Originally published in German: “Wider den 〈trüben, stinkenden Nebel der Heuchelei〉. Paolo Mantegazza war im 19. Jahrhundert ein Wegbereiter der modernen Sexualmedizin.” Deutsches Ärzteblatt, vol. 104, no. 7, p. A 406–410, 2007, Deutscher Ärzte-Verlag Köln, Germany. English translation provided by Aksam A. Yassin, MD, PhD, EdD, Hamburg-Norderstedt, and Bernd Meyenburg, MD, Frankfurt/M.-New York.
Volkmar Sigusch, MD, DSc, Institute of Sexual Science, University of Frankfurt/Main, new: Vitalicum am Opernplatz, D-60311 Frankfurt/Main, Neue Mainzer Str. 84. E-mail: Sigusch@em.uni-frankfurt.de
Introduction. It is generally assumed that modern sexual medicine was founded by German psychiatrists and dermatologists. Fequently mentioned are, for example, Richard von Krafft-Ebing and Iwan Bloch. History of modern sexual medicine began, indeed, decades earlier so that nowadays we look back over 150 years—not 100 years—of research, praxis, and teaching.
Aim. The goal of this report is an acknowledgement of the achievements of the Italian professor of pathology and anthropology, Paolo Mantegazza (1831–1910).
Methods. In several European countries, literary historical studies about the history of sexual science and sexual medicine have been conducted for over more than 30 years.
Results. It became evident that Paolo Mantegazza possesses already the whole width of modern sexual-medical activities, from laboratory experiments to cultural-critical and ethnological studies. Curiously enough, his books, translated in many languages, were almost completely forgotten after his death.
Conclusions. Modern sexual medicine originates in the second half of the 19th century, decades before the studies of Albert Moll, Havelock Ellis, Sigmund Freud, Iwan Bloch, or Magnus Hirschfeld. But its present name was coined generally only three or four researcher generations later. Sigusch V. The birth of sexual medicine: Paolo mantegazza as pioneer of sexual medicine in the 19th century. J Sex Med 2008;5:217–222.
The history of sexual medical sciences begins in the catholic North Italy. Paolo Mantegazza was a physician and anthropologist, also an author and poet since the spheres of scientific and creative writing were not so clearly separated at that time as they are today (Figure 1). Against general appraisals it was, however, argued: “Psychopathia sexualis” had been proposed before Richard Freiherr von Krafft-Ebing  by contemporary French and Russian physicians, to mention only Ambroise-Auguste Tardieu and Benjamin Tarnowski. Freud proposed indeed the most influential sexual theory of the 20th century; however, he could neither “unveil” the infantile sexuality nor identify phases of sexual development—because this had been done before. Physicians like Albert Moll, Havelock Ellis, Iwan Bloch, and Magnus Hirschfeld with great merits in setting up fundamentals of future sexual sciences, including modern sexual medicine, were preceded by pioneers like Mantegazza, especially in respect to formulating new sexual theories and fight for emancipation.
A Poet and Sexologist
Paolo Mantegazza was one of the first sexual physiologists, sexual ethnologists, sexual empirical researchers, sexual hygienists, and also sexual theoreticians. With his works like “Fisiologia del piacere”, “Fisiologia dell’amore” (Figure 2)  , “Igiene dell’amore”, “Gli amori degli uomini— Saggio di una etnologia dell’amore”, and “Fisiologia della donna”, he founded a new science that had not been given any name before, and which he defined himself, faute de mieux, “this science” and also “ the science of embrace.”
In the view of current knowledge, Mantegazza proposed at his time an experimental-physiologically, cultural-anthropologically, socio-hygienically and, occasionally, socio-philosophically oriented phenomenology of heterosexual love, a theory yet unequaled in the entire history of sexual medicine. Theoretically and practically, the female gender distinguishes itself not only as not being frigid, but rather more superseding its voluptuous male counterpart, and in it, all preference deviations or obsessions have not yet mutated into perversions. At the same time, Mantegazza described—especially from the position of an analyst of affection, poetic-scientific fragments of an art to love and to reach happiness. Although an obedient follower of the zeitgeist—Darwinism and Hygiene, “social” and “sexual” questions—and being so conservative as hardly any other researcher, Mantegazza retains irrational-esthetic, “hedonistic” remnants, which remind once more that sciences are neither able to comprehend the human nature nor to explain it or to provide happiness.
From Sexual Pleasure to Gender Differences
In the view of Mantegazza's serious and widely known work, it appears astounding that his theory was nearly forgotten during the 20th century. During his lifetime, Mantegazza was one of those very few scientific authors whose books reached the highest publishing rates in Europe. Critics saw him as important as Montaigne and Darwin.
In most of his works, without disapproval of aphorisms, Mantegazza shifts between a highly demanding warm prose or quasi-philosophical essays on one side, and on the other side, sober scientific reports on animal and human craniometry, statistic-empirical and ethnological studies on lactation periods or suicidal rates. Thus, he proved himself not only well-trained in European philosophy and creative writing, but also in contemporary scientific literature. Mantegazza compiles an enormous volume of documents, which surprised even the most experienced scientists. Also, the wide range of his topics was impressive.
His first book, “Fisiologia del piacere,” which he completed in Paris at the age of 22, showed that he was also influenced by the “psychological era” expanding at that time. He discussed not only the “enjoyments” of all senses, among them, sexual impulses including their deviations, but also the “emotional enjoyments” (egoism, shame, dignity, thirst for glory and fame, and haughtiness) and “intellectual enjoyments” (attention, longing for knowledge, thought processes, fantasy, and willpower). His book, which was reprinted in 22 editions in different languages, closed with “Fundamentals of Edonology or Science of Enjoyment” or “of Hedonism,” as we can also name it today because the word “edonology” comprises both greek words “hêdonê” and “lógos.”
A First Ethnography of Love
From the position of a teaching moralist, Mantegazza despised, first of all, the “false puritans” and so-called “Tartüffe in smallest format.” He wanted to remove the “foggy, smelly mist of hypocrisy,”“which surrounds us and smells like brothel and church at the same time,” and implored the “chaste and holy nudity of the Greeks” as contraposition to “the pathological lusts of our century.”
The fast-growing and dominating field of natural sciences had to digress from religion, also in Mantegazza's thinking. Religion became responsible for everything including the most sacred—the love between man and woman. “In the field of love we are all more or less primitives. Love, just as all other natural powers, must be conquered and ruled by science which understands and explains everything without losing one single spark of its energy or one blossom of its wreath.”
The great researcher was thus willing to sacrifice his most precious on the new altar of totipotent science. With persistence, he tried to find scientific relations in his somehow accumulated material and review it under this aspect. Already the titles of his books in which the topic was “physiology,” thus the natural processes, which were to be scientifically explored, indicate the epistemological transition from popular knowledge, philosophy, and literature to experimental science. Mantegazza tried to derive all sensorial or sexual dimentions directly from nature, sexual instinct, sex sense, sexual approach, sexual intercourse, voluptuousness, and many others—a strange approach for us today.
Mantegazza, who already as a child made experiments, collected herbs, who at the age of 19 was a deputy chemistry professor at a university and who tried himself all available narcotics—from coffee to opium, always followed this social rule.
Occasionally, the pioneering scientist recalled the many imponderabilities of love and wrote: “The amount or, better said the intensity of love is difficult to measure, and maybe we are fortunate as long as no instrument or weight to do so is available to indicate the difference.” As he tried to back up his theory with basic “physiological”—and that means pure scientific arguments—Mantegazza stumbled into contradictions. At first, he maintained that nature imposed the female gender to resist the masculine approach “for a length of time,” but later he descibed considerable cultural differences between the “uncivilized” and the “European” young women of his epoch.
This is one very special field of Mantegazza's pioneering work. Contemporary with Hermann Heinrich Ploss and his ethnological studies entitled “The woman in the natural and popular sciences”, completed after the author's death by Maximilian Carl August Bartels, Mantegazza published the results of his anthropological-ethnological research and collection of travelogues under the title “Gli amori degli uomini—Saggio di una etnologia dell’amore” (1886); for example, he had lived for several years in Argentina and traveled through countries like East India and Lappland. The translation reads as “Anthropological and cultural-historical studies on sex relations in humans”(Figure 3).
While Krafft-Ebing searched the literature for the rarest “perversions” among “civilized” Europeans, which he regarded as diseases, Mantegazza studied the “forms of love” in “uncivilized” and “civilized” people and discovered, for example, a negress of “dedicated, great-hearted passion,”“which would honor any one of our most ideally civilized ladies.”
As one of the first travel writers and scientists, Mantegazza identified the major differences between the art of love and sexual behavior among various people of the world, and described for the first time the “psychological ethnography of love”—before the work of Iwan Bloch who proposed a nonmedical-pathological but rather ethnological-anthropological view of sexual sciences, and who emphasized several times Mantegazza's merits. On a side note, Iwan Bloch did not also invent the word “sexual science” as many times erroneously reported.
In his book “Igiene dell’amore”, Mantegazza writes about the history of hygiene, puberty (including discussions on sperm in men and menstruation in women), masturbation in both genders, aphrodisia and anaphrodisia, erection and impotence, sexual deviations, sexual hypochondria, dysgenesia anticipans (today: premature ejaculation), dysgenesia posticipans (today: deficient ejaculation), vaginism, lewdness and chastity, genetics including pangenesis and neogenesis, endogamy (a topic on which he had already published in 1868, one of the largest studies including 512 cases of endogamic marriages), sterility in men and infertility in women, and voluntary-based infertility according to Malthus (today: contraception and prevention of reproduction).
Modern and Outmoded
Mantegazza advocated out-fashioned arguments against masturbation or deviations, which he observed: “a woman, who loved a girl and dressed as a man; a young man, who practiced coitus only at unusual spots for many years and searched for voluptuousness where only kisses were to be expected”—here is where the pioneer of “healthy and normal life” started to ramble: “congenital mental debility.”
Dangerously modern was Mantegazza when he promoted in eugenic measures, when he wanted “through selection of good begetters eliminate step by step the bad and ugly,” so that “our race will progressively and slowly improve.”
Very modern was Mantegazza when he talked about the female sexuality and her potency, which in his view was higher than in men. He also saw the future of females and gender relations extremely modern, with the exception of one point: he assumed that women were less intelligent than men. Mantegazza demanded repeatedly social reforms, which should have granted the poor, especially the impoverished mothers and children, the achievements of science, without subjugating them to the “humiliation of official charity.” Several reform proposals were considered by sexual sciences decades later. However, the injustice, which Mantegazza condemned, continued to exist: for example, lower wages for women doing the same work like men.
As early as in 1860, Mantegazza experimented with gonad transplantations in frogs.
A few years later, he conducted experiments in humans, which we would see today as experiments in the field of “sexual physiology;” for example, he measured the blood flow and temperature increase during penile erection. A researcher working with such diligence discovered, of course, also what was named “infantile sexuality.” Occasionally, he spoke like a psychoanalyst of the early 20th century: “The first impressions during our first years of childhood imprint themselves in our soft body and persevere till our last breath.”
After 100 years, for a surprising large amount of Mantegazza's writings  holds true: If old terms within the discourse of that time were replaced by current common words and definitions, where “amore” be replaced by “sexuality,”“delight” by “pleasure,”“embrace” by “coitus,”“highest physical love” by “orgasm,” and “physiology of love” by “sexual medicine,” these writings could easily be scientific essays in our contemporary, daily feuilletons.
Paolo Mantegazza was born October 31, 1831 in Monza/Lombardy near Milan, as son of a wealthy roman-catholic couple. He died on August 28, 1910 at his summer residence in San Terenzo near La Spezia. His father, Giovan Battista Mantegazza, is rarely mentioned in biographies; his mother, Laura Solera, on the contrary. She founded in 1850 in Italy the first kindergarten for young children coming from poor families, and in 1870, the first vocational training school for women; even today, she is regarded as one of the social reformers in Italy of that time, a friend of Garibaldi's, and patriot of the “Risorgimento.” Mantegazza loved his mother very much and his book “La mia mama” proves that.
Mantegazza studied medicine and some philosophy in Pisa, Milan, and Pavia. In 1854, he was awarded the title of doctor of medicine. After graduation, he worked as a physician in Argentina, where, in 1856, he married the 15-year-old Jacobita Tejeda de Montemajor—the daughter of the senator of Salta, with whom he had five children. In 1858, he and his family returned to Italy. At the age of 29, he was entitled Professor of General Pathology at the University of Pavia, where Camillo Gogli—whose name carries, among others, brain cells, skin cell receptors, and cellular structures—worked in his laboratory. Ten years later, in 1870, Mantegazza took over the first Italian professorship of anthropology and ethnology at the Faculty of Philosophy in Florence, where he founded a specialized museum, a periodical, and a scientific society.
From 1865 to 1876, he was appointed deputy member of the Parliament, and after that, senator of the Kingdom. After his first wife's death, he married in 1891 the countess Maria Fantoni with whom he had a daughter. Far beyond the Italian borders, the “senator erotico” was well-known as a natural science researcher, social hygienist, experimentalist and collector, enlightener and moralist, world traveler, and writer—for example, through his book “L’anno 3000”, a science fiction novel.