Nymphomania.—The most deplorable condition of all, to which the female is subject, is the uncontrollable, maniacal, erotic desire, called nymphomania. The disease is fortunately rare, and commonly makes its appearance at, or soon after puberty, but has been observed in adult and married women. Of the six cases that have come under my observation, one was a married woman, the mother of children, four were girls at puberty and one, which will be hereafter reported, aged 19 years.

In the commencement the sufferer is a prey to perpetual contest between feelings of modesty and impetuous desires. At an after period she abandons herself to the latter, seeking no longer to restrain them. In the last stage the obscenity is disgusting; and the mental alienation, for such it is, becomes complete. The cause is often obscure, but when known has been undue irritation, by titilation of the genitals, or anything that would cause turgescence. The disease is apparently local in the beginning, but seems to affect the entire nervous organization, through reflex excitation.

The clitoris, by some, is supposed to be the seat of irritation, and has been amputated or cauterized, but without generally effecting any relief. The disease is not generally confined to any particular locality of the genitals. If allowed, the patient will take the hand of the male and place it upon the mons veneris, and it is only by force that she will allow it to be taken away. She cannot locate the seat of pleasure, but will say that the entire surface touched contributes to the venereal excitement. Another peculiar feature is, that she obtains no satisfaction from venereal orgasm; but on the contrary it adds to her maniacal conduct and obscenity. She is not in any manner responsible for her conduct, and no punishment will cause her to desist. Everything is sacrificed that is feminine, for that which is disgusting and vulgar. The more modest she has been in health, the more obscene she is likely to become in her venereal frenzy. What the final result would be, without treatment, I have never witnessed, but must conclude that lunacy would soon be prominent and probably suicide. There is no tendency to recovery, but to continue from bad to worse, until publicity is no restraint to the obscenity and indecent conduct of the victim.

Case.—Nymphomania, with nocturnal involuntary orgasm. Miss U.—She was aged 19, very small in stature, only weighing 90 pounds, of very respectable family and herself perfectly respectable. She was refused by her probable “intended,” who had discovered signs entirely unnatural for her, in whom he had placed implicit trust. When the condition was first manifested in her, the intended, not thinking of anything wrong on her part, attempted to gratify her morbid erotic desire by coition, which only made her, as he said, “nearly crazy.” She had heretofore been modest and distant, but now she was on his lap, and all over him or leading him to a place of decumbiture. When she visited my office, and imparted to me her whole confidence, my first treatment toward her was so rigid and distant that my examination revealed the parts before orgasm had taken place; but as soon as I touched the nymphÆ; they became lubricated with a thin viscid fluid which was profuse. At first the clitoris and nymphÆ were red, dry and hot; but as my digit came in contact with the soft parts, she forgot the rough treatment and my cold conduct toward her, which I had assumed to prevent, if possible, her venereal crisis, and she became unmanageable for the time, until she had passed three or four orgasms, as I supposed, one immediately following the other, when she became more governable. To carefully portray in words what she said and did would be shocking to a fastidious doctor. With a speculum in the vagina the os uteri would contract and dilate in alternation, and undergo orgasms in rapid succession, with only a few seconds interval. She begged of me not to withdraw the instrument, but when I had completed my examination she was partially exhausted and docile. I could discover a mucoid fluid emitting from the os uteri which evolved a strong venereal odor.

She informed me that she had voluptuous dreams nightly—as many as three in a night. Her figure is small and round, eyes black, hair coal black, countenance very sallow and chlorotic. She seemed to know that this condition was not right, but her modesty was entirely gone, when in company with a male. The presence of a woman restrained her. Her own mother had not determined the true nature of her difficulty, only noticed that something was peculiar with her daughter. The patient had judgment enough left to go out of the room and isolate herself when a man would come about. The advent of this disease she says was first known by a peculiar thrill at the sight of a male, which became more aggravated from day to day. Now, one year has she suffered from this intolerable mania.

To pass over and not give the treatment would leave the case quite incomplete.

Treatment.—I directed monobromated camph., in two gr. pills, one every 4 hours, with formula No. 1, as directed; ice-water to the vulva nights, with daily applications of Faradisation by placing a wetted sponge upon a chair with the patient seated upon it, to which the negative pole is attached; used the positive in my left hand, with my right hand applied to the head and down the spine. Improvement took place from the beginning, and in forty days she was quite herself. She was improved in flesh, color and strength. In two months she was so modest that I could scarce gather courage to ask her if she was yet troubled with any signs of her old affliction. I could not obtain consent to make another physical examination, and she remains well, but is continuing to take the medicine, from formula No. 1. She has strength of will, I am informed by her “intended,” to refuse any degree of proximity. He says, “It seems like a dream. I am learning to court her over again, and succeed very slowly. She is so distant.”

The two cases reported by Prof. S. H. Potter in the April number of Am. Med. Journal, 1876, do not overdraw the picture, any one will testify who has had a few of these perplexing patients to manage.

Dr. Potter further says that examination showed this case to be one of nymphomania, relying upon the turgescence of the clitoris and nymphÆ and ichorous discharge from the os uteri as diagnostic.

It may be remarked that such turgescence not uncommonly produces an exalted erotic desire which is analogous to turgescence of the urethra in the male, manifested in gonorrhoeal priapism.

Such irritations are not always peripheral in origin, as may be supposed, but more commonly a general neurasthenia, or at times a spinal turgescence, which qualifies the genitals for any disturbing titilations that come along. This may seem more evident, when it is once considered, that a hyperÆmia of the nymphÆ and clitoris may and has often existed and no nymphomania; and if the peculiar centric condition does not first exist, there will be no local venereal turgescence of the genitalia.

Ovarian and uterine disease may produce first, a determination of blood to the cord, and then, by slight irritation of the vulva, the condition, nymphomania, may be established. Such is perhaps the most common cause; and the more have we reason to conclude so, from the fact, that the majority of these cases appear soon after puberty, when the first crisis of femininity has wrought its effect upon the uterus and ovaries. At such times is self-pollution most likely to produce a striking impression upon those organs, and most likely to bring about nervous shock by calling a superabundance of liquor-sanguinis to the developing genitalia and reproductive organs. This shock is sometimes so apparent that fainting results and alarming symptoms follow. To relate a case will the better illustrate what may sometimes occur.

Case.—Miss E. H., under the following peculiar circumstances, I was informed, needed my services, as it was known that I was the physician of her family. A young man, whom I well knew, came after me and returned with me to the house, and during our ride, he related the following story, to which I had reason to give entire credit:

The young man and the patient were “sitting up” with a sick lady. During the night, when all was quiet, the young man had taken the liberty to place his hand upon the genitalia of Miss H., when he noticed that she rolled her eyes in rather a peculiar manner which he considered only submission, as she leaned toward him in a very passive manner. He took her in his arms and placed her on a couch, replaced his hand, introducing his finger into the vagina, when he became alarmed at seeing her froth at the mouth, with slight muscular twitchings of the eyes and mouth. He attempted to arouse her, but failed and, becoming still more frightened, called the family, and hastened to my office.

I found the patient, Miss H., who was aged 18, fleshy (her weight was 150 pounds), had been a very healthy girl, of an excellent family, and rather pleasant in disposition. She had always been very modest and retiring; had rosy cheeks, black hair and eyes. She was then in a very delirious state, with pupils contracted, face flushed, no cramping, feet cold; head very hot, with occasional epileptiform movements of the eyes and mouth; biting the tongue and frothing at the mouth; twitching of the facial muscles and sphincters. I informed an old lady that I suspected some private trouble and invited her only, to remain in the room while I made an external inspection, which only gave me the satisfaction of knowing that nothing was the matter with her genitals, and that the young man had not deceived me and effected intromission, as the hymen was perfect.

A large dose of chloral hydrate produced quietude for the night, and I ordered her to be taken home as soon as she was rested by sleep.

I visited her the next morning at her own home. She was conscious, with pulse at 120; temperature, 102; pupils contracted, and face flushed; skin dry; tongue dry and red; asking for water often; head drawn back; throbbing of the carotids, with spasms of the dorsal and posterior cervical muscles.

She had never been sick, and she had never been of a nervous habit; and such a condition was entirely unexpected. There was no epidemic of such a character, and no accountable cause except that given. Her case was of an inflammatory type and lasted twenty-one days.

Treated by large doses of gelseminum, veratrum viride, and quinine when safe. The case was a sthenic one throughout, a meningitis without a doubt, and no cause but venereal shock.

When she recovered I asked her if she remembered what occurred during the night of her falling sick, and she flushed, but finally confessed knowing when he put his hand upon her genitalia, when she thought she fainted; but casually remarked, “I don’t understand it, but I had no power to prevent him doing so.”

The young man again informed me that his hand was upon the vulva, perhaps a minute, when he noticed a strange expression on her countenance.

The shock did not occur at or near her menstrual period, and she menstruated during convalescence, which her mother informed me was a period six weeks from her previous time. She never entirely recovered her mental vigor, and remained single till three years ago, when she married, and all has gone well.

The shock can only be attributed to that susceptibility to nervous impressions so common to the female reproductive organs in the stage of development. There is a strong probability that had this nervous shock been less impressive in character and more prolonged, a nymphomania might have occurred.