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Rh ; began to masturbate at eighteen. At thirty there were manifestations of neurasthenia sexualis (pollutions with consequent fatigue, which at last began to occur during the day; pain in the region of the sacral plexus, etc.). Gradually, spinal irritation, pressure in the head, and cerebral neurasthenia were added. Since the beginning of 1885 the patient had given up coitus, in which he no longer experienced pleasurable feeling. He masturbated frequently.

In 1888 he began to have delusions of suspicion. He noticed that he was avoided, and that he had unpleasant odors about him (olfactory hallucinations). In this way he explained the altered attitude of people, and their sneezing, coughing, etc. He smelled corpses and foul urine. He recognized the cause of his bad smells in inward pollutions. He recognized these in a feeling he had as if a fluid flowed up from the symphysis toward the breast. Patient soon left the clinic.

In 1889 he was again received in an advanced stage of paranoia masturbatoria persecutoria (delusions of physical persecution).

In the beginning of May, 1889, the patient attracted notice, in that he was cross when he was addressed as “mister.” He protested against it, because he was a woman. Voices told him this. He noticed that his breasts were growing. Some weeks before, others had touched him in a sensual manner. He heard it said that he was a whore. Of late, dreams of pregnancy. He dreamed that, as a woman, he indulged in coitus. He felt the immissio penis, and, during the hallucinatory act, also a feeling of ejaculation.

Head straight; facial form long and narrow; parietal eminences prominent; genitals normally developed.

The following case, observed in the asylum at Illenau, is a pertinent example of lasting delusional alteration of sexual consciousness:—

Case 102. Metamorphosis Sexualis Paranoica.—N., aged 23, single, pianist, was received in the asylum at Illenau in the last part of October, 1865. He came of a family in which there was said to be no hereditary taint; but it was tuberculous (father and brother died of pulmonary tuberculosis). Patient, as a child, was weakly and dull, though especially talented in music. He was always of abnormal character; silent, retiring, unsocial, and sullen. He practiced masturbation after fifteen. After a few years neurasthenic symptoms (palpitation of the heart, lassitude, occasional pressure in the head, etc.), and also hypochondriacal symptoms, were manifested. During the last year he had worked with great difficulty. For about six months neurasthenia had increased. He complained of palpitation of the heart, pressure in the head, and sleeplessness; was very irritable, and seemed to be sexually excited. He declared that he must marry for his health. He fell in love with an