belief; such disturbance of the nervous system might or might not be
caused, but in any case the alleged "degradation" could only be the
fiction of a distorted imagination. Again, confusion had been caused by
the ancient error of making the physical sexual organs responsible for
hysteria, first the womb, more recently the ovaries; the outcome of this
belief was the extirpation of the sexual organs for the cure of hysteria.
Charcot condemned absolutely all such operations as unscientific and
dangerous, declaring that there is no such thing as hysteria of menstrual
origin.[265] Subsequently, Angelucci and Pierracini carried out an
international inquiry into the results of the surgical treatment of
hysteria, and condemned it in the most unqualified manner.[266] It is
clearly demonstrated that the physical sexual organs are not the seat of
hysteria. It does not, however, follow that even physical sexual desire,
when repressed, is not a cause of hysteria. The opinion that it was so
formed an essential part of the early doctrine of hysteria, and was
embodied in the ancient maxim: "_Nubat illa et morbus effugiet_." The
womb, it seemed to the ancients, was crying out for satisfaction, and when
that was received the disease vanished.[267] But when it became clear that
sexual desire, though ultimately founded on the sexual apparatus, is a
nervous and psychic fact, to put the sexual organs out of count was not
sufficient; for the sexual emotions may exist before puberty, and persist
after complete removal of the sexual organs. Thus it has been the object
of many writers to repel the idea that unsatisfied sexual desire can be a
cause of hysteria. Briquet pointed out that hysteria is rare among nuns
and frequent among prostitutes. Krafft-Ebing believed that most
hysterical women are not anxious for sexual satisfaction, and declared
that "hysteria caused through the non-satisfaction of the coarse sensual
sexual impulse I have never seen,"[268] while Pitres and others refer to
the frequently painful nature of sexual hallucinations in the hysterical.
But it soon becomes obvious that the psychic sexual sphere is not confined
to the gratification of conscious physical sexual desire. It is not true
that hysteria is rare among nuns, some of the most tremendous epidemics of
hysteria, and the most carefully studied, having occurred in
convents,[269] while the hysterical phenomena sometimes associated with
revivals are well known. The supposed prevalence among prostitutes would
not be evidence against the sexual relationships of hysteria; it has,
however, been denied, even by so great an authority as Parent-Duchatelet
who found it very rare, even in prostitutes in hospitals, when it was
often associated with masturbation; in prostitutes, however, who returned
to a respectable life, giving up their old habits, he found hysteria
common and severe.[270] The frequent absence of physical sexual feeling,
again, may quite reasonably be taken as evidence of a disorder of the
sexual emotions, while the undoubted fact that sexual intercourse usually
has little beneficial effect on pronounced hysteria, and that sexual
excitement during sleep and sexual hallucinations are often painful in
the same condition, is far from showing that injury or repression of the
sexual emotions had nothing to do with the production of the hysteria. It
would be as reasonable to argue that the evil effect of a heavy meal on a
starving man must be taken as evidence that he was not suffering from
starvation. The fact, indeed, on which Gilles de la Tourette and others
have remarked, that the hysterical often desire not so much sexual
intercourse as simple affection, would tend to show that there is here a
real analogy, and that starvation or lesion of the sexual emotions may
produce, like bodily starvation, a rejection of those satisfactions which
are demanded in health. Thus, even a mainly _a priori_ examination of the
matter may lead us to see that many arguments brought forward in favor of
Charcot's position on this point fall to the ground when we realize that
the sexual emotions may constitute a highly complex sphere, often hidden
from observation, sometimes not conscious at all, and liable to many
lesions besides that due to the non-satisfaction of sexual desire. At the
same time we are not thus enabled to overthrow any of the positive results
attained by Charcot and his school.

It may, however, be pointed out that Charcot's attitude toward hysteria
was the outcome of his own temperament. He was primarily a neurologist,
the bent of his genius was toward the investigation of facts that could be
objectively demonstrated. His first interest in hysteria, dating from as
far back as 1862, was in hystero-epileptic convulsive attacks, and to the
last he remained indifferent to all facts which could not be objectively
demonstrated. That was the secret of the advances he was enabled to make
in neurology. For purely psychological investigation he had no liking, and
probably no aptitude. Anyone who was privileged to observe his methods of
work at the Salpetriere will easily recall the great master's towering
figure; the disdainful expression, sometimes, even, it seemed, a little
sour; the lofty bearing which enthusiastic admirers called Napoleonic. The
questions addressed to the patient were cold, distant, sometimes
impatient. Charcot clearly had little faith in the value of any results so
attained. One may well believe, also, that a man whose superficial
personality was so haughty and awe-inspiring to strangers would, in any
case, have had the greatest difficulty in penetrating the mysteries of a
psychic world so obscure and elusive as that presented by the
hysterical.[271]

The way was thus opened for further investigations on the psychic side.
Charcot had affirmed the power, not only of physical traumatism, but even
of psychic lesions--of moral shocks--to provoke its manifestations, but
his sole contribution to the psychology of this psychic malady,--and this
was borrowed from the Nancy school,--lay in the one word "suggestibility";
the nature and mechanism of this psychic process he left wholly
unexplained. This step has been taken by others, in part by Janet, who,
from 1889 onward, has not only insisted that the emotions stand in the
first line among the causes of hysteria, but has also pointed out some
portion of the mechanism of this process; thus, he saw the significance of
the fact, already recognized, that strong emotions tend to produce
anaesthesia and to lead to a condition of mental disaggregation, favorable
to abulia, or abolition of will-power. It remained to show in detail the
mechanism by which the most potent of all the emotions effects its
influence, and, by attempting to do this, the Viennese investigators,
Breuer and especially Freud, have greatly aided the study of
hysteria.[272] They have not, it is important to remark, overturned the
positive elements in their great forerunner's work. Freud began as a
disciple of Charcot, and he himself remarks that, in his earlier
investigations of hysteria, he had no thought of finding any sexual
etiology for that malady; he would have regarded any such suggestion as an
insult to his patient. The results reached by these workers were the
outcome of long and detailed investigation. Freud has investigated many
cases of hysteria in minute detail, often devoting to a single case over a
hundred hours of work. The patients, unlike those on whom the results of
the French school have been mainly founded, all belonged to the educated
classes, and it was thus possible to carry out an elaborate psychic
investigation which would be impossible among the uneducated. Breuer and
Freud insist on the fine qualities of mind and character frequently found
among the hysterical. They cannot accept suggestibility as an invariable
characteristic of hysteria, only abnormal excitability; they are far from
agreeing with Janet (although on many points at one with him), that
psychic weakness marks hysteria; there is merely an appearance of mental
weakness, they say, because the mental activity of the hysterical is split
up, and only a part of it is conscious.[273] The superiority of character
of the hysterical is indicated by the fact that the conflict between their
ideas of right and the bent of their inclinations is often an element in
the constitution of the hysterical state. Breuer and Freud are prepared to
assert that the hysterical are among "the flower of humanity," and they
refer to those qualities of combined imaginative genius and practical
energy which characterized St. Theresa, "the patron saint of the
hysterical."

To understand the position of Breuer and Freud we may start from the
phenomenon of "nervous shock" produced by physical traumatism, often of a
very slight character. Charcot had shown that such "nervous shock," with
the chain of resulting symptoms, is nothing more or less than hysteria.
Breuer and Freud may be linked on to Charcot at this point. They began by
regarding the most typical hysteria as really a _psychic traumatism_; that
is to say, that it starts in a lesion, or rather in repeated lesions, of
the emotional organism. It is true that the school of Charcot admitted the
influence of moral shock, especially of the emotion of fear, but that
merely as an "_agent provocateur_," and with a curious perversity Gilles
de la Tourette, certainly reflecting the attitude of Charcot, in his
elaborate treatise on hysteria fails to refer to the sphere of the sexual
emotions even when enumerating the "_agents provocateurs_."[274]

The influence of fear is not denied by Breuer and Freud, but they have
found that careful psychic analysis frequently shows that the shock of a
commonplace "fear" is really rooted in a lesion of the sexual emotions. A
typical and very simple illustration is furnished in a case, recorded by
Breuer, in which a young girl of seventeen had her first hysterical attack
after a cat sprang on her shoulders as she was going downstairs. Careful
investigation showed that this girl had been the object of somewhat ardent
attentions from a young man whose advances she had resisted, although her
own sexual emotions had been aroused. A few days before, she had been
surprised by this young man on these same dark stairs, and had forcibly
escaped from his hands. Here was the real psychic traumatism, the
operation of which merely became manifest in the cat. "But in how many
cases," asks Breuer, "is a cat thus reckoned as a completely sufficient
_causa efficiens_?"

In every case that they have investigated Breuer and Freud have found some
similar secret lesion of the psychic sexual sphere. In one case a
governess, whose training has been severely upright, is, in spite of
herself and without any encouragement, led to experience for the father of
the children under her care an affection which she refuses to acknowledge
even to herself; in another, a young woman finds herself falling in love
with her brother-in-law; again, an innocent girl suddenly discovers her
uncle in the act of sexual intercourse with her playmate, and a boy on his
way home from school is subjected to the coarse advances of a sexual
invert. In nearly every case, as Freud eventually found reason to believe,
a primary lesion of the sexual emotions dates from the period of puberty
and frequently of childhood, and in nearly every case the intimately
private nature of the lesion causes it to be carefully hidden from
everyone, and even to be unacknowledged by the subject of it. In the
earlier cases Breuer and Freud found that a slight degree of hypnosis is
necessary to bring the lesion into consciousness, and the accuracy of the
revelations thus obtained has been tested by independent witness. Freud
has, however, long abandoned the induction of any degree of hypnosis; he
simply tries to arrange that the patient shall feel absolutely free to
tell her own story, and so proceeds from the surface downwards, slowly
finding and piecing together such essential fragments of the history as
may be recovered, in the same way he remarks, as the archaeologist
excavates below the surface and recovers and puts together the fragments
of an antique statue. Much of the material found, however, has only a
symbolic value requiring interpretation and is sometimes pure fantasy.
Freud now attaches great importance to dreams as symbolically representing
much in the subject's mental history which is otherwise difficult to
reach.[275] The subtle and slender clues which Freud frequently follows in
interpreting dreams cannot fail sometimes to arouse doubt in his readers'
minds, but he certainly seems to have been often successful in thus
reaching latent facts in consciousness. The primary lesion may thus act as
"a foreign body in consciousness." Something is introduced into psychic
life which refuses to merge in the general flow of consciousness. It
cannot be accepted simply as other facts of life are accepted; it cannot
even be talked about, and so submitted to the slow usure by which our
experiences are worn down and gradually transformed. Breuer illustrates
what happens by reference to the sneezing reflex. "When an irritation to
the nasal mucous membrane for some reason fails to liberate this reflex,
a feeling of excitement and tension arises. This excitement, being unable
to stream out along motor channels, now spreads itself over the brain,
inhibiting other activities.... _In the highest spheres of human activity
we may watch the same process_." It is a result of this process that, as
Breuer and Freud found, the mere act of confession may greatly relieve the
hysterical symptoms produced by this psychic mechanism, and in some cases
may wholly and permanently remove them. It is on this fact that they
founded their method of treatment, devised by Breuer and by him termed the
cathartic method, though Freud prefers to call it the "analytic" method.
It is, as Freud points out, the reverse of the hypnotic method of
suggestive treatment; there is the same difference, Freud remarks, between
the two methods as Leonardo da Vinci found for the two technical methods
of art, _per via di porre_ and _per via di levare_; the hypnotic method,
like painting, works by putting in, the cathartic or analytic method, like
sculpture, works by taking out.[276]

It is part of the mechanism of this process, as understood by these
authors, that the physical symptoms of hysteria are constituted, by a
process of conversion, out of the injured emotions, which then sink into
the background or altogether out of consciousness. Thus, they found the
prolonged tension of nursing a near and dear relative to be a very
frequent factor in the production of hysteria. For instance, an originally
rheumatic pain experienced by a daughter when nursing her father becomes
the symbol in memory of her painful psychic excitement, and this perhaps
for several reasons, but chiefly because _its presence in consciousness
almost exactly coincided with that excitement_. In another way, again,
nausea and vomiting may become a symbol through the profound sense of
disgust with which some emotional shock was associated. Then the symbol
begins to have a life of its own, and draws hidden strength from the
emotion with which it is correlated. Breuer and Freud have found by
careful investigation that the pains and physical troubles of hysteria are
far from being capricious, but may be traced in a varying manner to an
origin in some incident, some pain, some action, which was associated with
a moment of acute psychic agony. The process of conversion was an
involuntary escape from an intolerable emotion, comparable to the physical
pain sometimes sought in intense mental grief, and the patient wins some
relief from the tortured emotions, though at the cost of psychic
abnormality, of a more or less divided state of consciousness and of
physical pain, or else anaesthesia. In Charcot's third stage of the
hysterical convulsion, that of "_attitudes passionnelles_," Breuer and
Freud see the hallucinatory reproduction of a recollection which is full
of significance for the origin of the hysterical manifestations.

The final result reached by these workers is clearly stated by each
writer. "The main observation of our predecessors," states Breuer,[277]
"still preserved in the word 'hysteria,' is nearer to the truth than the
more recent view which puts sexuality almost in the last line, with the
object of protecting the patient from moral reproaches. Certainly the
sexual needs of the hysterical are just as individual and as various in
force as those of the healthy. But they suffer from them, and in large
measure, indeed, they suffer precisely through the struggle with them,
through the effort to thrust sexuality aside." "The weightiest fact,"
concludes Freud,[278] "on which we strike in a thorough pursuit of the
analysis is this: From whatever side and from whatever symptoms we start,
we always unfailingly reach the region of the sexual life. Here, first of
all, an etiological condition of hysterical states is revealed.... At the
bottom of every case of hysteria--and reproducible by an analytical effort
after even an interval of long years--may be found one or more facts of
precocious sexual experience belonging to earliest youth. I regard this as
an important result, as the discovery of a _caput Nili_ of
neuropathology." Ten years later, enlarging rather than restricting his
conception, Freud remarks: "Sexuality is not a mere _deus ex machina_
which intervenes but once in the hysterical process; it is the motive
force of every separate symptom and every expression of a symptom. The
morbid phenomena constitute, to speak plainly, the patient's sexual
activity."[279] The actual hysterical fit, Freud now states, may be
regarded as "the substitute for a once practiced and then abandoned
_auto-erotic_ satisfaction," and similarly it may be regarded as an
equivalent of coitus.[280]

It is natural to ask how this conception affects that elaborate picture of
hysteria laboriously achieved by Charcot and his school. It cannot be said
that it abolishes any of the positive results reached by Charcot, but it
certainly alters their significance and value; it presents them in a new
light and changes the whole perspective. With his passion for getting at
tangible definite physical facts, Charcot was on very safe ground. But he
was content to neglect the psychic analysis of hysteria, while yet
proclaiming that hysteria is a purely psychic disorder. He had no cause of
hysteria to present save only heredity. Freud certainly admits heredity,
but, as he points out, the part it plays has been overrated. It is too
vague and general to carry us far, and when a specific and definite cause
can be found, the part played by heredity recedes to become merely a
condition, the soil on which the "specific etiology" works. Here probably
Freud's enthusiasm at first carried him too far and the most important
modification he has made in his views occurs at this point: he now
attaches a preponderant influence to heredity. He has realized that sexual
activity in one form or another is far too common in childhood to make it
possible to lay very great emphasis on "traumatic lesions" of this
character, and he has also realized that an outcrop of fantasies may
somewhat later develop on these childish activities, intervening between
them and the subsequent morbid symptoms. He is thus led to emphasize anew
the significance of heredity, not, however, in Charcot's sense, as general
neuropathic disposition but as "sexual constitution." The significance of
"infantile sexual lesions" has also tended to give place to that of
"infantilism of sexuality."[281]

The real merit of Freud's subtle investigations is that--while possibly
furnishing a justification of the imperfectly-understood idea that had
floated in the mind of observers ever since the name "hysteria" was first
invented--he has certainly supplied a definite psychic explanation of a
psychic malady. He has succeeded in presenting clearly, at the expense of
much labor, insight, and sympathy, a dynamic view of the psychic processes
involved in the constitution of the hysterical state, and such a view
seems to show that the physical symptoms laboriously brought to light by
Charcot are largely but epiphenomena and by-products of an emotional
process, often of tragic significance to the subject, which is taking
place in the most sensitive recess of the psychic organism. That the
picture of the mechanism involved, presented to us by Professor Freud,
cannot be regarded as a final and complete account of the matter, may
readily be admitted. It has developed in Freud's own hands, and some of
the developments will require very considerable confirmation before they
can be accepted as generally true.[282] But these investigations have at
least served to open the door, which Charcot had inconsistently held
closed, into the deeper mysteries of hysteria, and have shown that here,
if anywhere, further research will be profitable. They have also served to
show that hysteria may be definitely regarded as, in very many cases at
least, a manifestation of the sexual emotions and their lesions; in other
words, a transformation of auto-erotism.

The conception of hysteria so vigorously enforced by Charcot and his
school is thus now beginning to appear incomplete. But we have to
recognize that that incompleteness was right and necessary. A strong
reaction was needed against a widespread view of hysteria that was in
large measure scientifically false. It was necessary to show clearly that
hysteria is a definite disorder, even when the sexual organs and emotions
are swept wholly out of consideration; and it was also necessary to show
that the lying and dissimulation so widely attributed to the hysterical
were merely the result of an ignorant and unscientific misinterpretation
of psychic elements of the disease. This was finally and triumphantly
achieved by Charcot's school.

There is only one other point in the explanation of hysteria which I will
here refer to, and that because it is usually ignored, and because it has
relationship to the general psychology of the sexual emotions. I refer to
that physiological hysteria which is the normal counterpart of the
pathological hysteria which has been described in its physical details by
Charcot, and to which alone the term should strictly be applied. Even
though hysteria as a disease may be described as one and indivisible,
there are yet to be found, among the ordinary and fairly healthy
population, vague and diffused hysteroid symptoms which are dissipated in
a healthy environment, or pass nearly unnoted, only to develop in a small
proportion of cases, under the influence of a more pronounced heredity, or
a severe physical or psychic lesion, into that definite morbid state which
is properly called hysteria.

This diffused hysteroid condition may be illustrated by the results of a
psychological investigation carried on in America by Miss Gertrude Stein
among the ordinary male and female students of Harvard University and
Radcliffe College. The object of the investigation was to study, with the
aid of a planchette, the varying liability to automatic movements among
normal individuals. Nearly one hundred students were submitted to
experiment. It was found that automatic responses could be obtained in two
sittings from all but a small proportion of the students of both sexes,
but that there were two types of individual who showed a special aptitude.
One type (probably showing the embryonic form of neurasthenia) was a
nervous, high-strung, imaginative type, not easily influenced from
without, and not so much suggestible as autosuggestible. The other type,
which is significant from our present point of view, is thus described by
Miss Stein: "In general the individuals, often blonde and pale, are
distinctly phlegmatic. If emotional, decidedly of the weakest, sentimental
order. They may be either large, healthy, rather heavy, and lacking in
vigor or they may be what we call anaemic and phlegmatic. Their power of
concentrated attention is very small. They describe themselves as never
being held by their work; they say that their minds wander easily; that
they work on after they are tired, and just keep pegging away. They are
very apt to have premonitory conversations, they anticipate the words of
their friends, they imagine whole conversations that afterward come true.
The feeling of having been there is very common with them; that is, they
feel under given circumstances that they have had that identical
experience before in all its details. They are often fatalistic in their
ideas. They indulge in day-dreams. As a rule, they are highly
suggestible."[283]

There we have a picture of the physical constitution and psychic
temperament on which the classical symptoms of hysteria might easily be
built up.[284] But these persons were ordinary students, and while a few
of their characteristics are what is commonly and vaguely called "morbid,"
on the whole they must be regarded as ordinarily healthy individuals. They
have the congenital constitution and predisposition on which some severe
psychic lesion at the "psychological moment" might develop the most
definite and obstinate symptoms of hysteria, but under favorable
circumstances they will be ordinary men and women, of no more than
ordinary abnormality or ordinary power. They are among the many who have
been called to hysteria at birth; they may never be among the few who are
chosen.

We may have to recognize that on the side of the sexual emotions, as well
as in general constitution, a condition may be traced among normal persons
that is hysteroid in character, and serves as the healthy counterpart of a
condition which in hysteria is morbid. In women such a condition Has been
traced (though misnamed) by Dr. King.[285]

Dr. King describes what he calls "sexual hysteria in women,"
which he considers a chief variety of hysteria. He adds, however,
that it is not strictly a disease, but simply an automatic
reaction of the reproductive system, which tends to become
abnormal under conditions of civilization, and to be perpetuated
in a morbid form. In this condition he finds twelve characters:
1. Time of life, usually between puberty and climacteric. 2.
Attacks rarely occur when subject is alone. 3. Subject appears
unconscious, but is not really so. 4. She is instinctively
ashamed afterward. 5. It occurs usually in single women, or in
those, single or married, whose sexual needs are unsatisfied. 6.
No external evidence of disease, and (as Aitken pointed out) the
nates are not flattened; the woman's physical condition is not
impaired, and she may be specially attractive to men. 7. Warmth
of climate and the season of spring and summer are conducive to
the condition. 8. The paroxysm in short and temporary. 9. While
light touches are painful, firm pressure and rough handling give
relief. 10. It may occur in the occupied, but an idle,
purposeless life is conducive. 11. The subject delights in
exciting sympathy and in being fondled and caressed. 12. There is
defect of will and a strong stimulus is required to lead to
action.

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 anaemic
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 fuer
Geburtshuelfe und Gynaekologie_, 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 anaemia 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 haemoglobin.
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 Anaemia 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
anaemia 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.


FOOTNOTES:

[251] _Genese et Nature de l'Hysterie_, 1898; and, for Sollier's latest
statement, see "Hysterie et Sommeil," _Archives de Neurologie_, May and
June, 1907. Lombroso (_L'Uomo Delinquente_, 1889, vol. ii, p. 329),
referring to the diminished metabolism of the hysterical, had already
compared them to hibernating animals, while Babinsky states that the
hysterical are in a state of subconsciousness, a state, as Metchnikoff
remarks (_Essais optimistes_, p. 270), reminiscent of our prehistoric
past.

[252] Professor Freud, while welcoming the introduction of the term
"auto-erotism," remarks that it should not be made to include the whole of
hysteria. This I fully admit, and have never questioned. Hysteria is far
too large and complex a phenomenon to be classed as entirely a
manifestation of auto-erotism, but certain aspects of it are admirable
illustrations of auto-erotic transformation.

[253] The hysterical phenomenon of _globus hystericus_ was long afterward
attributed to obstruction of respiration by the womb. The interesting case
has been recorded by E. Bloch (_Wiener Klinische Wochenschrift_, 1907, p.
1649) of a lady who had the feeling of a ball rising from her stomach to
her throat, and then sinking. This feeling was associated with thoughts of
her husband's rising and falling penis, and was always most liable to
occur when she wished for coitus.

[254] As Gilles de la Tourette points out, it is not difficult to show
that epilepsy, the _morbus sacer_ of the ancients, owed much of its sacred
character to this confusion with hysteria. Those priestesses who, struck
by the _morbus sacer_, gave forth their oracles amid convulsions, were
certainly not the victims of epilepsy, but of hysteria (_Traite de
l'Hysterie_, vol. i, p. 3).

[255] Aretaeus, _On the Causes and Symptoms of Acute Diseases_, Book ii,
Chapter II.

[256] It may be noted that this treatment furnishes another instance of
the continuity of therapeutic methods, through all changes of theory, from
the earliest to the latest times. Drugs of unpleasant odor, like
asafoetida, have always been used in hysteria, and scientific medicine
to-day still finds that asafoetida is a powerful sedative to the uterus,
controlling nervous conditions during pregnancy and arresting uterine
irritation when abortion is threatened (see, e.g., Warman, _Der
Frauenarzt_, August, 1895). Again, the rubbing of fragrant ointments into
the sexual regions is but a form of that massage which is one of the
modern methods of treating the sexual disorders of women.

[257] _Les Demoniaques dans l'Art_, 1887; _Les Malades et les Difformes
dans l'Art_, 1889.

[258] Glafira Abricosoff, of Moscow, in her Paris thesis, _L'Hysterie aux
xvii et xviii siecles_, 1897, presents a summary of the various views held
at this time; as also Gilles de la Tourette, _Traite de l'Hysterie_, vol.
i, Chapter I.

[259] _Edinburgh Medical Journal_, June, 1883, p. 1123, and _Mental
Diseases_, 1887, p. 488.

[260] Hegar, _Zusammenhang der Geschlechtskrankheiten mit nervoesen
Leiden_, Stuttgart, 1885. (Hegar, however, went much further than this,
and was largely responsible for the surgical treatment of hysteria now
generally recognized as worse than futile.) Balls-Headley, "Etiology of
Nervous Diseases of the Female Genital Organs," Allbutt and Playfair,
_System of Gynecology_, 1896, p. 141.

[261] Lombroso and Ferrero, _La Donna Delinquente_, 1893, pp. 613-14.

[262] Charcot and Marie, article on "Hysteria," Tuke's _Dictionary of
Psychological Medicine_.

[263] Axenfeld and Huchard, _Traite des Nevroses_, 1883, pp. 1092-94.
Icard (_La Femme pendant la Periode Menstruelle_, pp. 120-21) has also
referred to recorded cases of hysteria in animals (Coste's and Peter's
cases), as has Gilles de la Tourette (op. cit., vol. i, p. 123). See also,
for references, Fere, _L'Instinct Sexuel_, p. 59.

[264] _Man and Woman_, 4th ed., p. 326. A distinguished gynaecologist,
Matthews Duncan, had remarked some years earlier (_Lancet_, May 18, 1889)
that hysteria, though not a womb disease, "especially attaches itself to
the generative system, because the genital system, more than any other,
exerts emotional power over the individual, power also in morals, power in
social questions."

[265] Gilles de la Tourette, _Archives de Tocologie et de Gynecologie_,
June, 1895.

[266] _Rivista Sperimentale di Freniatria_, 1897, p. 290; summarized in
the _Journal of Mental Science_, January, 1898.

[267] From the earliest times it was held that menstruation favors
hysteria; more recently, Landouzy recorded a number of observations
showing that hysterical attacks coincide with perfectly healthy
menstruation; while Ball has maintained that it is only during
menstruation that hysteria appears in its true color. See the opinions
collected by Icard, _La Femme pendant la Periode Menstruelle_, pp. 75-81.

[268] Krafft-Ebing, "Ueber Neurosen und Psychosen durch Sexuelle
Abstinenz," _Jahrbuecher fuer Psychiatrie_, vol. iii, 1888. It must,
however, be added that the relief of hysteria by sexual satisfaction is
not rare, and that Rosenthal finds that the convulsions are thus
diminished. (_Allgemeine Wiener Medizinal-Zeitung_, Nos. 46 and 47, 1887.)
So they are also, in simple and uncomplicated cases, according to Mongeri,
by pregnancy.

[269] "All doctors who have patients in convents," remarks Marro (_La
Puberta_, p. 338), "know how hysteria dominates among them;" he adds that
his own experience confirms that of Raciborski, who found that nuns
devoted to the contemplative life are more liable to hysteria than those
who are occupied in teaching or in nursing. It must be added, however,
that there is not unanimity as to the prevalence of hysteria in convents.
Brachet was of the same opinion as Briquet, and so considered it rare.
Imbert-Goubeyre, also (_La Stigmatisation_, p. 436) states that during
more than forty years of medical life, though he has been connected with a
number of religious communities, he has not found in them a single
hysterical subject, the reason being, he remarks, that the unbalanced and
extravagant are refused admission to the cloister.

[270] Parent-Duchatelet, _De la Prostitution_, vol. i, p. 242.

[271] It may not be unnecessary to point out that here and throughout, in
speaking of the psychic mechanism of hysteria, I do not admit that any
process can be _purely_ psychic. As Fere puts it in an admirable study of
hysteria (_Twentieth Century Practice of Medicine_, 1897, vol. x, p. 556):
"In the genesis of hysterical troubles everything takes place as if the
psychical and the somatic phenomena were two aspects of the same
biological fact."

[272] Pierre Janet, _L'Automatisme Psychologique_, 1889; _L'Etat mental
des Hysteriques_, 1894; _Nevroses et Idees fixes_, 1898; Breuer und Freud,
_Studien ueber Hysterie_, Vienna, 1895; the best introduction to Freud's
work is, however, to be found in the two series of his _Sammlung Kleiner
Schriften zur Neurosenlehre_, published in a collected form in 1906 and
1909. It may be added that a useful selection of Freud's papers has lately
(1909) been published in English.

[273] We might, perhaps, even say that in hysteria the so-called higher
centres have an abnormally strong inhibitory influence over the lower
centres. Gioffredi (_Gazzetta degli Ospedali_, October 1, 1895) has shown
that some hysterical symptoms, such as mutism, can be cured by
etherization, thus loosening the control of the higher centres.

[274] Charcot's school could not fail to recognize the erotic tone which