593 Riverside Drive - 27. Chapter 27

Thursday May 13, 1925, after Recess

Dr. Louis Casamajor, a witness called in behalf of the plaintiff, being first duly sworn, testified as follows:

Direct examination by Mr. Steuer.

Mr. Steuer: Doctor, will you be good enough to tell us what your education has been to qualify you to enter the medical profession?

Dr. Casamajor: Bachelor of Arts and Master of Arts in Columbia University. Doctor of Medicine, Columbia University, College of Physicians and Surgeons.

And, in a general way, what have you done since then?

Internship in the City Hospital. Two years of special study in nervous and mental diseases in Germany and Austria. Since 1910, practicing medicine in New York City, specialist in nervous and mental diseases. I am professor of neurology in Columbia University, consulting neurologist in the Veteran’s Hospital, and consulting neurologist in Beekman Street Hospital.

When did you first come in contact with Mrs. Ella Spingarn?

On January 7th this year, in consultation with Dr. R. H. Goldstein. He called me.

What did you do with reference to making an examination?

Mrs. Spingarn told us the history of her marital difficulties, of the way she had attempted to adjust to them, and that in late October of last year, she felt that she no longer could live with her husband on account of her nervous condition and could see no other way out of her situation.

Will you tell us what she said made her maritally unhappy?

Her only complaint was that her husband was unable to have sexual intercourse with her because he could not attain or maintain an erection, and that her anticipation of their continued unsuccessful attempts left her sleepless, followed by headaches and nervousness the next day.

What, if anything, did you do?

I began with a physical examination and determined there was no evidence of any organic derangement of the central nervous system. But there was evidence of intense emotional strain and stress. That is all I did on that occasion. I did not prescribe anything for her, and Dr. Goldstein did not, though either of us might have recommended something to help her sleep.

When did you see her again?

On January 17th, when I found she was just about in the same condition. She had not improved or changed.

What, if anything, did you do on that occasion?

We talked over the situation, and I recommended that she be sent to a sanitarium in the country somewhere for treatment of her nervous condition. I advised her to do this as soon as possible.

Did you see her again after the 17th of January?

I saw her with Dr. Nammack at his office in New Jersey on the 3rd of March. I asked no questions, and all the examinations were done by Dr. Nannack, who was quite satisfied with my previous findings.

Could you please tell what, if anything, you both observed about her genitalia?

Dr. Casamajor to Judge Crain: May I read from my report?

Judge Crain: Please do.

Dr. Casamajor: The external genitals appeared to be normal. The labias are normal in size and position. The vaginal orifice is normal. The hymen shows two small incomplete tears but admits two fingers easily and three without much difficulty. The perineal body is of normal firm consistency. The uterus is small but normal in position.

Mr. Steuer: Did you reach a conclusion as to whether or not Mrs. Spingarn had ever been penetrated in a normal way by contact with a man?

Since the vaginal orifice was large enough to admit three fingers, it could have admitted a normal penis.

Could you tell in what way the small tears were brought about?

There is no way to determine that.

In the statements that Mrs. Spingarn made, did she tell you of the attempts of sexual relations between herself and her husband?

She did.

And the periods of time that they spent, both of them, she and he?

A matter of two or three hours.

And did she describe the effect upon her after these attempts were over?

She did.

And what do you say in regard to the unconsummated acts she described and the conditions which followed therefrom in regards to producing the condition you observed her in?

My opinion was that the principal cause of the suffering Mrs. Spingarn was undergoing derived from the lack of sexual satisfaction in her married life.

Are you able to say with reasonable certainty if the consequence of Mrs. Spingarn’s continuing to live with Mr. Spingarn would be a continuance of her nervous condition and headaches?

Mr. Lewinson: Objection. The witness cannot say whether the same line of conduct would be continuous.

Judge Crain: Sustained.

Mr. Steuer to Dr. Casamajor: I ask the same question but assuming that the same line of conduct were to be continued with respect to an attempted sexual relationship.

Mr. Lewinson: Objection for the same reason.

Judge Crain: Overruled.

Dr. Casamajor: My opinion is that it was detrimental to Mrs. Spingarn’s nervous and mental health to continue to live with her husband under the circumstances in which she had lived with him in the past.

Mr. Steuer: May I ask whether you previously advised Mrs. Spingarn to that effect, and if so, when?

Mr. Lewinson: Objection.

Judge Crain to Mr. Lewinson: I will receive it as bearing on the circumstances under which Mrs. Spingarn parted from her husband.

Dr. Casamajor: I advised Mrs. Spingarn of that the first time I saw her.

Judge Crain: That was on the 7th of January of this year?

Dr. Casamajor: Yes.

Judge Crain: That it was detrimental to Mrs. Spingarn's health to continue her marriage?

Dr. Casamajor: Yes.

Judge Crain: Thank you. [To Mr. Steuer] Mr. Steuer?

Mr. Steuer: That is all.

Judge Crain: Then just a moment. Mr. Steuer, in answering one of your questions, Dr. Casamajor based his thoughts on his earlier statement that the natural desire for sexual intercourse on the part of Mrs. Spingarn was not gratified. His conclusion was based on the circumstance that there was not intercourse. This is as distinguished from conditions produced by an attempt at having intercourse. So his answer is really expressive of a physical condition on the part of Mrs. Spingarn due to the circumstance that while she had certain cravings, they were not satisfied. Might this not have been the case irrespective of the making of any attempt?

Mr. Steuer: I see your point, your Honor. I will now ask that question. [He addresses Dr. Casamajor] Doctor?

Dr. Casamajor: My opinion is that if such an attempt had been made by Mr. Spingarn at a time when Mrs. Spingarn did not have any sexual desire, and that no sexual desire was aroused in her thereby, that this attempt would have no effect on her whatsoever.

Judge Crain: That does not meet what I had in my mind. A nervous condition on the part of one person might be the outcome of an ungratified or unsatisfied desire on the part of the person for sexual intercourse. On the other hand, a nervous condition might be the outcome of successful physical attempts made to have sexual intercourse but where the person was still ungratified or unsatisfied. I wanted to know if you had taken that last circumstance into consideration and whether it in part led you to make the answer that you did.

Dr. Casamajor: I think so.

Mr. Steuer: And when you answer that, you mean you did?

Dr. Casamajor: Yes – at least, I believe I did. There was so much to be taken into consideration that I think I took it all in – I tried to.

Mr. Lewinson: I object because the question was put to the witness as one of a hypothesis.

Judge Crain: I will leave it in view of the answer Dr. Casamajor made.

Mr. Lewinson: Then I have it I mind exactly, I have it down in my notes, and I will refer to it.

Judge Crain: Good. [He addresses Mr. Steuer] Mr. Steuer?

Mr. Steuer: Again, that it all.

Judge Crain: Mr. Lewinson?

Cross-examination of Dr. Casamajor by Mr. Lewinson:

Mr. Lewinson: In each of the three examinations of the lady to which you have referred, you sought and procured all of the history of the case which was subjective in order for you to arrive at some intelligent decision, did you not?

Dr. Casamajor: I did.

And you heard all of the lady’s possible complaints so far as sexual life and her marital relations were concerned?

I think so.

Your opinion was not a partial statement, was it?

It was a kind of overview of the whole case. It did not have to contain it all in detail.

You mean it was all of the data – subjective and objective – that you were able to get from the lady in all three examinations?

It was my opinion of the outline of that data on which I based my opinion.

And in point of fact, as far as the subjective complaints were concerned, it was indispensable for you to assume the truth of all these subjective statements in order to arrive at a conclusion, is that not true?

I had to convince myself of the truth of those statements before I could reach a conclusion.

Then your answer is “Yes?”

Judge Crain: Dr. Casamajor does not say that he assumed they were true as a primary assumption. He said that he had to convince himself.

Mr. Lewinson: What did you mean by that, doctor?

I meant that in ordinary medical cases one is constantly up against the possibility of patients not telling the truth. So one must always first convince himself whether the patient’s statements are worthy of credence.

In other words, if you do not give credit to them for any reason, you would not allow them to influence you in the formation of an opinion?

Absolutely.

And here you believed that everything in the subjective history reported by Mrs. Spingarn was true?

I did.

You were not writing this to a medical man for medical purposes, were you? You were writing it to a lawyer?

Yes.

And you were dealing with the subject of sexual relations?

I was.

And he would not know unless you told him that you had not so much as a criticism of Mrs. Spingarn’s objectivity?

I don’t know whether I would explain it any differently to a doctor instead of a lawyer.

Now you came to the conclusion that there was a lack on the lady’s part of sexual satisfaction, is that right?

I did.

In other words, she was not gratified by the sexual act? That is what you meant?

That is.

And by reason of that fact, you thought that this non-satisfaction – or non-gratification – in its completeness might be cause for her alleged nervous condition, is that correct?

It is.

Of course, the question of a woman’s gratification and of a man’s ability to satisfy it is one that is history old?

It’s happened before.

And you are familiar with a very leading work, I take it, upon this sexual question, which is by Von Kraft-Elving?

I’ve read it.

And do you recall that part regarding the sexual gratification of women and how difficult it is for men to gratify women in all cases?

Yes. Though it’s been some years since I read that part of Kraft-Elving.

Perhaps you may be more familiar with Henry Kirsh’s thoughts upon the sexual life of women? He is a recognized authority?

I’ve read that as well.

And do you recall his statement at page 135 as follows: “It is asserted in the laws of the Hindus that sexual desire in women can be as little satisfied or fed full as a devouring fire can be fed full of combustible material or as the ocean can be overfilled by the rivers that pour their waters into it.”

Mr. Steuer: I object to that question.

Judge Crain: Overruled.

Dr. Casamajor to Mr. Lewinson: I recall that part of Henry Kirsh’s writing.

Then you recall the fact that some women – who are known for example as “passionate women” – are not easily satisfied by a man of normal physical character?

I believe there is not yet any medical proof that this is true.

But you take into consideration any disparity of years between the lady on one hand and her husband on the other? In other words, that there are fifteen years difference – the wife being his junior. Now would you expect a man of fifty to give full gratification to a woman of thirty-five?

I have known it to happen.

Referring to it as unique, I take it?

I do not consider it unique. A man of fifty is not old.

It is recognized by Von Kraft-Elving, and by Havelock Ellis, and by Kirsh that a man arrives at the summit of his sexual impulse between thirty-eight and forty years of age?

Mr. Steuer: I object to this whole line of questioning on the grounds that’s it about satisfaction and not about erection.

Judge Crain: This interrogation might be of value in the event that the decision reached by this trial is unsatisfactory to one of the litigants. But personally I think that – without a direct connection to the defendant, Mr. Spingarn – that Mr. Lewinson can pass from this matter.

Mr. Lewinson: Then I shall not attempt to elaborate on it, your Honor. [To Dr. Casamajor] Returning again to the written statement – to your report to Mr. Steuer and myself after your third meeting with Mrs. Spingarn – and this has already been accepted as evidence – Mrs. Spingarn told you her story
clearly and connectedly, did she not?

She did.

And when you said the neurological examination was entirely negative, I take it you meant what you said?

There was no evidence of any organic disturbance of Mrs. Spingarn’s nervous system.

Wouldn’t it be more embracive than that?

Not a bit.

It certainly reads that way to justify that assumption when you are sending it to a man who is not a physician or a neurologist.

If that is true, then it is a mistake on my part. I wrote it as I would to a doctor. I see that now.

What did you mean by your concluding paragraph: “I am convinced that Mrs. Spingarn is unable to live with her husband at present unless one of two things shall happen: Either some means must be found to give her sexual satisfaction or else she must change her life so that sexuality will play no part in it.” What did you mean by “some means?”

The curing of Mr. Spingarn’s impotence, for instance.

That is what you meant?

Yes.

You were not, of course, inviting any departure from the ethical side – inviting the lady to have a lover?

I’ve never advised that in my life to anyone who is married.

You did not even contemplate it?

Mr. Steuer: Objection.

Judge Crain: Sustained.

Mr. Lewinson to Dr. Casamajor: Now doctor, the hypothetical question did not contain any reference to what we will call the lady’s “digital self-stimulation?”

I don’t think it did.

In point of fact – and using the correct medical descriptive terms in regards to this “digital play” – the lady was really guilty of self-abuse or masturbation?

It is sometimes commonly called that.

And do you wish to go on record as to saying that it has no unhealthy effect nervously? That it is not commonly believed that masturbation undoubtedly procures a grave nervous effect?

It may also have no unhealthy effect nervously whatsoever.

How long do you think one can keep this process of dual methods of masturbation – digitally and by friction against a leg – up without finally showing some nervous effect as the result thereof?

Mr. Steuer: Objection.

Judge Crain: Sustained.

Dr. Casamajor to Judge Crain: I really don’t object to answering that question. In a recent study on masturbation in healthy college-bred women that was published in Mental Hygiene magazine by Dr. Tassa, there is a considerable percentage of the healthy women there who have admitted to masturbation over a considerable period of time.

Judge Crain to Mr. Lewinson: Does that answer your question?

Mr. Lewinson: Yes. Thank you. [To Dr. Casamajor] But there are neuroses that do develop in individuals that masturbate? And a woman who masturbates could be suffering from psychoneurosis?

Not that kind of psychoneurosis.

But psychoneurosis is, in point of fact, a mixed depression?

There may be depression, but the anxiety factor is not present.

Will you point me out any authority that will draw the distinction?

It was made by Dr. Freud, and you will find reference to it in Hitchman’s book.

But you have both depression and anxiety here in your diagnosis?

I have depression. The anxiety is another matter. It may follow or not. That is the social side of the question.

But you said some might result. Have you seen Dr. Nammack’s report?

I have.

The report was dated March 10th of this year, three days after your report, and has been accepted as evidence. It said that “with a neuropathic condition, a pathological increase of sexual desire is often associated.”

In this context, I don’t understand what the words “neuropathic condition” mean.

Well, I did not use it. It was Von Kraft-Elving, and it is also quoted by Kirsh. Do you concur with that statement?

No – I do not believe there is any such thing as a “neuropathic condition.”

Then, of course – not believing that – you don’t believe there is a pathological increase of sexual desire?

There may be a pathological increase of sexual desire under certain conditions, but I don’t believe that is a matter of neuropathic constitution.

And you have considered that in connection with other questions when you wrote your report?

I have.

And you have also considered that there was – after penetration – a warm liquid that was experienced by the lady?

I have. But if it came from Mrs. Spingarn, it certainly could not have been semen.

In other words, you don’t know what it was?

No.

And does semen always run concurrently with the orgasm?

It exists with the orgasm.

Therefore, you are not prepared to say – in view of penetration and the fact that there was this liquid – that there was an orgasm?

No.

What do you mean by “orgasm?”

It means the culmination of the sexual act. But that is a complex physiological phenomena.

For the purpose of applying it to this case, do you regard it as a culmination of an attempt to have sexual intercourse where – by definition – there is never a perfectly completed act acceptable to both parties?

Mr. Steuer: I object. Mr. Lewinson is trying to characterize what took place in terms agreeable to him. This departs from the facts brought out in previous testimony.

Judge Crain: Sustained.

Mr. Lewinson: Then that is all, your Honor.

Judge Crain: Mr. Steuer?

Mr. Steuer: Yes, that is all.

Judge Crain: Then we are in recess until tomorrow morning at 10 o’clock.