Phimosis, or narrowness of the opening of the prepuce is nearly always of embryonic origin. It prevents the glans p.e.n.i.s from becoming exposed, at least during erection. It is a very common condition and very disagreeable. If the prepuce is forcibly drawn back behind the glans p.e.n.i.s before erection, as is often the case in masturbation, the p.e.n.i.s is gripped by the prepuce so that it cannot sometimes be drawn forward and inflammation with oedema results; this condition is called _paraphimosis_, and may become dangerous. Secretions, urine and s.e.m.e.n acc.u.mulate and decompose in a phimosed prepuce, cause irritation and lead to masturbation. All cases of phimosis should be operated upon in infancy, by complete or partial circ.u.mcision.

In women, the number of diseases which prevent conception is much greater than in man. The ovary may undergo cystic degeneration or become the seat of a tumor; but affections of the uterus and v.a.g.i.n.a cause more sterility than ovarian affections. This results chiefly from catarrh and inflammation which destroy the spermatozoa before they can reach the egg during its descent. Disorders of menstruation have much less influence on fecundity. The womb sometimes remains in an _infantile state_, which may also cause sterility. Other diseases of the female s.e.xual organs have a more general pathological character and hardly influence s.e.xual intercourse.

A method of rendering women sterile without castration (removal of the ovaries) consists in interrupting the communication between the ovaries and the womb by dislocation of the Fallopian tubes: this avoids all the evil effects of castration.

Certain inflammations and displacements of the uterus and ovaries are often the origin of pains, indispositions and nervous disorders in women. Irregularity and pain in menstruation are a frequent cause of neuroticism.

The hymen is seldom so strongly developed as to offer a serious obstacle to coitus; but when this occurs it may be removed by a slight operation. Young women often suffer from vaginismus, or painful spasms occurring when an object, such as the finger or p.e.n.i.s, is introduced into the v.a.g.i.n.a.

Hermaphrodism in man is always pathological, extremely rare, and when it exists nearly always incomplete. These cases are generally incomplete mixtures concerning princ.i.p.ally the correlative characters.

A double function only exists in legends. I have myself seen a celebrated hermaphrodite named Catherine Hohmann who had a well-formed t.e.s.t.i.c.l.e on the left side enclosed in a fold of skin which resembled the larger lip of the v.u.l.v.a, while the p.e.n.i.s was very short and resembled a c.l.i.toris. This individual, who was baptized as a woman, was certainly male on one side; on the other hand, the feminine nature was more than problematical. Menstruation was alleged to have occurred but was not established with certainty, any more than an ovary or uterus.

Much more frequent are inverted correlative s.e.xual characters, such as bearded women, men with b.r.e.a.s.t.s; also mental s.e.xual inversions, of which we shall speak later.

VENEREAL DISEASES[5]

We cannot give here a complete description of the venereal diseases, which const.i.tute a terrible evil for humanity, by bringing a great deal of misfortunes and decadence into family and social life. Let us first point out the common error which attributes to s.e.xual excess the evil effects which are really due to venereal disease. Although it may be uncommon, one may be infected by these diseases after an innocent kiss, a cut finger, by sitting on a privy contaminated by a person suffering from venereal disease, by the use of contaminated linen, etc., etc. A pachydermatous Don Juan, on the contrary, may abandon himself to the wildest s.e.xual excess without being infected, if he is prudent and has good luck. On the other hand, young men may be infected after having been with a prost.i.tute only once in their lives, and thus ruin their whole existence.

There are three kinds of venereal disease, which we will describe in a few words. To these may be added certain parasites, such as crab-lice and the itch, which are easily communicated by s.e.xual intercourse with infected persons, but also in other ways.

=Gonorrhea or Clap.=--This disease consists in a purulent inflammation of the urethra caused by a microbe called the _gonococcus_. When treated properly it may be cured in a few weeks, but very often the inflammation becomes chronic and attacks the neighboring organs.

Chronic clap, or "morning-drop," may lead in the male to permanent stricture of the urethra, which in turn may produce retention of urine, catarrh of the bladder and disease of the kidneys, which may be fatal. One attack of gonorrhea in no way protects against a second infection, but rather predisposes to it, and when this disease becomes chronic exacerbations or relapses of the acute stage often occur without fresh infection.

In women the results of gonorrhea are, if possible, still worse than in men, because it is more difficult to cure. A prost.i.tute affected with gonorrhea may infect an enormous number of men, and in this case medical inspection of brothels is no guarantee. The gonococci are concealed in all the corners and folds of the internal genital organs of woman, where they set up inflammation of the womb, the Fallopian tubes and even the ovaries, which may lead to adhesions between the abdominal organs. Women affected with chronic gonorrhea generally become sterile. When the womb and the ovaries are affected there is much suffering and the woman may be confined to bed for some years.

Stricture of the urethra and inflammation of the bladder are more rare in women than in men, as the result of gonorrhea.

But gonorrhea is not confined to the adults of both s.e.xes. The innocent child, who at birth has to pa.s.s through its mother's v.u.l.v.a, when this is affected with gonorrhea, undergoes a baptism of gonococci which attack the conjunctiva of the eyes and set up a severe purulent inflammation, called ophthalmia of the newly born (_ophthalmia neonatorum_). This is one of the chief causes of total blindness, and if the child is not entirely blind, there are often large white patches left on the cornea which considerably interfere with sight.

Gonorrheal ophthalmia may also occur in adults by conveying pus from the urethra to the eyes by the fingers.

=Syphilis.=--This disease is still more formidable than gonorrhea. It is caused by a microbe which has been recently discovered (_Spirochaeta pallida_). Syphilis is much more chronic than gonorrhea and commences with a small sore indurated at its base and called the hard chancre.

This is situated on the genital organs or elsewhere; in the mouth, for instance, when this has been in contact with the buccal or genital organs of a person infected with syphilis. The syphilitic poison spreads through the body by means of the blood and lymph. At the end of a few weeks eruptions appear on the body and face, and then commences a series of disasters the cause of which may be suspended over the victim for his whole life, like the sword of Damocles, even when he believes himself cured; for the cure of syphilis is often uncertain. This disease may remain latent for months and years, to reappear later on in different organs and cause fresh lesions.

Syphilis causes ulcers of the skin and mucous membranes; it sometimes causes decay of the bones; it may cause disease of the internal organs, such as the liver and lungs; it affects the walls of the blood vessels, causing them to become hard and brittle (atheroma); it causes disease of the eyes, especially of the iris and retina, tumors (or gummata) in the brain, paralysis etc. In fact, it spares none of the organs of the body.

Among the most terrible results of syphilis we must mention _locomotor ataxy_ (sclerosis of the posterior columns of the spinal cord), with its lightning pains and paralysis of the legs and arms; also _general paralysis of the insane_, which by causing gradual atrophy of the brain, destroys one after the other, sensations, movements and all the mental faculties. These two diseases, which are so common at the present day, only occur in old syphilitics, five to twenty years, or more often ten to fifteen years after infection, and as a rule in persons who think they have been completely cured. Both these diseases are fatal. Before causing death, locomotor ataxy causes intolerable pain for several years. General paralysis first gives rise to grandiose ideas, and after disintegrating the human personality bit by bit, ends by transforming the individual into a being much inferior to animals, and of an aspect as miserable as it is repulsive. A general paralytic in his last stage is little more than a vegetating ruin, in whom the nervous activities are decomposed little by little, after the gradual disappearance of all the mental faculties. This is the result of slow atrophy of the brain and gradual destruction of its microscopic elements, or _neurones_.

The early stages of syphilis may easily pa.s.s unnoticed owing to their partly latent and completely painless character. Small eruptions may be mistaken for other affections, and mercurial treatment generally disperses the symptoms of _primary_ and _secondary_ syphilis. But syphilitics who are apparently cured are never safe from being attacked, after perhaps many years, with locomotor ataxy, general paralysis or the _tertiary_ or _quaternary_ manifestations of syphilis, such as disease of the bones, internal organs, eyes, brain, etc. The sores of the first two or three years of syphilis are contagious but painless, and hence do not prevent coitus when they occur in the genitals. After three years syphilis becomes less contagious, but there is no definite time limit and cases have been recorded in which contagious lesions occurred ten or fifteen years after the onset of the disease.

A syphilitic man may transmit the disease to his children without infecting his wife, and these children may die before birth or may be born with congenital syphilis. This is due to the spermatozoa being infected with syphilis. However, this is fortunately not always the case, for many cured syphilitics have healthy children. A child affected with congenital syphilis (from the father) may infect the mother during pregnancy; this is called "syphilis by conception."

Congenital syphilis may also cause locomotor ataxy and general paralysis.

It is difficult to enumerate all the infirmities which syphilis in the parents may transmit to the children. Syphilis often renders marriage sterile. It is more frequent in men than in women, because the number of prost.i.tutes is small compared with the number of men who go with them; a single prost.i.tute may contaminate a whole regiment. On their part, the clients of prost.i.tutes convey gonorrhea and syphilis to their wives, thus spreading in society this abominable plague and all the evils resulting from it.

=Soft Chancre.=--The third kind of venereal disease is the soft chancre, thus called in distinction to hard chancre, which is the primary sore of syphilis. Soft chancre is the least dangerous and the least common of the three diseases. It consists of an ulcer which remains localized to the genital organs (unless it is complicated with syphilis, which is frequent). The ulcerated parts are destroyed, but the sore heals generally without trouble.

Venereal diseases const.i.tute one of the worst satellites of the s.e.xual appet.i.te. If men were not so ignorant and careless, it would be on the whole easy to avoid them and cause their gradual disappearance. One of the most absurd and infamous organizations which can be imagined is that of the State regulation of prost.i.tution which, under the pretext of hygiene, compels prost.i.tutes to be registered by the police or to live in brothels. They then undergo regular medical examination, the object of which is to prevent those who are diseased from practicing their trade, and compel them to be treated in hospital. We shall see later on that this system absolutely fails in its object, for the simple reason that the treatment of venereal diseases is by no means the panacea which many people imagine.

The first attack of gonorrhea in man is very often spontaneously cured, while unskillful treatment often aggravates it. The relapses of this disease, on the other hand, especially in their chronic form, often resist all kinds of treatment and sometimes become incurable.

The gonococci become hidden in the folds of the deep parts of the mucous membrane, both in men and women, and cannot all be destroyed.

With regard to syphilis, mercurial treatment, although remarkable in its immediate effect, requires prolonged administration. And it is by such means that it is proposed to make prost.i.tutes clean! There is only one radical cure for venereal diseases; that is not to contract them! However, this does not prevent us from recommending all those who are affected with them to seek immediate treatment by a skilled specialist.

It is sad to see ladies of high position defending such barbarous inst.i.tutions as proxenetism (the business of keeping brothels) and the regulation of prost.i.tution, imagining that they thereby protect their daughters against seduction. Such aberration can only be explained by suggestive influence on the part of men. Among men, and especially among many physicians, the belief in the efficacy of regulation depends on a mixture of blind routine, faith in authority and want of judgment, combined perhaps with more or less unconscious eroticism. We shall consider this point in detail later on.

One of the most tragic effects of venereal disease is the contamination of an innocent wife, whose whole life, hitherto chaste and pure, becomes brutally deprived of its fruits, and whose dreams of the ideal and hopes of happiness become swamped in the mire with which prost.i.tution has contaminated her. Is it surprising that love in such cases becomes replaced by bitterness and despair? Some modern authors, such as Brieux (_Les Avaries_) and Andre Couvreur (_La Graine_), have pictured in their dramas and novels the tragic effects of venereal disease and heredity in the family, as well as their social consequences. What is deplorable, is the enormous proportion of persons who are infected with venereal diseases.

s.e.xUAL PSYCHOPATHOLOGY

With the exception of what is called s.e.xual inversion and pathological love of the insane, s.e.xual psychopathology (_i.e._, s.e.xual pathology of mind) is chiefly limited to the domain of the s.e.xual appet.i.te, and originates mainly in fetichism (see Chapter V), to which it is closely allied. Let us first examine certain anomalies which partly concern the lower nervous functions.

First of all a general question presents itself. Hereditary or congenital s.e.xual anomalies have been distinguished from those which are said to result from vicious habits. Krafft-Ebing, in his celebrated book which we have already quoted, makes a capital difference between these two causes, and stigmatizes the acquired vices with great indignation. I do not deny that there is reason for the distinction, but we must take exception to two fundamental errors in the manner in which the facts are presented.

In the first place, the difference between hereditary and acquired s.e.xual anomalies is only relative and gradual, so that it is necessary to avoid opposing one against the other. When an anomaly arrives spontaneously in the first s.e.xual glimmer of the child's mind during its development, it is obvious that it is the expression of a profound hereditary taint, the result of blastophthoria or of unfortunate combinations of ancestral energies which have been a.s.sociated by the conjugation of the two procreative germs. In such a case it is comparatively easy to prove that this is a pathological symptom independent of the will of the individual. But a continuous series of degrees in the intensity of a hereditary predisposition to a certain s.e.xual anomaly, or to other anomalies or peculiarities apt to provoke this anomaly, insensibly connects the purely hereditary pathological appet.i.te with that which is simply the effect of acquired vicious habits. In this way a strong hereditary predisposition may exaggerate a moderate normal s.e.xual appet.i.te, or may give it a pathological direction under influences which would have had no effect in a less predisposed individual. Again, a slightly marked tendency to h.o.m.os.e.xuality in a man may increase under the seductive influence of a pa.s.sionate invert, when the same individual would have lost this tendency if he had fallen seriously in love with a woman. On the other hand, the invert would have no influence on an individual who was not predisposed.

If the hereditary disposition is very strong, it is developed spontaneously or under the influence of very slight circ.u.mstances. If it is mediocre, it may remain latent and even become extinct when favorable circ.u.mstances do not awaken it. When it is entirely absent the most powerful seduction and the most evil influence cannot give rise to the corresponding anomaly. These facts are sufficient to show what abuse is made of the term _acquired vice_. Under this heading are designated a number of peculiarities the roots of which are to a great extent contained in the germ of heredity.

The power of words on the human mind produces antinomies which do not really exist; such is the case with the terms _vice_ and _disease_.

Vices depend on a hereditary mnemic disposition, of varying strength and more or less pathological, or at any rate unilateral (_i.e._, developed in one direction only, or connected with a single group of objects); according to the good or evil influence of the environment they may develop, become limited or even fail to appear. Inversely, we may say that many diseases, especially of the brain, are the source of vices.

In the second place, it follows from this fundamental principle, that the vicious and apparently acquired conduct of certain individuals should not be considered as the product of perverted free will, but rather as the unfortunate and destructive result of a bad hereditary disposition developed under the influence of the bad habits of a corrupt environment. This environment being itself composed of men, there is a vicious circle of cause and effect which will not escape the mind of the thoughtful reader. Bad habits are made by hereditary forces, and bad habits develop in their turn by custom, and may even create, by blastophthoria, vicious hereditary dispositions. The indignation of the moralists who condemn vicious persons are very like the temper of a child who strikes the fire which burnt him.

REFLEX ANOMALIES

We have already mentioned vaginismus, which is often produced in women by the first coitus. Priapism in man is somewhat a.n.a.logous to vaginismus. It is produced by an exaggerated reflex irritability of the nerve centers for erection, and results in continual and painful erections, which sometimes end in e.j.a.c.u.l.a.t.i.o.n without sensation.

Another anomaly, more or less reflex and very frequent, produces voluptuous sensations and premature e.j.a.c.u.l.a.t.i.o.n after short and incomplete erections. In some nervous women also, the venereal o.r.g.a.s.m occurs very rapidly and briefly. These anomalies belong to the domain of medicine and are of little importance for our subject.

PSYCHIC IMPOTENCE

Psychic impotence is a symptom which occurs accidentally in the normal state and very frequently in psychopathological conditions.

A representation or idea of any kind, may suddenly paralyze by suggestive action the normal reflex mechanism of the center for erection. The blood ceases to acc.u.mulate in the corpora cavernosa and erection is either arrested or not produced at all. For example, a very excited lover, who has had strong erections at the moment when he prepared to copulate, may be suddenly overcome with the idea that he will fail, or by some other thought which paralyzes erection and renders coitus impossible. The remembrance of such a failure and the distress and shame attached to it, even efforts to produce erection indirectly for another attempt, const.i.tute further causes of inhibition of the cerebro-spinal activity; they temporarily extinguish the s.e.xual appet.i.te, and prevent by their interference the automatic mechanism of erection which they strive to produce. The greater the fear of failure, the more the psychic impotence increases. This phenomenon may be limited to a certain woman, but it is more often general. Sometimes an incomplete erection is produced, which is insufficient.

This condition, which depends on auto-suggestion, is best treated by hypnotic suggestion. The sentiment of impotence powerfully depresses a man, and the depression increases his impotence. This condition often, however, disappears by itself.

A special variety of psychic impotence is that in which erection takes place, but the idea of e.j.a.c.u.l.a.t.i.o.n predominates so much that it paralyzes the voluptuous sensations, and causes e.j.a.c.u.l.a.t.i.o.n to occur without pleasure, or even erection to cease.

Impotence may occur at the first coitus, or may come on gradually. It is often produced suddenly at the time of marriage in persons who have hitherto been very capable, even in Don Juans. Men may have normal erections and pollutions, but these may be stopped by counter-suggestions at each attempt at coitus. Habitual masturbation may in some cases contribute to produce impotence, but we must not generalize from such cases, nor construct a dogma from them, for continence may also be a cause of impotence.

All these details, which are combined in all kinds of ways with other s.e.xual troubles, but which are also produced alone in men who are otherwise normal, throw much light on the relation of the momentary mental state of man to his s.e.xual appet.i.te and the accomplishment of coitus.

I do not know under what heading the following case should be placed:

A young man of steady habits, and normal s.e.xual appet.i.te, had always abstained from s.e.xual connection and masturbation. He only had emissions during sleep. The latter were accompanied by erotic dreams, but never produced an o.r.g.a.s.m, while disagreeable sensations occurred on waking. He married for love a woman in whom the hymen was resistant, and vaginismus occurred on each attempt at coitus. These attempts failed constantly in spite of the most intense love and the most ardent desire for children on both sides. The husband's erections were incomplete, and he never had an e.j.a.c.u.l.a.t.i.o.n except when asleep. By the aid of hypnotism I succeeded in strengthening his erections, and an operation on the hymen cured his wife's vaginismus. The first attempts at coitus were not immediately successful, but suggestion acted after a time; finally the attempts were crowned with success, and followed by a first and second pregnancy. The children were healthy.

In this case, the impotence, which had lasted about eighteen months, did not affect the mutual love and respect of the couple, because the husband's affection combined with his s.e.xual appet.i.te had sufficed for the happiness of a woman who was on the whole normal.