Carl Westphal, "Contrary Sexual Feeling", in: Archiv für Psychiatrie und Nervenkrankeiten, Vol. 2, Berlin, 1870.
 

In the disease cases that I will report and discuss in the following, the main manifestation that stood out was a symptom that per se has been described very little or not at all: an inborn reversal of the sexual feeling with consciousness of the morbidity of this manifestation. These cases are all the more interesting as they affect individuals of both sexes. -

Miss N. was delivered to the mental ward of the Charité on May 30, 1864 with a medical attestation whose content essentially purported: "N. allegedly has suffered since the age of eight from a fury to love women and to perform with them not only playing-around and kissing but masturbation. Meanwhile, if a woman refuses her wish to act as she desires with her, she flies into such a rage that she is capable of anything; she never wants to have to do with men and never even felt a tendency toward it. In playing around with women, such a feeling of delight is awakened in her, as she describes it, that she positively ejaculates her seed; as she admits, she is capable of anything when her wishes are denied. The illness of N. is to be classified as a mental illness and it is therefore urgently necessary, in order to prevent further harm, that the patient be brought to a public hospital and healed there as soon as possible, which she herself most ardently wishes." -

N. is 35 years old and has lived for a number of years with her older sister, who has founded a boarding school for young girls, and she runs her sister's house. The sister relates: "My sister, who had a hard time with studying in school, but whose memory was otherwise always good, has always tended somewhat toward melancholy and was always dissatisfied with her fate and herself. However, because of her defect (she has a cleft palate) she was indulged in many things and her discontented mood, her stubbornness, her irritability and her vehemence were always attributed to this misfortune. She did not have bad character traits like mendacity, meanness, a tendency to steal, etc.; in management of the house she was always diligent and orderly, but she tended to be reserved, which was assumed to be due to her defect. Last winter (1863 to 1864) her condition changed so much that I often did not know what to think of her. The episodes of melancholy have become much more frequent, and they were followed by complete indifference, almost apathy, and then she became extraordinarily violent, for no reason at all, threw things around while doing housework, used certain verbal expressions that she never used otherwise, and was totally deaf to all advice. When she was in this agitated condition, her eye had a completely changed, eerie expression and at the same time one noticed a strange twitching in her face that was not there otherwise. In such conditions, she wanted to leave the house, wanted to go to America, etc. These attacks returned regularly in just the same way; in the last eight days the condition worsened in such a way that I was often afraid to be alone with her. Often a great tendency to sleep was manifested; not rarely she laid down on the sofa at 5 p.m. until the evening, and could not go to bed soon enough; if by chance bedtime came earlier than usual for once, she did not like that either and she was beside herself that she was supposed to go to bed so early. Lately she has suffered frequently from headache at a specific part of her skull "as if she were being stabbed with knives"; at the time of menstruation there was "chest constriction", which she described as suppressed crying fits; she used to suffer from those even in the past sometimes.

On May 24, 1864 - 6 days before her admission to the Charité - toward evening I found her crying violently. Upon urgent pressing, she told me she was terribly unhappy, because she was frightfully in love with a young girl; she said she could not remain in the house any longer, she had to leave. This violent crying lasted several days and nights; she did not recover in the least bit in three days. Afterward she seemed to become calmer, but this calm lasted only a short time, and was followed by renewed outbreaks of rage. She spoke only of revenge, of dying, and had all sorts of black thoughts. On May 26 she went on her own initiative to Dr. S., who has known her for many years, and informed him of the actual reason for her unhappy condition. From then on thoughts ran vigorously through her head; she had scarcely made a decision when she discarded it again. On the 28th suddenly her rage rose to a peak: she threw everything around and uttered the most violent words and threats. She raged in this way until noon on the 29th. Then she became completely lethargic, laid down on the sofa and did not move. On the 30th she was transported to the Charité, because it was her innermost wish to be restored." - So much for the sister's information.

I myself found the patient on the day of her admission to be without any external manifestations; no special affect was recognizable in facial expression or gestures, nor was her speech unusually vigorous, nor was there any disturbance in the order or coherence of her thoughts. She stated that she herself had wanted to come to a hospital, but was very surprised that she had been brought to a mental ward, since she had no mental problems; she was especially frightened of the thought of sleeping with the other mental patients. In perfect coherence, responding precisely to every question, without digression she provided a portion of the following information which was then supplemented during the remainder of the patient's stay in the ward and which I convey here in context; I would like to state expressly right away, that nothing has been projected onto the patient, which should be clear as well from the content of the information provided.

She relates that as a child she enjoyed playing boys' games and liked to dress as a boy; from the age of eight she felt a tendency toward young girls, not to all, but just to certain ones in particular, who gripped her from their first meeting and in whose eyes she could see it immediately: "It's strange, it's in the eye - it is a kind of magnetism that attracts me." She then tries systematically to get closer to these girls, she "positively courts" them, likes to kiss them, and many times she got to the point of be allowed to grab their genitals. She has a positive aversion toward kissing other girls [than the ones she chooses]. She has only felt sexual arousal since the time when her period started. In the time between the age of 18 and 23, she had very frequent opportunity to gratify her drive, especially since she slept for five weeks in one bed with her cousin and exercised her nature with her every night; in doing so she worked her hand on the genitals of the other girl, but she never let herself be touched. She calls this time the happiest of her life! From the age of 23 until last October, she says she did not have opportunity again for such intimate intercourse; on the other hand, she masturbated, especially right before and after her period, while vividly imagining a beloved girl. She says she tried as much as she could to suppress the urge to masturbate, because she herself found it uncomfortable, and she also felt listless, weary, and moody thereafter, but often it compelled her with an irresistible power, so that she sometimes had to "slap it hard with my hand." She claims to have noticed small, often itchy knots on her inner thighs during her periods; but this was not what excited her to masturbate and these itchy knots existed only during her period, while the inclination to masturbate occurred about 8 days before and after it. She also claims to have often had an outflow from the genitals. When she suppressed the urge to masturbate by force, she claimed to have immediately noticed a revolting smell and taste arising as if from her own genitals. She often felt worried and tormented by the most vehement pangs of conscience, but she revealed herself to no one. According to the patient's statement, she has never had even the slightest interest in men, and conversations about them leave her completely cold; she states with great resolve that she could live and sleep among men without the slightest arousal. When she lay in bed with eyes closed, the girls she loved often appeared to her in full vividness. She often also saw a number of ugly heads pass by one after the other. In her lustful dreams she herself always appeared in the position of the man; she often heard beautiful melodies at the same time. With great resolve and without being asked she stated that her tendency toward her own sex was frightful to herself, that she could not understand how she came to it and was so completely different from other girls. How often she had most ardently wished to be freed of it!

As for the events of the least few days, she says she was excited, sleepless, and without appetite for the last 8 days, because she was tormented by the consciousness of having to leave the house. Namely, she had a passion for a beautiful young girl who was staying in her sister's boarding school. This girl had entered the house in August of the previous year (1863), and from the first moment on she had fallen in love, then tried to attach the girl to herself with flattery, and then one time when the girl happened to be sitting next to her she became affectionate, kissed her, hugged her, and became sexually very aroused and forgot herself to the point that she tried to grab the girl's genitals; when the girl indignantly resisted and expressed her outrage, she gave up the attempt and asked to be forgiven. This happened in October (1863). The young lady avoided the patient from then on and treated her very disdainfully, as she believes, which irritated and irked her. She tried to ask for forgiveness again and again, and says that she often had to stop cold, as if under a spell, while staring at the girl and unable to move. The excitation increased and increased, she cried, became exceedingly jealous when the object of her love spoke with someone, she believed she was being mocked by every laugh, she wanted to take her own life and would have preferred to do away with the object of her love as well. On May 24, 1864, she offered the girl, who was unwell and was laying on the sofa, first tea, then coffee, etc., in order to do her a favor, and when she finally, apparently annoyed, responded to her in an irritated tone, she stood suddenly, as if under a spell, staring at the young girl without being able to move - "she was too beautiful!" Once again she asked for forgiveness and just for a kiss, and when the girl sprang up in outrage and declared that she was going to write to her mother immediately and leave the house, she broke out in passionate agitation. In this state of agitation she revealed herself to her sister, who, like the rest of the people around, had no idea of her condition, with the words: "I love her passionately, I won't be able to stand to be without her." Her condition during the few days until her transport to the Charité has already been described in the information from the sister.

The patient is a moderately sized, rather delicately built individual of a not very attractive, nondescript external appearance; her physiognomy and clothing do not deviate in any way from the feminine type, her head is small without exhibiting anything unusual in shape, hair growth is normal, no deformities in the ears, the two halves of the face are not noticeably asymmetrical, only the nose is pointed slightly toward the left, there is a scar running upwards from the right upper lip caused by the operation on the harelip (performed by Dieffenbach), the soft and hard palate are totally cleft and exhibit a major defect, and accordingly her speech is very nasal but easily understandable. Otherwise, there are no deformities of external appearance, in particular not on the genitalia. The large labia gape somewhat, so that the small ones are visible in the genital split, the clitoris is of normal length, the hymen totally intact and scarcely allows penetration by the tip of the little finger. The mucous membrane of the external genitals is neither eroded nor reddened, but there was great sensitivity in the examination. An exploratio per vaginam had to be dispensed with due to the pain caused by the attempt with the finger. Small scratched places are visible on the inside of the upper thighs, where there was supposed to have been severe itching.

No problems apparent in the circulatory, respiratory, digestive, and urinary apparatus; on the other hand, the patient complains of headaches which she has suffered from for the about 4 years. The headache occupies a specific place in the vicinity of the small fontanel, and the patient allegedly hit herself hard at this point 5 years ago; pressure at this point does not noticeable increase the pain, and no scar is visible in the scalp. This pain occurs at irregular intervals at the same time as a feeling of dizziness, and usually soon leaves. She says she never had any fainting spells. The pupils are the same size and react well, slight convergent strabismus. Otherwise nothing unusual in sensory organs.

The patient's father was a suicide; he gambled, accumulated debts, and was melancholy for a long time; it was stated expressly (by the patient's sister) that the debts were insignificant and had been fully repaid. The mother died of a breast disease; when she was pregnant with the patient, she supposedly had a great shock when someone kissed her (information from patient). No cases of cleft palate are known in the family.

During the patient's two-month stay in the mental ward, she appeared externally completely calm; she complained a lot of the aforementioned headache, which was treated in vain with caffeine, cold compresses, etc., and also in the first month she complained sometimes of "nervous excitement, tingling in the fingers and toes, chills and heat throughout her body", a condition that she claims to have often had when she was irritated; presently she explains it by the fact that her sleep is often interrupted and disturbed by other patients. Menstruation occurred on time in June and July and, after being present for 1-2 days, stopped for a half a day or an entire day, before returning again for a short time; no pain or other manifestations from the nervous system were observed. Indications of the peculiar tendency of the patient emerged during her stay in the ward: she was found by the nurse a couple of times in tender embrace with another patient - an imbecile, suffering from a kind of moral insanity -, but she indignantly rejected any suspicion that she intended something untoward, and declared continually that she only felt a purely friendly affection, free of any sexual arousal, toward the respective woman, whom she considered neglected and misjudged by the others, and who aroused her sympathy for that reason. When this patient was discharged, she felt "very overcome" because of the departure of "her best friend". Moreover, she often demands to be discharged, saying she is not mentally ill; she claims she might get a nervous fever here due to agitation from the mental patients and would gladly come every day for morning rounds if that was desired. Later she complained that she often had to gaze intently at a cellar vault, and this was horrifying to her because the corpse of her father, who had died in the Charité, had been laid in a cellar, where it had been shown to her; this view was becoming more and more unbearable to her and she wished to be discharged for that reason as well.

More definite, affective conditions, hallucinations, delusions did not occur during the entire period of observation; on the other hand, it was impossible not to notice in her a certain slight degree of mental limitation. The patient whom she called her best friend and whose discharge moved her so much may have been able to fake the appearance of sanity for a short time, since she did not speak in a confused manner and usually did not express any very conspicuous delusions, etc. - yet her imbecilic, inane nature and her childish acts could hardly have escape the notice of a person gifted with a healthy sense of judgment. Also, statements were made not rarely that also attested to a lack of judgment; these include the aforementioned proposition of coming to the Charité for the morning rounds, as well as a contradictoriness in her statements often emerging within a few minutes: thus at one point she declared herself perfectly well and healthy, and immediately thereafter as unbelievably unhappy, etc. Moreover, it emerged clearly that even if she had an awareness of the morbidity of her inclination, any further correct judgment of the events and conditions associated with it went right past her; thus she showed herself, among other things, to be unjustly annoyed at her sister, accusing her of disrespecting her person, treating her badly, needing to control her, and so forth, and appeared not to appreciate the whole case that led her here in its full significance. - On July 28, 1864 she was discharged, after having occupied herself in the final period calmly and diligently in handiwork for most of the day in the company of the other patients.

In May of this year (1869) I sought out the patient in order to find out about her present condition. After having spent a period in the country far from Berlin, she was now living back with her sister in the same situation. Nothing of the sort had ever occurred again. The image of the young girl, who has been living in a distant place for some time, still comes to her often, especially vividly during her period and in her dreams; she still feels a certain tendency toward her, and her facial expression becomes lively when she talks about the girl's good qualities; she claims never since to have made attempts to approach other girls. On the other hand, she confesses that she still sometimes masturbates (she rubs her external genitalia with her right hand), namely, as before, in connection with her period; she also relates on her own that, if she suppresses the inclination, the same revolting smell arises. On the nature of her tendency toward girls, she expresses herself almost word for word just like before: "I feel in general like a man and would like to be a man; I have actually always hated feminine jobs, I would like to have a masculine job, for example I have always been interested in mechanical engineering." Even the retelling of the event from the past matches precisely the statements she made earlier. She still complains of the earlier headache, which is often very painful, so that she asks for help against it; it is mainly located in the vicinity of the small fontanel, more in depth, pressure on it is only sensitive to a slight degree, the skin itself is not more sensitive than on other parts of her head, and is not numb anywhere. The headache occurs after combing with a tight comb, and is felt less on the skin than deeper inside, especially at the place mentioned; but often it moves toward the forehead, and sometimes the entire head is as if overtaken: " then I am often so weak and I have to concentrate a long time to remember was I was doing." Examination of the external genitalia shows the same results as before: significant pain with touch, so that the patient immediately cries out in case of a strong touch, while in this there is at most only a slight reddening, if any, and the hymen is perfectly intact. I note expressly that the patient submitted to the examination without protest and without even the slightest trace of cynicism, and even now, as before, made a very civilized impression and would have gladly had a medical treatment prescribed. She now spoke of her sister with great love and respect and without any accusations, of whom during her stay in the Charité she had spoken only with irritation and lots of blame. Nonetheless, she even now still seemed not to appreciate the full significance of the event back then and actually represented her agitation at the time more and more as the natural result of the behavior of the girl.

The following information was of great interest, which rounded out the patient's earlier statements: for as long as she has been an adult, she has had the peculiarity of often having to stare intently at a particular spot so that her eyes really hurt; when she looks away for once, then she has to look back immediately. Her glance is directed both to persons, and namely without her really knowing afterwards what these people looked like, and to objects of various kinds. This involuntary staring occurs mainly when she is in a "sad mood", in any situation whatsoever, for example sitting at the table. Also on the street, when she is walking among many people, she often has to stare at something and has the feeling that people became aware of her for that reason and noticed it about her; then she became "totally weak" and therefore she usually goes out in the hour of darkness, in order to be less observed, as she says. The "sad mood" that she speaks of, and which she also describes as a "meditativeness", always occurs in quite a spontaneous manner with a certain periodicity, and alternates with the opposite mood. The latter exists for a short time before and after menstruation; at that time the patient is cheerful, lively, talkative, and at the same time - and only during this time - feels the urge for masturbation and sexual touching of girls, whose image becomes especially vivid at that time. This is followed by the "sad mood" and a certain "apathy" in which she does not feeling like talking and the aforementioned staring at a spot appears in particular. This mood lasts then again only 8 days or a short time and finally it is usually followed by a state in which she feels herself in a healthy mood and does not have to "stare" in that way; sometimes the weather appears to exert an influence insofar as gray days intensify the depressive mood.
 

A different picture in many respects was provided by the following case: In the winter of 1868 a man wearing women's clothing was arrested under suspicious circumstances at a local train station and was transferred under the name G. B. from investigational custody to the ward for sick prisoners at the Charité, since according to the report of the jail doctor he supposedly suffered from epileptic attacks and heavy pulmonary bleeding. At the respective ward, a gonorrhea was confirmed; later the patient acquired a facial erysipelas, and, after both afflictions were healed, he was transferred on November 24, 1868, to the ward for convulsive patients - linked to the ward for mental patients - because epileptic attacks had been observed in him repeatedly, in which he lost large quantities of blood through the mouth; external reasons and the overall impression of such an attack gave rise to suspicion of faking, as reported in the journal kept in his case. Nevertheless, as reported later, a pulse frequency of up to 100 beats and a temperature rise to 39.4 [°C] was confirmed after such an attack. Furthermore, the journal mentions an almost effeminate demeanor of the patient, who supposedly usually speaks in an effeminate tone with a lisping voice. -

I myself saw the patient directly for the first time after his transfer to the convulsive ward on November 24, 1868; he aroused my attention immediately by his general posture and the feminine embroidery work that I found him occupied with. He is a well-nourished man of strong build, tall stature, well developed muscles and fat layer. His posture, walk, the way he turns around, the movements of his head etc. have a certain slowness, measuredness, almost a stiffness, a theatricalness. His head is proportionate in size to his physical build, the diameters of height and length particularly developed, but otherwise regularly shaped, his face has a certain degree of rounding in its shapes, is very regular, with characteristics in which one may detect a certain femininity, his hair is blond, very abundant, long, slightly curled, and is worn combed over toward the back, the patient is clean shaven, and traces of a beard are visible all over in the usual way. The ears show no particular deformity, traces of ear-holes are found in the ear lobes (he had them pierced a few years ago in Stettin), his body is abundantly hairy overall, the hair of the genitals extends up to the navel; the genitals themselves are well-formed, the scrotum and the skin of the penis pigmented and wrinkled, testicles are of only moderate size and are easily pushed up into the inguinal canal. The larynx is clearly prominent, of usual size, the voice of the patient is queer, difficult to describe, somewhat soft, he also extends and drawls many words during speech, which is rather slow, namely at the end of a sentence, and he does not let his voice drop at that point; the latter by the way has by no means the high pitch of a woman's voice, but rather the middle depth of a male voice. The patient himself states that his voice first became deeper and rougher after his twentieth year and he says that when he moves in feminine company he speaks with a softer and higher voice. - Examination of the anus shows nothing unusual, namely no abnormal depressions, the anal folds are present in the usual manner, and a hemorrhoidal knot is also visible, from which the patient claims to lose blood occasionally. - Otherwise the examination reveals nothing remarkable, except for a slight enlargement of the tonsils. In the examination itself, the patient blushes and begins a general severe shaking, manifestations that were observed later as well under similar circumstances and when he was spoken to. He complains of convulsive attacks, dizziness that often forces him to lie down, blackouts in the eyes when bending over, and frequent pain in the left supraorbital region. Pressure on the exit point of the left N. supraorbitalis is very sensitive, not on the right.

He answers the questions put to him calmly, without agitation, often in rather florid expressions with a slight pathos and, when asked about the reasons for his costume, he relates the following in the course of the conversation, which was recorded as literally as possible:

"I have a great tendency to put on ladies' clothing; I myself often feel unhappy about it and think: 'Why aren't you like other people?' - there are days when I tell myself: "My God, you cannot be crazy." - I cannot understand it and especially when I am assisted towards it (i.e. when someone assists me towards it) - then I have been with people who said that I had a lady's face - particularly when I let my thoughts run in my leisure hours I do not know how I acquire the urge; I have had this urge already from the age of eight and was often punished by my mother because I often took her clothes; the older I became, the worse it got; I know of no cause. The effeminate nature was a real torment for me, the need to put on women's clothes rises in me often after long intervals. When I suppress it, then I acquire an actual fear until I can gratify it. I have been in the company of women since my youth onward, I enjoy interacting with them in women's clothing, especially going dancing, dancing as a gentleman was not as much fun by a long shot; I got myself some jewelry, needles, watch-pendants, chains, earrings, I wear my hair done up in the latest fashion. I have felt a tendency to have sexual intercourse with women, but rarely, because I feared that it would make me ugly." - He says he never let himself be used by men and never had anything to do with them sexually, although many offers in this direction were made to him; his spiritual advisor once told him that when he is excited he has a sparkling eye and a strange walk and that that attracted people to him. He claims to have masturbated only as a very young person, but not any more for a long time.

According to his own information, in his 16th year he had his first convulsive attack after a scare, and he was found lying unconscious on the ground. Then later he had an attack every quarter or half year and felt unwell beforehand; he never bit his tongue in it. He claims to have had night-time attacks as well, in which he fell out of bed. At the start of the attack he claims to sense heart palpitations, then becomes afraid and he runs cold, especially in his fingers. Sometimes these manifestations appear already a quarter of an hour before the attack; then he has ringing in the ears, blackouts in the eyes, he loses his orientation, falls and has convulsions, and sometimes blood emerges from his mouth. He says that he often screams in the convulsions. After an attack, he feels listless, fatigued and heavy-headed. The attacks supposedly come very irregularly now, several times in a week, often not for months; the patient cannot identify any particular causes for the outbreak of attacks. When asked, he reveals in addition that his memory is weak in parts so that after a few hours he forgets everything; he says sometimes he has forgotten to serve coffee after dinner and has been asked if he were in love, since he is so often lost in thought. He says he tends easily toward anger, easily breaks into tears, cannot tolerate alcoholic spirits and becomes immediately excited thereafter; in a state of excitement caused by a minor dispute at a military hospital in Altona where he worked for a while as a guard, he bit another guard and knocked him in the head with a chamber pot and came to his senses only after he saw the blood. Furthermore, he relates that he often has attacks of melancholy, in which he has cursed his father and mother (he is an illegitimate child), has become terribly afraid and excited, and has broken out in screaming; then he also read a lot in the Bible.

When asked to write down the events of his life, he gave me the following report about them, which I reproduce here with correction of the gross errors of spelling and grammar:
 

"I, Aug. Ha...., called Han...[at the time when the patient wrote this, it had already been revealed that the name G. B. that he gave initially was false], was born on June 7, 1841 in Cöslin, attended school there, was confirmed and then entered a servitude in which I was always praised by my mistress until the time when I got my first convulsions; sometime after the sickness my mistress had complained about me in a letter to my mother and said that I had become very disobedient since my illness, for which I was berated by my mother. I promised to improve, but in vain, I was released from my service at Easter and went back to Cöslin, where I was persuaded by someone named W. B. to dress up as a lady and so I had to do it - and he said that I had a pretty woman's face and in fact my plan succeeded and I was practically worshipped by the gentlemen and enjoyed many a beautiful adventure, always received rich presents from the gentlemen and then managed to remove myself. Then I decided in October to go into the world as a lady with a theatrical company, but I still didn't have any white undergarments. Since I had enjoyed another beautiful adventure one evening and was accompanied home fully intoxicated by several ladies, they were in fact only whor--, one of whom is now in prison, namely at the house where I was living we stole white shirting from a lady who was not at home; I kept the merchandise and gave the others 2 talers. It soon became known that I had brought shirting to a woman for alteration, for what reason, I do not remember. I was brought before the court, where I confessed immediately; I did not want to betray my girlfriend because I loved her. I received two months in jail and when I was released I started up my old life again and to a whole different degree than before, because I believed that my name had already been cursed; then I acted even worse and even made demands of the gentlemen and earned lots of money and knew how to get away from the respective persons with cunning, which I succeeded in until one evening I was pursued by several young gentlemen and violently seized. Then I revealed myself, since I did not know how else to help myself; the police came in response to my screaming, I was brought into custody where I was immediately recognized; accusers were found and I was sentenced to five months in jail [for repeated fraud. He had taken money from gentlemen based on the costume]. I was released again and started my business again, because at that particular time the industrial exhibition was in Coslin and many foreign gentlemen were there and I was taken for a pretty girl, and there was no shortage of lovers. Then I received such rich presents that I was in a position to travel; I traveled to Colberg, where I lived in a guest house and during the day I went walking with two whor-- and in the evening to dance halls where one night I was brought by a guard to the guard house, since it is customary in Colberg that ladies may not walk around alone at night unescorted if they cannot prove why - and that is what happened to me; after revealing myself I was given three days in jail and because I believed that the matter with the dress was discovered, I sought to flee. The issue with the dress was the following: one night I went with a certain Jo... Le... to a shoemaker to buy myself a pair of shoes while my girlfriend waited outside; when we went home, she showed me a dress, and because it did not fit her, I took it, gave her 1 taler for it, and she said that she had taken it from a clothes closet in a hallway. It was known already in Cöslin that I had escaped in Colberg; naturally I was arrested and since this theft that I had committed in Colberg was deemed aggravated, I was sentenced to 5 years imprisonment, for which I was happy in one respect, because I believed that through the long lock-up I would finally be liberated from this torment, because it truly was one indeed. And so I came to Naugard, where the clergy immediately took me under its wing and thereafter I had a much better time as a prisoner than here. I made every effort to become a better person, and when I had served my penalty, I was sent back to Cöslin, where I made a great attempt to reform myself, but there was no hope. Then I resolved to travel to America, but I was denied a passport. Then I resolved to go out into the world. I went to Stettin, where I was robbed by a friend and then denounced, whereupon I was arrested [according to the verbal explanation of the patient he was denounced by the respective friend for using a false name and was arrested for that reason] and when I fully regained consciousness I was in a hospital. So I luckily managed to escape jail. I stayed in the villages between Colberg and Cöslin. One day, when I was coming from Körlin, I met a girl on the street whom I did not know, but we became acquainted immediately in a long conversation. I said I was a cook and came from Colberg, and so we traveled together and arrived at a noble estate where I intended to get a job as a manorial cook; but since the place was vacant and it was evening, we found ourselves forced to spend the night in the village, where we slept together in one bed [he claims to have maintained his role as a woman in this]. In the morning I arose early and took a large scarf with me from my travel companion and left with it and left her my hat and believed that I had made a fair exchange, but it was interpreted as theft. I took the scarf in order to protect myself from the cold since my things had been taken from me. I went to Cöslin, where I was arrested at night in my mother's apartment, who was very sick, and was brought to Colberg, where I was accused of theft, namely for the dress that had been found among my things. I said that I had stolen the dress, as I had arranged with Jo... Le..., and said that I had also stolen the scarf and related what had happened. I was sentenced to nine months in jail; that was in December 1861 [the story is very confused here and the patient apparent mixes up the times. The sentence of 9 months in jail was prior to the 5 years imprisonment. See later.]. I enjoyed great trust with the jail guard and his family because I worked diligently for them, and because I was able to assist in the cooking, and I became a cook for my fellow inmates, and once I had served a few months and acquired such an urge for the damned women's clothes which had always been my misfortune, and since one day I could bear it no longer, I decided to run away the next day, whither I did not know myself. Only after I had recovered from my initial fear, I decided to go to Cöslin and make certain of whether it was really true that my mother had died; then I went to a house that I knew of, where I had once been in service, in order to fetch the women's things that I desired, which I also succeeded in doing. But my enjoyment would not last for long, because when I went to the train station intending to earn some money and in fact did find a lover and we intended to go to a guest house, I was recognized immediately because a .... (illegible) ... spoke to me there where I had been for several weeks. When I was released, I got a travel route to Cöslin, which I did not follow however, but rather I obtained for myself an employment reference of a certain B. [male], whose name I now used; then I went to Berlin, where however, I was unable to find a position. That was in February of 1867; then I went to Hamburg where I got a position in Altona. Your professorship knows the rest up to now when I was arrested in Berlin. Oh, I beg you most humbly, professor, sir, if I can be helped, please do your best, so that I can one day yet become a proper human being and participate in human society; you will not find me to be ungrateful." -
 

Esteemed Lady,
please, please forgive and pardon me for having caused such a disgrace to your house, but I could not help but to take this step, it was impossible for me to say that I wanted to go away, oh please pardon me Dear Lady for speaking so freely to you but you must know the cause of my deparcher (supposed to be "my departure") Oh I am ashamed before you to have insulted you so which you have not deserved from me, oh Mercy, oh, Precious Lady, I must confess my sins, namely I felt a burning love for you, and because I feared that the fire would break out I had to try to prevent it, I am going now into the world and I do not know where, because the 3 talers that I asked for is all the money I have.
Pardon. Pardon
I remain in spirit your most humble Dict B.

In order to get possession of the necessary wardrobe, he packed a few otherwise quite worthless items of the lady's clothing into a suitcase; the female clothing that he was wearing at his arrest was allegedly bought with money he had earned; he put it on during his trip because he wanted to see whether he could pass for a lady. He did not take jewelry and the like although he easily could have. At the train station in Berlin he was recognized only after someone stepped on his train and his veil was disarranged in turning around; he at first pretended to be a countess, but was arrested when he could not identify himself adequately. He was delivered to the Charité for the reasons stated above.

During his stay in the ward for convulsive patients, he was continually occupied with feminine handiwork; he knitted colorful scarves in many brilliant hues, embroidered, made little hats for ladies, etc., and was intentionally allowed to do so. It was reported that he sometimes made himself noticed by the female patients in the syphilitic ward, whom he could see occasionally from the window of his room, presented himself in the ladies' hats that he had made, etc., and had even cut his hair once like a girl. Once he complained vehemently about caresses from another patient; otherwise he generally behaved in a calm and sedentary manner, in fact often presented to others a somewhat foolishly elegant demeanor, usually spoke only when spoken to, but then without hesitation, often with blushing and shaking; sometimes he was childishly sensitive for minor causes and then easily got into a violent stormy rage. His behavior at the Christmas gift exchange was very remarkable; he stayed at the door, broke out in tears and did not want to go in. Another time, after having to give information about various things, he appeared very depressed, complained of heart palpitations and was found running stormily back and forth in the hallway. He often complained of pain in the supraorbital region; an examination toward the end of December after a convulsive attack on December 20 revealed pain after pressure to the left of the exit point of the left N. supraorbitalis, while pressure on the right was tolerated very well; the same difference existed at the exit points of the N. infraorbitalis, alveoralis superior, mentalis, but in general pressure on the skin of the left side of the face was somewhat more sensitive than on the right; this was also true for the conjunctiva bulbi and the mucous membrane of the tongue; his left arm was supposedly somewhat more listless than the right. Convulsive attacks were observed many times during the patient's stay in the ward; unfortunately, I myself was never a witness to one of them, on the other hand Dr. Sander, currently an assistant physician in the ward, saw an attack that he definitely believed that he had to call epileptic, others were observed by the subordinate doctors in the ward and by the guards. I will provide the description of some of these attacks according to the disease journal:
 

September 30. Patient had an attack this morning when he was still lying in bed, blood flowed from his mouth and nose, then flailing of the hands and feet followed, finally of his entire body; during the entire time dark blood flowed from his mouth and nose. Then the patient slept until 9 o'clock in the morning, and knew nothing about the attack, but was only worn out. The tonsils and fauces are swollen, but no blood is visible on them, nor is a source for the bleeding visible in the mouth; the tongue is not injured; complaints about pain in the left regio supraorbitalis, pressure on the exit point of the N. supraorbitalis is painful.

December 10. An attack yesterday morning after patient had been irritated beforehand; slept poorly in the night, often startled. In the morning it was noticed that he became absent-minded, his fingers shook, he was brought to bed. Then after a little while there was quiet whimpering, blood flowed from his mouth in a rather abundant quantity, then convulsions started.

December 20. An attack yesterday evening. He first walked around as if irritated, then dropped himself into a chair by the window, and as he started with movements of his arms, he broke two windows, only then came more violent movements. He claims to have maintained consciousness only to the point when he sat in the chair, and claims to have regained consciousness only this morning. No blood was noticed.

December 28. An attack yesterday evening, another this morning. More blood than usual comes out of the mouth. He lies with his face covered in blood, eyes closed, is convulsed as if in opisthotonus, strikes perpendicularly with arms and legs, thumbs pressed firmly between the fingers, then he resumes breathing quickly with loud sighs; often movements occur as in choking or convulsive movements of the diaphragm. Meanwhile, he often lays there quite calmly for a time, hands laid over his chest. Sometimes he makes rolling and twisting movements with his body. While one is occupied with him, he begins to throw himself around. Sometimes he makes his limbs stiff and rigid, pressing his mouth closed and breathing in slowly and deeply, then, as if in pressing, suddenly explodes, after which slackness of the limbs and face appears. - The patient was seen again immediately after the attack; he look very pale and suffering, and also appeared embarrassed, pretended not to know about the attack, said only that he had become dizzy while working the evening before and afterwards did not know what happened to him until the moment when he got up. Pressure on the left supraorbitalis very painful (see above, p. 89). In the left mandible there is a hollow tooth filled with a granular mass, which begins to bleed somewhat after some scraping with the nail. No other source of bleeding can be found.

Since Ha... was not suited for a longer stay in the Charité, I made a request for his release; he was sent back to the jail on January 25, 1869 and set free already on February 7, since the term of 3 months imposed on him had expired. In the mean time, however, - because the authorities had become aware of his earlier convictions - an investigation was pending against him again at the request of the State Prosecutor; by a ruling of the chamber court, the earlier ruling was modified and he was now punished with 2 years and 2 months imprisonment, as well as three year police supervision, for "simple theft and repeated recidivism", while the two months of prison was deemed served by the three months in jail. Currently he is in the Brandenburg penitentiary.

A few facts obtained from the legal files and as a result of private interviews regarding the theft and general actions of Ha... will be mentioned in the discussion of the case itself.

Of the cases presented above, the first represented the well-characterized type of a certain disease condition; the second presents difficulties for evaluation insofar as criminal acts of the respective individual are involved at the same time and doubts might arise as to whether the described tendency towards putting on women's clothing is really a symptom of a pathological condition or perhaps nothing more than a disguise assumed for criminal purposes.

I will turn to the first case first. It can be viewed as beyond any doubt that in this case involving a 35-year old girl the phenomenon of the reversal of the sexual feeling, the feeling of representing a male being, existed from earliest youth independently of any deliberate or self-delusion. Any lingering doubt about the inherent truth of the information provided by the patient must disappear when we see that her statements almost literally match the statements of male individuals who for their part had a similar contrary sexual feeling. I am relying here essentially on some documents which are quite above any suspicion of impure motives. The first is a written confession voluntarily sent in to Casper by an anonymous person [Casper, Klinische Novellen. Berlin 1863, p. 36] which match the notes given by Casper regarding the Count Cajus [id. Handbuch der gerichtl. Medic. Berlin 1858. Biolog. Theil, p. 182]; the second a protocol issued by Tardieu under the title "Ma Confession" which was found on the occasion of a pederast's trial; the third, finally, a brochure published under the title "Forschungen über das Räthsel der mannmännlichen Liebe" by Numa Numantius [the full title is: Forschungen über das Räthsel der mannmännlichen Liebe: "Inclusa" ("Research on the Enigma of Male-Male Love: 'Inclusa'"). Anthropological Studies on Male-Male Sexual Love. Second Document on Male-Male Love. Natural Science Part. Proof that sexual love for men is generically innate in a class of male-structured individuals. - As is apparent from the title and as I have discovered otherwise, the author has already written on the same topic before (I myself have seen only the cited document). By the way, he has emerged from behind the pseudonym, as is sufficiently well known in juridical circles.]. All of these documents are records of men who feel like women, whose sexual tendency is directed toward their own sex - and strangely enough there is agreement of these self-descriptions with one another and with the confessions of our patient! I must be allowed to quote a few characteristic passages from the last-named document, which is likely so far to be little known or accessible to the medical field, as proof of what I have said. It says therein:
 

"Our character, the way we feel, our whole mentality, is not male, it is female. This inner female element is recognizable in us externally by means of an externally salient female essence. Our external essence is male only insofar: as rearing, as the constant environment in which we were made to grow up, as the social position that we were given, artificially cultivated masculine manners in us. We are only playing the man. We are playing him like women play him on the stage ..."

"The Uranian [the author's name for the respective male individuals who feel like women] exhibits as a child a quite unmistakable tendency toward girlish occupations, interaction with girls, and playing with girls' toys, namely also with dolls. How such a child complains that it is not the custom for boys to play with dolls, that Christmas Man doesn't bring him dolls, too, and that he is forbidden to play with his sister's dolls! Such a child shows pleasure in sewing, knitting, embroidering, crocheting, in the soft, smooth-feeling clothes of girls, which he would rather wear himself, in colorful silk ribbons and fabric of which he likes to keep individual pieces." (Then the author relates how he himself was subjected as a boy to many a humiliation through no fault of his own because of his female essence.)

"With the start of puberty, our sexual love awoke immediately as love for the male sex. It happened without the slightest action by us or from outside. Until now, we have felt sexual love unremittingly for men only, namely for blossoming and beautiful young men. We feel drawn to physical touching with such a young man by an invisible, marvelous, extraordinarily strong power that dwells within us, even magnetically drawn: namely to sexual as well as non-sexual touching with him, for example, mere hand-holding, and caresses and kissing, or touching cheek to cheek. Every touch with him accords us a miraculous pleasure. Never, not even for an instant, did we feel sexual love for women. Even the most blossoming and beautiful girl leaves us completely cold. Rather we feel repelled and repulsed from sexual touch with the body of a female being by the same invisible power that dwells within us and draws us toward young men. If dreams show us images of love, then we see only male figures, never female. So it was from the initial onset of the developing puberty; so it has remained to this moment. Our very first love dream was of a male figure ..."

"It is absolutely impossible for us to transform our feminine drives into masculine ones. Indeed, it is absolutely impossible for us even to eradicate our feminine drives within ourselves by force of will ... "

"We never get a taste of the reciprocated love that we sorely long for ... I for my part do not hesitate to declare: 'If it were in my power to choose between love for men or love for women: I would never have chosen love for men, and I would absolutely choose love for women even today: not because of your persecutions but because of the actually existing great inadequacy of Uranian compared to Dionian love [male individuals with normal sexual feelings are called "Dionians"]; because, namely, the Uranian love is followed not by reciprocated love but by that miserable rejection, and then, because it is infertile. If we loved fellows by own will and not rather because we can do nothing else, i.e. by nature: we would be the most foolish of humans beings. It would be truly absurd to consider us to be such foolish people.'

About the manner of the love itself, it is said: "Our love is, under the same conditions, just as ideal and lofty as yours and as that of the women. Just like yours and like female love, it is accompanied by a deep amorous longing. It is in the same degree devout, tender, deeply-felt, noble, sacrificing and patient, selfless and willing to suffer deprivation. To me personally, it even seems to exceed yours in all these matters and to be equivalent to that of female love; namely in its devotion, in its patience in suffering, in its nobility, and in its willingness to sacrifice. It is decidedly more humble and devoted than male love, and in this regard is definitely equal to female love. Uranian love poetry breathes a whole different submission of the entire self to the beloved than does Dionian."
 

According to these statements, we can view it as beyond doubt that both in the male - and this is also conceded by forensic doctors with experience in this direction - and in the female, as our case incontestably demonstrates perhaps for the first time, a contrary sexual feeling occurs innately, such that the man feels as a woman, the woman as a man. But what is happening here? is this a completely isolated abnormal manifestation in an otherwise healthy psychology? or are these at the same time additional manifestations of a pathological condition?

In fact, the latter are unequivocally found in our female patient. There is a periodic alternation between states of depression and exaltation, which we observe often enough as a so-called folie circulaire. As is known, these conditions are not rarely so unpronounced as pathology that they do not stand out to the doctor as morbid, even to the expert doctor, unless he knew the patient in his healthy days or saw him again later in a healthy state. The depressed and the exalted mood (exaltation manique, manie tranquille) can remain within such limits that, without the ability to compare it to the earlier state of the patient, it may appear totally physiological, and only the nearest acquaintances of the patient, and often not even they, know that these are pathological psychological conditions arising in a compulsive manner, while the patient himself is often well aware of them as pathological. Patients with these symptoms that manifest externally as minor usually are not admitted to mental institutions, but it is not rare that they seek the help of a doctor, confiding in him alone, as has happened to us repeatedly. This externally so unpronounced form of mental disturbance is nonetheless one of the most incurable, the alternation of the pathological states often lasts throughout life, the individual stages of depression and exaltation sometimes maintain regular intervals, sometimes they represent shorter or longer periods, and a period that can be designated as a healthy or relatively healthy interim stage likewise fluctuates in terms of its duration. Apparently, in our female patient, these are quite analogous conditions, and her statements about it were made quite spontaneously and were not anticipated by me. Regularly, with implacable necessity, the pendulum swings of the pathological mechanism follow on one another, with nothing added by the will, all is a pathological compulsion. In the excitation stage, certain feelings, imaginations and drives emerge, just as in other maniacal forms, except here in the described direction; in the depression stage they submerge once again, and in their place a strange psychological numbness arises, consisting of the fact that - with their minds, so to speak, devoid of content - they must stare unremittingly for a long time at a certain object; compelled by a necessity that they cannot explain. In a certain interim period, all the manifestations return perfectly toward the one or other direction, and this is the relatively healthy period.

It could not be determined whether such a periodicity had existed from the beginning, but in any case it has existed for a long time now, and, as indicated above, it is closely associated with the menstruation process. Thus the patient currently suffers from a form of folie circulaire, and as a symptom of the maniacal stage, which intensified shortly before her admission to a height never reached before [the patient was caused to break out in rages when she even heard the voice of the girl she loved, as a second examining doctor stated], the sexual arousal appears, aimed in such a strange direction. At the same time, there is violent headache with dizziness as another symptom within the nervous system.

According to everything that I myself have seen from the patient and have heard about her from her sister, I believe that I can see another more general disturbance that at the same time forms the basis of the morbid condition. The limitation of the patient's judgment, which I spoke of in relating her disease history, the subordinate position that she assumes in relation to her two other sisters, the difficulties in learning that she seems to have felt in her earliest youth, suggest the assumption of a certain degree of innate mental weakness in her, which could of course only be demonstrated more clearly with longer interaction and more precise knowledge of details. We are in all probability dealing with a girl who from her youth has suffered from a certain slight degree of mental weakness, and thus the weird phenomenon of contrary sexual feeling that has existed in her from the age of eight [even in the second case we described, the eighth year of life was mentioned; Casper's unknown male also relates that, as an eight-year-old schoolboy, seated next to a somewhat older boy, he felt happy when he was touched by him; it was the first indefinite feeling of a tendency that remained hidden from him until the age of nineteen. Griesinger, who did not know the cases described by me, "took a confession from a solid, finely educated individual living in the refined world, who suffered however from severe hereditary handicaps, saying that since his eighth year of life he had had a sexual drive toward his own sex that arose at every opportunity, but never felt another healthy natural one." See Presentation for the Inauguration of the Psychiatric Clinic. Archiv für Psychiatrie und Nervenkrankheiten I, p. 651 - Thus it is always the eighth year!] lines up with a series of innate perversities of feeling, imagining, and acting that we have observed to be commonplace in other cases of innate mental weakness - namely in those that are preferentially expressed as moral insanity. Later the aforementioned periodic form of the mental disturbance developed on this basis, in the maniacal stage of which sexual arousals appeared whose goal corresponded to that of the innate perversity of the sexual feeling.

As a cause of the pathological state of the female patient, we can certainly point with some justification to heredity: the father took his life in an attack of melancholy mental disturbance. Whether pathological traits are also present in the patient's siblings, which might have supported this assumption, could not be ascertained. -

Now it certainly ought to be of interest to investigate whether other signs of a pathological condition are demonstrable in the cases cited by me from the literature in which the reversal of the sexual feeling is sometimes reported, sometimes thoroughly described by the respective individuals themselves. Naturally, such an investigation, based solely on these reports without acquaintanceship with the persons themselves, can only be very incomplete. However, a few indications can be obtained. Regarding the Count Cajus, accused of pederasty, it says in Casper that "his feminine-childlike being and his unselfconsciousness lend some credibility to his statement that he did not know that something like that was punishable under the law" - nonetheless, Casper declares that he is by no means "mentally weak or unaccountable." Anyone who knows how Casper judges indisputably mentally weak people, will not be surprised at such a pronouncement: for us this description of the Count Cajus demonstrates his mental weakness with great probability, and his "unselfconsciousness" was probably based on imbecility! Later I will have something to say about the confession of Casper's unknown male, from whom no clear signs of imbecility emerge; no judgment can be made in all propriety regarding the mental state of Numa Numantius, a man who, as I know from juridical circles, already plays some role in the public sphere, and the reader of his work may form his own opinion.
 

The second of the cases reported by us concerns a person who from his youth claims to have felt a particular urge to put on women's clothes, and has a tendency to mix with women in this costume and to act like a woman. He allegedly has no sexual tendency toward men, and claims never to have let himself be used by them; the fact that he did not shy away from sexual intercourse with women is apparent partly from his own testimony and partly from the fact that at the time of his arrest he was suffering from gonorrhea. What is the significance of this alleged urge toward women's clothing? Is here the perverse sexual feeling, as it were, stuck at a lower stage of development, so that only a general condition of feminine feeling and feminine tendencies occurred, a need to act like a woman - or is the entire alleged urge merely a pretense of Ha... used in order to better accomplish, in this disguise, the many thefts that he committed.

It is certain that Ha... in fact used the women's clothing for all sorts of frauds, and he is in general an exceedingly mendacious and deceitful person, who presented himself several times under other people's names on the basis of third-party employment references and finally had acquired possession of the employment reference of the maid of his mistress in order to legitimate himself as a woman. Furthermore, he has been sentenced repeatedly for fraud and theft, as seen in his own notes and in the court files that I had available, namely 1) on November 15, 1859 in Cöslin sentenced for simple theft to 2 months in jail and loss of civil honor for 1 year; 2) in the same place on April 12, 1861 sentenced for repeated fraud to 4 months in jail, eventually another 1 month in jail and loss of civil honor for 1 year; 3) in Colberg on December 18, 1860 sentenced for repeated theft in the 1st recurrence to 9 months in jail, loss of civil honor and police supervision for one year; 4) in Cöslin on October 29 1861 sentenced for two simple thefts and one aggravated theft and one simple theft with aggravating circumstances to 5 years in prison and placement under police supervision for 5 years. - He at first completely concealed all of these convictions both in his court hearing and toward me, so that - since he was using a false name - he was deemed previously unpunished and the first sentence was meted out accordingly. Only by chance did his real identity come to light; the director of the penitentiary in Naugard had received knowledge of the proceedings against Ha... from the newspapers, and expressed in a letter to the local court his suspicion that the alleged B. probably was named Ha... and was identical with a person who had served 5 years imprisonment in Naugard. Ha..., who was asked corresponding questions by the court based on this declaration, denied everything and claimed to be named B. and to have never been punished; only when the director of the penitentiary personally recognized him did he admit everything.

Called to account by me for his mendacity, he begged most imploringly for forgiveness, saying he was unable to admit himself to be such a bad person; moreover, he said, in all of these thefts, he had stolen only women's things, as in the current theft committed against his mistress in N. I was only able to ascertain the truth of this matter later from the files. In fact, the things found with him included an exemplary collection of all sorts of objects pertaining to feminine toilette. Of these, he initially said only a small number were taken from his mistress (the respective interviews are contained in the files), and even later after repeated follow-up questioning admitted only gradually a few more items, until finally, when confronted with an authentic index of the stolen items, he declared that it was indeed possible that this or that thing belonged to the mistress, he did not know, and that they should simply give back whatever they wanted so that the people would finally be satisfied. Of the large number of things that he demonstrably stole and that have been acknowledged as such, I mention among others several lady's dresses and blouses, sleeves, a feminine hair tower with plaits, chignon, slips, stockings, handkerchiefs, silk ribbons, a length of colorful gauze, a jet chain, a fake arm band, as well as gentlemen's neck-ties and a pair of gentlemen's shirts, finally a Bible, an album, two song books, a book of poetry, a photograph album, and I note that some of the respective books had expensive bindings; the travel bags in which the things were kept were also stolen. In addition, one gentleman of the house was missing items of clothing belonging to him that were not found among Ha....'s things and that he stubbornly denied having taken. Thus here too he had been untrue, although the majority of the stolen things consisted of feminine toilette items. Finally it should be mentioned that under some pretense Ha... had had a few talers given to himself as an advance on the day before his night flight in women's clothes - when confronted he described that as wages to which he was rightfully entitled.

Under these circumstances, can one still believe Ha... with regard to his alleged urge toward women's clothing arising in earliest youth, and are we dealing here with a pathological condition at all, rather than an ordinary swindler, cheat and thief? I have gathered together in the preceding everything that might qualify Ha... as such, and yet I believe that I can show that this involves a decidedly pathological condition.

In order to gain insight initially into his behavior outside the jail or hospital, I turned to his last mistress in N., whom he had robbed in the manner described. By the graciousness of the lady of the house, I learned that Ha..., whom she had not herself hired, had immediately displayed signs of "a highly-strung, morbid, untruthful nature, and that from her first sight of him she deemed him to be a swindler or a mental patient, since he "behaved in a strangely silly and foolish manner." It was further confirmed that he very often put on women's clothes in the house, owned false breasts, very often went out in the evening in women's costume, according to statements of the residents, and only came back late in the night. It is further confirmed by a letter included in the court files from a gentleman of the house, that Ha..., "who had very good references and otherwise showed himself quite capable as a servant, displayed many evidences of insanity" which, as he added, did not rule out the possibility that he was an out-and-out arch-swindler. In another letter by the same gentleman, it is stated that Ha... "knew how to ingratiate himself by attentive service and in the end one was able for a while to tolerate his repulsive vanity, his presumptuous sensitivity, and his overall rather skillfully played role of an unhappy and therefore highly-strung illegitimate son of a baron."

It is shown from this that even during his service relationship his character was represented as it was everywhere else.

After the foregoing, it cannot be a matter for doubt that we are not dealing here with an ordinary thief who uses women's clothing solely and exclusively with an aim toward committing frauds and thefts; if he were pursuing such purposes with a sound mind, what could motivate him toward such insane behavior? Moreover, the tender sentimental letter that he left for the lady of the house, that is printed on page 88 above, decidedly contradicts the assumption that his behavior was a, deliberately and consciously assumed, mere disguise. What could motivate an ordinary clothing thief to leave such a document behind?

On the other hand, Ha... states repeatedly that from his youth he had an urge to put on women's clothes; this is either so or it is invented. Leaving aside the improbability of such an invention, since Ha... could not possibly have constructed the pathological occurrence of such an urge, a person of sound mind could only have intended to exculpate himself by such an invention, if need be, by claiming the morbidity of the urge. Has B. ever done this? He has never even made the slightest attempt to do so; neither has any trace of such an attempt has been made to me, nor has any expression among the repeated court depositions testified to such, insofar as these are contained in the files; characteristically he has only spoken of his tendency to me, the doctor, but never to the court, although, as I said, even to me he has never used these facts to portray himself as guiltless. It is therefore certain that he has not invented this urge in order to exculpate himself, and it is also certain that his feminine behavior, his feminine occupations undertaken with a certain passion during his stay in the Charité, were not assumed artificially in order to lend credence to statements. I am therefore convinced that Ha...'s statement with regard to his urge towards women's clothing is based in truth, and probably more than he himself is aware. A whole series of other positive reasons support this assumption. First, the hard to describe strangeness of his entire being; the impression of it is not, say, merely a subjective one that only struck me, but rather one in which all who know Ha... agree; even the inspector of the jail in Brandenburg, whom I asked for and from whom I graciously received more detailed information about Ha...'s current behavior, describes him in quite similar terms as I myself have tried to do, in that he says that in his being "there lies something weird, awkward and affected, which is indicated by his way of expression alone." The respective official had had the opportunity to see Ha... already before in Naugard, where in his isolation cell he was busy with a large, beautiful tapestry work; "in speaking with him about the work," it says in his statement to me, "his feminine behavior was conspicuous" etc. In his current place of residence, Brandenburg, he generated concern that "with his feminine tendency he might easily get into some impure associations in his surroundings." Thus such a consistent being, dependent on a hundred tiny unconscious nuances, could not be brought forth consciously and intentionally (I also recall his frequent blushing and shaking when he was spoken to). But the inherent truth of the statements of Ha... in this regard becomes even greater when we compare his peculiarities with those of other male individuals who have admittedly suffered from a similar reversal of the feeling of their own sex. It is repeatedly stated and even the newspaper reports about his arrest speak of the fact that his voice is strange and soft - just like Casper's unknown male [Casper Novellen, l. c. p. 37 "and my voice so soft"!] and the Count Cajus [id. Lehrbuch, Biologischer Theil, p. 183 "always spoke very softly"]! In addition, he has a certain vanity in common with these individuals, a tendency to boast of his "adventures in love" and visibly enjoys an uncommon self-satisfaction in playing his feminine role. His claimed preference for theater-acting, reciting, poetry-writing, etc. also appears characteristic to me - a tendency found in Case 76 of Casper [ibid. p. 184].

I believe that, after what has been presented, it will be agreed with me that this tendency to feel and act like a feminine being in fact constituted a pathological trait in Ha... and is not an assumed disguise. But here too, as in the first case, this manifestation is only the symptom of a more general morbid condition. In telling about his condition, immediately after admission to the Charité, Ha... stated that the desire to put on women's clothes often arose in him after longer intervals and that he acquired a real fear when he was unable to gratify it. In order to finally be able to put on women's clothing again, he says in his notes, he once escaped from Colberg. He told the inspector at the penitentiary in Colberg (according to the latter's written communication to me), that the periodically arising mania to steal and put on women's clothes gradually developed in his early youth, a mania that disappears by itself after a while [whether Ha... himself uses the expression of periodically arising mania is not clear from the communication; probably the reporter merely worded Ha...'s statements about this in this way for short. In the Charité, Ha... never used the words "mania" or "periodic", but only referred to an "urge" and "drives," in the manner presented]. "At this moment," it says further, "he is quite free from this mania and possesses a clear judgment of the puzzling urge that suddenly overtakes him, although there is something weird, awkward, affected in his being" etc. --- In the Charité, the doctors have never spoken of any periodicity of his drive in front of the patient, indeed at that time no one was thinking in particular of such an occurrence, so that he cannot have learned of any such "periodicity" there, and therefore I must give credence to this statement of Ha... made to me and to the jail inspector regarding a temporary occurrence of his urge, especially since the first of the reported cases offers an interesting analogy to it. Finally I must focus on another manifestation that supports the inherent truth of the respective statements of the patient; he declares that he acquires a real fear when he suppresses the urge. This is based on a more general phenomenon. There are a number of patients, namely hypochondriacs, who temporarily feel an urge that cannot be described more exactly, sometimes connected with certain sensations, an urge toward certain expressions of motion, that manifest themselves sometimes in strange, mimic contortions, screaming, bellowing sounds, etc. and sometimes as more general, almost convulsive movements. If they try to suppress them, then according to their statement they fall into a state of indescribable fear, the subjective feelings intensify to the highest degree, and afterwards the expressions of motion emerge all the more forcefully and violently. I would like to interpret the above statement of our patient analogous to this manifestation as well, which vividly recalls a certain behavior in the occurrence of epileptic attacks; the female patient in the first observation had a subjective olfactory sensation when she suppressed the tendency toward masturbation!

Therefore we would probably also be dealing in Ha...'s case with a periodically expressed form of mental disturbance in which a tendency toward women's clothing, perhaps also a tendency toward stealing, emerge strongly as peculiar features. Ascertaining more precise information about the type of occurrence, the duration of this disturbance etc. will probably always be impossible if Ha... is not subject for a longer period to expert observation.

These periodic disturbances, or perhaps only periodically intensified disturbances, seem meanwhile to represent only a portion of the symptoms of the underlying morbid condition; namely I consider Ha... at the same time to be an imbecile. Leaving the letter with a declaration of love for the high-ranking lady in whose service he recently stood, while robbing her at the same time - is this not an act of imbecility? I at least would not know how else to qualify it; and he even has another patient from the Charité, to mention this finally, write a similar letter to the aforementioned lady, in the French language, so that the other servants in the house would not read the letter! When apprehended at the train station as well, he seems to have behaved in a foolish manner, since, once denial was no longer possible, he continued to play his feminine role; in general his often futile lying and cheating, his vanity, the tendency to pretend to be a person of the higher classes, his foolish sensitivity that often manifested itself in the ward, entirely featured the characteristics that one finds in certain imbecilic patients who present themselves in the form of moral insanity; even his emotion when entering the Christmas hall, that quickly turned to tears, can be classed as one of these manifestations. Just like these patients, he too has no clear conscious conception that his criminal acts are related to a morbid condition, or how they are so related.

In the document by Numa Numantius, there is mention of a man, Süsskind Blank, described by Doctor H. Fränkel in Dessau, who used every opportunity to costume himself as a female [S. Medic. Zeitung, published by the Verein für Heilkunde in Preussen (Prussian Medical Association), vol. 22, 1853, p. 102: Homo mollis]. After he started out helping his mother in sewing and knitting, he had attained such a considerable level of skill in all feminine work that he achieved a great reputation and a certain prosperity from his knitting work and especially his curtain embroidery. Subsequent to his occupation with feminine work, he surrendered to feminine vanity, meticulously destroyed his beard, set his hair in locks, created stuffed breasts and hips for himself and used every opportunity to disguise himself as a female. What may at first have been a silly affectation, gradually became second nature, the tone of his voice, deep by nature, became fine and shrill and his walk became tripping ... Blank applied for an official permit to dress and introduce himself as a female, and although his application was rebuffed, he nonetheless one day publicly announced his engagement to a foreign craftsman under the name "Friederike Blank [English: Frederica]" ... This Blank, whose sexual organs were normally shaped, approached men just like our patient, but was demonstrably a passive pederast [costumed as a woman, he performed coitus with young people whom he knew how to deceive so skillfully that they believed they were dealing with a woman; the anus was greatly expanded and fissured], was punished several times for it, and killed himself during an arrest by leaping into the water. Does not an obvious imbecility exist in this person as well? or how should one describe the level of intelligence of a man who applies for a state permit to use a female name and announces his engagement as "Frederica"? This case seems to me to be very analogous to ours, even though Ha... did not carry on passive pederasty as far as we know. These are probably only differences of degree.

I would like to call attention to one more thing on this occasion. Dr. Fränkel's presentation gives the impression that Blank became feminine as a result of feminine occupation; likewise, the inspector from the penitentiary in Brandenburg took the opportunity in his communication to me to mention that the wielding of feminine work among men is probably a cause for feminine behavior [namely, in Naugard the prisoners were sometimes occupied ex officio with tapestry work, among them our Ha...] - nonetheless this is certainly, where our cases are concerned, a mixing-up of cause and effect; the statements of Ha... and of similar individuals are too positive and consistent in this regard.

Finally, we find one more disturbance in Ha..., which, if it were definitely proven, would offer an important reference point for assessing the underlying affliction of the central nervous system: I mean the epileptic attacks. These were observed by experts who were perfectly familiar with the habitus of epileptic attacks, indeed after such an attack a temperature increase to 39.4 °C was observed, so that from the start an assumption of faking appears not to be admissible. Attacks also occurred repeatedly in the penitentiary in Brandenburg, and the "last, extremely violent attack showed the complication of raving madness, so that Ha... largely destroyed the upholstered convulsion crib, despite its iron mountings." Furthermore, the way and manner in which he describes his feelings at the start of an attack (heart palpitations, fear, a cold feeling in the fingers, etc.) contradicts faking, as well as Ha...'s apparently naive statement at the beginning of his autobiography that he had always been praised beforehand, and then some time after the start of his illness (the convulsions) was often criticized by his mistress because afterwards he had become very disobedient. This would correspond to completely familiar pathological facts, certain psychological changes as a result of and in connection with epilepsy. On the other hand, the abundant bleeding from the mouth that occurs almost every time in the attacks (a source for which could never be found), as well as the great violence of the attacks, make the matter somewhat suspicious. He also had these hemorrhages a few times during his latest employment in N. and the doctor at the time was of the opinion that the blood originated from the nose; at the same time, however, he found the patient very unclear and confused in his responses; no one knew about any epileptic attacks at the house in N, although Ha... claimed to have had them there. If the attacks were not simulated, then I would characterize them according to the descriptions of them given above as hystero-epileptic, such as we have observed not rarely at the Charité in youthful patients with certain psychological disturbances.

Whatever the case may be, according to what has been presented above I consider Ha... to be an imbecilic person, whose imbecility is preferentially manifested in the form of a moral insanity, and who has suffered since early youth from a reversal of the sexual feeling analogous to other pathological perversities, a manifestation that perhaps periodically emerges more intensely in connection with other perverse tendencies (stealing). The convulsive attacks would have to be viewed as an integral part of the disease manifestations, provided they are not faked - but would it not be greatly remarkable if Ha... were to fake precisely an illness that, according to experience, stands in such a close association with the described form of imbecility, that I at least scarcely recall having seen a case of so-called moral insanity in which epileptic attacks were not demonstrably in evidence? Finally, I call attention to the possibility that Ha... experiences real attacks and on the other hand fakes them; I have also seen this in such epileptic patients with moral insanity, namely in those of whom there was no talk of criminal acts. Deception is simply a characteristic quality of these imbecilic people.

I reported and explained the preceding cases without drawing more general conclusions from them other than that the manifestation of contrary sexual feeling [I have chosen the term "contrary sexual feeling" on the suggestion of a respected colleague who has excelled in the field of philology and the study of antiquity, after we were unsuccessful in coming up with shorter and more accurate references. It is intended to express the fact that the sexual drive as such is not always simultaneously involved, but rather it is the feeling of being alienated from one's own sex according to one's entire inner being, more or less an underdeveloped stage of the pathological phenomenon] can appear innately as a symptom of a pathological condition; in this way it would be somewhat removed from the mysteriousness that has seemed to be attached to it and has been attributed to it, and would be associated with more general experiences.

Perhaps it could easily be designated a symptom of a psychopathic condition; however, I have reason to assume that other manifestations of the central nervous system are often much more dominant than the psychological, indeed that the latter may be entirely absent, and therefore perhaps the term neuropathic might be preferred as more general and comprehensive. It will be the task of further observations to define more precisely the series of morbid manifestations on the part of the nervous system and the psychological sphere that were encountered in connection with innate contrary sexual feeling [since this was written, I observed a case of chronic insanity in a young man who had shown similar manifestations in his childhood and earliest youth] and namely also to decide the important question of whether the aforementioned feeling can occur as a totally isolated phenomenon in the complete absence of any other pathological manifestations.

I have also observed the case of a young man who was admitted to the mental ward due to a melancholic mental disturbance and an attempted suicide, and in whom all along there has been a complete absence of a sexual drive, and the latter could never be generated by any attempts made by the patient; the suicide attempts were caused in part by the tormenting imagination of this condition. I saw the respective patient later by chance when he perished of a lung tuberculosis. Besides the melancholic condition in which he was admitted, he too had earlier had a strange, nonsexual affection for certain men.

Finally, in order to prevent any misinterpretations from the start, I would like to declare expressly that I have no intention of declaring every individual who indulges in unnatural illicit sex to be a pathological character! I know very well that this is not the case. But just as pathological theft and murder exist, pathological sexual aberration also exists, without it being true that therefore the great majority of cases of theft, murder and unnatural illicit sex are pathological. Nonetheless, however, the described conditions may be more frequent than is known, and it is an obligation to devote attention to this subject, even just because of the forensic importance of the matter. If § 143 of the Criminal Code is one day repealed and the specter of jail is no longer faced for the confession of a perverse tendency, then the respective cases will certainly come to the cognizance of the doctors in whose sphere they rightly belong. [According to a note in the "Zeitschrift für Ethnologie" I, 1869, p. 88, similar manifestations occur among primitive peoples. Among the Indians there is accordingly a class of men who are driven by an irresistible urge to assume feminine clothing and act entirely as women. These woman-men, or man-women, usually make up the priestly class ... On the island of Ramrih, on the other hand, women acted as men in order to preside over the cult and had other women entrusted to themselves with whom they lived together as husband and wife. --- Cf. Sitzung der Berl. Med.-Psychol. Gesellschaft [meeting of the Berlin Medical Psychological Society] held on December 15, 1868, at which I presented the two preceding cases.]

I have not discussed the question of accountability in the second of the reported cases [it was never raised by the court]; the answer to it depends on the general principles that one holds with respect to what the task of the doctor is in this direction. To address this here in passing does not seem appropriate to me.