The desire to dress up as a man and the desire to smoke passed away, and have never returned, although X. now moves in circles in which many women smoke. And, most important fact of all, the homosexual relations were now completely broken off. The two girls remained on friendly terms; but alike in X. and in her friend the homosexual inclinations disappeared, and the improper sexual practices were entirely discontinued. X. began to flirt, now with one man, now with another, until when nineteen years old she fell in love with her present husband, and married him after a two years' engagement. This case shows that neither the existence of homosexual inclinations during childhood, nor the simultaneous exhibition of other contrary sexual mental qualities, necessarily foreshadows the development of permanent homosexuality. On the other hand, we must not from the subsequent appearance of heterosexuality draw the conclusion that this was first acquired _intra vitam_, for it very often happens that congenital heterosexuality first manifests itself during the period of the puberal development. In an analogous case, in which the homosexual and other contrary sexual tendencies and inclinations of childhood have persisted during the adult sexual life, it would be equally erroneous in the absence of further evidence to conclude that the homosexuality was congenital. I recognise the existence of congenital homosexuality, but I consider that the reality of this condition is established by other grounds than those just mentioned. This question has been fully discussed by me elsewhere,[57] and cannot here be further considered. Many investigators regard homosexuality as an acquired manifestation. In cases in which the existence of homosexuality can be traced back into childhood, they explain this on the ground that at a time when the individual concerned was in a state of sexual excitement, some other person of the same sex must have made a marked impression upon his imagination. In this way, they suggest, is effected an association whose influence endures throughout life. I will here say no more than this, that this association theory does not suffice to account for the facts. The deficiencies of the association theory will to some extent become apparent from the account I am about to give of the other sexual perversions.