II.

Hysteria and the Question of Its Relation to the Sexual Emotions—The Early Greek Theories of its Nature and Causation—The Gradual Rise of Modern Views—Charcot—The Revolt Against Charcot's Too Absolute Conclusions—Fallacies Involved—Charcot's Attitude the Outcome of his Personal Temperament—Breuer and Freud—Their Views Supplement and Complete Charcot's—At the Same Time they Furnish a Justification for the Earlier Doctrine of Hysteria—But They Must Not be Regarded as Final—The Diffused Hysteroid Condition in Normal Persons—The Physiological Basis of Hysteria—True Pathological Hysteria is Linked on to almost Normal States, especially to Sex-hunger.

The nocturnal hallucinations of hysteria, as all careful students of this condition now seem to agree, are closely allied to the hysterical attack proper. Sollier, indeed, one of the ablest of the more recent investigators of hysteria, has argued with much force that the subjects of hysteria really live in a state of pathological sleep, of vigilambulism.[[251]] He regards all the various accidents of hysteria as having a common basis in disturbances of sensibility, in the widest sense of the word "sensibility,"—as the very foundation of personality,—while anæsthesia is "the real sigillum hysteriæ." Whatever the form of hysteria, we are thus only concerned with a more or less profound state of vigilambulism: a state in which the subject seems, often even to himself, to be more or less always asleep, whether the sleep may be regarded as local or general. Sollier agrees with Féré that the disorder of sensibility may be regarded as due to an exhaustion of the sensory centres of the brain, whether as the result of constitutional cerebral weakness, of the shock of a violent emotion, or of some toxic influence on the cerebral cells.

We may, therefore, fitly turn from the auto-erotic phenomena of sleep which in women generally, and especially in hysterical women, seem to possess so much importance and significance, to the question—which has been so divergently answered at different periods and by different investigators—concerning the causation of hysteria, and especially concerning its alleged connection with conscious or unconscious sexual emotion.[[252]]

It was the belief of the ancient Greeks that hysteria came from the womb; hence its name. We first find that statement in Plato's Timæus: "In men the organ of generation—becoming rebellious and masterful, like an animal disobedient to reason, and maddened with the sting of lust—seeks to gain absolute sway; and the same is the case with the so-called womb, or uterus, of women; the animal within them is desirous of procreating children, and, when remaining unfruitful long beyond its proper time, gets discontented and angry, and, wandering in every direction through the body, closes up the passages of the breath, and, by obstructing respiration,[[253]] drives them to extremity, causing all varieties of disease."

Plato, it is true, cannot be said to reveal anywhere a very scientific attitude toward Nature. Yet he was here probably only giving expression to the current medical doctrine of his day. We find precisely the same doctrine attributed to Hippocrates, though without a clear distinction between hysteria and epilepsy.[[254]] If we turn to the best Roman physicians we find again that Aretæus, "the Esquirol of antiquity," has set forth the same view, adding to his description of the movements of the womb in hysteria: "It delights, also, in fragrant smells, and advances toward them; and it has an aversion to fœtid smells, and flies from them; and, on the whole, the womb is like an animal within an animal."[[255]] Consequently, the treatment was by applying fœtid smells to the nose and rubbing fragrant ointments around the sexual parts.[[256]]

The Arab physicians, who carried on the traditions of Greek medicine, appear to have said nothing new about hysteria, and possibly had little knowledge of it. In Christian mediæval Europe, also, nothing new was added to the theory of hysteria; it was, indeed, less known medically than it had ever been, and, in part it may be as a result of this ignorance, in part as a result of general wretchedness (the hysterical phenomena of witchcraft reaching their height, Michelet points out, in the fourteenth century, which was a period of special misery for the poor), it flourished more vigorously. Not alone have we the records of nervous epidemics, but illuminated manuscripts, ivories, miniatures, bas-reliefs, frescoes, and engravings furnish the most vivid iconographic evidence of the prevalence of hysteria in its most violent forms during the Middle Ages. Much of this evidence is brought to the service of science in the fascinating works of Dr. P. Richer, one of Charcot's pupils.[[257]]

In the seventeenth century Ambroise Paré was still talking, like Hippocrates, about "suffocation of the womb"; Forestus was still, like Aretæus, applying friction to the vulva; Fernel was still reproaching Galen, who had denied that the movements of the womb produced hysteria.

It was in the seventeenth century (1618) that a French physician, Charles Lepois (Carolus Piso), physician to Henry II, trusting, as he said, to experience and reason, overthrew at one stroke the doctrine of hysteria that had ruled almost unquestioned for two thousand years, and showed that the malady occurred at all ages and in both sexes, that its seat was not in the womb, but in the brain, and that it must be considered a nervous disease.[[258]] So revolutionary a doctrine could not fail to meet with violent opposition, but it was confirmed by Willis, and in 1681, we owe to the genius of Sydenham a picture of hysteria which for lucidity, precision, and comprehensiveness has only been excelled in our own times.