THE STUDY OF SEXUAL INVERSION. DE. HAVELOCK ELLIS, OF LONDON, ENGLAND, Westphal, an eminent professor of psychiatry at Berlin, may be said to have been the first to put the study of sexual inversion on an assured scientific basis. In 1870 he pub- lished in the Archiv fur Psychiatric, of which he was for many years editor, the detailed history of a young woman who, from her earliest years, was sexually inverted. She liked to dress as a boy, and only cared for boys’ games, and, as she grew up, was alone sexually attracted to women, with whom she formed a series of tender relationships, in which the friends obtained gratification by mutual caresses, accom- panied by the spontaneous or artificial production of the venereal orgasm; while she blushed and was shy in the presence of women, more especially the girl with whom she chanced to be in love. She was always absolutely indiffer- ent in the presence of men. Westphal combined keen scien- tific insight with a rare degree of personal sympathy for those who came under his care, and it was this combination of qualities which enabled him to grasp the true nature of a case such as this, which by most medical men at that time would have been hastily dismissed as a vulgar instance of vice or insanity. Westphal perceived that this abnormality was congenital, not acquired, so that it could not be termed vice; and, while he insisted on the presence of neurotic ele- ments, his observations showed the absence of anything that could legitimately be termed insanity. He gave to this condition the name of “contrary sexual feeling” {contrare 48 THE STUDY OF SEXUAL INVERSION. Sexualempfindung), by which it is to-day known in Germany. The way was thus made clear for the rapid progress of our knowledge of this abnormality. New cases were published in quick succession, at first exclusively in Germany, and more especially in Westphal’s Archiv, but soon in other countries also, chiefly France and Italy. While Westphal was the first to place the study of sexual inversion on a progressive footing, many persons had previ- ously obtained glimpses into the subject. Thus, in 1791, two cases were published (Moritz, Magazvn fur Erfahrungs- seelenkunde, Berlin, Bd. VIII.) of men who showed a typical emotional attraction to their own sex, though it was not quite clearly made out that the inversion was congenital. In 1856, again, a Swiss writer called Hossli published a rather diffuse and tedious work entitled Eros, which con- tained much material of a literary character bearing on this matter. He seems to have been moved to write this book by a trial which had excited considerable attention at that time. A man of good position had suddenly murdered a young man, and was executed for the crime, which, accord- ing to Hossli, was due to homosexual love and jealousy. Casper, the chief medico-legal authority of his time in Ger- many—for it is in Germany that the foundations of the study of sexual inversion have been laid—pointed out in 1852, in Casper’s Yierteljahrsschrift, that pederasty, in a broad sense of the word, was sometimes due to a peculiar congenital condition, and also that it by no means necessar- ily involved sodomy (immissis penis in anurn). Casper brought forward a considerable amount of valuable evidence concerning these cardinal points, which he was the first to note, but he failed to realize the full significance of his ob- servations, and they had no immediate influence. The man, however, who has done more than any one else to bring to light the phenomena of sexual inversion had not THE STUDY OP SEXUAL INVERSION. 49 been concerned either with the medical or the criminal aspects of the matter. Carl Heinrich Ulrichs, who for many years has been expounding and defending homosexual love, and whose views are said to have had some influence in drawing Westphal’s attention to the matter, was a Hano- verian legal official [Amtsassessor), himself sexually inverted. From 1864 onwards, at first under the name of “Numa Numantius” and subsequently under his own name, Ulrichs published a long series of works in various parts of Germany, dealing with this question, and made various attempts to obtain a revision of the legal position of the sexual invert in Germany. Since 1889 he has issued a Latin periodical from Aquila in the Abrazzi of southern Italy, but he has now ceased his propaganda in favor of homosexuality. For many years Ulrichs was alone in his efforts to gain scientific recognition for homosexual love. He devised (with allusion to Uranos in Plato’s Symposium) the word Urning, ever since frequently used for the homosexual lover, while he called the normal heterosexual lover a Hioning (from Dione). He regarded Uranismus, or homosexual love, as a congenital abnormality by which a female sord had become united with a male body—anima muliebris in corpora virili inclusa— and his theoretical speculations have formed the starting point for many similar speculations. His writings are re- markable in many respects, and it is probable that if it had not been for the polemical warmth with which, as one plead- ing pro domo, he argued his cause, they would have had more effect on scientific thought. This privilege was reserved for Westphal. After he had shown the way and thrown open his journal for their publi- cation, new cases appeared in rapid succession. In Italy, also, Ritti, Tamassia, Lombroso, and others began to study these phenomena, and it seems to have been in Italy that the convenient term “sexual inversion” was first used. 50 THE STUDY OF SEXUAL INVERSION. When the matter was taken up in France, the same term wTas used. In 1882 Charcot and Magnan published in the Archives de Neurologic the first important study which ap-. peared in France concerning sexual inversion and allied sexual perversions. They regarded sexual inversion as an episode (syndrome) in a more fundamental process of hered- itary degeneration, and compared it with such morbid ob- sessions as dipsomania and kleptomania. Magnan has since frequently observed and studied the phenomena of sexual inversion, both in his clinique at Sainte-Anue and in various periodicals, and some of his pupils, more especially Serieux, have brought valuable contributions to the subject. From a somewhat more medico-legal standpoint, the study of sexual inversion in France has' been furthered by Bronardel, and still more by Lacassague, who wrote the important article on “ Pederastie ” in the Dictionnaire Encydope digue des Sciences Medicates, and whose stimulating influence at Lyons has produced such fruitful results in the work of many pupils. During the last ten years, the increased attention devoted to these phenomena, and the rapid growth of fresh observa- tions, has led to various works devoted chiefly or entirely to sexual inversion. Thus, in 1886, Professor Tarnowsky, of Saint Petersburg, published his Krankhaften Erscheinungen des Geschlechtssinnes. The book is of much interest from the abundance of its facts, but it can scarcely be said that it greatly furthered the scientific study of sexual inversion. Tarnowsky’s experience seems to have been of a somewhat special character. He insists chiefly on the effeminate and passive side of inversion in males. He fails to arrange the phenomena he has witnessed with much system or insight, and he does not sufficiently distinguish between male prosti- tution and sexual inversion as a psychological abnormality. He admits three kinds of congenital sexual inversion, all the outcome of an hereditarily enfeebled nervous system; the THE STUDY OF SEXUAL INVERSION. 51 first chronic and persistent, the second periodical, the third epileptic. Of much more importance in the history of the theory of sexual inversion is the work of Dr. R. von Krefft-Ebing. This writer, who stands at the head of Austrian psychiatric and medico-legal authorities, is now professor of psychiatry and nervous diseases at Vienna. Since 1877 he has taken an active interest in all the various forms of sexual per- version, and his great work Psychopathia Sexualis, which, in its eighth edition (1893), contains two hundred histories, mostly original cases, is the best known book on the subject of sexual perversion, and the chief store-house of facts. It has been translated into English by Dr. C. G. Chaddock. Krefft-Ebing’s methods are open to some objection. His mind is not of a severely critical order. He has poured out new and ever enlarged editions of his great work with extra- ordinary rapidity, eight having appeared in the course of five years, while, during the same period, he issued at least two editions of a volume of Neue For seining en auf dem Gebiete dev Psychopathia Sexualis, containing material which has eventually been nearly all absorbed in the larger work. The various editions of this latter have been re- modeled from time to time, and interesting material has sometimes been thrown out. Krefft-Ebing has constantly introduced new subdivisions into his classification of sexual perversions, and although this rather fine-spun classification has doubtless contributed to give precision to the subject and to advance its scientific study, it is very doubtful whether it can be maintained in the future. Krefft-Ebing’s great service lies in the clinical enthusiasm with which he has approached the study of sexual perversions. With the firm conviction tliat he is conquering a great neglected field of morbid psychology, which rightly belongs to the physi- THE STUDY OF SEXUAL INVERSION. cian, lie has accumulated without any false shame a vast mass of detailed histories, and his reputation has induced sexually abnormal individuals in all directions to send him their autobiographies, in the desire to benefit their fellow- sufferers. It is as the great clinician of sexual inversion, rather than as its psychologist, that we must regard Krefft-Ebing. At the same time it is desirable to glance at his general attitude towards the phenomena. Referring to the fact that the sexual organs of inverts may be normal, he continues; “Here the cause can only be regarded as an anomaly of central conditions, an abnormal psychosexual predisposition. The anatomical and functional foundations of this predisposi- tion are at present altogether obscure. Since in nearly every case the subject of the perverse sexual instinct exhibits a neuropathic taint in many respects, and this is connected with hereditary degenerative conditions, every anomaly of the psychosexual emotion must be described clinically as a functional sign of degeneration. This perverse sexuality appears spontaneously with the developing sexual life, with- out external causes, as the individual manifestation of an abnormal modification of the vita sexualis, and must then be regarded as a congenital phenomenon; or it develops as a result of special injurious influences working on a sexuality which had at first been normal, and must then be regarded as an acquired phenomenon. On what this mysterious phenomenon, the acquired homosexual instinct, may rest, at present entirely escapes exploration, and belongs to the region of hypothesis. It is probable, from the careful inves- tigation of so-called acquired cases, that the predisposition here consists in a latent homosexuality, or; at least, bisexu- ality, which requires for its manifestation *the operation of accidental causes to awaken it from its slumber.” (Psycho- jpathia Sexualis, Bth ed., 1893, p. 188.) He divides acquired THE STUDY OF SEXUAL INVERSION. 53 sexual inversion into four stages; (1) Simple perversion of the sexual instinct. (2) Eviratio and defeminatio, in which the whole personality of the individual undergoes a change of disposition in harmony with the changed sexual instinct. (3) Transition to metamorphosis sexualis paranoica, in which the change is so complete as at times even to delude the subject into believing that there has been an actual physical change of sex. (4) Metamorphosis sexualis paranoica, in- volving systematic delusions as to a change of sex. Krefft- Ebing also recognizes four stages of the congenital form: (1) Psychosexual hermaphroditism, in which, while the homosexual instinct predominates, there are traces of the normal heterosexual instinct. (2) Homosexuality, in which the instinct goes out only towards the same sex. (3) Effemi- natio and viragiuity, in which the whole psychic disposition corresponds to the abnormal instinct. (4) Androgynia and gynandria, in which the general bodily form corresponds in some degree to the abnormal sexual instinct and psychic disposition. In 1891 Dr. Albert Moll, of Berlin, published his work, entitled Die Contrare Sexualempfindung. Subse- quent editions have appeared, very much enlarged, and the book has been translated into French. It may be regarded as beyond doubt the most important discussion of sexual inversion which has yet appeared. This is not due merely to the fact that Moll has published a notable number of new cases. It is true that some of the most interesting and care- fully detailed cases in the kite editions of Krefft-Ebing’s Psychopathia Sexualis were supplied by Dr. Moll, who has not only been able to fall back on his own medical practice as a specialist in nervous diseases, but has received great assistance from the Berlin police, who have furnished him with much material of great interest, and he has also had the valuable advice throughout of a distinguished German scholar, who is himself sexually inverted. In this work, 54 THE STUDY OF SEXUAL INVERSION. however, Moll refrains from making the hopeless attempt to rival Krefft-Ebing in wealth of clinical material. He attacks the problem which, now that so much material has been ac- cumulated, becomes of primary importance—the nature and causes of sexual inversion. He discusses the phenomena as a psychologist even more than as a doctor. For this task his previous work on hypnotism, which is perhaps the most cautious and judicial statement of the matter that has yet appeared, shows that he was well qualified. Moll approaches psychological problems not merely as a physician, but above all as one who is accustomed always to bear in mind their broader scientific bearings. He possesses also an unusual degree of general culture. He is a keen critic who never fails in acutely placing his finger on the weak points* in ac- cepted opinions, and he is judicially cautious in the state- ment of his conclusions. For the first time, Moll entirely clears away the ancient prejudices and superstitions surround- ing sexual inversion, which even Krefft-Ebing had sometimes incautiously repeated. He accepts the generally received doctrine that the sexually inverted usually belong to families in which various nervous and mental disorders prevail (Ist ed., p. 160), but he points out at the same time (p. 162) that it is not in all cases possible to prove that we are con- cerned with individuals possessing an hereditary neurotic taint. He does not, therefore, expatiate on the morbid character of sexual inversion, and excludes insanity. He shows excellent judgment, also, in rejecting any minute clas- sification of sexual inverts. He only recognizes psycho- sexual hermaphroditism and homosexuality. At the same time he wisely casts great doubt on the existence of acquired inversion, in a strict sense, except in rare cases. Dealing with the supposed influence of “vice” in the causation of sexual inversion, he casts ridicule on the theory that ex- cessive indulgence in women can produce an inclination THE STUDY OP SEXUAL INVERSION. 55 towards men, while he regards the tendency of old men to gratify their Inst with boys as due to incipient brain disease. No one who wishes to understand the nature of sexual in- version can afford to ignore Moll’s discussion of the problem, inconclusive as in many respects he is compelled to leave it. Several books have since appeared bearing on sexual in- version, although they cannot be compared with Krefft- Ebing’s book or Moll’s. Jolm Addington Symonds privately printed two remarkable pamphlets elucidating various as- pects of the matter. In America, Kiernan, Lydston, and others have investigated it. In 1892 Baron von Schrenck- Notziug, an Austrian physician who has occupied himself much with hypnotism, published a work entitled Suggestions- therapie, in which he argued that sexual perversions gener- ally are largely caused by suggestion, and may be cured by suggestion. He has produced a number of cases in point, and his work should not be neglected, but it is too much dominated by a single idea to be of great scientific value. In 1893 Dr. J. Chevalier, a pupil of Lacassague, and the author of an earlier study of a slighter character, published a comprehensive work on all the various aspects of the mat- ter, entitled JO Inversion Sexuelle. It is written with much facility and considerable exuberance. The author is very well read in all the various aspects of his subject, and he presents the results of his reading in a copious and usually accurate manner. While, however, the book may be read with some profit, though containing little that is original, it cannot be recommended as a handbook to the study of sexual inversion. The writer is lacking in critical percep- tion, and repeats without hesitation many of the old tradi- tions which, since Moll’s investigation of the subject, can no longer be accepted without proof. Even the existence, however, of such a treatise as Cheval- ier’s, and still more Moll’s vlim and philosophic discussion THE STUDY OF SEXUAL INVERSION. of the matter, is enough to show how rapidly the study of this subject has grown. A few years ago—for instance, when Dr. Paul Moreau wrote his Aberrations du Sens Generique—sexual inversion was scarcely even a name. It was a loathsome and nameless vice, only to be touched with a pair of tongs, rapidly and with precautions. As it now presents itself, it is a psychological and medico-legal prob- lem, so full of interest that we need not fear to face it, and so full of grave social actuality that we are bound to face it. Although so short a period has passed since sexual in- version has been considered otherwise than as an episode in insanity, and independently of the vice of pederasty, with which it may or may not be combined, its medico-legal in- terest has already become sufficiently clear. It is enough, taking examples from each sex, to refer to the cases of Alice Mitchell at Memphis and Guy Olmstead at Chicago. In both these cases we are concerned with individuals who may be said to be congenitally inverted, and who are not, proper- ly speaking, insane, although they may both be said to be hereditary neuropathies in a high degree. Such cases will undoubtedly come before the medico-legist from time to time, and they are not on the same level as those cases of vulgar vice with which the police are most familiar, or those cases of complete mental degeneration which the asylum doctor chiefly studies. They present to us a psychological anomaly which must be studied psychologically among the general population, where it may sometimes be found com- bined with a high degree of intellectual and artistic ability, and where it does not easily fall under the physician’s ob- servation. I have here briefly traced up to the present time the history of sexual inversion, regarded as a psycho- logical anomaly.