Hysteria and certain allied conditions, their nature and treatment, with special reference to the application of the rest cure, massage, electrotherapy, hypnotism, etc

Front matter

Chap..: — J. Copyrighrao.'...

1?*4

UNiTED STATES OF AMERICA.

Preface

At this day, when the fecundity of the medical press is so great, it behooves an author to offer a reason, an excuse, or an apology for bringing forth a new book. In regard to this volume there are two reasons that may, perhaps, be deemed sufficiently weighty to warrant its appearance. The first of these reasons is too obvious to require elaboration ; namely, the importance of the subject. Every day in his rounds the physician meets with some phase of hysteria. Sometimes the diagnosis can be made at the threshold of the door, but at other times it is difficult in the extreme — a common disease, often a puzzling disease, always difficult to manage.

The second reason is that, while there exists an immense amount of literature on hysteria, there is no recent book in English on the subject. Of course, it is treated of in works on general medicine, but rarely with the minuteness that the importance of the subject warrants.

The object of this little volume is to present the symptomatology and differential diagnosis of hysteria in as concise a manner as possible, and to indicate the various therapeutic measures that have iv PREFACE.

been found useful in the treatment of this disorder. The general practitioner, for whom this book is especially intended, not only wants to know to what class of cases the rest cure, massage, electricity, etc., are applicable, but also how these important therapeutic measures are to be carried out. Hence the sections on these and other modes of treatment are prepared with some attention to detail. A few conditions are discussed which, strictly speaking, do not belong to hysteria, but are very closely allied to this neurosis.

It was intended at first to illustrate certain phases of hysteria by original photographs, but these were found to be much inferior to, and far less typical than, the beautiful drawings of Richer which have been used. The diagrams have been taken some from the works of Gilles de la Tourette, others from Charcot.

A large amount of literature on the subject of hysteria has been reviewed and references given to the most important publications

The author will be more than satisfied if this little volume will contribute its mite toward furthering the work of that most important of all physicians, the general practitioner.

8ig Charles Street, N.

Contents

Chap. Page

I. Historical, 9

II. The Nature of Hysteria ; Etiology and Pathology, 29

Chapter I. Historical

The opinions and observations of men living at different periods of the world's history concerning some one subject form an interesting and often useful part of the study of such subject. There is much to be gained by thus following out the evolution of some general principle. At first sight it would seem a useless and empty labor to gather up the historical fragments of some scientific truth, since science has experienced such frequent and violent cataclysms, shaking her very foundations and changing completely the points of view. Yet even in science this retrospection is not without its uses. Our grasp of a subject is apt to be more comprehensive and the expression of our opinion less dogmatic if we have followed its history through the various phases of its development. Of all the branches of science, medicine has perhaps suffered the most sudden arid startling changes. The discovery of some new principle is revolutionary, and many of the observations made under the influence

2 9 io HYSTERIA: ITS NATURE AND TREATMENT.

of the old principles are rendered valueless. In spite of this fact, however, the study of the history of medicine is eminently suggestive, and consequently of great value.

A goodly volume would be required to do anything like justice to the history and literature of hysteria, and the sketch here given embraces only the barest outlines. If we consider the nature and frequency of hysteria, and the varied and striking phenomena which characterize it, we are not surprised to find it mentioned in the earliest medical writings. Hippocrates describes the affection in his ' k De Yirmnibus," and makes allusions to it in his " Prognostics." Sydenham * quotes a letter from Democritus to Hippocrates relative to hysteria. Aretaeus,f whose date is uncertain, but who probably lived in the latter part of the second century, while holding very remarkable views as to the etiology of hysteria, describes many of its characteristic symptoms. Celsus (" De Vulvae Morbo ") and Galen (" De Locis Affectis ") both give brief accounts of the disorder.

Throughout the centuries preceding the middle ages we find no additions to the literature of hysteria. The science of medicine was at a low ebb, and the teachings of Galen prevailed with little change for many centuries. With the middle ages came a curious and interesting manifestation of hysteria.

"* Rush's translation.

f " De Causis et Signis Morborum.

HISTORICAL. ii

Previous to this time hysteria appeared only in its simpler forms, but during the middle ages, and, in fact, coming down to our own time, occurred outbreaks of what may be regarded as epidemic hysteria. That these phenomena were not at the time regarded as hysterical manifestations is quite certain. The denseness of the superstition of the time and the unbridled power of priestcraft must be taken as the explanation both of the curious hysterical or psychic phenomena, and also of the failure in great part of the physicians of the day to recognize them as such. Many of these epidemics of hysteria were closely related to the religious notions at that time prevalent, either as to cause or cure, and it must be borne in mind that religious superstition was the most intense passion of the time of which we are speaking. Among the earliest of these hysterical epidemics was that curious and fantastic dancing mania known as the dance of Saint John.

The following description is taken from Hecker's * interesting work : "In 1334 were seen in France and Germany bands of men and women marching hand in hand in the streets, dancing furiously until they fell prostrate. They appeared entirely insensible to their surroundings, shrieking out the names of saints and leaping high in the air. The fits often resembled epilepsy, the subjects of them falling senseless, foaming at the mouth, and exhibiting grimaces and contortions of the body. A prominent symptom

* " The Epidemics of the Middle Ages." Tr. Babington, 1835.

was a marked condition of tympany, the abdomen being often enormously distended. If in any way this tympany could be relieved the fits generally came to an end. Many of the dancers wore belts into which sticks were stuck, which were twisted to produce compression, or some sympathetic friend would kick the affected person violently in the abdomen. This latter practice, as the old chroniclers relate, caused the custom of wearing sharppointed shoes, then in vogue, to be abandoned. Red colors so infuriated the dancers that in some towns the wearing of red garments was prohibited by law. The populace all turned out to witness these processions of dancers, who were supposed to be possessed of demons."

These epidemics spread with fearful rapidity, whole towns or cities becoming affected. The origin of the name, and perhaps of the dance itself, grew out of the orgies held upon Saint John's Day, and toward the close of these epidemics, that is after several years, these scenes took place only at or near the occurrence of this festival. In 141 8 Strasburg was visited by a dancing mania, known as the dance of Saint Vitus, from the fact that those affected found relief and cure at the shrine of this saint. Somewhat similar to the dancing manias mentioned above was the dance of Saint Guy. Some time before the occurrence of the epidemics which have been spoken of, in the year 1237, at Erfurt, a violent dancing mania seized the children of the town, many of whom are reported to have died from its effects, and others to have had a tremor to the end of their lives. Paracelsus describes these epidemics, stating that in some persons it took the form of immoderate and uncontrollable laughter, while in others it manifested itself in running, dancing, and other movements. In most of the epidemics the dancers were greatly affected by music, and the magistrates were accustomed to hire musicians to play for them, and also robust persons to dance with them until they were utterly exhausted and fell to the ground. Another epidemic which spread through Italy at this same epoch was the Tarentism. The cause of this epidemic was popularly supposed to be the bite of the tarantula, a species of spider. Baglivi* gives a minute account of the effects supposed to be produced by the bite of this insect. It is somewhat significant that in speaking of the persons who inhabited the region where this species of spider is found, Baglivi describes them as "irascible, impatient, and subject to insomnia," together with other symptoms of nervous instability. Hecker (loc. cit.) } in describing the symptoms of Tarentism, gives a fairly recognizable picture of hysteria. These persons, he says, were melancholy at times, again laughing, and often maniacal. They passed large quantities of pale urine, and were affected with loss of voice, blindness, and vertigo. The theory upon which this dance was founded was that the poison of the spider was eliminated through the pores of the skin, and hence some active ex-

* "Opera Omnia." Ed. 1788.

ercise was necessary to promote the free action of the perspiration. Music had a very soothing effect upon these persons, and the notes of some of the tunes are still extant. A dance similar to the Tarentism, called the Tigretier, is said to have been practised in Abyssinia from early times.* Throughout the middle ages, and, in fact, coming down to modern times, were to be seen epidemics of hysteria which differed more or less in their minute details, but conformed to the general type of hysterical disorders. These epidemics sometimes took the form of catalepsy or trance ; sometimes the form of more or less perfectly developed hystero-epilepsy. Again, the prominent symptoms were mental, associated with hallucinations and delusions. The most notable of these epidemics occurred in, or took their origin from, the convents. Youth, seclusion from the ordinary avocations of life, and the dominance of strong religious beliefs, amounting at this era to rank superstition, furnished the most favorable conditions possible for the growth and development of hysteria.

A few examples will illustrate the form of hysteria which flourished in the convents of Europe during this period. In 1609, to quote Richet,*)* — to whose work the reader is referred for a most interesting and complete account of these epidemics, — there occurred a demoniac possession among the nuns of

St. Ursula at Aix. Some of the symptoms were " hallucinations, impulsive movements, a horror of the confessional, suicidal tendencies," etc. The usual form of the delusion was that of demoniac possession. The nuns declared that Satan entered into their chambers, commanding them to commit sinful and shameful actions and forbidding confessional. At Loudun, in 1632, was enacted a drama of hysteria terrible in its denouement. The Sister Superior declared that she had been visited at night in her chamber by the phantom of a priest of the village, Urbain Grandier by name. During the first visits this demon in human shape hinted at certain revelations of religious secrets and religious mysteries which his power would reveal. Upon subsequent visits the demon made unholy propositions to the sister, declared his love for her, and overpowered her with caresses.

Very soon, one after another of the nuns of this convent declared that they in like manner were nightly visited by the apparition of Urbain Grandier, and described in the most glowing and shameful terms the amorous expressions and lascivious actions of the priest. The contagion spread to the women of the village, who testified at the trial that Grandier had made improper proposals to them during confessional. An immense amount of testimony was taken at this trial, the nature of which might have put Rabelais to the blush. The unfortunate priest, concerning whom there had never before been a breath of reproach, w T as condemned to death and executed.

The demoniac possession of Louviers in 1642 resembled in most respects that of Loudun. The unfortunate victims of this epidemic of hysteria had hallucinations of all the senses; they had visions of lighted torches, balls of fire, fantastic animals, or imaginary personages. Sounds of blasphemies or lascivious words and horrible suggestions rung in their ears. These subjective symptoms were often accompanied by convulsions, contractures, loss of consciousness, and the like. These young persons were for the most part girls of the best families, well educated and consecrated to a religious life.

In the year 1491 was seen a curious epidemic of hysteria in a convent at Cambrai. The nuns were horribly tormented by demons ; those thus affected ran about the fields like dogs, threw themselves in the air in imitation of birds, climbed trees like cats, and hung from the branches. They made all kinds of queer sounds, mostly in imitation of the cries of animals. They also professed the power of divination. The persons in authority, both temporal and spiritual, were in the habit of questioning these afflicted persons, and by certain exorcisms extorted confessions from them, which confessions were believed to be the veritable words of the Evil One. In the epidemic just spoken of the devil, in the form of one of the afflicted nuns, confessed that he had obtained admission into the convent by the aid of one of the sisters who had submitted to his embraces in the cloisters. The demons were exorcised by sending the names of the persons possessed to Rome, where they were read out at mass by the Pope himself.

Throughout the latter part of the fifteenth and early part of the sixteenth centuries occurred curious epidemics of demon worship. These took various forms and showed themselves, now as epidemics, now in isolated cases. The general features, either in the case of the epidemic or isolated form, were substantially the same. There was supposed to be a compact with the devil, formed in some mysterious way, and this compact required implicit obedience to the Satanic will. Many horrible instances of infant murder and anthropophagism are related by the old chroniclers. The civil authorities, stimulated by the priests, were eager in hunting out these demoniacs and putting them to death.

It is a very suggestive fact that sexual perversion played a prominent part in these demoniac possessions. Women declared under oath that they had visited the midnight orgies of the demons and witches and had been violated by demons. They described in disgusting detail and with shocking minuteness the sexual organs of the devil and his peculiar modes of cohabitation. One of the old writers naively remarks that fortunately this intercourse was never fruitful. In 1550 the nuns of the convent of Uvertet were seized with epidemic hysteria. The attacks began with hallucinations of various kinds. Thev declared that they were awakened by feeling themselves being drawn out of bed by the feet, and when they reached the floor the most violent convulsions would come on, so violent that the persons about them had great difficulty in restraining them ; pale urine was voided in enormous quantities. One very curious hallucination which characterized this epidemic was the sensation of being tickled on the soles of the feet, and this caused immoderate and uncontrollable laughter. A very harmless lady living in the neighborhood was, for no reason, supposed to be in league with the devil and the cause of this possession. The torture was applied to her, resulting, as it often did, in death. This epidemic lasted about three years, and it is curious to note that at the time of the subsidence of the epidemic, or, rather, immediately before its subsidence, it was thought best to refuse the public admission to the convent. It was the custom for large numbers of persons to go to the convent to witness the supposed manifestations of the devil, and the power of religion in overcoming the Evil One. Just as soon as the public were excluded the epidemic came to an abrupt conclusion. It is also curious to note that this coincidence attracted no attention, not even from the medical men, so absolute was the power of religious dogmas, so dense was the superstition of that period.

The nuns of St. Brigette were attacked with a similar affection ; they imitated the cries of animals, and were frequently seized with a constriction of the throat, so severe as to prevent their taking food. The first one of the inmates of the convent to be affected was a young girl who took the veil on account of an unfortunate love affair. This epidemic lasted ten years. The epidemic which took possession of the nuns of Kintorp, near Strasburg, was at first attributed to epilepsy. The persons affected fell to the £round, lost consciousness, bit and tore their clothing. As soon as one was seized it was a signal for the rest who were in the same apartment. They complained of a burning sensation in the soles of the feet, likening it to contact with boiling water. Here, as elsewhere, innocent persons were accused of being in league with the devil and causing the attacks. The cook of the convent and her mother were convicted and burned at the stake. The epidemic of the nuns of the convent of Nazareth at Cologne, in 1560, was notable for the prominent part played by sexual hallucinations, the nuns declaring that the demons came into their beds at night. At Amsterdam, in 1566, there appeared an epidemic of hysteria, similar to the epidemics that have been described, in an orphan asylum, the inmates being mostly boys. This epidemic was characterized by convulsive seizures, vomiting of foreign substances, such as nails, needles, bits of thread, wool, etc. There was noted in this epidemic a feature which was very common in the later epidemics, namely, the use of apparently unknown languages. Boys, who were not supposed to be acquainted with any other language than their own, spoke Latin or Greek with apparent fluency. This was the first epidemic of this kind among males, all the others before alluded to being confined to the opposite sex. In the province of Lorraine, in the space of fifteen years,

Remy, who was the public prosecutor, caused to be put to death no less than 900 persons accused of being devil worshipers.

To show that epidemic hysteria was not confined to Southern nations, the epidemic of Elfdalem, in Sweden, may be mentioned. Bekker, quoted by Calmeil,* describes this epidemic, which did not differ materially from those of France and Italy, except so far as the imagination of the North lacks the tropical luxuriance of the South. The details of the epidemic of Sweden necessarily differed somewhat from that of the Southern races, since the surroundings, the religion, and, above all, the mythology or superstition of the people, differs so greatly. The tribunal which was appointed by the king of Sweden to take action upon this supposed demoniac possession, condemned to death more than 80 persons and punished more lightly a large number of others. This was very heroic treatment, but in this particular instance was effective. In many other instances, perhaps we may say generally, rigorous persecution rather augmented than caused any abatement in the hysterical fury.

The practice of flagellation, f which began as a religious observance and can be traced to very early times, became, in the middle ages, a veritable hysterical epidemic. In 1260, through the influence of a monk named Rainer, an epidemic of flagellation

*"De la Folic"

f " Encyl. Brittan.," vol. IX.

spread through Italy, and thence through a large part of Europe. Vast crowds of men, women, and children, from every rank of society, marched through the country, furiously lashing themselves with leathern thongs. Pilgrimages were started, every village or city visited contributing its quota. So furious were these epidemics that edicts, both secular and religious, were issued against them. Many of the Crusades, especially the Children's Crusade, might, without doing violence to our subject, be ranked as hysterical manifestations. Certain it is that hysteria played a very prominent part in these uncontrollable relioious movements.

The hysterical phenomenon of stigmatization, or the appearance of wounds in the hands, feet, and side, resembling more or less closely the description given in the Scriptures of the wounds of Christ, have been made the subject of careful study, both from a scientific as well as from a theological standpoint. Cases of stigmatization are frequent, both in early and late literature. A very interesting review of this subject, by the Rev. Richard Wheatley,* traces the phenomenon from its earliest authentic instances down to modern times. Among the first stigmatists was St. Francis d'Assisi, in Italy, in 1224. This saint prayed that he might be allowed to suffer crucifixion like Christ, and immediately after one of his fervent prayers his feet, hands, and side showed the characteristic bleeding wounds. Christine de Stumbele,

* Popular Science Monthly, vol. XXXIII.

in 1242, Veronica Giulani, in 1727, Catherin Emmerich, in 181 1, Pal ma d' Oria, in 1 87 1, are among the notable examples. One of the latest cases, and one that was carefully observed, is that of Louise Lateau, in Belgium. This case attracted great attention, and has been so often described that it is too well known to make any reference to it. The cases mentioned are only the most notable ones, since the religious records show more than 100. While a few of these cases were evidences of purpura hemorrhagica, or some similar affection, the great majority were the grossest forms of deception, encouraged often by overzealous priests, and accepted by a people sunk in crass superstition.

The vampirism of Poland and Hungary, in 1740, was a wide-spread hallucination that certain specters came at night and sucked the blood. This superstition is, of course, very ancient, and can be found in the folk-lore of almost all peoples, but in the two countries mentioned, and at the time alluded to, the superstition amounted almost to an epidemic of hysteria.

In the history of our own country we would not expect to find records of wide-spread epidemics of hysteria. At the time of the first settlement of America the progress of civilization had materially lessened this form of hysteria ; superstition was not as rank, the power and influence of religion not as undisputed. Added to this, the country was very sparsely settled for so many decades, thus allowing little social intercourse, and the character of the early settlers, together with their active mode of life, was by no means that which favored the development of epidemic hysteria. Although the epidemfc form of hysteria was not often seen, the minds of the people were imbued with a belief in the miraculous, and this took the form of a demoniac possession, or, in other words, witchcraft. That many of the unfortunate persons burnt as witches were entirely innocent of any belief in witchcraft is certain, but a large number of the accused not only believed in the diabolic possession, the compact with the devil, the power to cast spells and to foretell the future, in short, to act as the special agent of His Satanic Majesty, but they sealed their belief with their blood. These persons were unquestionably hysterics ; the convulsions, the hallucinations, the well-known anesthetic condition of their bodies, all these recorded facts point unmistakably to hysteria. In regard to this latter symptom, the test for witches, or, as they were called on the continent of Europe during the middle ages, persons possessed of the devil, was made by blindfolding the accused one and with a needle ascertaining whether there were any spots on the body where the skin could be pierced without causing any evidence of sensation ; this, by the way, being a very commonly resorted to test for hysteria to-day. Dr. Andrew D. White, in his " New Chapters in the Warfare of Science," says in regard to the witchcraft and like hysterical phenomena of puritan New England :

"The life of the early colonists in New England was such as to give rapid growth to the germs of the doctrine of possession brought from the mother country. Surrounded by the dark pine forests, having as their neiehbors Indians, who were more than suspected of being children of Satan, harassed by wild beasts apparently sent by the powers of evil to torment the elect, with no varied literature to while away the long winter evenings, with few amusements save neighborhood- quarrels, dwelling intently on every text of Scripture which supported their gloomy theology, and adopting its most literal interpretation, it is not strange that ideas regarding the darker side of nature were rapidly developed."

More closely akin to epidemic hysteria, in fact a distinct phase of it, were the orgies enacted at the religious revivals of Kentucky and Tennessee in the early part of this century. Dr. Felix Robertson * gives a very interesting account of one of these early "revivals" in Tennessee in the year 1803. The ecstatic state, or as we would undoubtedly call it now hysterical state, into which so many persons passed, was regarded as- a favorable visitation of the Deity, as a special gift of the Spirit. The ages of those affected varied from six to sixty, but by far the greater number affected were young women. The paroxysm continued for an hour or more, and consisted of violent trembling and shaking, accompanied with loud groans and cries. At other times there would be "jerks," — sudden inclinations of the head

* Phila. Med. and Phys. Journal, vol. II, 1805.

continuing for a quarter of an hour or longer. Sometimes the affected person would leap high in the air or run violently and aimlessly until exhausted. Other symptoms were dancing, singing, labored respiration, lethargy, etc. Anesthesia was very generally present and excited much comment. Yandell * gives a graphic account of similar epidemics in Kentucky about the same period.

At one meeting it was computed that no less than 3000 persons fell to the ground in convulsions. A quotation from Dr. Davidson shows how wide-spread the epidemic was, resembling in this respect some of those of the middle ages. The same author paints in striking language the impressive scenes enacted at these early and primitive religious gatherings: " The glare of the camp fires falling on a dense assemblage of heads simultaneously bowed in prayer, hundreds of candles suspended from the trees, the solemn chanting of hymns, the impassioned exhortations, the sobs, shrieks, or shouts, the sudden spasms which seized upon scores and dashed them to the ground, all conspired .not only to invest the scene with terrific interest, but to work up to the highest pitch of excitement the feelings of all present." Granade, a celebrated exhorter, says that at one of his meetings "the people fell as if slain by a mighty weapon, and lay in such piles and heaps that it was feared they would suffocate, and that in the woods." Catalepsy, convulsions, mimicry of ani-

* " Brain," vol. IV.

mals, a peculiar laugh, called the " holy laugh," were some of the most notable symptoms.

Epidemics of hysteria have often been observed among the North American Indians, the most striking examples, perhaps, being the "ghost dance," the " Messiah dance," etc., which have been described in some of the late magazines.

Hysteria plays a very important part in the " camp meetings " and "revivals " of the negroes. A former student of mine, Dr. S. W. Welch, of Alabama, has kindly given me some instances that have fallen under his observation, of hysteria in the negro. The " camp meetings " usually lasted for two weeks or longer, being terminated by the commencement of the cotton picking. Besides the usual shouting, dancing, singing, and such-like performances, there appeared an epidemic of catalepsy, or, as the negroes called it, " trance."

After recovering from this " trance " wonderful accounts were given of the things seen and heard. One example will sufficiently illustrate the vividness of the negro imagination. A negro girl about sixteen years of age, after awakening from a "trance," told Dr. Welch that she had walked a two-inch plank over the abyss of hell. Below she saw the blue flames, and the "Old Boy" piling fuel around the sinners' heads. Conspicuous among these latter was the figure of a gentleman of the community, who had recently died, and who was noted for his profanity and cruelty to the negroes. She made a safe escape, although the devil reached after her and was so

HISTORICAL.

close that she could see his Ion or claws. She then found herself in a golden street, and in the distance saw God sitting upon a white throne, with Jesus on His right hand and " Old Miss Jesus " on His left. Upon being interrogated as to what " Miss Jesus " looked like, she replied that " Miss Jesus " had long white hair like "Old Miss" (a saintly old lady who had formerly owned the girl).

It is very interesting to compare such accounts as this with the hysterical visions of the middle ages.

Apart from these wild outbursts of epidemic hysteria of which we have been speaking — -this accentuation of the hysterical state — we find frequent and important mention in the literature of the ages past of the milder forms of the malady. We find certain diseases, such, for example, as blindness, deafness, paralysis, and the like, cured by the laying on of bands of the Irishman, Greatrakes, or by a pilgrimage to a famous shrine, such as the tomb of Francois, the " diacre Paris." The kind's touch and the wonderful cures wrought by it, not only of the king's evil, but of diverse diseases, all of which bear a close resemblance to hysterical symptoms, show us how common such conditions were. The method employed, and the instantaneousness of the cure, according to the old chronicles, fully warrant us in regard in o- these so-called diseases as evidences of hysteria.