III. GENERAL PATHOLOGY.[28]

III. GENERAL PATHOLOGY.^[28]

(NEUROLOGICAL AND PSYCHOLOGICAL.)

Abnormality of the sexual functions proves to be especially frequent in civilized races. This fact is explained in part by the frequent abuse of the sexual organs, and in part by the circumstance that such functional anomalies are often the signs of an abnormal constitution of the central nervous system, which is, for the most part, hereditary (“functional signs of degeneration”).

Since the generative organs stand in important functional connection with the entire nervous system, and especially with its psychical and somatic functions, it is easy to understand the frequency of general neuroses and psychoses arising in sexual (functional or organic) disturbances.

Schema of the Sexual Neuroses.

I. Peripheral.^[29] 1. Sensory. a. Anæsthesia.

b. Hyperæsthesia.

c. Neuralgia.

2. Secretory. a. Aspermia.

b. Polyspermia.

3. Motor. a. Pollutions (spasm).

b. Spermatorrhœa (paralysis).

II. Spinal. 1. Affections of the erection centre.

2. Affections of the ejaculation centre.

III. Cerebral. 1. Paradoxia.

2. Anæsthesia.

3. Hyperæsthesia.

4. Paræsthesia.

35

II. SPINAL NEUROSES.

1. Affections of the Erection Centre.

(a) Irritation (priapism) arises reflexly from peripheral sensory irritants (e.g., gonorrhœa); directly, from organic irritation of the nerve-tracts from the brain to the erection centre (spinal disease in the lower cervical and upper dorsal regions), or of the centre itself (certain poisons); or from psychical irritation. In the latter case satyriasis exists, i.e., abnormal duration of erection, with libido sexualis. In simply reflex or direct organic irritation, libido sexualis may be wanting, and the priapism be accompanied by unpleasant feelings.

(b) Paralysis from destruction of the centre or of the nerve-tracts (nervi erigentes), in diseases of the spinal cord (paralytic impotence). A milder form is that of lessened excitability of the centre, resulting from overstimulation (in sexual excesses, especially in onanism), or from alcoholic intoxication, abuse of bromides, etc. It may be accompanied by cerebral anæsthesia, and often with anæsthesia of the external genitals. Cerebral hyperæsthesia is here more frequent (increased libido sexualis, lust). A peculiar form of diminished excitability is shown in those cases where the centre responds only to certain stimuli. Thus there are men for whom sexual contact with their virtuous wives does not supply the necessary stimulus for the excitation of an erection, but in whom it occurs when the act is attempted with a prostitute, or in the form of some unnatural sexual act. As far as psychical stimuli are here concerned, they may be inadequate (v. infra, paræsthesia and perversion of sexual instinct).

(c) Inhibition. The erection centre may become functionally incapable as a result of cerebral influence. This inhibitory influence is an emotion (disgust, fear of contagion), or an idea^[30] of impotence. There are many men in the first condition who have an unconquerable loathing for their wives, or fear of infection, or are suffering with perverse sexual feelings. In the latter condition are neuropathic individuals (neurasthenics, hypochondriacs), frequently weakened sexually (masturbators), who have reason, or think they have, to mistrust their sexual power. This idea acts as an inhibitory concept, and makes the act with the person concerned of the opposite sex temporarily or absolutely impossible.

(d) Irritable weakness. In this condition there is abnormal impressionability of the centre, but accompanied by rapid diminution of its energy. There may be functional disturbance of the centre itself, or weakness of the innervation through the nervi erigentes; or there may be 36weakness of the ischio-cavernosus muscle. Cases in which the erection is ineffectual, on account of abnormally early ejaculation, form a transition to the following anomalies:—

2. Affections of the Ejaculation Centre.

(a) Abnormally easy ejaculation from absence of cerebral inhibition, resulting from excessive psychical excitement or irritable weakness of the centre. In this case, under certain circumstances, the simple conception of a lascivious situation is sufficient to set the centre in action (high degree of spinal neurasthenia, usually resulting from sexual abuse). A third possibility is hyperæsthesia of the urethra, by virtue of which, when the semen enters it, an immediate and excessive reflex action of the ejaculation centre is induced. In such a case, simple proximity to the female genitals may be sufficient to induce ejaculation (ante portam).

In case of hyperæsthesia of the urethra as a cause, the ejaculation may be accompanied by painful, instead of pleasurable, sensations. Usually, in cases where there is hyperæsthesia of the urethra, there is, at the same time, irritable weakness of the centre. Both functional disturbances are important in the production of pollutio nimia and diurna.

The accompanying pleasurable feeling may be pathologically absent. This occurs in defective men and women (anæsthesia, aspermia?), and, further, as a result of disease (neurasthenia, hysteria); or (in prostitutes) it follows overstimulation and the blunting thus induced. The intensity of the pleasurable feeling depends on the degree of psychical and motor excitement accompanying the sexual act. Under pathological conditions this may become so pronounced that the movements of coitus take on the character of involuntary convulsive movements, and even pass into general convulsions.

(b) Abnormally difficult ejaculation. It is occasioned by inexcitability of the centre (absence of libido, paralysis of the centre: organic, from disease of brain or spinal cord; functional, from sexual abuses, marasmus, diabetes, morphinism), and, in this case, for the most part, in connection with anæsthesia of the genitals and paralysis of the erection centre. Or it is the result of a lesion of the reflex arc, or of peripheral anæsthesia (urethra), or of aspermia. The ejaculation occurs not at all, or tardily, in the course of the sexual act, or only afterward, in the form of a pollution.

III. CEREBRAL NEUROSES.

1. Paradoxia, i.e., sexual excitement occurring independently of the period of the physiological processes in the generative organs.

2. Anæsthesia (absence of sexual instinct). Here all 37organic impulses arising in the sexual organs, as well as all concepts, and visual, auditory, and olfactory sense-impressions, fail to excite the individual sexually. This is physiological in childhood and old age.

3. Hyperæsthesia (increased desire, satyriasis). In this state there is an abnormally increased impressionability of the vita sexualis to organic, psychical, and sensory stimuli (abnormally intense libido, lustfulness, lasciviousness). The stimulus may be central (nymphomania, satyriasis) or peripheral, functional or organic.

4. Paræsthesia, (perversion of the sexual instinct, i.e., excitability of the sexual functions to inadequate stimuli).

These cerebral anomalies fall within the domain of psychopathology. The spinal and peripheral anomalies may occur in combination with them, but these affect persons, as a rule, that are free from mental disease. They may occur in various combinations, and become the cause of sexual crimes. For this reason, they demand consideration in the following description. However, the cerebral anomalies claim the principal interest, since they very frequently lead to the commission of perverse and even criminal acts.

A. Paradoxia. Sexual Instinct Manifesting itself Independently of Physiological Processes.

1. Sexual Instinct Manifested in Childhood.

Every physician conversant with nervous affections and diseases incident to childhood is aware of the fact that manifestation of sexual instinct may occur in very young children. The observations of Ultzmann concerning masturbation in childhood^[31] are worthy of attention in relation to it. It is necessary here to differentiate between the numerous cases where, as a result of phimosis, balanitis, or oxyuris in rectum or vagina, young children have itching of the genitals, and experience a kind of pleasurable sensation from manipulations 38thus induced, and thus come to practice masturbation; and those cases in which sexual ideas and impulses occur in the child as a result of cerebral processes without peripheral causes. It is only in this latter class of cases that we have to do with the early manifestation of sexual instinct. In such cases it may always be regarded as an accompanying symptom of a neuro-psychopathic constitutional condition. A case of Marc’s (“Die Geisteskrankheiten,” etc., von Ideler, i, p. 66) illustrates very well these conditions. The subject was a girl of eight years, of respectable family, who was devoid of all child-like and moral feelings, and had masturbated from her fourth year; at the same time she consorted with boys of the age of ten or twelve. She had thought of killing her parents, that she might become her own mistress and give herself up to pleasure with men. In these cases of early manifestation of libido the children come also to masturbate; and, since they are greatly predisposed constitutionally, they frequently sink into dementia, or become subjects of severe degenerative neuroses or psychoses.

Lombroso (Archiv di Psichiatria, iv, p. 22) has collected a number of cases of children affected with very decided hereditary taint, which belong in this category. One was that of a girl who masturbated shamelessly and almost constantly at the age of three. Another girl began at the age of eight, and continued to practice masturbation when married, and even during pregnancy. She was pregnant twelve times. Five of the children died early, four were hydrocephalic, and two boys began to masturbate,—one at the age of seven, the other at the age of four.

Zambaco (L’Encéphale, 1882, Nr. 1, 2) tells the disgusting story of two sisters affected with premature and perverse sexual desire. The elder, R., masturbated at the age of seven, practiced lewdness with boys, stole wherever she could, seduced her four-year-old sister into masturbation, and at the age of ten was given up to the practice of the most revolting vices. Even ferrum candens ad clitoridem had no effect in overcoming the practice, and she masturbated with the cassock of a priest while he was exhorting her to reformation.

2. Re-awakening of Sexual Instinct in Old Age.^[32]

There are infrequent cases in which the sexual instinct persists until a great age. “Senectus non quidem annis sed viribus 39magis æstimatur” (Zittmann). Oesterlen (Maschka, Handb., iii, p. 18) mentions the case of a man aged 83, who was sentenced to three years’ imprisonment by a Wurtemberg court on account of sexual misdemeanors. Unfortunately nothing is said of the nature of the crime or of the mental condition of the criminal.^[33]

The manifestation of sexual instinct in old age is not in itself pathological; but presumption of pathological conditions must necessarily be entertained when the individual is decrepit and his sexual life has already long become extinct; and when the impulse, in a man whose sexual needs were in his early life, perhaps, not very marked, manifests itself with greater strength, and strives for even perverse satisfaction in a shameless and impulsive manner. In such cases there is at once suggested a presumption of pathological conditions. Medical science recognizes the fact that such an impulse depends upon the morbid alterations of the brain which lead to senile dementia. This abnormal manifestation of sexual life may be the precursor of senile dementia, and make its appearance even long before there are any well-defined manifestations of intellectual weakness. The attentive and experienced observer will always be able to detect in this prodromal stage an alteration of character in pejus, and a deterioration of the moral sense accompanying the peculiar sexual manifestation.

The libido of those passing into senile dementia is at first expressed in lascivious speech and gesture. The next objects of the attempts of these senile subjects of brain atrophy and psychical degeneration are children. This sad and dangerous fact is explained by the better opportunity they have of falling in with children, but more especially by a feeling of imperfect sexual power. Defective sexual power and greatly diminished moral sense explain the additional fact of the perversity of the 40sexual acts of these aged men. They are the equivalents of the impossible physiological act.

The annals of legal medicine distinguish, as such, exhibition of the genitals,^[34] lustful handling of the genitals of children,^[35] inducing them to perform manustupration of the seducer, and performing masturbation^[36] or flagellation on the victim.

In this stage the intellect may still be sufficiently intact to allow avoidance of publicity and discovery, while the moral sense is too far gone to allow consideration of the moral significance of the act and resistance to the impulse. With the progress of dementia, these acts are more and more shamelessly committed. Then care on account of defective sexual power disappears, and adults also become the objects of the senile passion; but the defective sexual power necessitates equivalents for coitus. Not infrequently sodomy results, and, as Tarnowsky (op. cit., p. 77) points out, in the sexual act performed with geese, chickens, etc., the sight of the dying animal and its death-struggles at the time of coitus afford complete satisfaction. The perverse sexual acts with adults are quite as horrible, and may be explained psychologically in the same way.

Case 49, in the author’s “Text-Book of Legal Psychopathology,” second ed., p. 161, demonstrates how enormously increased sexual lust may be during the course of senile dementia. Quum senex libidinosus germanam suam filiam æmulatione motus necaret et adspectu pectoris sciosi puellæ moribundæ delectaretur.

Erotic delirium and states of satyriasis may occur, in the course of the malady, with or without maniacal episodes, as the following case shows:—

Case 1. J. René, always given to indulgence in sensuality and sexual pleasures, but always with regard for decorum, has shown, since his seventy-sixth year, a progressive loss of intelligence and increasing perversion of his moral sense. Previously bright and outwardly moral, he now wasted his property in concourse with prostitutes, frequented brothels 41only, asked every woman on the street to marry him or allow coitus, and thus became so publicly obnoxious that it was necessary to place him in an asylum. There the sexual excitement increased to a veritable satyriasis, which lasted until he died. He masturbated continuously, even before others; took delight only in obscene ideas; thought the men about him were women, and followed them with indecent proposals (Legrand du Saulle, “La Folie,” p. 533).

Moreover, women previously moral, when affected with senile dementia, may manifest similar conditions of great sexual excitement (nymphomania, furor uterinus).

It may be seen from a reading of Schopenhauer,^[37] that, as a result of senile dementia, the abnormally excited and perverse instinct may be directed exclusively to persons of the same sex (v. infra). The manner of the satisfaction is here passive pederasty, or, as I ascertained in the following case, mutual masturbation:—

Case 2. Mr. X., aged 80, of high social position, from a family having hereditary taint. He was always very sensual and a cynic, of uncontrollable temper, and, according to his own confession, as a young man, preferred masturbation to coitus. However, he never showed signs of contrary sexual instinct, and kept mistresses, raising a child by one. At the age of forty-eight he married, out of inclination, and begat six children, and never gave his wife cause for complaint. I could obtain but an incomplete history of his family. It was certain that his brother was suspected of love for men, and that a nephew became insane as a result of excessive masturbation.

The patient, always peculiar and quick-tempered, for years has been growing more extreme in character. He has become exceedingly suspicious, and slight opposition to his wishes induces attacks of anger which may become actual raving, and in which he may raise his hand against his wife. For a year there have been unmistakable signs of incipient senile dementia. The patient has become forgetful, localizes past events incorrectly, and has false ideas of time. For fourteen months it has been noticed that he manifests affection for certain male servants, especially for a gardener’s boy. Otherwise rude and overbearing to servants, he surfeits his favorite with favors and presents, and commands his family and his house officials to treat the boy with the greatest respect. The aged patient awaits the hour of rendezvous in true sexual excitement. He sends his family away, that he may be with his favorite undisturbed, and remains shut up with him for hours; and when the 42doors are opened again, he is found lying on the bed exhausted. Besides this object of his passion, the patient had intercourse episodically with other servants. It is certain that he enticed them, asked them for kisses, exhibited himself, allowed manipulation ad genitalia, and practiced mutual masturbation. By these practices absolute demoralization was brought about. The family was powerless; for any opposition caused violent outbreaks of anger and even threats against his relatives. The patient was completely without appreciation of his perverse sexual acts; and therefore the only course left to the afflicted family was to remove all authority from his hands and place him in an asylum. No erotic inclination toward the opposite sex was observed, though the patient occupied a sleeping-apartment with his wife. With reference to the perverse sexuality and the defective moral sense of this unfortunate man, it is worthy of note that he questioned the servants of his daughter-in-law as to whether she had a lover.

B. Anæsthesia Sexualis (Absence of Sexual Feeling).

1. As a Congenital Anomaly.

Only those cases can be regarded as unquestionable examples of absence of sexual instinct dependent on cerebral causes, in which, in spite of generative organs normally developed and the performance of their functions (secretion of semen, menstruation), the corresponding emotions of sexual life are absolutely wanting. These functionally sexless individuals are seldom seen, and are, indeed, always persons having degenerative defects, and in whom other functional cerebral disturbances, states of psychical degeneration, and even anatomical signs of degeneration, are observed. Legrand du Saulle describes a classical case that falls under this head (Annales médico-psychol., May, 1876).

Case 3. D., aged 33, had a mother who suffered with insanity of persecution. The mother’s father also suffered with persecutory insanity, and committed suicide. Her mother was insane, and this woman’s mother became insane in the puerperal state. Three of her mother’s children died in babyhood, and those that lived longer had an abnormal character. As early as his thirteenth year, D. was troubled with the thought of becoming insane. At fourteen he attempted suicide. Later, vagabondage, and, as a soldier, repeated insubordination and crazy pranks. His intelligence was very limited; no sign of degeneration, genitals normal. At seventeen or eighteen he had emissions of semen, had never masturbated or had sexual feeling, and never had sought intercourse with women.

Case 4. P., aged 36, common laborer, was received at my clinic in 43the beginning of November on account of spastic spinal paralysis. He declares he comes of a healthy family. A stutterer from his youth. Cranium microcephalic (cf. 53 cm.). Patient somewhat imbecile. He was never sociable, never had a sexual emotion. The sight of a woman never had anything enticing for him. He never had a desire to masturbate. Erections frequent, but only on waking in the morning with a full bladder, and without a trace of sexual feeling. Pollutions very infrequent,—about once a year, in sleep,—and usually while dreaming that he is concerned with a female. These dreams, however, as his dreams in general, are not markedly erotic. He says the act of pollution is not accompanied by any pleasurable sensation. Patient does not feel this absence of sexual sensations. He gives the assurance that his brother, aged 34, is in exactly the same sexual condition as himself, and he makes it seem probable that a sister, aged 21, is in a similar state. A younger brother, he says, is normal sexually. The examination of his genitals reveals nothing abnormal besides phimosis.

Hammond (“Sexual Impotence”), even with his wide experience, reports only the following three cases of anæsthesia sexualis:—

Case 5. Mr. W., aged 33; strong, healthy, with normal genitals. He had never experienced libido, and had vainly sought to awaken his defective sexual instinct by means of obscene stories and intercourse with prostitutes. On the occasion of such attempts he experienced only disgust, with even a feeling of nausea, and became nervously and mentally exhausted. Only once, when he forced the situation, did he have a transitory erection. W. had never masturbated, and had had pollutions about once every two months from his seventeenth year. Important interests demanded that he marry. He had no horror feminæ, and longed for a home and a wife, but felt that he was incapable of the sexual act. He died, unmarried, in the American civil war.

Case 6. X., aged 27; genitals normal; never felt libido. Mechanical or thermic stimuli easily induced erection, but instead of libido sexualis there was regularly a desire for alcoholic indulgence. Such excesses also induced erections, and he then sometimes masturbated. He had a disinclination for women and a loathing of coitus. If, with an erection, he made an attempt at coitus, it disappeared at once. Death in coma during an attack of cerebral hyperæmia.

Case 7. Mrs. O., normally developed, healthy, menstruated regularly; aged 35, fifteen years married. She never experienced libido, and never had any erotic excitement in sexual intercourse with her husband. She was not averse to coitus, and sometimes seemed to experience pleasure in it, but she never had a wish for repetition of cohabitation.

44In connection with such pure cases of anæsthesia there should be considered other cases in which the mental side of the vita sexualis is a blank leaf in the life of the individual, but where elementary sexual sensations manifest themselves at least in masturbation (comp. the transitional Case 6). According to Magnan’s ingenious classification, which, however, is not strictly correct and somewhat too dogmatic, in such cases the sexual life is so limited as to be designated spinal. Possibly in some such cases there exists virtually a mental side of the vita sexualis, but it is very weak, and undermined by masturbation before it attains development. These represent the transitional cases from the congenital to the acquired (psychical) anæsthesia sexualis. This danger threatens many masturbators of vicious constitution. It is psychologically interesting that when the sexual element is early vitiated, then an ethical defect is manifested.

The two following cases, previously published by me in the Archiv für Psychiatrie, vii, are given here as illustrations worthy of consideration:—

Case 8. F. J., aged 19, student; mother was nervous, sister epileptic. At the age of four, acute brain affection, lasting two weeks. As a child he was not affectionate, and was cold toward his parents; as a student he was peculiar, retiring, preoccupied with self, and given to much reading. Well endowed mentally. Masturbation from fifteenth year. Eccentric after puberty, with continual alternation between religious enthusiasm and materialism,—now studying theology, now natural sciences. At the university his fellow-students took him for a fool. He read Jean Paul almost exclusively, and wasted his time. Absolute absence of sexual feeling toward the opposite sex. Once he indulged in intercourse, experienced no sexual feeling in the act, found coitus absurd, and did not repeat it. Without any emotional cause whatever, he often had a thought of suicide. He made it the subject of a philosophical dissertation, in which he contended that it was, like masturbation, a justifiable act. After repeated experiments, which he made on himself with various poisons, he attempted suicide with fifty-seven grains of opium; but he was saved, and sent to an asylum.

Patient is destitute of moral and social feelings. His writings disclose incredible frivolity and vulgarity. His knowledge is of a wide range, but his logic is peculiarly distorted. There is no trace of emotionality. He treats everything (even the sublime) with incomparable cynicism 45and irony. He pleads for the justification of suicide with false philosophical premises and conclusions, and, as one would speak of the most indifferent affair, he declares that he intends to accomplish it. He regrets that his penknife has been taken from him. If he had it he would open his veins as Seneca did,—in the bath. A short time before a friend had given him, instead of a poison as he supposed, a cathartic. Instead of having been a means to send him to the other world, it had sent him to the water-closet. Only the Great Operator could eradicate his foolish and fatal idea by removing his senses, etc.

The patient has a large, rhombic, distorted skull, the left half of the forehead being flatter than the right. The occiput is very straight. Ears far back, widely projecting, and the external meatus forms a narrow slit. Genitals very lax; testicles unusually soft and small.

Now and then the patient suffers with onomatomania. He is compelled to think of the most useless problems and give up to an interminable distressing and worrying thought; and is so fatigued after it that he is no longer capable of any rational thought. After some months the patient was sent home unimproved. There he spent his time in reading and frivolities, and busied himself with the thought of founding a new Christianity, because Christ had been subject to grand delusions and had deceived the world with wonders (!). After remaining at home some years the sudden occurrence of a maniacal outbreak brought him again to the asylum. He presented a mixture of primordial delirium of persecution (devil, anti-christ, persecution, poisoning, persecutory voices) and delusions of grandeur (Christ, redemption of the world), with impulsive, incoherent actions. After five months there was a remission of this intercurrent acute mental disease, and the patient returned to the level of his original intellectual peculiarity and moral defect.

Case 9. E., aged 30, journeyman-painter, was arrested while trying to cut off the scrotum of a boy he had caught in the woods. He gave as a motive for this act that he wished to cut into it in order that the world should not multiply. Often in his youth, with like purpose, he had cut into his own genitals.

It is impossible to learn anything of his ancestry. From his childhood he was mentally abnormal, violent, never lively, very irritable, irascible, selfish, and weak-minded. He hated women, loved solitude, and read much. He sometimes laughed to himself and did silly things. Of late years his hatred of women had increased, especially of those that were pregnant, they being responsible for the misery of the world. He also hated children, and cursed his father. He entertained communistic ideas, and berated the rich and the ministry, and God, who had allowed him to come into the world so poor. He declared that it would be better to castrate all children than to allow others to come into the world that could only be fated to endure poverty and misery. He had always had the intention, from his fifteenth year, to castrate himself, in order to have 46no part in increasing unhappiness and adding to the number of men. He hated the female sex because it was a means of procreation. Only twice in his life had he allowed women to practice manustupration on him, and, with the exception of this, he had never had anything to do with them. Occasionally he had sexual desire, but never for a natural satisfaction of it. When nature did not help him, he occasionally helped himself by means of masturbation.

He is a powerful, muscular man. The formation of the genitals presents no abnormality. On the scrotum and penis are numerous scars, which resulted from his attempts at self-emasculation, but which, he asserts, were not carried out on account of pain. Genu valgum of right limb. No evidence of onanism could be discovered. He is moody, defiant, irritable. Social feelings are absolutely foreign to him. With the exception of imperfect sleep and frequent headaches, there are no functional disturbances.

From cases of this kind, depending on cerebral causes, there must be distinguished others where the absence of function arises from an absence or malformation of the generative organs, as in certain hermaphrodites, idiots, and cretins. A case belonging here is found in Maschka’s hand-book.

Case 10. Complainant pleads for divorce on account of impotence of her husband, who has never had intercourse with her. She is thirty-one years old, and a virgin. The husband is somewhat weak mentally, physically strong; the genitals well developed. He declares that he has never had a complete erection or a flow of semen, and says that he is totally indifferent about intercourse with women.

Ultzmann’s^[38] observations show that anæsthesia sexualis is not caused by aspermia simply. He shows that even in congenital aspermia the vita sexualis and sexual power may be entirely satisfying; an additional proof that defective libido ab origine is to be sought for in cerebral conditions.

The naturæ frigidas of Zacchias are examples of a milder form of anæsthesia. They are met more frequently among women than among men. The characteristic signs of this anomaly are: slight inclination to sexual intercourse, or pronounced disinclination to coitus without sexual equivalent, and 47failure of corresponding psychical, pleasurable excitation during coitus, which is indulged in simply from sense of duty. I have often had occasion to hear complaints from husbands about this. In such cases the wives have always proved to be neuropathic ab origine. Some were at the same time hysterical.

2. Acquired Anæsthesia.

Acquired diminution of sexual instinct, extending through all degrees to extinction, may depend on various causes. These may be organic and functional, psychical and somatic, central and peripheral. The diminution of libido, as age advances, and its temporary disappearance after the sexual act, are physiological. The variations with reference to the duration of the sexual instinct are dependent upon individual factors. Education and manner of life have a great influence upon the intensity of the vita sexualis. Intense mental activity (hard study), physical exertion, emotional depression, and sexual continence decidedly diminish sexual inclination. Continence at first induces increase, but sooner or later, according to constitutional conditions, the activity of the generative organs decreases, and with it libido. At all events, in a person sexually mature, a close connection exists between the activity of the generative glands and the degree of libido. That this relation is not determinate is shown by the cases of sensual women, who, after the climacterium, continue to have sexual intercourse, and may manifest states of sexual excitement (cerebral). Also in eunuchs it is seen that libido may long outlast the production of semen.

On the other hand, however, experience teaches that libido is essentially conditioned by the function of the generative glands, and that the facts mentioned are exceptional manifestations. As peripheral causes of diminution or extinction of libido, may be mentioned castration, degeneration of the sexual glands, marasmus, sexual excesses in the form of coitus and masturbation, and alcoholism [cocainism]. In the same way, the disappearance of libido in general disturbances of nutrition (diabetes, morphinism, etc.) may be explained. Finally, the atrophy of 48the testicles should be remembered, which has sometimes been observed to follow focal lesions of the brain (cerebellum).

A diminution of the vita sexualis, from degeneration of the tracts of the cord and genito-spinal centre, occurs in diseases of the spinal cord and brain. A central interference with the sexual instinct may be organically induced by cortical disease (dementia paralytica in its advanced stages); functionally, by hysteria (central anæsthesia?) and emotional insanity (melancholia, hypochondria).

C. Hyperæsthesia (Abnormally Increased Sexual Desire).

Pathology has no easy task, in the single case, when it has to decide whether the impulse to sexual satisfaction has reached a pathological degree. Emminghaus (“Psychopathologie,” p. 225) declares that the immediate re-awakening of desire after satisfaction, with its occupation of the entire attention, and no less the excitation of libido by the sight of persons and things which in themselves should have but an indifferent sexual effect, are decidedly abnormal. In general, sexual instinct and its corresponding needs are in proportion to physical strength and age. Sexual desire rapidly increases after puberty, until it reaches a marked degree; is strongest from the twentieth to the fortieth year, and then slowly decreases. Married life seems to preserve and control the instinct. Sexual intercourse with many persons increases the desire.

Since woman has less sexual need than man, a predominating sexual desire in her arouses a suspicion of its pathological significance; and the more, when this finds expression in desire for adornment, coquetry, or male society, which, passing beyond the limits set by good breeding and manners, becomes quite noticeable.

The constitution, in both sexes, is of the greatest significance. An abnormally strong sexual instinct is frequently accompanied by a neuropathic constitution; and such individuals pass a great part of their lives heavily burdened with the weight of this constitutional anomaly of their sexual life. The power of the sexual impulse in such cases may at times rise to the 49importance of an organic necessity, and really endanger the freedom of the will. The want of satisfaction of this impulsive desire may, under such conditions, induce a condition allied to actual rutting, or a psychical condition, accompanied by emotions of fear, in which the individual gives up to the impulse, and responsibility becomes doubtful. If the individual does not give up to his powerful impulse, he is in danger, by reason of his enforced abstinence, of ruining his nervous system by inducing a neurasthenia, or seriously increasing such a condition if it be already present. In normally constituted individuals, too, the sexual instinct is an inconstant quantity. Aside from the temporary indifference following satisfaction, and the diminution of sexual desire in long-continued continence after a certain reactionary stage of sexual desire is overcome, the manner of life has a great influence. Those living in large cities, who are constantly reminded of sexual things and incited to sexual enjoyment, certainly have more sexual desire than those living in the country. A dissipated, luxurious, sedentary manner of life, preponderance of animal food, and the consumption of spirits, spices, etc., have a stimulating influence on the sexual life. In woman the sexual inclination is post-menstrually increased. At this time, in neuropathic women, the excitement may reach a pathological degree.

The great libido of consumptives is remarkable. Hofmann tells of a consumptive peasant who satisfied his wife sexually on the evening before his death.

The sexual acts are coitus (eventually rape) and, faute de mieux, masturbation; and, with defective moral sense, pederasty or bestiality. If sexual power is diminished or extinct, with excessive sexual desire, all manner of perversity of sexual acts becomes possible.

Excessive libido may be peripherally or centrally induced. The former manner of origin is the more infrequent. Pruritus and eczema of the genitals may cause it; and likewise certain substances, like cantharides, which powerfully stimulate sexual desire. Not infrequently, in women at the climacteric, sexual 50excitement occurs, occasioned by pruritus; and also in cases where there is neuropathic taint. Magnan (Annales médico-psychol., 1885, p. 157) reports the case of a lady who was afflicted mornings with attacks of frightful erethismus genitalis, and the case of a man, aged 55, who was tormented at night by unbearable priapism. In each case there was a neurosis.

The central origin of sexual excitement is of frequent occurrence^[39] in persons having neurotic taint or hysteria, and in conditions of psychical exaltation. Here, where the cortex and the psycho-sexual centre are in a condition of hyperæsthesia (abnormal excitability of the imagination, increased ease of association), not only visual and tactile impressions, but also auditory and olfactory sensations, may be sufficient to call up lascivious concepts.

Magnan (op. cit.) reports the case of a young woman who had an increasing sexual desire from puberty, and satisfied it by masturbation. Gradually she grew to become sexually excited at the sight of any man pleasing to her; and, since she was unable to control herself, she would sometimes shut herself up in a room until the storm had passed. At last she gave herself up to men of her choice, that she might get rest from her tormenting desire; but neither coitus nor masturbation brought relief, and she went to an asylum.

The case of a mother of five children is added, who, in despair about her inordinate sexual impulse, attempted suicide, and then sought an asylum. There her condition improved, but she never trusted herself to leave it.

There are several illustrative cases in men and women in the author’s article, “On Certain Anomalies of Sexual Instinct,” Cases 6 and 7 (Archiv für Psychiatrie, vii, 2); Cases 3 and 5 are given here.

51Case 11. On the afternoon of July 7, 1874, Clemens, engineer, being on his way, on business, from Trieste to Vienna, left the train at the town of Bruck, and, passing through the town to the neighboring village of St. Ruprecht, attempted a rape on an old woman, aged 70, whom he found alone in a house. He was seized by the neighbors and arrested by the local police. At his hearing he declared that he had tried to find the pound, in order to satisfy his sexual desire with a bitch. He said that he often suffered with such sexual excitement. He did not deny his act, but excused it as the result of disease. The heat, the motion of the cars, and anxiety about his family, to which he wished to go, had confused him and made him ill. Shame and remorse were not shown. His conduct was open, his mien gay; eyes red and bright, head hot, tongue coated; pulse full, soft, beating over 100; fingers somewhat tremulous. The statements of the accused were precise, but hurried; his glance uncertain, and with an unmistakable expression of lasciviousness. To the medical expert summoned to examine him, he gave the impression of one suffering with disease,—as if he were in the beginning of alcoholic insanity.

C. is forty-five years old, married, father of one child. He does not know what diseases his parents or other members of his family have had. In childhood he was weak and neuropathic. At the age of five his head was injured by a blow with a hoe. A scar one-half cm. broad by one cm. long, situated on the right parietal and frontal bones, dates from that injury. The bone is here somewhat depressed. The overlying skin is united to the bone. Pressure at this point causes pain, which radiates along the lower branch of the trigeminus. This spot is also frequently spontaneously painful. In his youth he had frequent attacks of “fainting”; before puberty, pneumonia, rheumatism, and intestinal catarrh. At the age of seven he experienced a peculiar inclination for men,—i.e., for a certain superior. Whenever he saw this man he had a peculiar feeling in his heart; kissed the ground he walked on. At ten he fell in love with a certain deputy. Later he had an enthusiasm for men, though it was entirely platonic. He began to masturbate at the age of fourteen; first intercourse at seventeen. Then the earlier manifestations of contrary sexual feeling disappeared entirely. At that time he passed through a peculiar acute psychopathic condition, which he described as a kind of clairvoyance. From fifteen, hæmorrhoids, with symptoms of plethora abdominalis. When he had profuse hæmorrhoidal hæmorrhage, which occurred usually every three or four weeks, he was better. At other times he was constantly in a condition of painful sexual excitement, which he satisfied partly by means of onanism and partly by coitus. Every woman he met excited him; even when he was among female relatives he was impelled to make indecent proposals. Sometimes it was possible for him to master his desire; sometimes he was driven to indecent acts. If, after these, he was kicked out-of-doors, it seemed perfectly right to him; for he thought that he needed such correction and support against his 52powerful impulse, which was a burden to him. No periodicity in this sexual excitement was recognizable.

Until 1861 he committed excesses in venery and was several times infected with gonorrhœa and chancres. In 1861, marriage. He was sexually satisfied, but became a burden to his wife on account of his great sensuality. In 1864 he passed through an attack of mania in the hospital at Fiume, and in the same year he again fell ill, and was taken to the insane asylum at Ybbs, where he remained until 1867. There he suffered with recurrent mania accompanied by great sexual excitement. He says that intestinal catarrh and anxiety were the cause of his illness at that time.

Thereafter he was well, but he suffered much on account of his excessive sexual desire. If he were absent from his wife but a short time, the impulse became so powerful that man or animal was indifferent to him for the satisfaction of his lust. In summer these impulses were much stronger, and were always accompanied by abdominal plethora. Something that he remembered in medical reading, made him think that in his case the ganglionic system was more powerful than the cerebral. In October, 1873, on account of business, he had to leave his wife. From that time until Easter, with the exception of occasional masturbation, there was no sexual indulgence. After that he made use of women and bitches. From the middle of June until July 7, he had no opportunity for sexual indulgence. He felt nervously excited, relaxed, and as if he were going crazy. Of late he had slept badly. A longing for his wife, who lived in Vienna, drove him to leave his business. He obtained leave of absence. The heat and the noise of the train confused him, and he could no longer hold out against his sexual excitement and the pressure of blood in his abdomen. Everything danced before his eyes. He left the car at Bruck, and was absolutely confused, not knowing where he went; and for a moment the thought came to him to throw himself in the water; all was like a mist before his eyes. Then he saw a woman, exposed his genitals, and tried to embrace her. She cried for help, and thus he was arrested.

After the attempt it suddenly became clear to him what he had done. He openly confessed his crime, which he remembered in all its details, but which seemed to him to be something abnormal. He could not help it. For some days after this, C. suffered with headache and congestions, and was now and then excited and restless, and slept badly. His mental functions are undisturbed, but he is, nevertheless, a congenitally peculiar man, with a character weak and devoid of energy. The facial expression has something lascivious and peculiar about it. He suffers with hæmorrhoids. The genitals present nothing abnormal. The cranium is narrow and retreating at the forehead. Body large and well nourished. With the exception of diarrhœa, there is no disturbance of the vegetative functions.

53Case 12. Mrs. E., aged 47. Uncle on father’s side was insane; father was sanguine, and given to excess in venery. Patient’s brother died of an acute cerebral affection. Patient from childhood has been nervous, eccentric, and romantic; and while little more than a child manifested excessive sexual desire, and at ten began sexual indulgence. At nineteen, marriage. Unhappy married life; her husband, who was normal, did not satisfy her, and until recent years she constantly had other friends besides her husband. She was well aware of the immorality of her life, but felt her powerlessness against her insatiable desire, which she sought to keep, at least outwardly, a secret. Later she thought that she had suffered with a “mania for men.” Patient has borne six children. Six years ago she was thrown from a wagon and received a severe cerebral concussion. Following this there was melancholia, with delusions of persecution, which sent her to the asylum. She is approaching the climacterium, and of late the menses have been profuse and too frequent. Since this period she is pleased to note that the previously powerful sexual impulse has declined. Proper behavior. Slight degree of descensus uteri and prolapsus ani.

Hyperæsthesia sexualis may be continuously present with exacerbations, or it may be intermittent or periodic. In the latter case it is a cerebral neurosis per se (vide “Special Pathology”), or an accompanying symptom of a condition of general psychical excitement (mania; episodically in dementia paralytica, dementia senilis, etc.).

Lentz has published a remarkable case of intermittent satyriasis (Bulletin de la société de méd. légale de Belgique, Nr. 21):—

Case 13. For three years the generally respected farmer D., married, aged 35, has manifested states of sexual excitement, with increasing frequency and severity, which, during the past year, have become true paroxysms of satyriasis. It was impossible to discover hereditary or other organic cause. D. was compelled, at times when his sexual excitement was excessive, to perform the sexual act from ten to fifteen times in twenty-four hours, without deriving any feeling of satisfaction. Gradually he developed a condition of general nervous hyper-irritability (éréthisme général) with increased emotional irritability to the extent of pathological outbreaks of anger, and impulse to over-indulgence in alcohol, which induced symptoms of alcoholism. His attacks of satyriasis became so violent that consciousness was interfered with, and the patient raged about in blind impulse to sexual acts. He demanded that his wife give herself to other men or to animals in his presence; that she allow copulation with him, presentibus filiabus, because this would afford him 54greater enjoyment. Memory for the events at the height of these attacks, in which the extreme irritability even led to outbreaks of maniacal rage, was entirely wanting. D. himself thought that he must have had moments in which he no longer had control of his senses, and without satisfaction from his wife would have been compelled to seize the next best female. After an attack of violent emotion, these attacks of sexual excitement suddenly disappeared entirely.

The two following cases show how powerful, dangerous, and painful sexual hyperæsthesia may become in those afflicted with this anomaly:—

Case 14. Hyperæsthesia Sexualis—Delirium Acutum ex Abstinentia.—On May 29, 1882, F., aged 29, single, shoemaker, was received at the clinic. Father was of passionate temper; mother neuropathic, and had an insane brother. Patient had never been seriously ill previously, and was not a drinker, but had always been sexually very passionate. Five days before, he was taken acutely ill mentally. He made two attempts at rape in broad daylight, before witnesses, and when arrested talked in delirium only of obscene things, and masturbated without stint, and for three days had been raving mad. On admission he presented the picture of a severe acute delirium, with violent motor symptoms of irritation, and fever. Under treatment with ergotin a cure was effected.

On January 5, 1888, second admission, in a state of violent mania. On January 4, he had become morose, irritable, whining, and sleepless; and then, after vain assaults on women, had manifested symptoms of increasing angry excitement.

On January 6, progress of the condition to severe acute delirium (great disturbance of consciousness, jactation, grinding of the teeth, grimacing, and other motor symptoms of irritation; temperature as high as 40.7° C.); impulsive masturbation. Recovery was complete by January 11, under energetic treatment with ergotin.

After his recovery the patient gives an interesting account of the cause of his illness. Always very passionate sexually; first coitus at the age of sixteen. Continence caused headache, great psychical irritability, lassitude, great loss of pleasure in work, and sleeplessness. Since he had few opportunities in the country to satisfy his desire, he had recourse to masturbation. It was necessary for him to masturbate once or twice daily. No coitus in two months. Increasing sexual excitement; could think of nothing save means for the gratification of his impulse. Masturbation was not sufficient to banish the constantly increasing torment ex abstinentia. During the last four days violent impulse to coitus; increasing sleeplessness and irritability. There was only a summary recollection of the height of the illness. Patient recovered in 55December. A very respectable man; he considers his inordinate desire decidedly pathological, and is anxious about his future.

Case 15. On July 11, 1884, R., aged 33, servant, was admitted suffering with paranoia persecutoria and neurasthenia sexualis. Mother was neuropathic; father died of spinal disease. From childhood he had an intense sexual desire, of which he became conscious as early as his sixth year. From this age, masturbation; from fifteenth year, faute de mieux, pederasty; occasionally, sodomitic indulgences. Later, abusus coitus in marriage cum uxore. Now and then even perverse impulse to commit cunnilingus and to administer cantharides to his wife, because her libido did not equal his own. His wife died after a short period of married life. Patient’s circumstances became straightened, and he had no means to indulge himself sexually. Then masturbation again; employment of lingua canis to induce ejaculation. At times, priapism and conditions approaching satyriasis. He was then driven to masturbate, in order not to become stuporous. Beneficial diminution of the libido nimia, with the gradually predominating sexual neurasthenia and hypochondria.

The following case, valuable for an understanding of many Messalinas, some of whom are historically celebrated, is a classical example of pure hyperæsthesia sexualis, which I take from Trelat’s “Folie lucide”:—

Case 16. Mrs. V. has suffered with a passion for men since her earliest youth. Of good family, well bred, of pleasant disposition, exceedingly modest, she was, as a little girl, a terror to her family, because she could scarcely be alone with a person of the opposite sex, no matter whether it was with child or man of any age, without exposing herself immediately and demanding satisfaction for her sexual passion, even going so far as to lay hold of him. An attempt was made to cure her by marriage. She loved her husband passionately, but even with him she could not keep from demanding coitus of every one with whom she could be alone, no matter whether it was servant, laborer, or school-boy.

Nothing could cure her of this impulse. Even when she became a grandmother, she was still a Messalina. One day she locked a twelve-year-old boy in her room and tried to seduce him. The boy defended himself and escaped. She was severely punished by his brother. All was in vain. She was put in a cloister. There she was an example of morality, and gave not the slightest cause for blame. Immediately after her return the scandal began again. The family banished her, and set aside money to support her. She earned by her own hand-work enough to buy herself lovers. Any one seeing this neatly dressed matron, of good manners and amiable disposition, would never suspect how recklessly passionate she still was at the age of sixty-five. On January 7, 1854, her family, in 56despair at new scandals, placed her in an asylum. She lived there until May, 1858, when she died of apoplexia cerebri, in her seventy-third year. Her conduct in the asylum was exemplary. Left to herself, and under favorable conditions, her sexual impulses manifested themselves shortly before her death. With the exception of this, during an observation of four years by physicians of the asylum, she never showed a sign of mental abnormality.

D. Paræsthesia of Sexual Feeling (Perversion of the Sexual Instinct).

In this condition there is perverse emotional coloring of the sexual ideas. Ideas physiologically and psychologically accompanied by feelings of disgust, give rise to pleasurable sexual feelings; and the abnormal association finds expression in passionate, uncontrollable emotion. The practical results are perverse acts (perversion of the sexual instinct). This is more easily the case if the pleasurable feelings, increased to passionate intensity, inhibit any opposing ideas with corresponding feelings of disgust; or the influence of such opposing concepts may be impossible on account of the absence or loss of all ideas of morality, æsthetics, and law. This loss, however, is only too frequently found where the spring of ethical ideas and feelings (a normal sexual instinct) has been poisoned from the beginning.

With opportunity for the natural satisfaction of the sexual instinct, every expression of it that does not correspond with the purpose of nature,—i.e., propagation,—must be regarded as perverse. The perverse sexual acts resulting from paræsthesia are of the greatest importance clinically, socially, and forensically; and, therefore, they must here receive careful consideration; all æsthetic and polite disgust must be overcome.

Perversion of the sexual instinct, as will be seen from what follows, is not to be confounded with perversity in the sexual act; since the latter may be induced by conditions which are not psychopathology. The concrete perverse act, monstrous as it may be, is not decisive. In order to differentiate between disease (perversion) and vice (perversity), one must investigate the whole personality of the individual and the original impulse 57leading to the perverse act. Therein will be found the key of diagnosis (v. infra).

Paræsthesia may occur in combination with hyperæsthesia. This association seems to be frequent clinically. Sexual acts are then confidently to be expected. The perverse direction of sexual activity may be toward sexual satisfaction with the opposite or the same sex. Thus two great groups of perversions of the sexual life may be distinguished.

1. Sexual Inclination toward Persons of the Opposite Sex, with Perverse Activity of the Instinct.

1. Association of Active Cruelty and Violence with Lust—Sadism.^[40]—That lust and cruelty frequently occur together is a fact that has long been recognized and not infrequently observed. Writers of all kinds have called attention to this phenomenon.^[41] The not infrequent cases where individuals of very excitable sexual natures bite or scratch the companion in intercourse fall within physiological limits.^[42] The older authors have called attention to the relation between lust and cruelty.

Blumröder (“Ueber Irresein,” Leipzig, 1836, p. 51) saw a man who had several wounds bitten into the pectoral muscle, which a woman, in great sexual excitement, had given him at the acme of lustful feeling during coitus. Blumröder (“Ueber Lust und Schmerz,” Friedreich’s Magazin für Seelenkunde, 1830, ii, 5) calls especial attention to the psychological connection between lust and murder. In relation to this, he especially refers to the Indian myths of Siva and Durga (Death and Lust); to human sacrifice with sensual mysteries; and to sexual instinct at puberty with a lustful impulse to suicide, with whipping, pinching, and pricking of the genitals, in the blind impulse to satisfy sexual desire. Lombroso (“Verzeni e Agnoletti,” Rome, 1874) also cites numerous examples of the occurrence of a desire to murder with greatly increased lust.

58On the other hand, when murderous lust has been excited, lust itself often follows. Lombroso (op. cit.) alludes to the fact, mentioned by Mantegazza, that, with fear of being plundered by bandits, there was always a dread of brutal lust.^[43] These examples form transitions to the pronounced pathological cases.

The examples of the degenerate Cæsars (Nero, Tiberius) are also instructive. They took delight in having youths and maidens slaughtered before their eyes. Not less so is the history of that monster, Marschalls Gilles de Rays (Jacob, “Curiosités de l’histoire de France,” Paris, 1858), who was executed in 1440, on account of mutilation and murder, which he had practiced for eight years on more than eight hundred children. As the monster confessed it, it was from reading Suetonius and the descriptions of the orgies of Tiberius, Caracalla, etc., that the idea was gained of locking children in his castles, torturing them, and then killing them. This inhuman wretch confessed that in the commission of these acts he enjoyed inexpressible pleasure. He had two assistants. The bodies of the unfortunate children were burned, and only a number of heads of particularly beautiful children were preserved—as memorials.

In an attempt to explain the association of lust and cruelty, it is necessary to return to a consideration of the quasi-physiological cases, in which, at the moment of most intense lust, very excitable individuals, who are otherwise normal, commit such acts as biting and scratching, which are usually the result of anger. It must further be remembered that love and anger are not only the most intense emotions, but also the only two forms of active (sthenic) emotion. Both seek their object, try to possess themselves of it, and naturally exhaust themselves in a physical effect on it; both throw the psycho-motor sphere into the most intense excitement, and thus, by means of this excitation, reach their normal expression.

From this stand-point it is clear how lust impels to acts that otherwise are expressive of anger.^[44] The one, like the 59other, is a state of exaltation, an intense excitation of the whole psycho-motor sphere. Thus there arises an impulse to react on the object that induces the stimulus, in every possible way, and with the greatest intensity. Just as maniacal exaltation easily passes to furibund destructiveness, exaltation of the sexual emotion often induces an impulse to expend itself in senseless and apparently harmful acts. To a certain extent these are psychical accompaniments; but it is not simply an unconscious excitation of innervation of muscles (which also sometimes occurs as blind violence); it is a true hyperbulia, a desire to exert the most intense effect on the individual giving rise to the stimulus. The most intense means, however, is the infliction of pain.

Through such cases of infliction of pain, during the most intense emotion of lust, we approach the cases in which a real injury, wound, or death, is inflicted on the victim.^[45] In these cases, the impulse to cruelty, which may accompany the emotion of lust, becomes unbounded in a psychopathic individual; and, at the same time, owing to defect of moral feeling, all normal inhibitory ideas are absent or weakened. Such monstrous, sadistic acts have, however, in men, in whom they are much more frequent than in women, another source in physiological conditions. In the intercourse of the sexes, the active or aggressive rôle belongs to man; woman remains passive, defensive.^[46] It affords a man great pleasure to win a woman, to conquer her; and in the ars amandi, the modesty of a woman who keeps herself on the defensive until the moment of surrender, is an element of great psychological significance and importance. Under normal conditions a man meets obstacles which it is his part to overcome, and for which nature has given him an aggressive character. This aggressive character, however, under pathological conditions, may likewise be excessively developed, and express itself in an impulse 60to subdue absolutely the object of desire, even to destroy or kill it.^[47][48]

If both these constituent elements occur together,—the abnormally intensified impulse to a violent reaction toward the object of the stimulus, and the abnormally intensified desire to conquer the woman,—then the most violent outbreaks of sadism occur.

Sadism is thus nothing else than an excessive and monstrous pathological intensification of phenomena,—possible, too, in normal conditions in rudimental forms,—which accompany the psychical vita sexualis, particularly in males. It is, of course, not at all necessary, and not even the rule, that the sadistic individual should be conscious of his instinct. What he feels is, as a rule, only the impulse to cruel and violent treatment of the opposite sex, and the coloring of the idea of such acts with lustful feelings. Thus arises a powerful impulse to commit the imagined deeds. When the actual motive of this instinct is not comprehended by the individual, the sadistic acts have the character of impulsive deeds.

When the association of lust and cruelty is present, not only does the lustful emotion awaken the impulse to cruelty, but vice versâ; cruel ideas and acts cause sexual excitement, and in this way are used by perverse individuals.^[49]

61A differentiation of original and acquired cases of sadism is scarcely possible. Many individuals, tainted ab origine, for a long time do everything to conquer the perverse instinct. If they are potent, at first they are able to lead a normal vita sexualis, often with the assistance of subjective ideas of a perverse nature. Later, after the opposing motives of an ethical and æsthetic kind have been gradually overcome, and after the constantly repeated experience that the natural act does not bring complete satisfaction, the abnormal instinct bursts forth. Owing to this late expression, in acts, of an originally perverse disposition, the appearances are those of an acquired perversion. As a rule, it may be safely assumed that this psychopathic state exists ab origine.

Sadistic acts vary in monstrousness with variation in the power of the perverse instinct over the individual afflicted, and with variation in the strength of opposing ideas that may be present, which almost always are more or less weakened by original ethical defect, hereditary degeneracy, or moral insanity. Thus there arises a long series of forms which begins with capital crime and ends with silly acts which afford the perverse desires of the sadistic individual merely symbolic satisfaction.

Sadistic acts may be further differentiated with reference to their nature: either as they are indulged in after consummated coitus by which the libido nimia remains unsatisfied; or, with diminished virility, as they are used to stimulate the diminished power; or, finally, where virility is absolutely wanting, as they become an equivalent for the impossible coitus, for the induction of ejaculation. In the last two cases, notwithstanding the impotence, there is still intense libido; or there was, at least, intense libido in the individual at the time when the sadistic acts became habitual. Sexual hyperæsthesia is always to be regarded as the basis of sadistic inclinations. The impotence which occurs so frequently in the psychopathic and neuropathic individuals here considered, as a result of excesses indulged in from early youth, is usually dependent upon spinal weakness. Often, too, there is a kind of psychical impotence, induced by concentration of thought on the perverse act with 62simultaneous fading of the idea of normal satisfaction. No matter what the external form of the act may be, the mentally perverse predisposition and instinct of the individual are essential to an understanding of it.

(a) Lust-Murder^[50] (Lust Potentiated as Cruelty, Murderous Lust Extending to Anthropophagy).—The most horrible example, and one which most pointedly shows the connection between lust and a desire to kill, is the case of Andreas Bichel, which Feuerbach published in his “aktenmässige Darstellung merkwürdiger Verbrechen.”

B. puellas stupratas necavit et dissecuit. With reference to one of his victims, at his examination he expressed himself as follows: “I opened her breast and with a knife cut through the fleshy parts of the body. Then I arranged the body as a butcher does a beef, and hacked it with an axe into pieces of a size to fit the hole which I had prepared up in the mountain for burying it. I may say that while opening the body I was so greedy that I trembled, and could have cut out a piece and eaten it.”

Lombroso, too (“Geschlechtstrieb und Verbrechen in ihren gegenseitigen Beziehungen.” Goltdammer’s Archiv, Bd. xxx), mentions cases falling in the same category. A certain Phillipe indulged in choking prostitutes, post-actum, and said: “I am fond of women, but it is sport for me to choke them after having enjoyed them.”

A certain Grassi (Lombroso, op. cit., p. 12) was one night seized with sexual desire for a relative. Irritated by her remonstrance, he stabbed her several times in the abdomen with a knife, and also stabbed her father and uncle who attempted to hold him back. Immediately thereafter he hastened to visit a prostitute in order to cool his sexual passion in her arms. But this was not sufficient. He then murdered his father and slaughtered several oxen in the stable.

It cannot be doubted, from what has gone before, that a great number of so-called lust-murders depend upon a combination of hyperæsthesia and paræsthesia sexualis. As a result of this perverse coloring of the feelings, further acts of bestiality with the body may result,—e.g., cutting it up and wallowing in the intestines. The case of Bichel points to this possibility.

A modern example is that of Menesclou (Annales 63d’hygiène publique), who was examined by Lasègue, Brouardel, and Motet, declared to be mentally sound, and executed.

Case 17. A four-year-old girl was missing from her parents’ home, April 15, 1880. On April 16th, Menesclou, one of the occupants of the house, was arrested. The forearm of the child was found in his pocket, and the head and entrails, in a half-burned condition, were taken from the stove. Parts of the body were found in the water-closet. The genitals could not be found. M., when asked their whereabouts, became embarrassed. The circumstances, as well as an obscene poem found on his person, left no doubt that he had violated the child and then murdered her. M. expressed no remorse, asserting that his deed was an accident. His intelligence is limited. He presents no anatomical signs of degeneration; is somewhat deaf, and scrofulous.

M., aged 20; convulsions at the age of nine months. Later, he suffered from poor sleep (enuresis nocturna); was nervous, and developed tardily and imperfectly. From the time of puberty he was irritable, showed evil inclinations; was lazy; could not be taught, and in all trades proved, to be of no use. He grew no better even in the House of Correction. He was made a marine, but there, too, he proved useless. When he returned home he stole from his parents, and spent his time in bad company. He did not run after women, but gave himself up passionately to masturbation, and occasionally indulged in sodomy with bitches. His mother suffered with mania menstrualis periodica. An uncle was insane, and another an inebriate. The examination of M.’s brain showed morbid changes of the frontal lobes, of the first and second temporal convolutions, and of a part of the occipital convolutions.

Case 18. Alton, a clerk in England, goes out of town for a walk. He lures a child into a thicket, and returns after a time to his office, where he makes this entry in his note-book: “Killed to-day a young girl; it was fine and hot.” The child was missed, searched for, and found cut into pieces. Many parts, and among them the genitals, could not be found. A. did not show the slightest trace of emotion, and gave no explanation of the motive or circumstances of his horrible deed. He was a psychopathic individual, and occasionally subject to states of depression with tædium vitæ. His father had had one attack of acute mania. A near relative suffered from mania with homicidal impulses. A. was executed.

In such cases it may even happen that appetite for the flesh of the murdered victim arises, and, in consequence of this perverse coloring of the idea, parts of the body may be eaten.

Case 19. Leger, vine-dresser, aged 24. From youth moody, silent, shy of people. He starts out in search of a situation. He wanders about eight days in the forest, there catches a girl twelve years old, violates her, 64mutilates her genitals, tears out her heart, eats of it, drinks the blood, and buries the remains. Arrested, at first he lied, but finally confessed his crime with cynical cold-bloodedness. He listened to his sentence of death with indifference, and was executed. At the post-mortem examination, Esquirol found morbid adhesions between the cerebral membranes and the brain (Gorget, “Darstellung der Prozesse Leger, Feldtmann,” etc., Darmstadt, 1827).

Case 20. Tirsch, hospital beneficiary of Prag, aged 55, always silent, peculiar, coarse, very irritable, grumbling, revengeful, was sentenced to twenty years’ imprisonment, on account of violating a girl ten years old. He had attracted attention on account of outbursts of anger from insignificant causes, and also on account of tædium vitæ. In 1864, on account of the refusal of an offer of marriage which he made to a widow, he developed a hatred toward women, and on July 8th he went about with the intention of killing one of this hated sex. Vetulam occurentem in silvam allexit, coitum poposcit, renitentem prostravit, jugulum feminæ compressit “furore captus.” Cadaver virga betulæ desecta verberare voluit neque tamen id perfecit, quia conscientia sua hæc fieri vetuit, cultello mammae et genitalia desecta domi cocta proximis diebus cum globis comedit. On September 12th, when he was arrested, the remains of this meal were found. He gave as the motive of this act “inner impulse.” He himself wished to be executed because he had always been persecuted. In confinement there were great emotional irritability and occasional outbursts of fury, preceded by refusal of food, which made isolation, lasting several days, necessary. It was authoritatively established that the most of his earlier excesses were coincident with outbreaks of excitement and fury (Maschka, Prager Vierteljahrsschrift, 1866, i, p. 79).

The Whitechapel murderer, who still eludes the vigilance of the police, probably belongs in this category of psycho-sexual monsters.^[51] The constant absence of uterus, ovaries, and labia, in the victims (ten) of this modern Bluebeard, allows the presumption that he seeks and finds still further satisfaction in anthropophagy.

In other cases of lust-murder, for physical and mental reasons (vide supra), violation is omitted, and the sadistic crime alone becomes the equivalent of coitus. The prototype of such cases is the following one of Verzeni. The life of his victim hung on the rapid or retarded occurrence of ejaculation. Since 65this remarkable case presents all the peculiarities which modern science knows concerning the relation of lust to lust-murder with anthropophagy, and especially since it was carefully studied, it receives detailed description here:—

Case 21. Vincenz Verzeni, born in 1849; since January 11, 1872, in prison; is accused (1) of an attempt to strangle his nurse Marianne, four years ago, while she lay sick in bed; (2) of a similar attempt on a married woman, Arsuffi, aged 27; (3) of an attempt to strangle a married woman, Gala, by grasping her throat while kneeling on her body; (4) on suspicion of the following murders:—

In December a fourteen-year-old girl, Johanna Motta, set out for a neighboring village between seven and eight o’clock in the morning. Since she did not return, her master set out to find her, and discovered her body near the village, lying by a path in the fields. The corpse was frightfully mutilated with numerous wounds. The intestines and genitals had been torn from the opened body, and were found near by. The nakedness of the body and erosions on the thighs made it seem probable that there had been an attempt at rape; the mouth filled with earth pointed to suffocation. In the neighborhood of the body, under a pile of straw, were found a portion of flesh torn from the right calf, and pieces of clothing. The perpetrator of the deed remained undiscovered.

On August 28, 1871, a married woman, Frigeni, aged 28, set out in the fields early in the morning. Since she did not return by eight o’clock, her husband started out to fetch her. He found her a corpse, lying naked in the field, with the mark of a thong around her neck, with which she had been strangled, and with numerous wounds. The abdomen had been slit open, and the intestines were hanging out.

On August 29, at noon, as Maria Previtali, aged 19, went through a field, she was followed by her cousin, Verzeni. He dragged her into a field of grain, threw her to the ground, and began to choke her. As he let go of her for a moment to ascertain whether there were any one near, the girl got up and, by her supplicating entreaty, induced Verzeni to let her go, after he had pressed her hands together for some time.

Verzeni was brought before a court. He is twenty-two years old. His cranium is of more than average size, but asymmetrical. The right frontal bone is narrower and lower than the left, the right frontal prominence being less developed, and the right ear smaller than the left (by 1 centimetre in length and 3 centimetres in breadth); both ears are defective in the inferior half of the helix; the right temporal artery is somewhat atheromatous. Bull-necked; enormous development of the zygomæ and inferior maxilla; penis greatly developed, frænum wanting; slight divergent alternating strabismus (insufficiency of the internal rectus muscle, and myopia). Lombroso concludes, from these signs of degeneration, 66that there is a congenital arrest of development of the right frontal lobe. As seemed probable, Verzeni has a bad ancestry,—two uncles are cretins; a third, microcephalic, beardless, one testicle wanting, the other atrophic. The father shows traces of pellagrous degeneration, and had an attack of hypochondria pellagrosa. A cousin suffered from cerebral hyperæmia; another is a confirmed thief.

Verzeni’s family is bigoted and low-minded. He himself has ordinary intelligence; knows how to defend himself well; seeks to prove an alibi and cast suspicion on others. There is nothing in his past that points to mental disease, but his character is peculiar. He is silent and inclined to be solitary. In prison he is cynical. He masturbates, and makes every effort to gain sight of women.

Verzeni finally confessed his deeds and their motive. The commission of them gave him an indescribably pleasant (lustful) feeling, which was accompanied by erection and ejaculation. As soon as he had grasped his victim by the neck, sexual sensations were experienced. It was entirely the same to him, with reference to these sensations, whether the women were old, young, ugly, or beautiful. Usually, simply choking them had satisfied him, and he then had allowed his victims to live; in the two cases mentioned, the sexual satisfaction was delayed, and he had continued to choke them until they died. His satisfaction in this garroting was greater than in masturbation. The abrasions of the skin on Motta’s thighs were produced by his teeth, while sucking her blood in most intense lustful pleasure. He had torn out a piece of flesh from her calf and taken it with him to roast at home; but on the way he hid it under the straw-stack, for fear his mother would suspect him. He also carried pieces of the clothing and intestines some distance, because it gave him great pleasure to smell and touch them. The strength which he possessed in these moments of intense lustful pleasure, was enormous. He had never been a fool; while committing his deeds he saw nothing around him (apparently as a result of intense sexual excitement, annihilation of apperception—instinctive action). After such acts he was always very happy, enjoying a feeling of great satisfaction. He had never had pangs of conscience. It had never occurred to him to touch the genitals of the martyred women, or to violate his victims. It had satisfied him to throttle them and suck their blood. These statements of this modern vampire seem to rest on truth. Normal sexual impulses seem to have remained foreign to him. Two sweethearts that he had, he was satisfied to look at; it was very strange to him that he had no inclinations to strangle them or press their hands; but he had not had the same pleasure with them as with his victims. There was no trace of moral sense,—remorse and the like.

Verzeni said himself that it would be a good thing if he were to be kept in prison, because with freedom he could not resist his impulses. Verzeni was sentenced to imprisonment for life (Lombroso, “Verzeni e 67Agnoletti,” Rome, 1873). The confessions which Verzeni made after, his sentence, are interesting:—

“I had an unspeakable delight in strangling women, experiencing during the act erections and real sexual pleasure. It was even a pleasure only to smell female clothing. The feeling of pleasure while strangling them was much greater than that which I experienced while masturbating. I took great delight in drinking Motta’s blood. It also gave me the greatest pleasure to pull the hair-pins out of the hair of my victims.

“I took the clothing and intestines, because of the pleasure it gave me to smell and touch them. At last my mother came to suspect me, because she noticed spots of semen on my shirt after each murder or attempt at one. I am not crazy, but in the moment of strangling my victims I saw nothing else. After the commission of the deeds I was satisfied and felt well. It never occurred to me to touch or look at the genitals or such things. It satisfied me to seize the women by the neck and suck their blood. To this very day I am ignorant of how a woman is formed. During the strangling and after it, I pressed myself on the entire body without thinking of one part more than another.”

Verzeni arrived at his perverse acts entirely independently, after having noticed, when he was twelve years old, that he experienced a peculiar feeling of pleasure while wringing the necks of chickens. After this he had often killed great numbers of them, and then said that a weasel had been in the hen-coop (Lombroso, Goltdammer’s Archiv, Bd. xxx, p. 13).

Lombroso mentions an analogous case (Goldtdammer’s Archiv) which occurred in Vittoria (Spain):—

Case 22. A certain Gruyo, aged 41, with a blameless past life, having been three times married, strangled six women in the course of ten years. They were almost all public prostitutes and quite old. After the strangling he tore out their intestines and kidneys per vaginam. Some of his victims he violated before killing, others, on account of the occurrence of impotence, he did not. He set about his horrible deeds with such care that he remained undetected for ten years.

(b) Mutilation of Corpses.—Following the preceding horrible group of perversions of the sexual instinct, which arise from hyperæsthesia and paræsthesia sexualis with retained virility, come naturally the necrophiles; for in these cases, just as with lustful murderers and analogous cases, an idea which in itself awakens a feeling of horror, and before which a healthy person would shudder, is accompanied by lustful feelings, 68and thus leads to the impulse to indulge in acts of necrophilia.

The cases of mutilation of bodies mentioned in literature seem to be pathological; but, with the exception of the celebrated one of Sergeant Bertrand (v. infra), they come far from being described and observed with exactness. In certain cases there may be nothing more than the possibility that unbridled desire sees in the idea of death no obstacle to its satisfaction. The seventh case mentioned by Moreau is perhaps such a one:—

A man, aged 23, attempted to rape a woman, aged 53. Struggling, he killed her and then violated her, threw her in the water, and fished her out again for renewed violation. The murderer was executed. The meninges of the anterior lobes were thickened and adherent to the cortex.

French writers have recorded numerous examples of necrophilia. Two cases concerned monks, where they were performing the watch for the dead. In a third case the subject was an idiot, who also suffered from periodical mania, and after commission of rape was sent to an insane asylum, and there mutilated female bodies in the mortuary.

In other cases, however, there is undoubtedly direct preference of a corpse to the living woman. When no other act of cruelty—cutting into pieces, etc.—is practiced on the cadaver, it is probable that the lifeless condition itself forms the stimulus for the perverse individual. It is possible that the corpse—a human form absolutely without will—satisfies an abnormal desire, in that the object of desire is seen to be capable of absolute subjugation, without possibility of resistance.

Brierre de Boismont (Gazette médicale, July 21, 1859) relates the history of a corpse-violator who, after bribing the watchman, had gained entrance to the corpse of a girl of sixteen, who belonged to a family of high social position. At night a noise was heard in the death-chamber, as if a piece of furniture had fallen over. The mother of the dead girl effected an entrance, and saw a man dressed in his night-shirt springing from the bed where the body lay. It was at first thought that the man was a thief, but the real explanation was soon discovered. It was afterward ascertained that the culprit, a man of good family, had often violated the bodies of young women. He was sentenced to imprisonment for life.

The story of a prelate, reported by Taxil (“La prostitution contemporaine,” p. 171), is of great interest as an example of 69necrophilia. From time to time he would visit houses of prostitution in Paris and order a prostitute, dressed in white like a corpse, to be laid out on a bed. At the appointed hour he would appear in the room, which, in the meantime, had been elaborately prepared as a room of mourning; then he would act as if reading a mass for the soul, and finally throw himself on the girl, who, during the whole time, was compelled to play the rôle of a corpse.^[52]

The cases in which the perpetrator injures and cuts up the corpse are clearer. Such cases come next to those of lust-murder, in that, in these individuals, cruelty, or at least an impulse to attack the female body, is connected with lust. It is possible that a remnant of moral sense deters from the cruel act on a living woman, and possibly the fancy passes beyond lust-murder and rests on its result, the corpse. Here, also, it is possible that the idea of defenselessness of the body plays a rôle.

Case 23. Sergeant Bertrand, a man of delicate physical constitution and of peculiar character; from childhood silent and inclined to solitude.

The details of the health of his family are not satisfactorily known; but the occurrence of mental diseases in his ancestry is ascertained. It is said that while he was a child he was affected with destructive impulses, which he himself could not explain. He would break whatever was at hand. In early childhood, without teaching, he learned to masturbate. At nine he began to feel inclinations toward persons of the opposite sex. At thirteen the impulse to sexual intercourse became powerfully awakened in him. He now masturbated excessively. When he did this his fancy always created a room filled with women. He would imagine that he carried out the sexual act with them, and then killed them. Immediately thereafter he would think of them as corpses, and of how he defiled them. Occasionally, in such situations, the thought of carrying out a similar act with male corpses would come up, but it was always attended with a feeling of disgust.

In time he felt the impulse to carry out such acts with actual corpses. For want of human bodies, he obtained those of animals. He would cut open the abdomen, tear out the entrails, and masturbate during the act. He declares that in this way he experienced inexpressible pleasure. In 701846 these bodies no longer satisfied him. He now killed dogs, and proceeded with them as before. Toward the end of 1846 he first felt the desire to make use of human bodies. At first he had a horror of it. In 1847, being by accident in a grave-yard, he ran across the grave of a newly-buried corpse. Then this impulse, with headache and palpitation of the heart, became so powerful that, although there were people near by, and he was in danger of detection, he dug up the body. In the absence of a convenient instrument for cutting it up, he satisfied himself by hacking it with a shovel.

In 1847 and 1848, during two weeks, as reported, the impulse, accompanied by violent headache, to commit brutalities on corpses, actuated him. Amidst the greatest dangers and difficulties, he satisfied this impulse some fifteen times. He dug up the bodies with his hands, in nowise sensible, in his excitement, to the injuries he thus inflicted on himself. When he had obtained the body, he cut it up with a sword or pocket-knife, tore out the entrails, and then masturbated. The sex of the bodies is said to have been a matter of indifference to him, though it was ascertained that this modern vampire had dug up more female than male corpses. During these acts he declares himself to have been in an indescribable state of sexual excitement. After having cut them up, he had sometimes reinterred the bodies.

In July, 1848, he accidentally came across the body of a girl of sixteen. Then, for the first time, he experienced a desire to carry out coitus on a cadaver. “I covered it with kisses and pressed it wildly to my heart. All that one could enjoy with a living woman is nothing in comparison with the pleasure I experienced. After I had enjoyed it for about a quarter of an hour, I cut the body up, as usual, and tore out the entrails. Then I buried the cadaver again.” Only after this, as B. declares, had he felt the impulse to use the bodies sexually before cutting them up, and thereafter he had done it in three instances. The actual motive of the exhuming of the bodies, however, was then, as before, to cut them up; and the enjoyment in so doing was greater than in using the bodies sexually. The latter act had always been nothing more than an episode of the principal one, and had never quieted his desires; therefore, he had always cut up the body afterward or mutilated another body. The medico-legal examiners gave an opinion of “monomania.” Court-martial sentence to one year’s imprisonment. (Michéa, Union méd., 1849; Lunier, Annal. méd.-psychol., 1849, p. 153; Tardieu, “Attentats aux moeurs,” 1878, p. 114; Legrand, “La folie devant les tribun.,” p. 524.)

(c) Injury of Women (Stabbing, Flagellation, etc.).—Following lust-murder and violation of corpses, come cases closely allied to the former, in which injury of the victim of lust and sight of the victim’s blood are a delight and pleasure for degenerate 71men. The notorious Marquis de Sade,^[53] after whom the combination of lust and cruelty has been named, was such a monster. Coitus only excited him when he could prick the object of his desire until the blood came. His greatest pleasure was to injure prostitutes and then bind their wounds.

Here also belongs the case of a captain mentioned by Brierre de Boismont, who always compelled the object of his affection to place leeches ad pudenda before coitus, which was very frequent. Finally this woman became very anæmic and, as a result of this, insane.

The following case, borrowed from my own clientele, very clearly shows the connection between lust and cruelty, with desire to shed and see blood:—

Case 24. Mr. X., aged 25; father syphilitic, died of paretic dementia; mother hysterical and neurasthenic. He is a weak individual, constitutionally neuropathic, and presents several anatomical signs of degeneration. When a child, hypochondria and imperative conceptions; later, constant alternation of exaltation and depression. While yet a child of ten, the patient felt a peculiar lustful desire to see blood flow from his fingers. Thereafter he often cut or pricked himself in the fingers, and took great delight in it. Very early, erections were added to this, and also if he saw the blood of others; for example, when he saw a servant-girl cut her finger it gave him an intense lustful feeling. From this time his vita sexualis became more and more powerful. Without any teaching he began to masturbate, and always during the act there were memory-pictures of bleeding girls. It now no longer sufficed him to see his own blood flow; he longed to see the blood of young females, especially those that were attractive to him. Often he could scarcely overcome the impulse to injure two cousins and a certain servant. But also young women that were in themselves not attractive induced this impulse when they excited him by some peculiarity of dress or adornment, especially coral jewelry. It was necessary for him to 72overcome these desires; but in his imagination bloody thoughts were constantly present, and induced lustful excitement. There was an inner relation existing between both thoughts and feelings. Often there were other cruel fancies. He imagined himself in the rôle of a tyrant who had the people shot in crowds with grape-shot. He was compelled to fancy a scene as it would be if enemies were to take a city and mutilate, torture, kill, and rape the young women. In times of quiet this patient, who had a mild disposition and was not morally defective, was shamed and horrified by such cruel, lustful fancies, and they always became immediately latent as soon as his sexual excitement had been satisfied by masturbation.

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 73first 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]

74Impotence 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 75cut 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.