Part 28

Regarding vicarious epistaxis, especially exact observations have been published, showing the mutual relationship between the genital and the nasal mucous membrane. A series of cases has been recorded by Fliess. In one of these a remarkably well-developed girl of fourteen, who complained at three-weekly intervals of molimina, in the form of languor, headache, and sacrache, after an interval of four weeks epistaxis occurred instead of the expected menstruation; three weeks later came another attack of epistaxis; and finally, after an interval of seven weeks, came the first menstruation, which henceforward recurred every three weeks. In another case, that of a girl aged fifteen, menstruation appeared once; four weeks later came an attack of epistaxis instead of menstruation, and these attacks of epistaxis were continually repeated, at intervals of twenty-nine days, in place of menstruation, until finally pregnancy occurred. During pregnancy the epistaxis ceased, to recur however six weeks after parturition; the attacks continued for eight monthly periods, when they ceased finally at the commencement of the second pregnancy.

Other similar cases are known in which epistaxis recurred with all the regularity of the menstruation it replaced during pregnancy and ceased at parturition. Analogous cases occur in which epistaxis has persisted during pregnancy, during the puerperium, and at the climacteric period, replacing the physiologically suppressed menstrual flow. Similarly Liégois has observed vicarious hæmoptysis during pregnancy. According to Baumgarten, in vicarious epistaxis the bleeding almost always proceeds from the region of the cartilaginous septum, and may become very violent; vicarious hæmorrhage from the larynx proceeds from the true and false vocal cords. Tracheal hæmorrhage is a much rarer occurrence.

Analogous to these cases are those in which the vicarious hæmorrhages occur after removal of the ovaries. Thus Tauffer in one case saw epistaxis replace menstruation after this operation. Schmalfuss reports a case in which a woman suffering from valvular disease of the heart, was said after oöphorectomy to have had almost daily attacks of hæmoptysis and epistaxis. Glaevecke found in the post-operative history of forty-four cases of oöphorectomy that two patients suffered from vicarious hæmorrhages. The last-quoted author is of opinion that the suppression of menstruation resulting from oöphorectomy rarely leads to vicarious hæmorrhages, and that even when these do occur they are so inconsiderable in amount as to have no practical significance.

Quain records the case of a woman aged thirty-three, in whom uterus and ovaries were absent, and in whom for two years epistaxis recurred every month with considerable regularity.

In cases in which menstruation is in abeyance, we sometimes witness, instead of vicarious hæmorrhages, the occurrence of non-sanguineous vicarious discharges from various mucous membranes. Thus, vicarious leucorrhœa is seen, especially in chlorotic patients, in whom, from the time of the menarche onward, such a discharge may occur every month, instead of the delayed menstruation. Similarly, vicarious diarrhœa and vicarious salivation have been observed.

THE SEXUAL IMPULSE.

By the term sexual impulse, we understand the impulse shared by women and by men towards intimate physical contact and sexual intercourse with individuals of the opposite sex. In the child this impulse slumbers, to awaken at the menarche with the onset of puberty, to increase slowly at first, and then more rapidly, after the manner of an avalanche, until it becomes a powerful passion, dominant throughout the active sexual life of the woman, and it may even continue far beyond this period. The proper aim for whose attainment the sexual impulse in woman strives is by no means (as is asserted in some quarters) the fulfilment of “the impulse toward motherhood,” but is merely the complete satisfaction of sensual passion by intercourse with the male. Still, the sexual impulse is often satisfied by the minor degrees of sexual gratification in the form of the mutual contact, so agreeable to the sense of touch, of portions of the body, and even by the play of imagination and illusion under the dominion of love. Finally, also, love amounts to what Buffon, the celebrated naturalist, expressed with coarse incisiveness in the phrase, “L’amour c’est le frôlement de deux intestins.”

In the sexually mature woman, the sexual impulse always exists, though its strength varies in accordance with individual inheritance, with physical and mental condition, and with external circumstances, and though its manifestation may be repressed by force of will. The sensation of the sexual impulse in a maiden during the years of development is described by Goethe in a masterly manner in the verses.

“Meine Ruh ist hin Mein Herz ist schwer, Ich finde sie nimmer Und nimmermehr. Mein Busen drängt Sich nach ihm hin, Ach, dürft ich ihn fassen Und halten ihn Und küssen ihn, So wie ich wollt, An seinen Küssen Vergehen sollt.”

A resemblance to heat or rut in animals, who exhibit the sexual impulse only at definite periods, those at which the ovules ripen, is manifested in females of the human species only in so far as there is during menstruation a more intense sexual sensibility; but the limitation of the sexual impulse to definite periods, and its close association with reproduction, are not found in women. Education and morality impose artificial limitations on the sexual impulse in women, whilst nature endows this impulse with a coercive power, a fact recognized by thinkers of all times and all peoples. Thus, Buddha wrote: “The sexual impulse is stronger than the ankus with which the wild elephant is controlled, it is hotter than flame, it is like unto an arrow driven into the spirit of man.” In a similar sense Luther writes: “He who wishes to restrain the impulse of nature and not to allow it free play, as nature will and must, what does he do but this, to insist that nature shall not be nature, that fire shall not burn, that water shall not wet, that man shall neither eat, drink, nor sleep.” Schopenhaur describes the sexual impulse as “the completest outward manifestation of the will to live, the concentration, that is to say, of all wills. * * * The affirmation of the will to live concentrates itself in the act of generation, and this act is its most determined expression.” Mainländer in his Philosophy of Deliverance makes the following statement: “In the sexual impulse lies the centre of gravity of human life. To nothing does man devote a more earnest attention than to the business of generation, and in the pursuit of no other aim does he concentrate the intensity of his will in so striking a manner as in the performance of the act of generation.” Debay similarly insists on the strength of the sexual impulse, saying: “The union of the sexes is one of the great laws of nature; to that law men and women are subordinated as completely as all other creatures, they cannot escape its operation.”

According to the general opinion, the sexual impulse is not so strongly developed in women as it is in men. Hegar, Litzmann, Lombroso, P. Müller, and many others, assume that the sexual sensibility of women is less than that of men; Fürbringer is inclined to attribute the characteristic of sexual frigidity to the great majority of German wives. I do not believe that this view, of the slight intensity of the sexual impulse in women in general, is well grounded, and can admit only this much, that in adolescent girls who are inexperienced in sexual matters, the sexual impulse is less powerful than in youths of the same age who have undergone sexual enlightenment. From the moment when the woman also has been fully enlightened as to sexual affairs, and has actually experienced sexual excitement, her impulse toward intimate physical contact and toward copulation is just as powerful as that of men. According, however, to the dominant artificial conditions, man assumes it as his right to give free rein to his sexual desires and to gratify them without regard to consequences, whereas woman, narrowly confined within the boundaries imposed by law and convention, cannot so readily yield to her inclination in the direction of physical love, and must forcibly control that inclination. Moreover, a powerful check on the free indulgence of the sexual impulse is imposed on woman by the consequences of such indulgence, consequences which exist for woman only.

I may further indicate as differential characteristics, that in woman the sexual impulse is more accessible to voluntary control than it is in man, the ardor of female sexual passion is more readily diminished than that of the male; and again that in the female the gratification of the sexual impulse is less narrowly restricted than in the male. Excessive sexual gratification on the one hand and suppression of sexual desire on the other are, generally speaking, less harmful to the female organism than to the male. In these differentiæ is to be found, in my opinion, the influence which determines the type of sexuality in the respective sexes.

The following account is given by Havelock Ellis of the differential characters of the sexual impulse in the female: “In courtship, woman plays a more passive part than man; in woman the physiological mechanism of the sexual processes is more complicated, and the orgasm develops more deliberately; the sexual impulse in woman needs more frequently to be actively stimulated; the culmination of sexual activity is attained later in the life of woman than in the life of man, the strength of sexual desire in woman becomes greater after she has entered upon regular sexual intercourse, women bear sexual excesses better than men; the sexual sphere is larger and more widely diffused in women than it is in men; finally, in woman the sexual impulse exhibits a distinct tendency to periodic exacerbations, and it is in any case much more variable than in man.” The same author, who has published several notable biological studies on subjects connected with sex, maintains that the source of erotic pleasure in the case of the male lies in activity, but in the female in the passive state, in the experience of compulsion, and he holds that sexual subordination is a necessary element in the sexual enjoyment of women.

Hegar maintains that under the term sexual impulse two distinct conceptions are confounded: First, the impulse toward copulation, the desire of carnal union with a member of the opposite sex; secondly, the impulse toward reproduction, the desire for children. At the same time, this author admits that it is questionable if we can properly speak of an impulse toward reproduction, when reproduction is merely a consequence of copulation; in the case of civilized man, at any rate, so much reflection is connected with the idea of reproduction that it can hardly be proper to speak of anything of the nature of an impulse. In the case of woman, the expression is less unsuitable, since in woman special organs exist for the maintenance of the ovum after fertilization, and these organs may perhaps lead to the production of this peculiar form of mental activity.

According to Darwin, a comparatively less intensity of sexual desire is common to the females of all species of the animal kingdom. The female demands a prolonged courtship, and often endeavors for a considerable time to elude the male. In the lowest classes of the animal kingdom the female leads a separate existence as soon as she has been fertilized by the male, the sexual functions being thus subordinated to the maternal. Among birds at the pairing season the male is always the more passionate and active of the two, whilst the female commonly remains passive and occupies herself in building the nest. Among mammals, it is difficult to determine whether sexual feeling is stronger in the female or in the male; but it is certain that sexual relations are seldom long lasting, they continue in most cases only during the period of heat or rut, and at most only till the birth of the young.

From these phenomena witnessed in the animal kingdom, many naturalists have concluded that in females of the human species also, sexual sensibility and the intensity of the sexual impulse are less than in the males, and even that the sexual sense in general is but little developed in the female sex, or sometimes entirely wanting. The complicated apparatus which the primary and secondary sexual characters of the female combine to make up, exists, according to this view, not for the gratification of the sexual impulse, but for the fulfilment of the function of motherhood. “Love in women,” says Lombroso, “is in its fundamental nature no more than a secondary character of motherhood, and all the feelings of affection that bind woman to man arise, not from sexual impulses, but from the instincts, acquired by adaptation, of subordination and self-surrender.”

Mantegazza lays stress on the fact that in the female, sexual desire is very rarely accompanied by pains analogous to those which occur in man, in whom sexual excitement manifests itself in painful tension of the testicle and the seminal vesicles, or in spasmodic, long-continued priapism.

Sergi writes to Lombroso: “The normal woman loves to be flattered and wooed by man, but yields herself to his sexual desires only like an animal at the sacrifice. It is well known how much pains must be taken, how many caresses must be expended, before a woman will yield with pleasure to a man’s desires, and will share his sexual passion. Without the employment of these means, a woman remains cold and gives as little satisfaction as she feels. There are girls who are quite obtuse to the joys of love, and either resist energetically a man’s approaches, or yield to him passively, without ardor and without enthusiasm. It is well known, also, that among the lower races of mankind, means are employed to stimulate the sexual sensibility in women, means that seem to us to amount to torture; and that the male, with the same end in view, undergoes the most painful operations, from which it is apparent that the slight sexual sensibility of women in these lower grades of civilization is fully recognized.” And again: “If a normal woman marries for love, she hides that love deep in her heart, and even on the wedding-day exhibits no great sexual excitement; she often complains later that in her husband the love-fervor of the first days still continues; the very moderate sexual needs of the wife form a natural and most valuable check to the much more powerful passion of the male.”

Saint Prospêre expresses himself to a similar effect: “Women do not fall in consequence of the excessive power of the senses—in this domain they are overlords, in striking contrast to men, whose weakest side is here. It is not by means of the senses that a woman is to be overcome; her weakness lies elsewhere—in her heart, in her vanity.” And de Lambert wrote the epigram, “Women play with love, and yield themselves to love, but they do not abandon themselves to love.”

Well known also is the saying of Dante:

“We know how speedily in women the fire of love is consumed Unless eye and hand continually supply it with fresh fuel.”

On the other hand, it is asserted in the laws of the Hindus that sexual desire in women can as little be satisfied or fed full as a devouring fire can be fed full of combustible materials, or as the ocean can be overfilled by the rivers that pour their waters into it.

Lombroso finds a proof of the sexual indifference of women and of the greater sexual needs of man, in the existence of prostitution, with which can be contrasted the existence only among the degenerate classes (both rich and poor) of a small group of male prostitutes (alfons, souteneurs). This author also refers to the rarity and uniformity in women of the sexual psychoses so frequent in men, as indications of the minor intensity of sexual desire in the former; and he refers also to a series of facts, as for instance, to the occurrence of platonic love, which, though indeed often hypocritical, has a real existence more often in the female sex than in the male; to the long-enduring chastity of girls, and to vows of chastity, which are rarely made except by females; moreover, the ready adaptation of women to polygamy, as well as their scrupulous observance of monogamy, which latter for the male is nominal rather than actual. If in general the opposite view concerning women prevails, this is ascribed by Lombroso to the fact, that love is the most important circumstance in a woman’s life. The reason therefore, however, is to be found, not in the erotic sphere, but in the desire for the satisfaction of the maternal instinct, and in a woman’s need for protection. A celebrated accoucheur, Giordano, has remarked: “Man loves woman for the sake of the vulva; what woman loves in man is the husband and the father. Comprehensively we may express the matter by saying that woman has less eroticism and more sexuality.”

As a rule, remarks Erb, it is believed that the sexual impulse is less intense in women than in men. This is true enough, he writes, as regards youthful and virgin individuals, who have not yet come into intimate contact with men, and in whom sexual desire and sensibility have not yet been directly excited; later, however, when sexual intercourse has been begun, a change usually takes place, and the sexual needs become active in women also, and demand satisfaction. It is well known that not a few women experience powerful and uncontrolled sensual inclinations, just like those of men. On the other hand, we must insist that quite a large number of women possess the so-called naturae frigidae, and have no sensual inclination to sexual intercourse, to which they are either indifferent, or in some cases strongly averse, even regarding it with horror. This lack of the sexual sense in women, is especially common in hysterical subjects, and Erb reports that he has encountered quite a large number of cases of this character. Whether in quite healthy women with normal sexual impulse, complete abstinence from sexual intercourse, too often compulsory but sometimes voluntarily undertaken, is harmful in its consequences—this, says Erb, is a question very difficult to answer. Many such unfortunate women have assured him that they suffered severely in consequence of their enforced continence; the majority of these became neurasthenic or hysterical. The complication of purely physical influences with mental influences, increases the difficulty of the problem. Neurologists have observed women on whom continence was forced either during marriage or after its dissolution, who thereupon fell into a state of severe nervous exhaustion or nervous excitement, or suffered from threatening or even actually developed psychoses. That sexual abstinence is “absolutely harmless,” as moralists and many physicians would so gladly believe, appears to Erb a quite unwarrantable assumption.

“In the processes of reproduction,” continues Erb in his discussion of this subject, “woman is the principal sufferer. With inhuman cruelty, nature has condemned woman to a far more difficult rôle than man in the intercourse of the sexes and in the preservation of the species; she is overpowered and forced by man, she is compelled to make the most severe sacrifices for the sake of the new generation, first when it is germinating within her womb, and later when it is entrusted to her care; and only too frequently she fails to find the respect and protection due to her for the performance of these functions! Compared with the sacrifices made by woman, the temporary continence which is all that is demanded from man will be admitted to be a small matter! It is fortunate that as a rule the young woman who has never come into intimate contact with the male, appears to be endowed by nature with a relatively weak sexual impulse! This unequal and unjust distribution of the male and female rôles on the part of nature may be regretted, but it cannot be altered.”

The modern advocates of the rights of women, who demand that in the sexual sphere also, woman should receive emancipation, oppose the view that in the male the sexual impulse is stronger than in the female, and also the view that whilst in the male the impulse is simply one toward sexual congress, in the female the determining motive to intercourse is furnished by the desire for motherhood. They complain of “the perverse repression in woman of the sexual impulse and its physiological gratification,” since sexual energy and sexual sensibility are equal in intensity and identical in quality in the female and in the male. Thus, Johanna Elberskirchen writes (Die Sexualempfindung bei Weib und Mann—Sexual Sensation in Woman and Man): “Body and soul, the whole being is subordinated to a single powerful feeling and impulse, a single will flows through nerves and blood, forcing and driving the female toward the male with irresistible power; the yearning, the longing for the relief of sexual tension, the craving for the euphoria and fleshly delight that dominate the whole personality. And this elementary sexual longing it is that clouds the woman’s brain, that drives her into the man’s arms, that leads her to forget all the shame threatening her and her child, that brings her to sexual union—not the longing for a child, not the so-called impulse to motherhood.” And again: “Woman yearns for love, all her love-organs cry out for love, soul and body * * *. We do not long only for the rude sexual act. We spiritualise it—at least some of us do so; at any rate we individualize it. It is one particular man whom we desire, he alone can still our longing, our bodily and mental hunger for love. He satisfies us with all his love-affinities.” Naturally, also, the consequence is deduced, “a free course must be given to sexual sensation in women, and to the satisfaction of sexual desire, within physiological limits, within the bounds of physiological necessity.”

Löwenfeld asserts that in the life of woman the sexual functions play a comparatively much greater part than in the life of man, woman’s thoughts and feelings are, that is to say, much more powerfully influenced by sexual matters than those of men; but none the less he is of opinion that in the normal woman the desire for sexual satisfaction is on the average less keen than in the normal man. Distinctly greater in woman is the erotic element only, the need to love and to be loved after an ideal manner, which is excited by the reproductive glands just as much as is the simple sensual desire. Very frequently, manifestations of this ideal need are erroneously attributed to the sensual impulse, yet this latter may be entirely absent in cases in which the erotic element is strongly developed. According to Löwenfeld, the sexual impulse is altogether wanting in young girls before the time of puberty, and in elderly women (in the case of the latter we consider this assertion most questionable); this lack of the sexual impulse persists in girls for an indeterminate time even after puberty, as long as they remain free from all experience of sexual stimulation. In this respect they offer a notable contrast to males of the same age. In normal girls, according to the same author, erotic dreams and similar occurrences are entirely wanting, and specific sexual sensations therefore remain absolutely unknown to them; hence it follows that the sexual impulse cannot, properly speaking, arise in such individuals, and in so far as they experience any desire for sexual intercourse it can only take the form of a craving for some enjoyment, the nature of which is entirely unknown. The absolute lack of the sexual impulse (complete frigidity) persists, according to Löwenfeld, in a not inconsiderable proportion of women even after their introduction to sexual intercourse—Effertz estimates that such complete frigidity is permanent in 10 per cent. of all women—and in a still greater proportion of women the sensual impulse never exceeds a certain minimal intensity (partial frigidity). It is probable that in the higher classes of society, inherited predisposition, education, and perhaps also higher intelligence, combine to diminish the intensity of the sexual impulse. In contrast with these women of frigid temperament, however, we meet with women, certainly in very limited numbers, whose sexual passions are extremely powerful, and whose needs no man can satisfy.

Hegar, who considers that the sexual impulse in women is seldom very powerful, draws the following conclusions in respect of the influence of sexual gratification, on the one hand, or of continence, on the other, on the duration of life and on physical and mental health: “As far as comparisons between married women and women vowed to celibacy (nuns and members of other celibate religious orders) justify any conclusion, sexual activity and inactivity, respectively, would appear to have little influence on the duration of life. Comparisons between married and single women show, indeed, that the gratification of the sexual impulse and the processes of reproduction are distinctly injurious when experienced before the attainment of complete sexual maturity. In married women up to the age of thirty, in some countries even up to the age of forty, the mortality is greater than in unmarried women. The notably smaller mortality of married women, as compared with unmarried, after the age of forty, is usually explained as the result of the complete fulfilment of the genital functions. It may, however, find a truer explanation in the selection effected by marriage, especially when we take into consideration that from the women thus selected the weaker individuals have been previously weeded out by the processes of reproduction: