Appendix — Sexual Perversions Due to Disease
It is the immortal service of Casper and von Krafft-Ebing to have insisted energetically upon the fact that numerous individuals whose vita sexualis is abnormal are persons suffering from disease. This is their monumentum ære perennius in the history of medicine and of civilization. Purely medical, anatomical, physical, and psychiatric investigations show beyond question that there are many persons whose abnormal sexual life is pathologically based.
I shall not here discuss the peculiar borderland state between health and disease, the existence of which can be established in many sexually perverse individuals; I shall not refer to the “abnormalities,” the “psychopathic deficiencies,” the “unbalanced,” etc.; nor shall I discuss the question of the significance of the stigmata of degeneration, because these will be adequately dealt with in connexion with the forensic consideration of punishable sexual perversions.
Here we shall speak only of actual and easily determined diseases which possess a causal importance in the origination and activity of sexual perversions. The great majority of these are, naturally, mental disorders.
Von Krafft-Ebing, to whom we owe the most important observations regarding the pathological etiology of sexual perversions, enumerates the following conditions: Psychical developmental inhibitions (idiocy and imbecility), acquired weak-mindedness (after mental disorders, apoplexy, injuries to the head, syphilis, in consequence of general paralysis), epilepsy, periodical insanity, mania, melancholia, hysteria, paranoia.
Among these, epilepsy possesses the greatest importance.485 It comes into play much more frequently as a causal morbid influence in the case of sexually perverse actions and offences than has hitherto been believed. The psychiatrist Arndt maintains that wherever an abnormal sexual life exists, we must always consider the possibility of epileptic influence. Lombroso assumes that all premature and peculiar instances of satyriasis are instances of larval epilepsy. He gives several examples in support of this view, and also a case of Macdonald’s which illustrates the connexion between epilepsy and sexual perversity.486 Especially in the so-called epileptic “confusional states” do we meet with sexually perverse actions; exhibitionism and other manifestations of sexual activity coram publico are frequently referable to epileptic disease. Similar impulsive sexual activities and similar confusional states are seen after injuries to the head and in alcoholic intoxication, also after severe exhaustion. Many cases of “periodic psychopathia sexualis” are due to epilepsy.
Senile dementia and paralytic dementia (general paralysis of the insane), also severe forms of neurasthenia and hysteria, often change the sexual life in a morbid direction, and favour the origin of sexual perversions.
It is a fact of great interest that Tarnowsky and Freud attribute to syphilis an important rôle in the pathogenesis of sexual anomalies. In 50 % of his sexual pathological cases Freud found that the abnormal sexual constitution was to be regarded as the last manifestation of a syphilitic inheritance (Freud, op. cit., p. 74). Tarnowsky observed that congenital syphilitics, and also persons whose parents had been syphilitic, but who themselves had never exhibited any definite symptoms of the disease, were apt later to show manifestations of a perverse sexual sensibility (Tarnowsky, op. cit., pp. 34 and 35). Obviously this is to be explained by the deleterious influence upon the nervous system (perhaps by means of toxins?) which syphilis is also supposed to exert in the causation of tabes dorsalis and general paralysis of the insane. When investigating the clinical history of cases of sexual perversion, it appears that previous syphilis is a fact to which some importance should be attached.487
From syphilis we pass to consider direct physical abnormalities and morbid changes in the genital organs as causes of sexual anomalies. In women prolapsus uteri sometimes leads to perverse gratification of the sexual impulse—for example, by pædication;488 in men, shortness of the frænum preputii plays a similar part,489 also phimosis. Wollenmann reports the case of a young man suffering from phimosis, who, at the first attempt at coitus, experienced severe pain, and since that time had an antipathy to normal sexual intercourse. He passed under the influence of a seducer to the practice of mutual masturbation. Only after operative treatment of the phimosis did his inclination towards the male sex pass away, and the sexual perversion then completely disappeared.490
Notes
456 Hermann Joseph Löwenstein, “De Mentis Aberrationibus ex Partium Sexualium Conditione Abnormi Oriundis” (Bonn, 1823).
457 Joseph Häussler, “The Relations of the Sexual System to the Psyche” (Würzburg, 1826).
458 Heinrich Kaan, “Psychopathia Sexualis” (Leipzig, 1844).
459 R. von Krafft-Ebing, “Psychopathia Sexualis” (Stuttgart, 1882).
460 We must not omit to mention the fact that a little earlier the French physician Moreau de Tours published a comprehensive work upon psychopathia sexualis, entitled “Des Aberrations du Sens Génésique” (Paris, 1880).
461 S. Freud, “Three Essays in Contribution to the Sexual Theory,” p. 70.
462 Cf. the interesting remarks of G. H. C. Lippert, “Mankind in a State of Nature,” p. 1 et seq. (Elberfeld, 1818).
463 Christian Muff, “What is Civilization?” pp. 30, 31 (Halle, 1880).
464 G. L. N. Delvincourt, “De la Mucite Génito-Sexuelle,” p. 64 (Paris, 1834). Apt remarks on the alleged degeneration of the French are to be found also in the work of P. Näcko, “The Alleged Degeneration of the Latin Races, more Especially of the French,” published in Archives for Racial and Social Biology, 1906, vol. iii.
465 As, for example, Immermann, in his work “Epigonen,” published at the same period (1836), assumes. In the mouth of the physician he puts the following words: “The physician has a great task to perform in the present day. Diseases, especially nervous troubles, to which for a number of years the human race has been especially disposed, are a modern product.” Cf. Leopold Hirschberg, “Medical Matters as dealt with in General Literature: the Judgment of a Member of the Laity regarding Nervousness in the Year 1876,” published in Medizinische Wochenschrift, 1906, No. 41, p 428. Seventy years ago the German people was “nervous”; thirty-four years before Sedan, thirty years after Jena! Therefore neither Jena nor Sedan can be connected with the nervous “degeneration.” The authors of the eighteenth century (!) made similar complaints of the nervousness of their time, upon which Cullen and Brown founded their medical theories.
466 J. Pohl-Pincus, “The Diseases of the Human Hair, and the Care of the Hair,” third edition, p. 57 (Leipzig, 1885).
467 Carl Bleibtreu, “Paradoxes the Conventional Lies,” sixth edition, pp. 1, 2 (Berlin, 1888).
468 See “Nature and Man,” E. Ray Lankester’s Romanes Lecture, 1905.—Translator.
469 G. Hirth, “Hereditary Enfranchisement,” published in “Ways to Freedom,” pp. 106-127 (Munich, 1903).
470 Näcke’s thesis is in agreement with this, that “all sexual abnormal practices in an asylum are for the most part much more rare than the laity, or even many physicians, imagine.” Cf. P. Näcke, “Some Psychologically Obscure Cases of Sexual Aberrations in the Asylum,” published in the Annual for Sexual Intermediate Stages, vol. v., p. 196 (Leipzig, 1903). See also, by the same author, “Problemi nel Campo delle Psicopatie Sessuali,” in Archivio delle Psicopatie Sessuali, 1896; “Sexual Perversities in the Asylum,” in the Wiener klinische Rundschau, 1899, Nos. 27-30.
471 S. Freud, op. cit., pp. 19, 20.
472 A. Hoche, “The Problem of the Forensic Condemnation of Sexual Transgressions,” published in the Neurologisches Centralblatt, 1896, p. 58.
473 Ploss-Bartels, “Das Weib in der Natur-und Volkerkunde,” eighth edition, 2 vols. (Leipzig, 1906).
474 Mantegazza, “Anthropological and Historical Studies on the Sexual Relationship of Mankind.”
475 F. S. Krauss, “Morals and Customs relating to Sexual Reproduction among the Southern Slavs,” published in “Kryptadia,” vols. vi.-viii. (Paris, 1899-1902); and in the larger work, “Anthropophyteia” (Leipzig, 1904-1906).
476 In all his works.
477 Cf. Charles Darwin, “The Descent of Man, and Selection in Relation to Sex,” vol. i., p. 182 (2 vols., London, 1898).
478 Cf. the inquiry of C. Wagner, containing extremely valuable material, “The Sexual and Moral Relationships of the Protestant Agricultural Population of the German Empire” (3 vols., Leipzig, 1897, 1898).
479 “Prostitution in Berlin and its Victims,” p. 27 (Berlin, 1846).
480 Cf. the detailed bibliography of these works in my “Contributions to the Etiology of Psychopathia Sexualis,” vol. i., pp. 29, 30.
481 Typical sexual perversions have, however, been observed even in children, and it is this fact which has chiefly given rise to the doctrine of the “congenital” character of sexual perversions.
482 Cf. the remarks of the Marquis de Sade regarding the abnormal sexuality of elderly men, in my “New Research Concerning the Marquis de Sade,” pp. 421, 422 (Berlin, 1904).
483 C. Albert, “Free Love,” p. 148.
484 Joseph Guislain, “Clinical Lectures on Mental Diseases,” p. 229 (Berlin, 1854).
485 Kowalewski, “Perversions of Sexual Sensibility in Epileptics,” published in the Jahrbücher für Psychiatrie, 1887, vol. vii., No. 3.
486 C. Lombroso, “Recent Advances in the Study of Criminology,” pp. 197-200 (Gera, 1899).—Tarnowsky has even described a form of “epileptic pæderasty” (cf. B. Tarnowsky, “Morbid Phenomena of Sexual Sensibility,” pp. 8, 51; Berlin, 1886).
487 E. Laurent (“Morbid Love,” pp. 43-45; Leipzig, 1895) regards tubercular inheritance as an important etiological factor of sexual anomalies, for these occur more frequently in blonde, weakly individuals, than in brunettes (?).
488 Bacon, “The Effect of Developmental Anomalies and Disorders of the Female Reproductive Organs upon the Sexual Impulse,” published in the American Journal of Dermatology, 1899, vol. iii., No. 2.
489 M. Féré, “Sexual Hyperæsthesia in Association with Shortness of the Frænum Preputii,” published in the Monatshefte für praktische Dermatologie, 1896, vol. xxiii., p. 45.
490 A. G. Wollenmann, “Phimosis as a Cause of Perversion of Sexual Sensibility,” published in Der ärztliche Praktiker, 1895, No. 23. Matthaes has shown that morbid changes of the genital sphere or its vicinity are apt to give rise to offences against morality (“The Statistics of Offences against Morality,” published in the Archiv für Kriminalanthropologie, 1903, vol. xii., p. 319).