the assumption that the subsidence of the pains'is a part of 
the euphoria produced by the drug. The fact alluded to 
above, that in cocainization of certain parts of the genital 
zones only individual pains disappear from the symptom com- 
plex, militates against the supposition of a simple, general 
narcotic effect. 
I cannot vouch for or deny the accuracy of the above state- 
ments, as Fliess's monograph has just come into my possession 
and I have had neither time nor opportunity to put them to 
the test. Curiously enough, the genital zones of Fliess corre- 
spond exactly with the most sensitive portions of the sensitive 
reflex area mapped out by me in 1883.* 
*0n Nasal Cough, and the Existence of a Sensitive Reflex Area 
in the Nose. American Journal of the Medical Sciences, July, 
1883. The results of these experiments were first brought before 
the Baltimore Medical Association in the early part of 1883, and 
subsequently before the Medico-Chirurgical Faculty of Maryland 
(April, 1883, wide Transactions), and the American Laryngological 
Association (May, 1883, ride Transactions). The conclusions 
reached from these investigations were as follows : 
"(1) That in the nose there exists a definite, well-defined sensi- 21 
tive area, whose stimulation, either through a local pathological' 
process, or through the action of an irritant introduced from with- 
out, is capable of producing an excitation which finds its expres- 
sion in a reflex act or in a series of reflected phenomena. 
(2) That this sensitive area corresponds in all probability with 
that portion of the nasal mucous membrane which covers the tur- 
binated corpora cavernosa. 
(3) That reflex cough is produced only by stimulation of this 
area, and is only exceptionally evoked when the irritant is applied 
to other portions of the nasal mucous membrane. 
(4) That all the parts of this area are not equally capable of gen- 
erating the reflex act, the most sensitive spot being probably repre- 
sented by that portion of the membrane which clothes the poste- 
rior extremity of the inferior turbinated body and that of the 
septum immediately opposite. 
(5) That the tendency to reflex action varies in different indi- 
viduals, and is probably dependent upon the varying degree of 
excitability of the erectile tissue. In some the slightest touch is 
sufficient to excite it; in others, chronic hypersemia or hypertrophy 
of the cavernous bodies seems to evoke it by constant irritation of 
the reflex centers, as occurs in similar conditions of other erectile 
organs, as for example the clitoris. 
(6) That this exaggerated or disordered functional activity of the 
area may possibly throw some light on the physiological destiny of 
the erectile bodies. Among other properties which they possess, 
may they not act as sentinels to guard the lower air passages and 
pharynx against the entrance of foreign bodies, noxious exhala- 
tions and other injurious agents to which they might otherwise be 
exposed ? 
Apart from their physiological interest, the practical importance 
of the above facts from a diagnostic and therapeutic point of view 
is sufficiently obvious. Therein lies the explanation of many 
obscure cases of cough which heretofore have received no satisfac- 
tory solution, and their recognition is the key to their successful 
treatment." 
In calling attention to this area as containing the spots most sen- 
sitive to reflex-producing impressions, I did not, nor do I now (as 
has been wrongly inferred), desire to maintain that pathological 
reflexes may not originate fr^m other portions of the nasal mucous 
membrane. Indeed, wherever there is a terminal nervous filament 
it may be possible to provoke sneezing, lachrymation and other 
reflex movements. My contention is simply this, that the area 
indicated in my original paper represents by far the most sensitive 
portion of the nasal cavities, and that pathological reflex phenom- 
ena are in the large majority of cases related to diseased conditions 
of some portion of this sensitive area. That all pathological nasal 22 
I have on innumerable occasions* shown that phenomena 
widely different in character and anatomical sphere of opera- 
tion may be produced at will by artificial stimulation of this 
area, and that they may be dissipated by local applications to, 
or removal of, the membrane covering the diseased surface. 
It is therefore not difficult to conceive that the phenomena 
referable to the uterus and ovaries during menstruation may 
be influenced in a similar manner. The specific relations of 
the two zones and the crossed action of the reflex, if such it 
be, are much more difficult of explanation. If such a con- 
reflexes arise from irritation of this particular area is a proposition 
which I do not, and never have maintained. The determination 
of these sensitive areas is of special importance and interest in the 
solution of the pathology of the so-called nasal reflex neuroses. 
Whether a special sensitiveness in certain portions of the nasal 
mucous membrane exists or not, the agitation of the question has 
led to more rational methods of procedure in the treatment of a 
large class of nasal affections, and to more conservative methods in 
intra nasal surgery. Before the location of the sensitive area or 
areas, the nasal tissues were destroyed with an almost ruthless 
recklessness that hade fair to bring intra nasal surgery into the 
worst repute. (For an elaborate discussion of this whole subject 
see article by the author in Wood's Reference Handbook of the 
Medical Sciences, edited by Buck, Wm. Wood & Co., N. Y., 1887, 
vol. v, pp. 222-242.) 
*My views upon this subject may be found in the following 
publications: A contribution to the study of coryza vaso-motoria 
periodica, or so-called " hay fever," N. Y. Med. Record, July 19, 
1884. Coryza vaso-motoria periodica in the negro, with remarks 
on the etiology of the disease, N. Y. Med. Record, Oct. 18, 1884. 
Rhinitis sympathetica, essay read before Clin. Soc. of Md. ; see 
brief abstract in Md. Med. Journal, April 11th, 1885, and in Inter- 
nationales Centralblatt f. Laryngologie, etc., Sept., 1885. Observa- 
tions on the origin and cure of coryza vaso-motoria periodica, 
Trans. Medico-Chir. Faculty of Maryland, 1885. Review of Morell 
Mackenzie's essay on hay fever, etc., The American Journal of the 
Med. Sciences, Oct., 1885, pp. 511-528. See also discussion of the 
subject before the American Laryngological Association (May 14th, 
1884, vide Transactions, p. 113 et seq.). See also cases of reflex 
cough due to nasal polypi, Trans, of the Medico-Chirurgical 
Faculty of Md., 1884, and articles in Wood's Handbook already 
referred to. 23 
dition of affairs exists, it is certainly a remarkable phenome- 
non. 
These observations, therefore, encourage the belief, if they 
do not establish the fact, that the natural stimulation of the 
reproductive apparatus, as in coitus, menstruation, etc., when 
carried beyond its normal physiological limits, or pathological 
states of the sexual apparatus, as in certain diseased condi- 
tions, or as the result of their over-stimulation from venereal 
excess, masturbation, etc., are often the predisposing, and 
occasionally the exciting causes of nasal congestion and inflam- 
mation and perversion of the sense of olfaction. Whether this 
occur through reflex action, pure and simple, or as a sequel of 
an excitation in which several or all of the erectile structures 
of the body participate, the starting point of the nasal disease 
is, in all probability, the repeated stimulation and congestion 
of the turbinated erectile tissue of the nose. It is highly 
probable that this erectile area, or organ, so sensitive to reflex- 
producing impressions, is the correlative of certain vascular 
areas in the reproductive tract, and that the phenomena 
observed may therefore be explained by the doctrine of what 
we may call, for want of a better name, reflex, correlated 
action. 
In these remarks I have attempted no thoroughgoing exposi- 
tion of the subject, but simply laid before you the results of 
my personal labors. These no longer represent, I am glad to 
say, the result of solitary observation and isolated experience. 
I have not attempted, as Fliess has done, to touch upon the 
biological side of the question. 
The study of the relations between the nose and the sexual 
apparatus opens up a new field of research, of pleasing land- 
scape and almost boundless horizon, which bids to its explora- 
tion not only the physiologist and pathologist, but also the 
biologist. Above all it brings us face to face with a serious 
problem of life, an interesting enigma, whose significance it 
will be the task of the future to divine.