While it is extremely difficult to trace homosexuality to an invariably congenital source, there can be little doubt that the delusional idea of sex-transformation, arising from a neurasthenic basis, which may or may not be somatic in character, is inborn. This paranoiac condition— highly interesting from a neuro-psychical standpoint—is well set forth by Case 100 of Krafft-Ebing,1 in which a typical instance of jmrancna perse-cutoria resulted from sexual neurasthenia.

Several brothers and sisters were psychopathic, and the subject of the sketch, at all times strongly sensual, began to masturbate at nineteen. He became sexually neurasthenic, had daily ejaculations of semen, and became ill and miserable, finally developing paranoia. He began to have parres-thetic sensations; and felt as if there were a "great coil" in the place of his genitals; then he imagined that the scrotum and penis were gone, and that his genitals were changed into those of a female. He thought he felt the growth of his breasts, that his hair changed to that of a woman, and that feminine garments were on his body. He believed he had changed into a woman. In a half dreamy state, he had the feeling of playing the part of a woman in intercourse with a man, and therefrom experienced the liveliest pleasure. Treated for his neurasthenia, this sex-metamorphosis disappeared, gradually, and the man ultimately recovered.