such energy as to flow over into the waking life and influence conscious
emotion and action, while very well marked in normal and healthy women, is
seen to an exaggerated extent in hysterical women, in whom it has,
therefore, chiefly been studied. Sante de Sanctis, who has investigated
the dreams of many classes of people, remarks on the frequently sexual
character of the dreams of hysterical women, and the repercussion of such
dreams on the waking life of the following day; he gives a typical case of
hysterical erotic dreaming in an uneducated servant-girl of 23, in whom
such dreams occur usually a few days before the menstrual period; her
dreams, especially if erotic, make an enormous impression on her; in the
morning she is bad-tempered if they were unpleasant, while she feels
lascivious and gives herself up to masturbation if she has had erotic
dreams of men; she then has a feeling of pleasure throughout the day, and
her sexual organs are bathed with moisture.[244] Pitres and Gilles de la
Tourette, two of Charcot's most distinguished pupils, in their elaborate
works on hysteria, both consider that dreams generally have a great
influence on the waking life of the hysterical, and they deal with the
special influence of erotic dreams, to which, doubtless, we must refer
those conceptions of _incubi_ and _succubi_ which played so vast and so
important a part in the demonology of the Middle Ages, and while not
unknown in men were most frequent in women. Such erotic dreams--as these
observers, confirming the experience of old writers, have found among the
hysterical to-day--are by no means always, or even usually, of a
pleasurable character. "It is very rare," Pitres remarks, when insisting
on the sexual character of the hallucinations of the hysterical, "for
these erotic hallucinations to be accompanied by agreeable voluptuous
sensations. In most cases the illusion of sexual intercourse even provokes
acute pain. The witches of old times nearly all affirmed that in their
relations with the devil they suffered greatly.[245] They said that his
organ was long and rough and pointed, with scales which lifted on
withdrawal and tore the vagina." (It seems probable, I may remark, that
the witches' representations, both of the devil and of sexual intercourse,
were largely influenced by familiarity with the coupling of animals). As
Gilles de la Tourette is careful to warn his readers, we must not too
hastily assume, from the prevalence of nocturnal auto-erotic phenomena in
hysterical women, that such women are necessarily sexual and libidinous in
excess; the disorder is in them psychic, he points out, and not physical,
and they usually receive sexual approaches with indifference and
repugnance, because their sexual centres are anæsthetic or hyperæsthetic.
"During the period of sexual activity they seek much more the care and
delicate attention of men than the genital act, which they often only
tolerate. Many households, begun under the happiest auspices--the bride
all the more apt to believe that she loves her betrothed in virtue of her
suggestibility, easily exalted, perhaps at the expense of the
senses--become hells on earth. The sexual act has for the hysterical woman
more than one disillusion; she cannot understand it; it inspires her with
insurmountable repugnance."[246] I refer to these hysterical phenomena
because they present to us, in an extreme form, facts which are common
among women whom, under the artificial conditions of civilized life, we
are compelled to regard as ordinarily healthy and normal. The frequent
painfulness of auto-erotic phenomena is by no means an exclusively
hysterical phenomenon, although often seen in a heightened form in
hysterical conditions. It is probably to some extent simply the result of
a conflict in consciousness with a merely physical impulse which is strong
enough to assert itself in spite of the emotional and intellectual
abhorrence of the subject. It is thus but an extreme form of the disgust
which all sexual physical manifestations tend to inspire in a person who
is not inclined to respond to them. Somewhat similar psychic disgust and
physical pain are produced in the attempts to stimulate the sexual
emotions and organs when these are exhausted by exercise. In the detailed
history which Moll presents, of the sexual experiences of a sister in an
American nursing guild,--a most instructive history of a woman fairly
normal except for the results of repressed sexual emotion, and with strong
moral tendencies,--various episodes are narrated well illustrating the way
in which sexual excitement becomes unpleasant or even painful when it
takes place as a physical reflex which the emotions and intellect are all
the time struggling against.[247] It is quite probable, however, that
there is a physiological, as well as a psychic, factor in this phenomenon,
and Sollier, in his elaborate study of the nature and genesis of hysteria,
by insisting on the capital importance of the disturbance of sensibility
in hysteria, and the definite character of the phenomena produced in the
passage between anæsthesia and normal sensation, has greatly helped to
reveal the mechanism of this feature of auto-erotic excitement in the
hysterical.
No doubt there has been a tendency to exaggerate the unpleasant character
of the auto-erotic phenomena of hysteria. That tendency was an inevitable
reaction against an earlier view, according to which hysteria was little
more than an unconscious expression of the sexual emotions and as such was
unscientifically dismissed without any careful investigation. I agree with
Breuer and Freud that the sexual needs of the hysterical are just as
individual and various as those of normal women, but that they suffer from
them more, largely through a moral struggle with their own instincts, and
the attempt to put them into the background of consciousness.[248] In many
hysterical and psychically abnormal women, auto-erotic phenomena, and
sexual phenomena generally, are highly pleasurable, though such persons
may be quite innocent of any knowledge of the erotic character of the
experience. I have come across interesting and extreme examples of this in
the published experiences of the women followers of the American religious
leader, T.L. Harris, founder of the "Brotherhood of the New Life." Thus,
in a pamphlet entitled "Internal Respiration," by Respiro, a letter is
quoted from a lady physician, who writes: "One morning I awoke with a
strange new feeling in the womb, which lasted for a day or two; I was so
very happy, but the joy was in my womb, not in my heart."[249] "At last,"
writes a lady quoted in the same pamphlet, "I fell into a slumber, lying
on my back with arms and feet folded, a position I almost always find
myself in when I awake, no matter in which position I may go to sleep.
Very soon I awoke from this slumber with a most delightful sensation,
every fibre tingling with an exquisite glow of warmth. I was lying on my
left side (something I am never able to do), and was folded in the arms of
my counterpart. Unless you have seen it, I cannot give you an idea of the
beauty of his flesh, and with what joy I beheld and felt it. Think of it,
luminous flesh; and Oh! such tints, you never could imagine without
seeing. He folded me so closely in his arms," etc. In such cases there is
no conflict between the physical and the psychic, and therefore the
resulting excitement is pleasurable and not painful.
At this point our study of auto-erotism brings us into the sphere of
mysticism. Leuba, in a penetrating and suggestive essay on Christian
mysticism, after quoting the present _Study_, refers to the famous
passages in which St. Theresa describes how a beautiful little angel
inserted a flame-tipped dart into her heart until it descended into her
bowels and left her inflamed with divine love. "What physiological
difference," he asks, "is there between this voluptuous sensation and that
enjoyed by the disciple of the Brotherhood of New Life? St. Theresa says
'bowels,' the woman doctor says 'womb,' that is all."[250]
The extreme form of auto-erotism is the tendency for the sexual
emotion to be absorbed and often entirely lost in
self-admiration. This Narcissus-like tendency, of which the
normal germ in women is symbolized by the mirror, is found in a
minor degree in some men, and is sometimes well marked in women,
usually in association with an attraction for other persons, to
which attraction it is, of course, normally subservient. "The
mirror," remarks Bloch (_Beiträge_ 1, p. 201), "plays an
important part in the genesis of sexual aberration.... It cannot
be doubted that many a boy and girl have first experienced sexual
excitement at the sight of their own bodies in a mirror."
Valera, the Spanish novelist, very well described this impulse in
his _Genio y Figura_. Rafaela, the heroine of this novel, says
that, after her bath: "I fall into a puerility which may be
innocent or vicious, I cannot decide. I only know that it is a
purely contemplative act, a disinterested admiration of beauty.
It is not coarse sensuality, but æsthetic platonism. I imitate
Narcissus; and I apply my lips to the cold surface of the mirror
and kiss my image. It is the love of beauty, the expression of
tenderness and affection for what God has made manifest, in an
ingenuous kiss imprinted on the empty and incorporeal
reflection." In the same spirit the real heroine of the _Tagebuch
einer Verlorenen_ (p. 114), at the point when she was about to
become a prostitute, wrote: "I am pretty. It gives me pleasure to
throw off my clothes, one by one, before the mirror, and to look
at myself, just as I am, white as snow and straight as a fir,
with my long, fine, hair, like a cloak of black silk. When I
spread abroad the black stream of it, with both hands, I am like
a white swan with black wings."
A typical case known to me is that of a lady of 28, brought up on
a farm. She is a handsome woman, of very large and fine
proportions, active and healthy and intelligent, with, however,
no marked sexual attraction to the opposite sex; at the same time
she is not inverted, though she would like to be a man, and has a
considerable degree of contempt for women. She has an intense
admiration for her own person, especially her limbs; she is
never so happy as when alone and naked in her own bedroom, and,
so far as possible, she cultivates nakedness. She knows by heart
the various measurements of her body, is proud of the fact that
they are strictly in accordance with the canons of proportion,
and she laughs proudly at the thought that her thigh is larger
than many a woman's waist. She is frank and assured in her
manners, without sexual shyness, and, while willing to receive
the attention and admiration of others, she makes no attempt to
gain it, and seems never to have experienced any emotions
stronger than her own pleasure in herself. I should add that I
have had no opportunity of detailed examination, and cannot speak
positively as to the absence of masturbation.
In the extreme form in which alone the name of Narcissus may
properly be invoked, there is comparative indifference to sexual
intercourse or even the admiration of the opposite sex. Such a
condition seems to be rare, except, perhaps, in insanity. Since I
called attention to this form of auto-erotism (_Alienist and
Neurologist_, April, 1898), several writers have discussed the
condition, especially Näcke, who, following out the suggestion,
terms the condition Narcissism. Among 1,500 insane persons, Näcke
has found it in four men and one woman (_Psychiatrische en
Neurologische Bladen_, No. 2, 1899), Dr. C.H. Hughes writes (in a
private letter) that he is acquainted with such cases, in which
men have been absorbed in admiration of their own manly forms,
and of their sexual organs, and women, likewise, absorbed in
admiration of their own mammæ and physical proportions,
especially of limbs. "The whole subject," he adds, "is a singular
phase of psychology, and it is not all morbid psychology, either.
It is closely allied to that æsthetic sense which admires the
nude in art."
Féré (_L'Instinct Sexuel_, 2d ed., p. 271) mentions a woman who
experienced sexual excitement in kissing her own hand. Näcke knew
a woman in an asylum who, during periodical fits of excitement,
would kiss her own arms and hands, at the same time looking like
a person in love. He also knew a young man with dementia præcox?
who would kiss his own image ("Der Kuss bei Geisteskranken,"
_Allgemeine Zeitschrift für Psychiatrie_, Bd. LXIII, p. 127).
Moll refers to a young homosexual lawyer, who experienced great
pleasure in gazing at himself in a mirror (_Konträre
Sexualempfindung_, 3d ed., p. 228), and mentions another inverted
man, an admirer of the nates of men, who, chancing to observe his
own nates in a mirror, when changing his shirt, was struck by
their beauty, and subsequently found pleasure in admiring them
(_Libido Sexualis_, Bd. I, Theil I, p. 60). Krafft-Ebing knew a
man who masturbated before a mirror, imagining, at the same time,
how much better a real lover would be.
The best-observed cases of Narcissism have, however, been
recorded by Rohleder, who confers upon this condition the
ponderous name of automonosexualism, and believes that it has not
been previously observed (H. Rohleder, _Der Automonosexualismus_,
being Heft 225 of _Berliner Klinik_, March, 1907). In the two
cases investigated by Rohleder, both men, there was sexual
excitement in the contemplation of the individual's own body,
actually or in a mirror, with little or no sexual attraction to
other persons. Rohleder is inclined to regard the condition as
due to a congenital defect in the "sexual centre" of the brain.
FOOTNOTES:
[176] All the above groups of phenomena are dealt with in other volumes of
these _Studies_: the manifestations of normal sexual excitement, in vols.
iii, iv, and v; homosexuality, in vol. ii, and erotic fetichism, in vol.
v.
[177] See Appendix C.
[178] Letamendi, of Madrid, has suggested "_auto-erastia_" to cover what
is probably much the same field. In the beginning of the nineteenth
century, Hufeland, in his _Makrobiotic_, invented the term "_geistige
Onanie_," to express the filling and heating of the imagination with
voluptuous images, without unchastity of body; and in 1844, Kaan, in his
_Psychopathia Sexualis_, used, but did not invent, the term "_onania
psychica_." Gustav Jaeger, in his _Entdeckung der Seele_, proposed
"monosexual idiosyncrasy," to indicate the most animal forms of
masturbation taking place without any correlative imaginative element, a
condition illustrated by cases given in Moll's _Untersuchungen über die
Libido Sexualis_, Bd. I, pp. 13 et seq. Dr. Laupts (a pseudonym for the
accomplished psychologist, Dr. Saint-Paul) uses the term _autophilie_, for
solitary vice. (_Perversion et Perversité Sexuelles_, 1896, p. 337.) But
all these terms only cover a portion of the field.
[179] H. Northcote, _Christianity and Sex Problems_, p. 231.
[180] Rosse observed two elephants procuring erection by entwining their
proboscides, the act being completed by one elephant opening his mouth and
allowing the other to tickle the roof of it. (I. Rosse, _Virginia Medical
Monthly_, October, 1892.)
[181] Féré, "Perversions sexuelles chez les animaux," _Revue
Philosophique_, May, 1897.
[182] Tillier, _L'Instinct Sexuel_, 1889, p. 270.
[183] Moll, _Libido Sexualis_, Bd. I, p. 76. The same author mentions
(ibid., p. 373) that parrots living in solitary confinement masturbate by
rubbing the posterior part of the body against some object until
ejaculation occurs. Edmund Selous ("Habits of the Peewit," _Zoölogist_,
April, 1902) suggests that the peewit, when rolling on the ground, and
exerting pressure on the anal region, is moved by a sexual impulse to
satisfy desire; he adds that actual orgasm appears eventually to take
place, a spasm of energy passing through the bird.
[184] Dr. J.W. Howe (_Excessive Venery, Masturbation, and Continence_,
London and New York, 1883, p. 62) writes of masturbation: "In savage lands
it is of rare occurrence. Savages live in a state of Nature. No moral
obligations exist which compel them to abstain from a natural
gratification of their passions. There is no social law which prevents
them from following the dictates of their lower nature. Hence, they have
no reason for adopting onanism as an outlet for passions. The moral
trammels of civilized society, and ignorance of physiological laws, give
origin to the vice." Every one of these six sentences is incorrect or
misleading. They are worth quoting as a statement of the popular view of
savage life.
[185] I can recall little evidence of its existence among the Australian
aborigines, though there is, in the Wiradyuri language, spoken over a
large part of New South Wales, a word (whether ancient or not, I do not
know) meaning masturbation (_Journal of the Anthropological Institute_,
July-Dec., 1904, p. 303). Dr. W. Roth (_Ethnological Studies Among the
Northwest-Central Queensland Aborigines_, p. 184), who has carefully
studied the blacks of his district, remarks that he has no evidence as to
the practice of either masturbation or sodomy among them. More recently
(1906) Roth has stated that married men in North Queensland and elsewhere
masturbate during their wives' absence. As regards the Maori of New
Zealand, Northcote adds, there is a rare word for masturbation (as also at
Rarotonga), but according to a distinguished Maori scholar there are no
allusions to the practice in Maori literature, and it was probably not
practiced in primitive times. The Maori and the Polynesians of the Cook
Islands, Northcote remarks, consider the act unmanly, applying to it a
phrase meaning "to make women of themselves." (Northcote, loc. cit., p.
232.)
[186] Greenlees, _Journal of Mental Science_, July, 1895. A gentleman long
resident among the Kaffirs of South Natal, told Northcote, however, that
he had met with no word for masturbation, and did not believe the practice
prevailed there.
[187] Hyades and Deniker, _Mission Scientifique du Cap Horn_, vol. vii, p.
295.
[188] _La Criminalité en Cochin-Chine_, 1887, p. 116; also Mondière,
"Monographie de la Femme Annamite," _Mémoires Société d'Anthropologie_,
tome ii, p. 465.
[189] Christian, article on "Onanisme," _Dictionnaire Encyclopédique des
Sciences Médicales_; Ploss and Bartels, _Das Weib_; Moraglia, "Die Onanie
beim normalen Weibe," _Zeitschrift für Criminal-Anthropologie_, 1897;
Dartigues, _De la Procréation Volontaire des Sexes_, p. 32. In the
eighteenth century, the _rin-no-tama_ was known in France, sometimes as
"pommes d'amour." Thus Bachaumont, in his Journal (under date July 31,
1773), refers to "a very extraordinary instrument of amorous mystery,"
brought by a traveler from India; he describes this "boule erotique" as
the size of a pigeon's egg, covered with soft skin, and gilded. Cf. F.S.
Krauss, _Geschlechtsleben in Brauch und Sitte der Japaner_, Leipzig, 1907.
[190] It may be worth mentioning that the Salish Indians of British
Columbia have a myth of an old woman having intercourse with young women,
by means of a horn worn as a penis (_Journal of the Anthropological
Institute_, July-Dec., 1904, p. 342).
[191] In Burchard's Penitential (cap. 142-3), penalties are assigned to
the woman who makes a phallus for use on herself or other women.
(Wasserschleben, _Bussordnungen der abendländlichen Kirche_, p. 658.) The
_penis succedaneus_, the Latin _phallus_ or _fascinum_, is in France
called _godemiche_; in Italy, _passatempo_, and also _diletto_, whence
_dildo_, by which it is most commonly known in England. For men, the
corresponding _cunnus succedaneus_ is, in England, called _merkin_, which
meant originally (as defined in old editions of Bailey's _Dictionary_)
"counterfeit hair for women's privy parts."
[192] Dühren, _Der Marquis de Sade und Seine Zeit_, 3d ed., pp. 130, 232;
id. _Geschlechtsleben in England_, Bd. II, pp. 284 et seq.
[193] Gamier, _Onanisme_, p. 378.
[194] _Zeitschrift für Ethnologie_, 1899, p. 669.
[195] The mythology of Hawaii, one may note, tells of goddesses who were
impregnated by bananas they had placed beneath their garments. B. Stern
mentions (_Medizin in der Türkei_, Bd. II, p. 24) that the women of Turkey
and Egypt use the banana, as well as the cucumber, etc., for masturbation.
In a poem in the _Arabian Nights_, also ("History of the Young Nour with
the Frank"), we read: "O bananas, of soft and smooth skins, which dilate
the eyes of young girls ... you, alone among fruits are endowed with a
pitying heart, O consolers of widows and divorced women." In France and
England they are not uncommonly used for the same purpose.
[196] See, e.g., Winckel, _Die Krankheiten der weiblichen Harnrohre und
Blase_, 1885, p. 211; and "Lehrbuch der Frauenkrankheiten," 1886, p. 210;
also, Hyrtl, _Handbuch du Topographischen Anatomie_, 7th ed., Bd. II, pp.
212-214. Grünfeld (_Wiener medizinische Blätter_, November 26, 1896),
collected 115 cases of foreign body in the bladder--68 in men, 47 in
women; but while those found in men were usually the result of a surgical
accident, those found in women were mostly introduced by the patients
themselves. The patient usually professes profound ignorance as to how the
object came there; or she explains that she accidentally sat down upon it,
or that she used it to produce freer urination. The earliest surgical case
of this kind I happen to have met with, was recorded by Plazzon, in Italy,
in 1621 (_De Partibus Generationi Inservientibus_, lib. ii, Ch. XIII); it
was that of a certain honorable maiden with a large clitoris, who, seeking
to lull sexual excitement with the aid of a bone needle, inserted it in
the bladder, whence it was removed by Aquapendente.
[197] A. Poulet, _Traité des Corps étrangers en Chirurgie_, 1879. English
translation, 1881, vol. ii, pp. 209, 230. Rohleder (_Die Masturbation_,
1899, pp. 24-31) also gives examples of strange objects found in the
sexual organs.
[198] E.H. Smith, "Signs of Masturbation in the Female," _Pacific Medical
Journal_, February, 1903, quoted by R.W. Taylor, _Practical Treatise on
Sexual Disorders_, 3d ed., p. 418.
[199] L. Tait, _Diseases of Women_, 1889, vol. i, p. 100.
[200] _Obstetric Journal_, vol. i, 1873, p. 558. Cf. G.J. Arnold,
_British, Medical Journal_, January 6, 1906, p. 21.
[201] Dudley, _American Journal of Obstetrics_, July, 1889, p. 758.
[202] A. Reverdin, "Epingles à Cheveux dans la Vessie," _Revue Médicale de
la Suisse Romande_, January 20, 1888. His cases are fully recorded, and
his paper is an able and interesting contribution to this by-way of sexual
psychology. The first case was a school-master's wife, aged 22, who
confessed in her husband's presence, without embarrassment or hesitation,
that the manoeuvre was habitual, learned from a school-companion, and
continued after marriage. The second was a single woman of 42, a _curé's_
servant, who attempted to elude confession, but on leaving the doctor's
house remarked to the house-maid, "Never go to bed without taking out your
hair-pins; accidents happen so easily." The third was an English girl of
17 who finally acknowledged that she had lost two hair-pins in this way.
The fourth was a child of 12, driven by the pain to confess that the
practice had become a habit with her.
[203] "One of my patients," remarks Dr. R.T. Morris, of New York,
(_Transactions of the American Association of Obstetricians_, for 1892,
Philadelphia, vol. v), "who is a devout church-member, had never allowed
herself to entertain sexual thoughts referring to men, but she masturbated
every morning, when standing before the mirror, by rubbing against a key
in the bureau-drawer. A man never excited her passions, but the sight of a
key in any bureau-drawer aroused erotic desires."
[204] Freud (_Drei Abhandlungen zur Sexualtheorie_, p. 118) refers to the
sexual pleasure of swinging. Swinging another person may be a source of
voluptuous excitement, and one of the 600 forms of sexual pleasure
enumerated in De Sade's _Les 120 Journées de Sodome_ is (according to
Dühren) to propel a girl vigorously in a swing.
[205] The fact that horse exercise may produce pollutions was well
recognized by Catholic theologians, and Sanchez states that this fact need
not be made a reason for traveling on foot. Rolfincius, in 1667, pointed
out that horse-riding, in those unaccustomed to it, may lead to nocturnal
pollutions. Rohleder (_Die Masturbation_, pp. 133-134) brings together
evidence regarding the influence of horse exercise in producing sexual
excitement.
[206] A correspondent, to whom the idea was presented for the first time,
wrote: "Henceforward I shall know to what I must attribute the
bliss--almost the beatitude--I so often have experienced after traveling
for four or five hours in a train." Penta mentions the case of a young
girl who first experienced sexual desire at the age of twelve, after a
railway journey.
[207] Langdon Down, _British Medical Journal_, January 12, 1867.
[208] Pouillet, _L'Onanisme chez la Femme_, Paris, 1880; Fournier, _De
l'Onanisme_, 1885; Rohleder, _Die Masturbation_, p. 132.
[209] _West-Riding Asylum Reports_, 1876, vol. vi.
[210] _Das Nervöse Weib_, 1898, p. 193.
[211] In the Appendix to volume iii of these _Studies_, I have recorded
the experience of a lady who found sexual gratification in this manner.
[212] Dr. J.G. Kiernan, to whom I am indebted for a note on this point,
calls my attention also to the case of a homosexual and masochistic man
(_Medical Record_, vol. xix) whose feelings were intensified by
tight-lacing.
[213] Some women are also able to produce the orgasm, when in a state of
sexual excitement, by placing a cushion between the knees and pressing the
thighs firmly together.
[214] _Leçons sur les Déformations Vulvaires_, p. 64. Martineau was
informed by a dressmaker that it is very frequent in workrooms and can
usually be done without attracting attention. An ironer informed him that
while standing at her work, she crossed her legs, slightly bending the
trunk forward and supporting herself on the table by the hands; then a few
movements of contraction of the adductor muscles of the thigh would
suffice to produce the orgasm.
[215] C.W. Townsend, "Thigh-friction in Children under one Year," Annual
Meeting of the American Pediatric Society, Montreal, 1896. Five cases are
recorded by this writer, all in female infants.
[216] Soutzo, _Archives de Neurologie_, February, 1903, p. 167.
[217] Zache, _Zeitschrift für Ethnologie_, 1899, p. 72. I have discussed
what may be regarded as the normally sexual influence of dancing, in the
third volume of these _Studies_, "The Analysis of the Sexual Impulse."
[218] The case has been recorded of a Russian who had the spontaneous
impulse to self-flagellation on the nates with a rod, for the sake of
sexual excitement, from the age of 6. (_Rivista Mensile di Psichiatria_
April, 1900, p. 102.)
[219] Kryptadia, vol. v, p. 358. As regards the use of nettles, see
Dühren, _Geschlechtsleben in England_, Bd. II, p. 392.
[220] Debreyne, _Moechialogie_, p. 177.
[221] R.W. Taylor, _A Practical Treatise on Sexual Disorders_, 3rd ed.,
Ch. XXX.
[222] Hammond, _Sexual Impotence_, pp. 70 et seq.
[223] Niceforo, _Il Gergo_, p. 98.
[224] _Functional Disorders of the Nervous System in Women_, p. 114.
[225] Schrenck-Notzing, _Suggestions-therapie_, p. 13. A. Kind (_Jahrbuch
für Sexuelle Zwischenstufen_, Jahrgang ix, 1908, p. 58) gives the case of
a young homosexual woman, a trick cyclist at the music halls, who often,
when excited by the sight of her colleague in tights, would experience the
orgasm while cycling before the public.
[226] Janet has, however, used day-dreaming--which he calls "_reveries
subconscients_"--to explain a remarkable case of demon-possession, which
he investigated and cured. (_Névroses et Idées fixes_, vol. i, pp. 390 et
seq.)
[227] "Minor Studies from the Psychological Laboratory of Wellesley
College," _American Journal of Psychology_, vol. vii, No. 1. G.E.
Partridge ("Reverie," _Pedagogical Seminary_, April, 1898) well describes
the physical accompaniments of day-dreaming, especially in Normal School
girls between sixteen and twenty-two. Pick ("Clinical Studies in
Pathological Dreaming," _Journal of Mental Sciences_, July, 1901) records
three more or less morbid cases of day-dreaming, usually with an erotic
basis, all in apparently hysterical men. An important study of
day-dreaming, based on the experiences of nearly 1,500 young people (more
than two-thirds girls and women), has been published by Theodate L. Smith
("The Psychology of Day Dreams," _American Journal Psychology_, October,
1904). Continued stories were found to be rare--only one per cent. Healthy
boys, before fifteen, had day-dreams in which sports, athletics, and
adventure had a large part; girls put themselves in the place of their
favorite heroines in novels. After seventeen, and earlier in the case of
girls, day-dreams of love and marriage were found to be frequent. A
typical confession is that of a girl of nineteen: "I seldom have time to
build castles in Spain, but when I do, I am not different from most
Southern girls; i.e., my dreams are usually about a pretty fair specimen
of a six-foot three-inch biped."
[228] The case has been recorded of a married woman, in love with her
doctor, who kept a day-dream diary, at last filling three bulky volumes,
when it was discovered by her husband, and led to an action for divorce;
it was shown that the doctor knew nothing of the romance in which he
played the part of hero. Kiernan, in referring to this case (as recorded
in John Paget's _Judicial Puzzles_), mentions a similar case in Chicago.
[229] _Uranisme_, p. 125.
[230] The acute Anstie remarked, more than thirty years ago, in his work
on _Neuralgia_: "It is a comparatively frequent thing to see an unsocial,
solitary life (leading to the habit of masturbation) joined with the bad
influence of an unhealthy ambition, prompting to premature and false work
in literature and art." From the literary side, M. Léon Bazalgette has
dealt with the tendency of much modern literature to devote itself to what
he calls "mental onanism," of which the probable counterpart, he seems to
hint, is a physical process of auto-erotism. (Léon Bazalgette, "L'onanisme
considéré comme principe createur en art," _L'Esprit Nouveau_, 1898.)
[231] Pausanias, _Achaia_, Chapter XVII. The ancient Babylonians believed
in a certain "maid of the night," who appeared to men in sleep and roused
without satisfying their passions. (Jastrow, _Religion of Babylonia_, p.
262.) This succubus was the Assyrian Liler, connected with the Hebrew
Lilith. There was a corresponding incubus, "the little night man," who had
nocturnal intercourse with women. (Cf. Ploss, _Das Weib_, 7th ed., pp. 521
et seq.) The succubus and the incubus (the latter being more common) were
adopted by Christendom; St. Augustine (_De Civitate Dei_, Bk. XV, Ch.
XXIII) said that the wicked assaults of sylvans and fauns, otherwise
called incubi, on women, are so generally affirmed that it would be
impudent to deny them. Incubi flourished in mediæval belief, and can
scarcely, indeed, be said to be extinct even to-day. They have been
studied by many authors; see, e.g., Dufour, _Histoire de la Prostitution_,
vol. v, Ch. XXV, Saint-André, physician-in-ordinary to the French King,
pointed out in 1725 that the incubus was a dream. It may be added that the
belief in the succubus and incubus appears to be widespread. Thus, the
West African Yorubas (according to A.B. Ellis) believe that erotic dreams
are due to the god Elegbra, who, either as a male or a female, consorts
with men and women in sleep.
[232] "If any man's seed of copulation go out from him, then he shall
bathe all his flesh in water and be unclean until the even. And every
garment, and every skin, whereon is the seed of copulation, shall be
washed with water and be unclean until the even." Leviticus, XV, v. 16-17.
[233] It should be added that the term _pollutio_ also covers voluntary
effusion of semen outside copulation. (Debreyne, _Moechialogie_,
p. 8; for a full discussion of the opinions of theologians concerning
nocturnal and diurnal pollutions, see the same author's _Essai sur la
Théologie Morale_, pp. 100-149.)
[234] _Memoirs_, translated by Bendyshe, p. 182.
[235] _Sexual Impotence_, p. 137.
[236] _L'Hygiène Sexuelle_, p. 169.
[237] _Sexualleben und Nervenleiden_, p. 164.
[238] I may here refer to the curious opinion expressed by Dr. Elizabeth
Blackwell, that, while the sexual impulse in man is usually relieved by
seminal emissions during sleep, in women it is relieved by the occurrence
of menstruation. This latter statement is flagrantly at variance with the
facts; but it may perhaps be quoted in support of the view expressed above
as to the comparative rarity of sexual excitement during sleep in young
girls.
[239] Löwenfeld has recently expressed the same opinion. Rohleder believes
that pollutions are physically impossible in a _real_ virgin, but that
opinion is too extreme.
[240] It may be added that in more or less neurotic women and girls,
erotic dreams may be very frequent and depressing. Thus, J.M. Fothergill
(_West-Riding Asylum Report_, 1876, vol. vi) remarks: "These dreams are
much more frequent than is ordinarily thought, and are the cause of a
great deal of nervous depression among women. Women of a highly-nervous
diathesis suffer much more from these drains than robust women. Not only
are these involuntary orgasms more frequent among such women, but they
cause more disturbance of the general health in them than in other women."
[241] I may remark here that a Russian correspondent considers that I have
greatly underestimated the frequency of erotic manifestations during sleep
in young girls. "All the women I have interrogated on this point," he
informs me, "say that they have had such pollutions from the time of
puberty, or even earlier, accompanied by erotic dreams. I have put the
question to some twenty or thirty women. It is true that they were of
southern race (Italian, Spanish, and French), and I believe that
Southerners are, in this matter, franker than northern women, who consider
the activity of the flesh as shameful, and seek to conceal it." My
correspondent makes no reference to the chief point of sexual difference,
so far as my observation goes, which is that erotic dreams are
comparatively rare in those women "_who have yet had no sort of sexual
experience in waking life_." Whether or not this is correct, I do not
question the frequency of erotic dreams in girls who have had such
experience.
[242] C.C. Hersman, "Medico-legal Aspects of Eroto-Choreic Insanities,"
_Alienist and Neurologist_, July, 1897. I may mention that Pitres (_Leçons
cliniques sur l'Hystérie_, vol. ii, p. 34) records the almost identical
case of a hysterical girl in one of his wards, who was at first grateful
to the clinical clerk to whom her case was intrusted, but afterward
changed her behavior, accused him of coming nightly through the window,
lying beside her, caressing her, and then exerting violent coitus three or
four times in succession, until she was utterly exhausted. I may here
refer to the tendency to erotic excitement in women under the influence of
chloroform and nitrous oxide, a tendency rarely or never noted in men, and
of the frequency with which the phenomenon is attributed by the subject to
actual assault. See H. Ellis, _Man and Woman_, pp. 269-274.
[243] In Australia, some years ago, a man was charged with rape, found
guilty of "attempt," and sentenced to eighteen months' imprisonment, on
the accusation of a girl of 13, who subsequently confessed that the charge
was imaginary; in this case, the jury found it impossible to believe that
so young a girl could have been lying, or hallucinated, because she
narrated the details of the alleged offence with such circumstantial
detail. Such cases are not uncommon, and in some measure, no doubt, they
may be accounted for by auto-erotic nocturnal hallucinations.
[244] Sante de Sanctis, _I sogni e il sonno nell'isterismo e nella
epilessia_, Rome, 1896, p. 101.
[245] Pitres, _Leçons cliniques sur l'Hystérie_, vol. ii, pp. 37 et seq.
The Lorraine inquisitor, Nicolas Remy, very carefully investigated the
question of the feelings of witches when having intercourse with the
Devil, questioning them minutely, and ascertained that such intercourse
was usually extremely painful, filling them with icy horror (See, e.g.,
Dufour, _Histoire de la Prostitution_, vol. v, p. 127; the same author
presents an interesting summary of the phenomena of the Witches' Sabbath).
But intercourse with the Devil was by no means always painful. Isabel
Gowdie, a Scotch witch, bore clear testimony to this point: "The youngest
and lustiest women," she stated, "will have very great pleasure in their
carnal copulation with him, yea, much more than with their own
husbands.... He is abler for us than any man can be. (Alack! that I should
compare him to a man!)" Yet her description scarcely sounds attractive; he
was a "large, black, hairy man, very cold, and I found his nature as cold
within me as spring well-water." His foot was forked and cloven; he was
sometimes like a deer, or a roe; and he would hold up his tail while the
witches kissed that region (Pitcairn, _Criminal Trials in Scotland_, vol.
iii, Appendix VII; see, also, the illustrations at the end of Dr. A.
Marie's _Folie et Mysticisme_, 1907).
[246] Gilles de la Tourette, loc. cit., p. 518. Erotic hallucinations have
also been studied by Bellamy, in a Bordeaux thesis, _Hallucinations
Erotiques_, 1900-1901.
[247] On one occasion, when still a girl, whenever an artist whom she
admired touched her hand she felt erection and moisture of the sexual
parts, but without any sensation of pleasure; a little later, when an
uncle's knee casually came in contact with her thigh, ejaculation of mucus
took place, though she disliked the uncle; again, when a nurse, on
casually seeing a man's sexual organs, an electric shock went through her,
though the sight was disgusting to her; and when she had once to assist a
man to urinate, she became in the highest degree excited, though without
pleasure, and lay down on a couch in the next room, while a conclusive
ejaculation took place. (Moll, _Libido Sexualis_, Bd. I, p. 354.)
[248] Breuer and Freud, _Studien über Hysterie_, 1895, p. 217.
[249] Calmeil (_De la Folie_, vol. i, p. 252) called attention to the
large part played by uterine sensations in the hallucinations of some
famous women ascetics, and added: "It is well recognized that the
narrative of such sensations nearly always occupies the first place in the
divagations of hysterical virgins."
[250] H. Leuba, "Les Tendances Religieuses chez les Mystiques Chrétiens,"
_Revue Philosophique_, November, 1902, p. 465. St. Theresa herself states
that physical sensations played a considerable part in this experience.
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 foetid 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 foetid 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.
It was not possible any longer to maintain the womb theory of Hippocrates
in its crude form, but in modified forms, and especially with the object
of preserving the connection which many observers continued to find
between hysteria and the sexual emotions, it still found supporters in the
eighteenth and even the nineteenth centuries. James, in the middle of the
eighteenth century, returned to the classical view, and in his _Dictionary
of Medicine_ maintained that the womb is the seat of hysteria. Louyer
Villermay in 1816 asserted that the most frequent causes of hysteria are
deprivation of the pleasures of love, griefs connected with this passion,
and disorders of menstruation. Foville in 1833 and Landouzy in 1846
advocated somewhat similar views. The acute Laycock in 1840 quoted as
"almost a medical proverb" the saying, "_Salacitas major, major ad
hysteriam proclivitas_," fully indorsing it. More recently still Clouston
has defined hysteria as "the loss of the inhibitory influence exercised on
the reproductive and sexual instincts of women by the higher mental and
moral functions" (a position evidently requiring some modification in view
of the fact that hysteria is by no means confined to women), while the
same authority remarks that more or less concealed sexual phenomena are
the chief symptoms of "hysterical insanity."[259] Two gynæcologists of
high position in different parts of the world, Hegar in Germany and
Balls-Headley in Australia, attribute hysteria, as well as anæmia, largely
to unsatisfied sexual desire, including the non-satisfaction of the "ideal
feelings."[260] Lombroso and Ferrero, again, while admitting that the
sexual feelings might be either heightened or depressed in hysteria,
referred to the frequency of what they termed "a paradoxical sexual
instinct" in the hysterical, by which, for instance, sexual frigidity is
combined with intense sexual pre-occupations; and they also pointed out
the significant fact that the crimes of the hysterical nearly always
revolve around the sexual sphere.[261] Thus, even up to the time when the
conception of hysteria which absolutely ignored and excluded any sexual
relationship whatever had reached its height, independent views favoring
such a relationship still found expression.
Of recent years, however, such views usually aroused violent antagonism.
The main current of opinion was with Briquet (1859), who, treating the
matter with considerable ability and a wide induction of facts,
indignantly repelled the idea that there is any connection between
hysteria and the sexual facts of life, physical or psychic. As he himself
admitted, Briquet was moved to deny a sexual causation of hysteria by the
thought that such an origin would be degrading for women ("_a quelque
chose de dégradant pour les femmes_").
It was, however, the genius of Charcot, and the influence of his able
pupils, which finally secured the overthrow of the sexual theory of
hysteria. Charcot emphatically anathematized the visceral origin of
hysteria; he declared that it is a psychic disorder, and to leave no
loop-hole of escape for those who maintained a sexual causation he
asserted that there are no varieties of hysteria, that the disease is one
and indivisible. Charcot recognized no primordial cause of hysteria beyond
heredity, which here plays a more important part than in any other
neuropathic condition. Such heredity is either direct or more occasionally
by transformation, any deviation of nutrition found in the ancestors
(gout, diabetes, arthritis) being a possible cause of hysteria in the
descendants. "We do not know anything about the nature of hysteria,"
Charcot wrote in 1892; "we must make it objective in order to recognize
it. The dominant idea for us in the etiology of hysteria is, in the widest
sense, its hereditary predisposition. The greater number of those
suffering from this affection are simply born _hystérisables_, and on them
the occasional causes act directly, either through autosuggestion or by
causing derangement of general nutrition, and more particularly of the
nutrition of the nervous system."[262] These views were ably and
decisively stated in Gilles de la Tourette's _Traité de l'Hystérie_,
written under the inspiration of Charcot.
While Charcot's doctrine was thus being affirmed and generally accepted,
there were at the same time workers in these fields who, though they by no
means ignored this doctrine of hysteria or even rejected it, were inclined
to think that it was too absolutely stated. Writing in the _Dictionary of
Psychological Medicine_ at the same time as Charcot, Donkin, while
deprecating any exclusive emphasis on the sexual causation, pointed out
the enormous part played by the emotions in the production of hysteria,
and the great influence of puberty in women due to the greater extent of
the sexual organs, and the consequently large area of central innervation
involved, and thus rendered liable to fall into a state of unstable
equilibrium. Enforced abstinence from the gratification of any of the
inherent and primitive desires, he pointed out, may be an adequate
exciting cause. Such a view as this indicated that to set aside the
ancient doctrine of a physical sexual cause of hysteria was by no means to
exclude a psychic sexual cause. Ten years earlier Axenfeld and Huchard had
pointed out that the reaction against the sexual origin of hysteria was
becoming excessive, and they referred to the evidence brought forward by
veterinary surgeons showing that unsatisfied sexual desire in animals may
produce nervous symptoms very similar to hysteria.[263] The present
writer, when in 1894 briefly discussing hysteria as an element in
secondary sexual characterization, ventured to reflect the view, confirmed
by his own observation, that there was a tendency to unduly minimize the
sexual factor in hysteria, and further pointed out that the old error of a
special connection between hysteria and the female sexual organs, probably
arose from the fact that in woman the organic sexual sphere is larger than
in man.[264]
When, indeed, we analyze the foundation of the once predominant opinions
of Charcot and his school regarding the sexual relationships of hysteria,
it becomes clear that many fallacies and misunderstandings were involved.
Briquet, Charcot's chief predecessor, acknowledged that his own view was
that a sexual origin of hysteria would be "degrading to women"; that is to
say, he admitted that he was influenced by a foolish and improper
prejudice, for the belief that the unconscious and involuntary morbid
reaction of the nervous system to any disturbance of a great primary
instinct can have "_quelque chose de dégradant_" is itself an immoral
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-Duchâtelet
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 Salpêtrière 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
anæsthesia 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 archæologist
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 anæsthesia. 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 anæmic 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 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.
FOOTNOTES:
[251] _Genèse et Nature de l'Hystérie_, 1898; and, for Sollier's latest
statement, see "Hystérie 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 (_Traité de
l'Hystérie_, vol. i, p. 3).
[255] Aretæus, _On the Causes and Symptoms of Acute Diseases_, Book ii,