child pilgrimages.[52] These pilgrimages, like the dancing mania,
occurred in the Middle Ages. The greatest was the boy crusade in the
year 1212. The passion to repossess the Holy Land then had its grip on
Catholic Europe. The first impulse to the child pilgrimages was given
by a shepherd-boy, who had revelations and ecstatic seizures, and held
himself to be an ambassador of the Lord. Soon thirty thousand souls
came to partake of his revelations; new child-prophets and
miracle-workers arose; the children of rich and poor flocked together
from all quarters; parents were unable to restrain them, and some even
began to urge them. A host of boys, armed and unarmed, assembled at
Vendôme, and started for Jerusalem with a boy-prophet at their head.
They got to Marseilles, and embarked on seven large ships. Two ships
were wrecked, and not a soul was saved. The other five ships reached
Bougia and Alexandria, and the young crusaders were all sold as slaves
to the Saracens. In Germany child-prophets arose, especially in the
Rhine countries and far eastward. An army of them gathered together,
crossed the Alps, and reached Genoa. They were soon scattered; many
perished; many were retained as servants in foreign lands; some
reached Rome. A second child's pilgrimage occurred twenty-five years
later. It was confined to the city of Erfurt. One thousand children
wandered, dancing {225} and leaping, to Armstadt, and were brought
back in carts. Another child's pilgrimage from Halle, in Suabia, to
Mount St. Michel in Normandy, occurred in 1458.
[Footnote 52: Translated by Robert H. Cooke, M. R. C. S.]
In the convent of Yvertet in the territory of Liège, in 1550, the
inmates were seized with a leaping and jumping malady. The disorder
began with a single individual, and was soon propagated.
Sometimes the convulsive disorders of early days, especially those
occurring in convents, were associated with the strange delusion that
the subjects of them were changed into lower animals. Various names
have been given to disorders of this kind, such as lycanthropia or
wolf madness, zoomania or animal madness, etc. Burton in the _Anatomy
of Melancholy_ gives an interesting summary of these disorders, which
are also discussed by Levick.
In 1760 a religious sect known as the Jumpers prevailed in Great
Britain. They were affected with religious frenzy, and jumped
continuously for hours. Other jumping epidemics have appeared at
different times, both in Great Britain and in this country.
The New England witchcraft episode is of historical interest in
connection with this subject of epidemic hysteria. This excitement
occurred during the latter part of the seventeenth century. Adults and
children were its subjects. The Rev. Cotton Mather records many cases,
some of which illustrate almost every phase of hysteria. Individuals
who were seized with attacks, which would now be regarded as
hysterical or hystero-epileptic, were supposed to have become
possessed through the machinations of others. Those who were supposed
to be possessed were tried, condemned, and executed in great numbers.
Many accused themselves of converse with the devil. The epidemic
spread with such rapidity, and so many were executed, that finally the
good sense of the people came to the rescue.
The nervous epidemics, nearly all religious, which have occurred in
this country have usually been during the pioneer periods, and have
therefore appeared at different eras as one part of the country after
another has been developed. Kentucky, Tennessee, Virginia, and
neighboring States were visited time and again. Even to-day we
occasionally hear of outbreaks of this kind in remote or primitive
localities, whether it be in the far South-west or in the woods of
Maine.
David W. Yandell[53] has published a valuable paper on “Epidemic
Convulsions,” the larger part of the materials of which were collected
by his father for a medical history of Kentucky. From this it would
appear the convulsions were first noticed in the revivals from 1735 to
1742. Many instances are related of fainting, falling, trance,
numbness, outcries, and spasms. The epidemic of Kentucky spread
widely, reappeared for years, and involved a district from Ohio to the
mountains of Tennessee, and even to the old settlements in the
Carolinas. Wonderful displays took place at the camp-meetings. At one
of these, where twenty thousand people were present, sobs, shrieks,
and shouts were heard; sudden spasms seized upon scores and dashed
them to the ground. Preachers went around in ecstasy, singing,
shouting, and shaking hands. Sometimes a little boy or girl would be
seen passionately exhorting the multitude, reminding one of the part
taken by {226} the children in the epidemics of the Middle Ages. A
sense of pins and needles was complained of by many; others felt a
numbness and lost all control of their muscles. Some subjects were
cataleptic; others were overcome with general convulsions.
[Footnote 53: _Brain_, vol. iv., Oct., 1881, p. 339 _et seq._]
The term jerks was properly applied to one of the forms of convulsion.
Sometimes the jerking affected a single limb or part. The Rev. Richard
McNemar has given a graphic description of this jerking exercise in a
_History of the Kentucky Revival_. The head would fly backward and
forward or from side to side; the subject was dashed to the ground, or
would bounce from place to place like a football, or hop around with
head, limbs, and trunk twitching and jolting in every direction.
Curiously, few were hurt. Interesting descriptions of the jerks can be
found in various American autobiographical and historical religious
works. In such books as the _Autobiography of Peter Cartwright_, a
Western Methodist, for instance, striking accounts of some of the
phases of these epidemics are to be found. Lorenzo Dow in his
_Journal_, published in Philadelphia in 1815, has also recorded them.
Hysterical laughter was a grotesque manifestation often witnessed. The
holy laugh began to be a part of religious worship. Dancing, barking,
and otherwise acting like dogs, were still other manifestations. It is
remarkable that, according to Yandell, no instance is recorded in
which permanent insanity resulted from these terrible excitements.
The absurd and extraordinary exhibitions witnessed among the Shakers
belong to the same category, and have been well described by Hammond
and others.
In a _History of the Revival in Ireland in 1859_, by the Rev. William
Gibson, instances of excitement that fairly rivalled those which
occurred in our Western States are given. Cases of ecstasy are
described.
The religious sect known as the Salvation Army, which has in very
recent years excited so much attention, curiosity, and comment both in
America and England, has much in common with the Jumpers, the Jerkers,
and the Convulsionnaires. The frenzied excitement at their meetings,
with their tambourine-playing, dancing, shouting, and improvising are
simply the same phases of religio-hysterical disorder, modified by
differences in the age and environment.
In 1878, in the district of Tolmezo, Italy, an epidemic of hysteria
which recalls the epidemics of the Middle Ages occurred. It has been
described by M. Léon Colin.[54] It was reported to the prefect of
Undine that for three months some forty females living in the commune
of Verzeguis had been attacked by religious mania. “From the report it
appears that the first was in the person of a woman named Marguerite
Vidusson, who had been the subject of simple hysteria for about eight
years. In January, 1878, she began to suffer from convulsive attacks,
accompanied by cries and lamentations. She was regarded as the subject
of demoniacal possession, and on the first Sunday in May was publicly
exorcised. Her affection, however, increased in severity; the attacks
were more frequent and more intense, and were especially provoked by
the sound of the church-bells and by the sight of priests. Seven
months later three other hysterical girls became subject to convulsive
and clamorous attacks. Here, again, an attempt was made to get rid of
the {227} supposed demon. A solemn mass was said in the presence of
the sufferers, but was followed only by a fresh outbreak. At the time
of the visit of the delegates eighteen were suffering, aged from
sixteen to twenty-six years, except three, whose ages were
respectively forty-five, fifty-five, and sixty-three years. Similar
symptoms had also appeared in a young soldier on leave in the
village.” During the attacks the patients talked of the demon which
possessed them, stated the date on which they were seized by it, and
the names of the persons who were possessed before them. Some boasted
of being prophetesses and clairvoyants and of having the gift of
tongues. In all, the sound of church-bells caused attacks, and
religious ceremonies appeared not only to aggravate the disease in the
sufferers, but also to cause its extension to those not previously
attacked. M. Colin points out that the soil is particularly favorable
for the development of an epidemic of this nature. The people of
Verzeguis are backward in education and most superstitious. Functional
nervous diseases are common among them. The inhabitants of the village
are largely cut off from intercourse with the adjacent country in
consequence of comparative inaccessibility and the frequent
interruption of communications by storms and floods. Craniometric
observations on twelve of the inhabitants seemed to show that the
brachycephalic form of skull predominated, and that the development of
the cranium was slightly below the average. The epidemic proved
extremely obstinate.
[Footnote 54: _Annales d'Hygiène_, quoted in _Lancet_, Oct. 16, 1880.]
In Norway and New Caledonia similar hysterical outbreaks have been
observed in recent times.
An endemic of hysteria from imitation occurred in Philadelphia in
1880. Some of the cases fell under my own observation. A brief account
of them is given by Mitchell in his _Lectures_. The outbreak occurred
in a Church Home for Children, to which Dr. S. S. Stryker was
physician. The Home contained ninety-five girls and six boys; all of
them were well nourished and in good condition. The epidemic began by
a girl having slight convulsive twitchings of the extremities, with a
little numbness. Attacks returned daily; respiration became loud and
crowing. She soon had all the phenomena of convulsive hysteria. Many
of her comrades began to imitate her bark. Soon another girl of ten
was attacked with harsh, gasping breathing, with crowing,
speechlessness, clutching at her throat, and the whole series of
phenomena exhibited by the first girl attacked. Nine or ten others
were affected in like manner, and many of the remaining children had
similar symptoms in a slight degree. At first convulsions occurred
irregularly; after a while they appeared every evening; later, both
morning and evening. The presence of visitors would excite them. Many
interesting hysterical phases occurred among the children. One night
some of them took to walking about on their hands and knees; others
described visions. The girls often spoke of being surrounded by wild
beasts, and one child would adopt the fiction which another related in
her hearing. The cases were scattered about in different hospitals,
and made good recoveries in from one to two months.
The Jumpers or Jumping Frenchmen of Maine and Northern New Hampshire
were described by Beard in 1880.[55] They presented nervous phenomena
in some phases allied to hysteria. In June, 1880, Beard {228} visited
Moosehead Lake and experimented with some of them. Whatever order was
given them was at once obeyed. One of the Jumpers, who was sitting in
a chair with a knife in his hand, was told to throw it, and he threw
it quickly so that it struck in a beam opposite; at the same time he
repeated the order to throw it with a cry of alarm. They were tried
with Latin and Greek quotations, and repeated or echoed the sound as
it came to them. They could not help repeating any word or sound that
came from the person that ordered them. Any sudden or unexpected
noise, as the report of a gun, the slamming of a door, etc., would
cause them to exhibit some phenomena. It was dangerous to startle them
where they could injure themselves, or if they had an axe, knife, or
other weapon in their hands. Since the time of Beard's observation
accounts of their doings have now and then found their way into
newspapers. One recent account tells of one of these peculiar people
jumping from a raft into the Penobscot River on an order to jump.
[Footnote 55: _Journal of Nervous and Mental Diseases_, vol. vii.,
1880, p. 487.]
Hammond[56] has described under the name Miryachit an affection which
seems to be essentially the same disorder as that of which the Jumpers
are the victims. He quotes from a report of a journey from the Pacific
Ocean through Asia to Europe by Lieutenant B. H. Buckingham and
Ensigns Geo. C. Foulk and Walter McLean of the United States Navy, an
account of this disease. The party made their first observations on
this affection while on the Ussuri River in Siberia. The captain of
the general staff approached the steward of the boat suddenly, and
without any apparent reason or remark clapped his hand before his
face; instantly the steward clapped his hand in the same manner, put
on an angry look, and passed on. When the captain slapped the
paddle-box suddenly, the steward instantly gave it a similar thump.
Some of the passengers imitated pigs grunting or called out absurd
names, etc.; the poor steward would be compelled to echo them all. The
United States naval officers were informed that the affection was not
uncommon in Siberia, and that it was commonest about Yakutsk, where
the winter cold is extreme. Both sexes were subject to it, but men
much less than women. It was known to Russians by the name of
Miryachit.
[Footnote 56: _New York Med. Journ._, Feb. 16, 1884.]
In both these classes of cases a suggestion of some kind was required,
and then the act took place independently of the will. “There is
another analogous condition known by the Germans as Schlaftrunkenheit,
and to English and American neurologists as somnolentia or
sleep-drunkenness. In this state an individual on being suddenly
awakened commits some incongruous act of violence, ofttimes a murder.
Sometimes this appears to be a dream, but in others no such cause
could be discovered.” Curious instances are mentioned by Hammond of
this disorder.
The phenomena of automatism at command in hypnotized subjects have
much similarity to the phenomena of these affections, and the same
explanation to a certain extent will answer for both.
Paget[57] has ably discussed the subject of neuromimesis in general,
and Mitchell[58] devotes two lectures to its consideration. As already
stated when discussing the synonyms of hysteria, the mistake must not
be made of supposing all cases of hysteria to be instances of
neuromimesis; but, as Mitchell remarks, the hysterical state, however
produced, is a fruitful {229} source of mimicry of disease in its
every form, from the mildest of pains up to the most complete and
carefully-devised frauds. “Its sensitiveness and mobility, its
timidity and emotionalness, its greed of attention, of sympathy, and
of power in all shapes, supply both motive and help, so that while we
must be careful not to see mimicry in every hysteric symptom, we must
in people of this temperament be more than usually watchful for this
form of trouble, and at least reasonably suspicious of every peculiar
or unusual phenomenon.”
[Footnote 57: _Op. cit._]
[Footnote 58: _Op. cit._]
SYMPTOMATOLOGY.—At the outset of the discussion of the symptomatology
of hysteria, hysterical cases should be divided into four classes—viz.
(1) Cases in which the symptoms are involuntary; (2) cases in which
the symptoms are artificially induced and become involuntary; (3)
cases in which the symptoms are acted or simulated, but in which the
patient, because of impaired mental power, is irresistibly impelled to
their performance; (4) cases in which the symptoms are purely acts of
deception which are under the control of the patient.
Keeping in mind these different classes, we will always be able to
link to the phenomena of hysteria the psychical element which is
present in all genuine cases of this disorder. To comprehend the
existence of the psychical element in the first class, in which the
manifestations are absolutely involuntary, may offer difficulties. In
these cases, at a period more or less recent or remote, psychical
stimuli may have acted to produce the hysterical phenomena, and, once
produced, these have been repeated and intensified by habit, and
continue independently both of volition and consciousness. The
experiments of Dercum and Parker show how hysterical symptoms may be
artificially induced and may get beyond the patient's control. The
difference between induced and simulated manifestations must always be
clearly borne in mind. To induce a set of phenomena a certain
mechanism must be set in action, and this, through rational,
explicable processes, leads to certain results. The psychical element
enters here both positively and negatively—positively, in the
determination to produce a certain train of events; negatively, in the
condition of mental concentration or abstraction which is a part of
the procedure. In the third class of cases acting or simulation is
dependent upon the irresistible inclinations of the patient. This may
seem to some an uncertain and even dangerous ground to take. I am
convinced, however, after observing many hysterical cases, that acts
clearly purposive, so far as the particular performance is concerned,
are sometimes the result of a general unstable mental condition. Some
at least of these patients are as irresistibly impelled to swallow
blood and vomit, to scream and gesticulate, etc., as is the monomaniac
to commit arson, to ravish, or to kill. In the fourth class, the cases
of pure, unmitigated, uncontrollable deception, the psychical element
is very evident, although some may question whether such cases should
be ranged under the banner of hysteria, where it is both convenient
and customary to place them.
The symptoms of hysteria may develop in any order or after any
fashion. The graver hysterical phenomena, such as convulsions,
paralysis, and anæsthesia, often seem to come on suddenly, but usually
this suddenness of onset is apparent rather than real. Minor
hysterical symptoms, such as general nervous irritability, pains,
aches, and discomforts, and mental peculiarities, have usually been
present for a long {230} time. These minor evidences of the hysterical
constitution are sometimes the only phenomena ever presented.
Todd[59] has described an expression of countenance which he
designates as the facies hysterica. The characteristics of this
expression are a remarkable depth and prominent fulness, with more or
less thickness, of the upper lip, and a peculiar drooping of the upper
eyelids. It would be absurd to assert that all hysterical patients
presented this cast of countenance, but an appearance which approaches
closely to this description is presented in a fair percentage of
cases. It has seemed to me that male hysterics were more likely to
have this peculiar facies than hysterical females.
[Footnote 59: _Reynolds's System of Medicine_, vol. ii. p. 656.]
The psychical peculiarities or mental disorders of hysteria form a
large and important part of its phenomena. We have to deal not only
with peculiar and diverse psychical manifestations, but to one form of
mental disorder it is clinically convenient and correct to apply the
designation hysterical insanity.
In the mildest cases of ordinary hysteria conditions of mental
irritability and mobility are sometimes the only striking features.
“Patients,” says Jolly,[60] “are timid, easily overcome by any
unexpected occurrence, sentimental, and sensitive. Every trifle annoys
and upsets them; and there is this peculiarity—that a more recent
stimulus may often effect a diversion in an exactly opposite
direction.”
[Footnote 60: _Op. cit._]
As bearing upon the question of the mental state in hysteria, the
confessions obtained by Mitchell from several patients are of great
interest. One patient, who had learned to notice and dwell upon any
little symptom, vomited daily and aroused much sympathy. She took
little or no food. Spasms came on, and she confessed that every new
symptom caused new anxiety, and that somehow she rather liked it all.
She gradually lost all her symptoms except vomiting, and overcame this
by desperate efforts. Another patient confessed to having played a
game upon her doctor for a long time by pretending she took no food.
She would get out of bed at night, but remain there all day; she
filled up a vessel with water to make others believe she passed large
quantities of urine, etc. Another patient, a girl of nineteen, who
came on a litter from a Western State, after a time regained her feet.
In her confession she stated that what she lacked was courage. She
believed that she would have overcome her difficulties if any one had
told her that nothing was the matter. “In looking back over the year
with the light of the present,” she says, “I can only say that I
believe that there was really nothing the matter with me; only it
seemed to me as if there was, and because of these sensations I
carried on a sort of starvation process physical and mental.”
The older and some of the more recent classifications of insanity
recognize hysterical insanity as a distinct form of mental disease.
Morel and Skae, however, in their etiological classifications, and
Hammond, Spitzka, Mann, and Clouston in their recently-published
works, give it a “local habitation and a name.” Krafft-Ebing not only
recognizes hysterical insanity as a distinct form of mental disease,
but, after the German fashion, subdivides it quite minutely, as
follows: First, transitory forms: _a_. with fright; _b_.
hystero-epileptic deliria; _c_. ecstatic visionary forms; {231} _d_.
moria-like conditions. Second, chronic forms: _a_.
hystero-melancholia; _b_. hystero-mania; _c_. degenerative states with
hysterical basis.
Spitzka[61] speaks of chronic hysterical insanity as an
intensification of the hysterical character, to which “a silly
mendacity is frequently added, and develops pari passu with advancing
deterioration.” At the State Hospital for the Insane at Norristown and
at the department for the insane of the Philadelphia Hospital cases of
chronic hysterical insanity have come under my observation. Hammond
under hysterical mania includes several different and somewhat
distinct mental disorders.
[Footnote 61: _Insanity, its Classification, Diagnosis, and
Treatment_, by E. C. Spitzka, M.D., New York, 1883.]
With regard to the occurrence of hysterical manifestations amongst
patients suffering from some well-recognized non-hysterical forms of
insanity, a tour through any large asylum will afford abundant
evidence. Cases of tremor closely simulating cerebro-spinal sclerosis
have been observed frequently among the insane. Paralysis,
contracture, hysterical joints, hysterical neuralgias, convulsions,
and cataleptoid phenomena are among other hysterical manifestations
which have fallen under personal observation among the insane of
various classes.