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fore this). Oh, do you mean the outward and visible sign of true communion? That was two years before." The religious ceremony was thus to the patient an outer symbol of some actual physical mode of sexual gratification. On another occasion she told me how puzzled she had been at a statement of her minister's to the effect that no one should partake of holy communion until after having two weeks' preparation; later she “ discovered” that he had referred to the necessity for previous purification--by thoroughly washing the genitals with soap and water.

After this revelation it now became plain to her that all her life she had been enjoying sexual pleasures in the wrong way, and that the true way was to admit the male organ not into the vagina but into the mouth (fellatorism). The seed was in this way to enter into the body--had not Christ said " Take and drink"?where it would perform its function of creating and nourishing the child. She would thus be able to bear another child to replace the one she had lost, in spite of the ruin of her internal genital organs. Perhaps her deepest grudge against her husband was the fact that his “ uncleanness” had put an end to her child-bearing at the early age of twenty-two. Her belief that "the new way" would bring to fruition her maternal desires, and secure both the creation and nourishment of the child, was confirmed by a piece of advice given to her by her doctor to the effect that " she ought to swallow as much milk as possible."

One naturally next enquired into the source of the patient's knowledge of the perverse pleasure just described. She had on a few occasions performed cunnilingus with her husband, but never actually fellatorism. “He was not clean enough; he did not bathe so often as Mr. X" (the music teacher). She had, however, on several occasions performed the act in question with another man. There were further evidences to show that the patient was one of that frequent type to whom the excitation of the lips and mouth is capable of yielding as intense sexual pleasure as that of the genital regions. In these people one might say that in a certain respect the cavity of the mouth is an equivalent of that of the vagina, and can in fact replace it (Freud's Verlegung von Unten nach Oben). This is of course, as a rule, accompanied by marked sucking movements, and the earliest source of this abnormality has been clearly traced by Freud to the sucking movements of the

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infant at the nipple. Children destined later to show this abnormality are morbidly fond of sucking various objects, particularly their own toes or fingers. This simple pleasure had still persisted in the patient in question. On several occasions I witnessed her develop an obvious orgasm by vigorously sucking her thumb. When she was first seduced, at the age of sixteen, by the music teacher, he aroused her passions by warmly kissing her and at the same time moving his tongue round and round in her mouth (" like I am now turning the cup,” she said, carrying out this action). On one occasion when referring to some high words she had had with a doctor, she said, “I gave him a good tongue-ing. That's a word that has two meanings, you know. I mean it here in the innocent sense.”

The patient had thus by devious routes come to the idea that fellatorism was the “true way” of obtaining sexual gratification, and that the conception of a child would follow on this act. “The seed of a man must enter into the woman-into the woo-mannot into the womb-man, but into the mouth was a remark that amongst many others exemplified this. The form of gratification just mentioned she identified with the partaking of the holy sacrament;* a vital fluid was swallowed in both cases, the name communion she used indifferently for both, and the penis she referred to as the “cup of kindness."

A series of consequences followed from this belief. Swallowing became for her an act of the highest significance. In a number of articles of diet, particularly in a peach, she saw resemblance to the genital organs and entered into an orgasm when sucking and swallowing them; she would frequently keep one hand on the communion service in the prayer-book during this process. Drink had always to be taken in a certain way, following a ritual resembling that of the holy sacrament. Her husband had poisoned her with his uncleanness; therefore, the food at home, i. e., belonging to him, which she had to swallow was also poisoned. On the other hand, she could not obtain enough food to “satisfy” her.

* The bearing of this identification on the subject of the historical development of the communion ceremony cannot here be discussed, but will be obvious to those who have made a comparative study of the origin of Christian rites.

It was, therefore, not only injurious in quality, but also inadequate in quantity.

If we now make a short synthesis of the order of development of the psychosis it will run somewhat as follows: A woman, of passionate temperament and strong religious training, had at the age of sixteen been seduced, and at the age of nineteen had married another man by whom she was already pregnant. After bearing one child she had a miscarriage, which she attributed to a gonorrhoea contracted from her husband, and underwent a number of gynæcological operations and other treatment for the relief of subsequent pelvic complications; her ovaries were removed at the age of twenty-three. As the years went by, her desire to have more children was strong and her sexual inclinations increased in intensity; at the same time her husband's capacity to gratify these grew less, and she contrasted him unfavorably in this respect with her former lover. She thus blamed her husband twice over for her lack of children. She had illicit relations with other men, which caused her much remorse. Religious appeals to forsake her evil ways and lead a new life she interpreted as a revelation indicating the error of her past sexual life and advocating a new form of sexual life. For a number of reasons this idea of a new sexual life took the form of the fellatorism perversion. She tenderly loved her husband so that there arose in her mind an intense conflict between this feeling of love and duty, and the forces impelling her to turn from him to a new kind of life. The compromise between the two sets of forces was found in identifying, for a number of reasons, the act of fellatorism with the partaking of the holy sacrament. A number of abnormal mental processes were the direct outcome of this; such were delusions of poisoning, refusal to take food, intense excitement evidently of erotic origin, belief that various ministers were in love with her and eager to lead her into the "new way" of sexual life, etc. These abnormal processes clinically constituted recurrent attacks of mania.

It was impossible to perform a complete psycho-analysis of the case, and I have contented myself here with giving a few examples out of the rich material of observations made, together with the main conclusions to which the study led. By means of the knowledge gained by psycho-analytic methods one was able to render intelligible the abnormal mental processes in a way otherwise impossible, and to obtain most valuable clues into the significance and origin of the symptoms of the psychosis. No generalizations as to the nature of manic-depressive insanity are offered from the observation of this case, but it is maintained that studies undertaken by means of the psycho-analytic method promise better than any others to give us in time an understanding of the mechanism, and perhaps the nature, of the malady.

IMPRESSIBILITY IN DEMENTIA PRÆCOX.*

BY CHARLES RICKSHER, M. D.,
Assistant Physician, Danvers State Hospital, Hathorne, Mass.

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There have been many monographs and articles written on the subject of memory, considering it both from the practical and theoretical sides. The mechanism, the laws of acquisition and of conservation have been studied, and the many questions relating to these have been frequently debated. Binét, Henri, Ebbinghaus, Münsterberg and others have experimented with the memory of phrases, sentences and objects, and Stern a short time ago founded a journal devoted entirely to this work. In the abnormal cases the various amnesias have received special attention and have given rise to many articles based on organic brain lesions or on toxic processes.

In working on the subject of impressibility the methods of experimentation differ with each experimenter and the time which separates the presentation and reproduction also varies greatly. Some authors have allowed the subject to tell freely what they have seen or heard, while other have questioned the subject about it. Both sexes and various types of intellectual development have been studied, and the general conclusion drawn is that exactness of memory is the exception and not the rule. Stern in 100 cases received 91.5% of correct answers, while Wreschener, who experimented under similar conditions, found only 74% correct. Stern found that women forget less than men, but their memories are more unfaithful.

In the following work an attempt was made to study certain cases of dementia præcox and to determine how well the subject

* In this impressibility means not only the power to receive and retain stimuli but also the ability to reproduce them. The experiments are analogous to the "aussage " experiments of Stern and were undertaken in order to determine whether there was a marked deviation from the normal in this field in cases of dementia præcox.

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