Among civilized women, the author proceeds, this condition does not appear to subserve any useful purpose. "Let us, however, go back to aboriginal woman—to woman of the woods and the fields. Let us picture ourselves a young aboriginal Venus in one of her earliest hysterical paroxysms. In doing so, let us not forget some of the twelve characteristics previously mentioned. She will not be 'acting her part' alone, or, if alone, it will be in a place where someone else is likely soon to discover her. Let this Venus be now discovered by a youthful Apollo of the woods, a man with fully developed animal instincts. He and she, like any other animals, are in the free field of Nature. He cannot but observe to himself: 'This woman is not dead; she breathes and is warm; she does not look ill; she is plump and rosy.' He speaks to her; she neither hears (apparently) nor responds. Her eyes are closed. He touches, moves, and handles her at his pleasure. She makes no resistance. What will this primitive Apollo do next? He will cure the fit, and bring the woman back to consciousness, satisfy her emotions, and restore her volition—not by delicate touches that might be 'agonizing' to her hyperesthetic skin, but by vigorous massage, passive motions, and succussion that would be painless. The emotional process on the part of the woman would end, perhaps, with mingled laughter, tears, and shame; and when accused afterward of the part which the ancestrally acquired properties of her nervous system had compelled her to act, as a preliminary to the event, what woman would not deny it and be angry? But the course of Nature having been followed, the natural purpose of the hysterical paroxysm accomplished, there would remain as a result of the treatment—instead of one discontented woman—two happy people, and the possible beginning of a third."
"Natural, primary sexual hysteria in woman," King concludes, "is a temporary modification of the nervous government of the body and the distribution of nerve-force (occurring for the most part, as we see it to-day, in prudish women of strong moral principle, whose volition has disposed them to resist every sort of liberty or approach from the other sex), consisting in a transient abdication of the general, volitional, and self-preservational ego, while the reins of government are temporarily assigned to the usurping power of the reproductive ego, so that the reproductive government overrules the government by volition, and thus, as it were, forcibly compels the woman's organism to so dispose itself, at a suitable time and place, as to allow, invite, and secure the approach of the other sex, whether she will or not, to the end that Nature's imperious demand for reproduction shall be obeyed."
This perhaps rather fantastic description is not a presentation of hysteria in the technical sense, but we may admit that it presents a state which, if not the real physiological counterpart of the hysterical convulsion, is yet distinctly analogous to the latter. The sexual orgasm has this correspondence with the hysterical fit, that they both serve to discharge the nervous centres and relieve emotional tension. It may even happen, especially in the less severe forms of hysteria, that the sexual orgasm takes place during the hysterical fit; this was found by Rosenthal, of Vienna, to be always the case in the semiconscious paroxysms of a young girl whose condition was easily cured;[[286]] no doubt such cases would be more frequently found if they were sought for. In severe forms of hysteria, however, it frequently happens, as so many observers have noted, that normal sexual excitement has ceased to give satisfaction, has become painful, perverted, paradoxical. Freud has enabled us to see how a shock to the sexual emotions, injuring the emotional life at its source, can scarcely fail sometimes to produce such a result. But the necessity for nervous explosion still persists.[[287]] It may, indeed, persist, even in an abnormally strong degree, in consequence of the inhibition of normal activities generally. The convulsive fit is the only form of relief open to the tension. "A lady whom I long attended," remarks Ashwell, "always rejoiced when the fit was over, since it relieved her system generally, and especially her brain, from painful irritation which had existed for several previous days." That the fit mostly fails to give real satisfaction, and that it fails to cure the disease, is due to the fact that it is a morbid form of relief. The same character of hysteria is seen, with more satisfactory results for the most part, in the influence of external nervous shock. It was the misunderstood influence of such shocks in removing hysteria which in former times led to the refusal to regard hysteria as a serious disease. During the Rebellion of 1745-46 in Scotland, Cullen remarks that there was little hysteria. The same was true of the French Revolution and of the Irish Rebellion, while Rush (in a study On the Influence of the American Revolution on the Human Body) observed that many hysterical women were "restored to perfect health by the events of the time." In such cases the emotional tension is given an opportunity of explosion in new and impersonal channels, and the chain of morbid personal emotions is broken.
It has been urged by some that the fact that the sexual orgasm usually fails to remove the disorder in true hysteria excludes a sexual factor of hysteria. It is really, one may point out, an argument in favor of such an element as one of the factors of hysteria. If there were no initial lesion of the sexual emotions, if the natural healthy sexual channel still remained free for the passage of the emotional overflow, then we should expect that it would much oftener come into play in the removal of hysteria. In the more healthy, merely hysteroid condition, the psychic sexual organism is not injured, and still responds normally, removing the abnormal symptoms when allowed to do so. It is the confusion between this almost natural condition and the truly morbid condition, alone properly called hysteria, which led to the ancient opinion, inaugurated by Plato and Hippocrates, that hysteria may be cured by marriage.[[288]] The difference may be illustrated by the difference between a distended bladder which is still able to contract normally on its contents when at last an opportunity of doing so is afforded and the bladder in which distension has been so prolonged that nervous control had been lost and spontaneous expulsion has become impossible. The first condition corresponds to the constitution, which, while simulating the hysterical condition, is healthy enough to react normally in spite of psychic lesions; the second corresponds to a state in which, owing to the prolonged stress of psychic traumatism,—sexual or not,—a definite condition of hysteria has arisen. The one state is healthy, though abnormal; the other is one of pronounced morbidity.
The condition of true hysteria is thus linked on to almost healthy states, and especially to a condition which may be described as one of sex-hunger. Such a suggestion may help us to see these puzzling phenomena in their true nature and perspective.
At this point I may refer to the interesting parallel, and probable real relationship, between hysteria and chlorosis. As Luzet has said, hysteria and chlorosis are sisters. We have seen that there is some ground for regarding hysteria as an exaggerated form of a normal process which is really an auto-erotic phenomenon. There is some ground, also, for regarding chlorosis as the exaggeration of a physiological state connected with sexual conditions, more specifically with the preparation for maternity. Hysteria is so frequently associated with anæmic conditions that Biernacki has argued that such conditions really constitute the primary and fundamental cause of hysteria (Neurologisches Centralblatt, March, 1898). And, centuries before Biernacki, Sydenham had stated his belief that poverty of the blood is the chief cause of hysteria.
It would be some confirmation of this position if we could believe that chlorosis, like hysteria, is in some degree a congenital condition. This was the view of Virchow, who regarded chlorosis as essentially dependent on a congenital hyoplasia of the arterial system. Stieda, on the basis of an elaborate study of twenty-three cases, has endeavored to prove that chlorosis is due to a congenital defect of development (Zeitschrift für Geburtshülfe und Gynäkologie, vol. xxxii, Part I, 1895). His facts tend to prove that in chlorosis there are signs of general ill-development, and that, in particular, there is imperfect development of the breasts and sexual organs, with a tendency to contracted pelvis. Charrin, again, regards utero-ovarian inadequacy as at least one of the factors of chlorosis. Chlorosis, in its extreme form, may thus be regarded as a disorder of development, a sign of physical degeneracy. Even if not strictly a cause, a congenital condition may, as Stockman believes (British Medical Journal, December 14, 1895), be a predisposing influence.
However it may be in extreme cases, there is very considerable evidence to indicate that the ordinary anæmia of young women may be due to a storing up of iron in the system, and is so far normal, being a preparation for the function of reproduction. Some observations of Bunge's seem to throw much light on the real cause of what may be termed physiological chlorosis. He found by a series of experiments on animals of different ages that young animals contain a much greater amount of iron in their tissues than adult animals; that, for instance, the body of a rabbit an hour after birth contains more than four times as much iron as that of a rabbit two and a half months old. It thus appears probable that at the period of puberty, and later, there is a storage of iron in the system preparatory to the exercise of the maternal functions. It is precisely between the ages of fifteen and twenty-three, as Stockman found by an analysis of his own cases (British Medical Journal, December 14, 1895), that the majority of cases occur; there was, indeed, he found, no case in which the first onset was later than the age of twenty-three. A similar result is revealed by the charts of Lloyd Jones, which cover a vastly greater number of cases.
We owe to Lloyd Jones an important contribution to the knowledge of chlorosis in its physiological or normal relationships. He has shown that chlorosis is but the exaggeration of a condition that is normal at puberty (and, in many women, at each menstrual period), and which, there is good reason to believe, even has a favorable influence on fertility. He found that light-complexioned persons are more fertile than the dark-complexioned, and that at the same time the blood of the latter is of less specific gravity, containing less hæmoglobin. Lloyd Jones also reached the generalization that girls who have had chlorosis are often remarkably pretty, so that the tendency to chlorosis is associated with all the sexual and reproductive aptitudes that make a woman attractive to a man. His conclusion is that the normal condition of which chlorosis is the extreme and pathological condition, is a preparation for motherhood (E. Lloyd Jones, "Chlorosis: The Special Anæmia of Young Women," 1897; also numerous reports to the British Medical Association, published in the British Medical Journal. There was an interesting discussion of the theories of chlorosis at the Moscow International Medical Congress, in 1898; see proceedings of the congress, volume in, section v, pp. 224 et seq.).
We may thus, perhaps, understand why it is that hysteria and anæmia are often combined, and why they are both most frequently found in adolescent young women who have yet had no sexual experiences. Chlorosis is a physical phenomenon; hysteria, largely a psychic phenomenon; yet, both alike may, to some extent at least, be regarded as sexual aptitude showing itself in extreme and pathological forms.