After a few years the patient became neurasthenic. Then simple imaginary representation of blood and scenes of blood was sufficient to induce ejaculation. In order to free himself from his vice and his cruel imagination, he began to indulge in sexual intercourse with females. Coitus was possible, but only when the patient called up the idea that the girl’s fingers were bleeding. Without the assistance of this idea no erection was possible. The cruel thought of cutting was limited to the woman’s hand. At times of greatest sexual excitement, simply the sight of the hand of an attractive woman was sufficient to induce violent erections. Frightened by the popular stories about the injurious results of onanism, he abstained and fell into a condition of severe general neurasthenia, with hypochondriacal dysthymia and tædium vitæ. Careful and watchful medical treatment cured the patient after a few months. He has remained mentally well three years; but now, as before, he is very sensual, though it is very seldom that he is troubled by his earlier bloody ideas. X. has given up masturbation entirely. He finds satisfaction in natural sexual indulgence, is virile, and it is no longer necessary for him to call up ideas of blood.
The following case, reported by Tarnowsky (op. cit., p. 61), shows that such lustful, cruel impulses may be simply episodical, and occur in certain exceptional states of mind in neurotic individuals:—
Case 25. Z., physician; neuropathic constitution, reacting badly to alcohol. Under ordinary circumstances capable of normal coitus, as soon as he has indulged in wine he finds that his increased libido is no longer satisfied by simple coitus. In this condition he is compelled to prick the nates puellæ or to make stabs with the lancet, to see blood, and feel the entrance of the blade into the living body, in order to have ejaculation and experience complete satiety of his lust.
The majority of those afflicted with this form of the perversion seem insensible to the normal stimulus of woman. In the first case (24), the assistance of the idea of blood was necessary in order to obtain erection. The following case is that of a man who, by masturbation, etc., in early youth, had diminished his power of erection so that the sadistic act took the place of coitus:
Case 26. The girl-stabber of Bozen (reported by Demme, “Buch der Verbrechen,” Bd. ii, p. 341). In 1829, H., aged 30, soldier, became the subject of legal investigation. At different times and in different places, he had wounded girls with bread-knives or pocket-knives, by stabbing them in the abdomen, probably in the region of the genitals. He gave, as a motive for these acts, heightened sexual impulse, increasing to the intensity of fury, which found satisfaction only in the thought and act of stabbing persons of the female sex. This impulse would pursue him for days at a time. He would then pass into a confused mental state, which would clear away only when the impulse had been satisfied by the deed. In the act of stabbing he had a satisfaction like that of completed coitus, which was increased by the sight of the blood that ran from the knife. In his tenth year the sexual instinct became powerfully manifest. At first he gave himself up to masturbation, and felt physically and mentally weakened by it. Before he became a girl-stabber he had satisfied his sexual lust in violation of immature girls, by causing them to practice masturbation on him, and by sodomy. Gradually the thought came to him of how pleasurable it would be to stab a young and pretty girl in the region of the genitals, and take delight in the sight of the blood running from the knife.
Among his effects were found copies of objects of art and obscene pictures, painted by himself, of Mary’s conception, and of the “congealed thought of God” in the lap of the Virgin. He was considered a peculiar, very irritable man, shy of people, given to women, moody, and glum. He was apparently a person[[54]] that had become impotent through earlier sexual excesses, and who was thus predisposed, by the continuance of intense libido sexualis, and heredity, to perversion of the sexual life.
Case 27. In the “sixties” the inhabitants of Leipzig were frightened by a man who was accustomed to attack young girls on the street and stab them in the upper-arm with a dagger. Finally arrested, he was recognized as a sadist, who, at the instant of stabbing, had an ejaculation, and with whom the wounding of the girls was an equivalent for coitus. (Wharton, “A Treatise on Mental Unsoundness,” § 623. Philadelphia, 1873.)[[55]]
Impotence exists, likewise, in the next three cases. It may be psychical, however, in that the principal tone of the vita sexualis lies in the sadistic inclination, and the normal elements are distorted:—
Case 28. The girl-cutter of Augsburg (reported by Demme, “Buch der Verbrechen,” vii, p. 281). Bartle, wine-merchant. He was subject to lively sexual excitement at the age of fourteen, though decidedly opposed to its satisfaction by coitus, his aversion going so far as disgust for the female sex. At that time he already had the idea to cut girls, and thus satisfy his sexual desire. He refrained from it, however, on account of lack of opportunity and courage. He practiced masturbation, and now and then had pollutions with erotic dreams of girls that had been cut. At the age of nineteen he first cut a girl. During the act he had a seminal emission, and experienced intense pleasure. From that time the impulse became constantly more powerful. He chose only young and pretty girls, and, as a rule, asked them before the deed whether they were still single. The ejaculation or sexual satisfaction occurred only when he was sure that he had actually wounded the girls. After such an act he always felt tired and bad, and was also troubled with qualms of conscience. Until thirty-two years old he carried on this process of cutting, but always with care not to wound the girls dangerously. From that time until his thirty-sixth year he was able to control his impulse. Then he sought to satisfy himself by simply pressing the girls on the arm or neck; but this gave rise to erections and not to ejaculation. Then he sought to attain his object by pricking the girls with a knife in its sheath; but this did not suffice. Finally, he stabbed with the open knife and had complete success, for he thought that a girl when stabbed bled more and had more pain than one that was merely, cut. In his thirty-seventh year he was detected and arrested. In his dwelling was found a collection of daggers, sword-canes, and knives. He said that the mere sight of these weapons, and still more the grasping of them, gave him an intense feeling of sensual pleasure, with violent excitement. According to his confession he had injured, in all, fifty girls. His external appearance was rather pleasing. He lived in very good circumstances, but was peculiar and shy.
Case 29. J. H., aged 25, in 1883 came for consultation concerning severe neurasthenia and hypochondria. Patient confesses that he has practiced onanism since his fourteenth year, infrequently up to his eighteenth year; but since that time he has been unable to resist the impulse. Up to that time he had no opportunity to approach females, for he had been anxiously cared for and never left alone, on account of his invalidism. He had had no real desire for this unknown pleasure; but he accidentally learned what it was when one of his mother’s maids cut her hand severely on a pane of glass she had broken while washing windows. While helping to stop the blood he could not keep from sucking up the blood that flowed from the wound, and in the act he experienced extreme erotic excitement, with complete orgasm and ejaculation.