Opinion: 1. Mr. v. H., according to all observations and reports, is mentally an abnormal and defective person, and that, in fact, ab origine. His contrary sexual instinct represents a part of his abnormal physical and mental condition.
2. This condition, in that it is congenital, is incurable. There exists defective organization of the highest cerebral centres, which renders him incapable of leading an independent life, and of obtaining a position in life. His perverse sexual instinct prevents him from exercising normal sexual functions; and this is attended by all the social consequences of such an anomaly, and the danger of satisfaction of perverse impulses arising out of his abnormal organization, with consequent social and legal conflicts. Fear of the latter, however, cannot be great, since the (perverse) sexual impulse of the patient is weak.
3. Mr. v. H., in the legal sense of the word, is not irresponsible, and neither fit for, or in need of, treatment in a hospital for the insane. It is possible for him—though but an overgrown child, and incapable of personal independence—to live in society, though under the care and guidance of normal individuals. Too, to a certain extent, it is possible for him to respect the laws and restrictions of society, and to judge his own acts; but, with respect of possible sexual errors and conflicts with criminal laws, it must be emphasized that his sexual instinct is abnormal, having its origin in organic pathological conditions; and this circumstance should eventually be used in his favor. On account of his notorious lack of independence, he cannot be discharged from parental care or guardianship, inasmuch as otherwise he would be ruined financially.
4. Mr. v. H. is also physically ill. He presents signs of slight anæmia and of neurasthenia spinalis. A rational regulation of his manner of life and a tonic regimen, and, if possible, hydro-therapeutic treatment, seem necessary. The suspicion that this trouble has its origin in early masturbation should be entertained, and the possibility of the existence of spermatorrhœa, that is of importance etiologically and therapeutically, lies near. (Personal case. Zeitschr. f. Psychiatrie.)
Case 130. Miss X., aged 38, consulted me, late in the fall of 1881, on account of severe spinal irritation and obstinate sleeplessness, in combating which she had become addicted to morphine and chloral. Her mother and sister were nervous sufferers, but the rest of the family were healthy. The trouble dated from a fall on her back in 1872, at which time the patient was terribly frightened, though, when a girl, she had been subject to muscular cramps and hysterical symptoms. Following this shock, a neurasthenic and hysterical neurosis developed, with predominating spinal irritation and sleeplessness. Episodically, hysterical paraplegia, lasting as long as eight months, and hysterical hallucinatory delirium, with convulsive attacks, occurred. In the course of this, symptoms of morphinism were added. A stay of some months in the hospital relieved the latter, and considerably improved the neurasthenic neurosis, in the