_Effemination and viraginity with bodily perversion._—In the fourth degree of homosexuality not only are the mental characteristics peculiarly feminine, respectively masculine, but the form of the body approaches that of women, respectively of men. Only the genitals are differentiated and are completely male or female; otherwise the patient could be considered a woman, respectively a man. The following case of a male patient will illustrate this degree of the anomaly. A man of forty had always had homosexual impulses, as far back as he can remember. His stuprosæ acts were attached by mental images of men. The autoerotic fantasies are all of men. In his erotic dreams the images of men accompany the orgasm. The patient feels himself entirely like a woman and is attracted by physically well built men. Naked men in life or in sculpture have a great attraction for him. Women have never made the slightest impression on him. The mere sight of a naked woman disgusts him. Initus with women always failed for lack of erection, while homosexual acts afford complete satisfaction. The patient has a disinclination to masculine pursuits. He does not drink nor smoke. His habitus is entirely feminine. The body is slight and non-muscular. The shoulders are narrow, the pelvis broad, the hands and feet decidedly small. The form is rounded with an abundant development of adipose tissue. He has few hairs on beard and mustache. His complexion is fine. His voice is feminine, he speaks in falsetto voice. His gait is rocking, womanly. He wears his hair quite long. Since childhood he was actuated by the desire to put on female attire. He always wore female undergarments, such as shirts, drawers, corsets, etc. He generally wears bracelets on his arms. Whenever he can, he dresses up like a woman and takes long walks upon the streets in such costumes. Through his love for feminine attire he came in contact with several transvestites who form a kind of club in this city. But the latter who abhor homosexual practices soon discovered his motive for the desire of feminine attire and avoided his company. In his reveries, dreams and acts the patient always plays the pathicus. For some reason or other, unknown to the author, the patient committed suicide. The female, suffering from the fourth degree of viraginity with bodily perversion, approaches in the form of her body that of men. For this reason she may easily masquerade as a man, associate with men, go through the marriage ceremony with a homosexual woman of the class suffering from the first three degrees of homosexuality, and she will never be found out until she dies. A few cases of this class were described by Krafft-Ebing.