him a lively feeling of pleasure, which was denied to him in coitus; and at first he felt himself fresher and brighter, as a result of the masturbation.
In time, however, symptoms of sexual, and, later, of general, neurasthenia, with spinal irritation, appeared. He then at first gave up masturbation, and sought his first love; but she was now more than ever indifferent to him. Since he finally became impotent, even when he called ideas of boots to his assistance, he gave up women entirely, and again practiced masturbation; by which he felt himself protected from the impulse to kiss and blacken servants’ boots. At the same time, he continued to feel that his sexual position was a painful one. He again occasionally attempted coitus, and was successful in it as soon as he thought of blackened boots. Too, after continued abstinence from masturbation, he was sometimes successful in coitus without any artificial aid.
The patient says that his sexual needs are intense. If he has not had an ejaculation in a long time, he becomes congestive and psychically much excited, and tormented by repugnant images of boots, so that he is forced to have coitus, or, preferably, to masturbate.
For some time his moral position has been complicated most painfully by the fact that, as the last of a wealthy line of high position, and at the importunate desire of his parents, he must marry. The bride is of rare beauty, and mentally in perfect sympathy with him; but, as a woman, she is as indifferent to him as any other. Æsthetically she satisfies him “as a work of art;” in his eyes, she is an ideal. To honor her in platonic way would be happiness worth striving for; but to possess her as a wife is a painful thought. He is certain beforehand that with her he will be impotent, save with the help of ideas of boots. To use such means, however, is in opposition to his respect and his moral and æsthetic feeling for the lady. Were he to soil her with such thoughts, she would lose, in his eyes, all her æsthetic value; and then he would become impotent for her, and she would become repugnant to him. The patient considers his position one of despair, and confesses that he has lately been repeatedly near suicide.
He is a man of much intelligence, and decidedly of masculine appearance, with abundant growth of beard, deep voice, and normal genitals. The eye has a neuropathic expression. No signs of degeneration. Symptoms of spinal neurasthenia. It was possible to reassure the patient, and give him hope of his future.
The medical advice consisted in means for combating the neurasthenia, and the interdiction of masturbation and indulgence of the fancy in images of boots, in the hope that, with the removal of the neurasthenia, cohabitation without ideas of boots would become possible; and that, in time, the patient would become morally and physically capable of marriage.
