This hereditary character of inversion (which was denied by Naecke) is a fact of great significance, and, as it occurs in cases with which I am well acquainted, I can have no doubt concerning the existence of the tendency.  The influence of suggestion may often be entirely excluded, especially when the persons are of different sex.  Both Krafft-Ebing and Moll noted a similar tendency.  Von Roemer states that in one-third of his cases there was inversion in other members of the family.  Hirschfeld also found that there is a relatively high proportion of cases of family inversion.

Twenty-six, so far as can be ascertained, belong to reasonably healthy families; minute investigation would probably reduce the number of these, and it is noteworthy that even in some of the healthy families there was only one child born of the parents’ marriage.  In 28 cases there is more or less frequency of morbidity or abnormality—­eccentricity, alcoholism, neurasthenia, insanity, or nervous disease—­on one or both sides, in addition to inversion or apart from it.  In some of these cases the inverted offspring is the outcome of the union, of a very healthy with a thoroughly morbid stock; in some others there is a minor degree of abnormality on both sides.

GENERAL HEALTH.—­It is possible to speak with more certainty of the health of the individual than of that of his family.  Of the 80 cases, 53—­or about two-thirds—­may be said to enjoy good, and sometimes even very good, health, though occasionally there is some slight qualification to be made.  In 22 cases the health is delicate, or at best only fair; in these cases there is sometimes a tendency to consumption, and often marked neurasthenia and a more or less unbalanced temperament.  Four cases are morbid to a considerable degree; the remaining case has had insane delusions which required treatment in an asylum.  A considerable proportion, included among those as having either good or fair health, may be described as of extremely nervous temperament, and in most cases they so describe themselves; a certain proportion of these combine great physical and, especially, mental energy with this nervousness; all these are doubtless of neurotic temperament.[184] Very few can be said to be conspicuously lacking in energy.  On the whole, therefore, a large proportion of these inverted individuals are passing through life in an unimpaired state of health, which enables them to do at least their fair share of work in the world; in a considerable proportion of my cases that work is of high intellectual value.  Only in 5 cases, it will be seen, or at most 6, can the general health be said to be distinctly bad.

This result may, perhaps, seem surprising.  It must, however, be remembered that my cases do not, on the whole, represent the class which alone the physician is usually able to bring forward:  i.e., the sexual inverts who are suffering from a more or less severe degree of complete nervous breakdown.