After a few years the patient became neurasthenic. Then simple imaginary representation of blood and scenes of blood was sufficient to induce ejaculation. In order to free himself from his vice and his cruel imagination, he began to indulge in sexual intercourse with females. Coitus was possible, but only when the patient called up the idea that the girl’s fingers were bleeding. Without the assistance of this idea no erection was possible. The cruel thought of cutting was limited to the woman’s hand. At times of greatest sexual excitement, simply the sight of the hand of an attractive woman was sufficient to induce violent erections. Frightened by the popular stories about the injurious results of onanism, he abstained and fell into a condition of severe general neurasthenia, with hypochondriacal dysthymia and tædium vitæ. Careful and watchful medical treatment cured the patient after a few months. He has remained mentally well three years; but now, as before, he is very sensual, though it is very seldom that he is troubled by his earlier bloody ideas. X. has given up masturbation entirely. He finds satisfaction in natural sexual indulgence, is virile, and it is no longer necessary for him to call up ideas of blood. The following case, reported by Tarnowsky (_op. cit._, p. 61), shows that such lustful, cruel impulses may be simply episodical, and occur in certain exceptional states of mind in neurotic individuals:— Case 25. Z., physician; neuropathic constitution, reacting badly to alcohol. Under ordinary circumstances capable of normal coitus, as soon as he has indulged in wine he finds that his increased libido is no longer satisfied by simple coitus. In this condition he is compelled to prick the nates puellæ or to make stabs with the lancet, to see blood, and feel the entrance of the blade into the living body, in order to have ejaculation and experience complete satiety of his lust. The majority of those afflicted with this form of the perversion seem insensible to the normal stimulus of woman. In the first case (24), the assistance of the idea of blood was necessary in order to obtain erection. The following case is that of a man who, by masturbation, etc., in early youth, had diminished his power of erection so that the sadistic act took the place of coitus: