in regard to the fasting abilities of the young woman. It simply, with
the other, may be accepted as indicating that hysterical women are able
to go for comparatively long periods without food, and that fact we
already knew. It will be observed that it is stated that she "_seemed_"
to go four years without food or drink.
In regard to Miss Fancher, the evidence is a little conflicting. First
we have Dr. Speir reported as saying, in answer to a question as to her
having lived fourteen years without food:
"'Yes, she became my patient in 1864. Her case is a most remarkable
one.'
"'But has she eaten nothing during all these years?'
"'I can safely say she has not.'"
This in the _Herald_.
But about a month afterward we find the following conversation, reported
as taking place between the same physician and another reporter, this
time of the _Sun_:
"'Is it true that she has not partaken of food in all these thirteen
years?'
"'No, I cannot say that she has not; I have not been constantly with her
for thirteen years. She may have taken food in my absence.'"
In which opinion all physiologists will join.
As I have said, hysterical women certainly do exhibit a marked ability
to go without both food and drink. I have had patients abstain from
sometimes one, sometimes the other, and sometimes both, for periods
varying from one day to eleven, and this without much, if any,
suffering, for as soon as the suffering came they did not hesitate to
signify their desire to break their voluntary fasts. Real suffering is a
condition which the hysterical woman avoids with the most assiduous
care.
FOOTNOTES:
[14] Curiosities of Medical Experience. London, 1837, Vol. I., page 269,
article, _Abstinence_.
V.
THE PHYSIOLOGY AND PATHOLOGY OF INANITION.
The opinion that food and drink are necessary to life is so generally
accepted by mankind, that few venture to dispute the dictum of Virchow
relative to Louise Lateau, "Fraud or miracle." But although it is
impossible so far as we know for individuals to continue to exist for
months and years without the ingestion of nutriment into the system, it
is undoubtedly true that under certain circumstances life can be
prolonged for days and weeks without any food of any kind going into the
organism.
The body is a machine constructed for the purpose of working. The kinds
of work which the body of a man or woman does are many. Every act of
perception or sensation, is an act of work; so is every thought, every
emotion, every volition. The action of the heart or lungs in the
circulation and respiration, the evolution of the animal heat, the
various functions of secretion and excretion, digestion, motion,
speech, etc., are all so many kinds of work. Now as regards work, it is
well known that for its due performance force is required, and it is
equally well known that for the development of force, matter that can be
metamorphosed is necessary. The engine may be perfect, the water may be
in the boiler, but unless there be force in the form of heat there will
be no steam; and there will be no heat unless there be fuel in a state
of combustion.
The human body differs from any other machine in the fact that it uses
its fuel in great part indirectly; only in fact after it has been
assimilated and converted into tissues of various kinds. Thus when a
muscle contracts, it is the muscle itself which is consumed; when a
thought is conceived it is the brain which provides the force; when an
emotion is experienced, it is again the brain which is decomposed. The
body, therefore, lives by the death of its own substance. It is true,
some kinds of food such as alcohol, tea and coffee, and perhaps some
others do not require to go farther than the blood to be burned, but
these are mainly heat-producing, and not tissue-producing substances.
But whether matter be consumed directly or indirectly, all bodily force
results from its decomposition, and without this destruction of matter
the body would be absolutely incapable of a single functional action of
any kind whatever, and its temperature like that of the so-called
cold-blooded animals would be that of the surrounding medium, the
atmosphere.
The quantity of food required by the system varies like the demands of
other machines in accordance with the amount of work which is to be
performed. A plowman, other things being equal, consumes more than a
watchmaker; just as a locomotive burns more fuel than the little engine
that runs a sewing machine; the strong able-bodied active man, one who
works his brains and muscles up to their full power, eats more than the
weak, emaciated and inactive girl, who passes all her time in the
recumbent position in bed; and the latter will, other things being
equal, endure for a longer period entire abstinence from food. A little
food with such a one goes a great way, the demands of the system are at
their minimum, and hence a mouthful of bread, or a little tea and toast
taken at long intervals, suffices for the supply of all, or a great
portion of the waste of the body. With such a person there is not much
intense thought, there is little or no muscular action, the pulsations
of the heart do not require to be of much force, the respiration is
feeble, digestion is at its lowest point, there are no great demands for
animal heat, and in fact if the temperature of the atmosphere of the
room in which such a person lies, be kept high, the function of
calorification may be almost nothing. Still there must be some food
taken. The body, can to a certain extent, be used up in supplying the
force required for the several functions without the necessity for an
immediate restoration of its tissues, but there is a limit to this,
beyond which it is certain death to go.
Chossat[15] has determined this point very accurately by many
experiments performed upon doves, pigeons, Guinea pigs, rabbits, etc. He
found that as a mean result, death ensued when the body lost four-tenths
of its original weight. For instance, a body weighing one hundred
pounds, could endure the loss of forty pounds without death necessarily
following. Five-tenths or one-half appeared to be the extreme loss of
weight in inanition which the body could endure without death resulting.
In addition to the loss of weight the temperature fell rapidly, the
action of the heart was lessened, the number and depth of the
respirations was diminished, and the excretions gradually became smaller
in amount.
Experiments such as those of Chossat on the lower animals, cannot of
course be instituted on the human subject, nevertheless nature sometimes
performs experiments for us which are not without valuable results; and
accidents of various kinds, have also given us important data.
On the 19th of March, 1755, twenty-two persons living in the Alpine
village of Bergemoletto, in Piedmont, were buried in their houses by an
avalanche or whirlwind of snow. The space covered was about two hundred
and seventy feet in length, sixty in breadth, and the snow was over
forty-two feet in depth. Notwithstanding all the efforts made by the
survivors it was impossible to extricate the buried persons till the
18th of April following. All were dead except three women, who, having
found some hay, fed a goat with it, and thus obtained from this animal a
pint of milk daily, on which they had managed to sustain life for a
month.[16]
In Belgium in the year 1683, four colliers were confined in a coal pit
for twenty-four days without anything to eat. On the twenty-fifth day
they were taken out. In all that time they had lived on nothing but a
little water, which flowed from the walls of the prison in which they
were immured.[17]
A case is mentioned by Fodere[18] on the authority of M. Chaussier, in
which some workmen were taken out alive after having been confined for
fourteen days in a cold damp vault. When released at the end of the time
mentioned, their pulses were slow and weak, their animal heat greatly
reduced, and respiration barely perceptible. Fodere ascribes their long
existence without either food or drink, to the fact that the atmosphere
of the vault was exceedingly humid, and that the moisture was absorbed
into their bodies, taking the place of water ingested into the stomach.
In another case reported by Dr. Straus,[19] a man sixty-five years of
age, was extracted alive from a coal mine, in which he had been
imprisoned for twenty-three days. During the first ten days he had a
little dirty water, but for the last thirteen days nothing whatever.
When taken out he was in a condition of great weakness and emaciation
and died after three days, notwithstanding all efforts made to preserve
his life.
Cases of prolonged abstinence often occur among the insane, who, under
the influence of delusions, or in order to destroy their lives refuse
all food. Dr. Willan relates the case of a young man, who, through
delusions, refused all food but a little orange juice, and who lived for
sixty days on this alone.
Of course such persons, if under the observation of a physician, could
be fed forcibly, but through the ignorance of friends or relatives it
not unfrequently happens that medical aid is not invoked in time, and
serious symptoms, or even death itself, may result. The time at which
this last termination ensues varies according to the kind of insanity
with which the patient is affected. A general paralytic deprived of all
food dies sooner than a healthy person. An insane person suffering from
acute mania also resists inanition badly, but one the subject of
melancholia often endures the total deprivation of aliment for a long
time. Esquirol[20] cites the case of a melancholic who did not succumb
till after eighteen days of complete abstinence, and Desbarreaux-Bernard
another in which life was prolonged for sixty-one days, but in this case
a little broth was taken once. Desportes[21] refers to the case of a
woman subject to melancholia who continued to exist during two months of
abstinence, during which she took nothing into the stomach but a little
water.
It would be easy to go on and quote other instances occurring among
prisoners, shipwrecked persons, those suffering from diseases which
prevented food entering the stomach, others lost in deserts, forests,
etc., in which life has been prolonged for considerable periods. Such
cases are, however, quite exceptional. An interesting instance occurring
under one of these heads may, however, be cited as an example.
M. Lepine[22] reports the case of a young girl nineteen years of age who
swallowed a quantity of sulphuric acid. As a consequence a stricture of
the [oe]sophagus was produced. Three months after the act, liquids alone
passed into the stomach; emaciation was extreme and the countenance
pallid. Four months subsequently, that is, seven months after swallowing
the acid, the obliteration of the [oe]sophagus was complete, and
nothing whatever could be swallowed. The patient lived for sixteen days
after all food or drink was prevented reaching the stomach. During the
last days of her starvation she complained only of thirst and not of
hunger. The prostration was extreme and the temperature greatly
lessened. A tendency to sleep was present, and there was a subdued
delirium. On the last day of life there was more excitement; the
conjunctivae were red, the pulse thread-like, and the skin cold. It is
not stated whether or not attempts were made to feed this patient by
injections into the rectum of nutritious substances, or by the use of
baths containing such matters in solution. It may, however, safely be
taken for granted that efforts of these kinds were made, and if so, the
unusually long period during which life was sustained is explained.
In all the cases in which life was extraordinarily prolonged there was
either not a total deprivation of food and drink, or there was a state
of muscular inaction present particularly favorable to retardation of
the destructive changes in the body which abstinence produces. It may be
asserted that in ordinary cases absolute deprivation of food and drink
cannot be endured by a healthy adult longer than ten days, and death
generally ensues before the end of the eighth day. It is said that women
sustain abstinence better than men. Young persons and the aged certainly
resist with less power than those of the middle period of life. Dante
was aware of this fact when he made the children of Ugolino die before
their father, the youngest first, the oldest last.
Even though there be a total deprivation of what may strictly be called
food, some of the cases already cited show that if water be taken life
is preserved for a much longer period than would otherwise be the case.
Thus a negro woman, according to Dr. J. W. Francis,[23] believing
herself to be bewitched, abstained from food for three weeks, but during
this period took two small cups of water, to which a very little wine
had been added.
In a case reported by Dr. McNaughton[24] a longer resistance was
maintained.
"The subject of this case was a young man, aged twenty-seven, who for
three years immediately preceding his death almost constantly kept his
room, apparently engaged in meditation, a Bible his only companion. At
the latter end of May, 1829, his appetite began to fail; he ate very
little, and on the 2d of July he declined eating altogether. For the
first six weeks of his fast he went regularly to the well, washed
himself, and took a bowl full of water with him into the house. With
this he occasionally washed his mouth and drank a little; the quantity
taken during the twenty-four hours did not exceed a pint. On one
occasion he went three days without taking water, but on the fourth
morning he was observed to go to the well and drink copiously and
greedily. For the first six weeks he walked out every day, and sometimes
spent the greater part of the day in the woods. He retained his strength
until a short time before his death. During the first three weeks he
emaciated rapidly; afterwards he did not seem to waste so sensibly.
Prof. Willoughby visited him a few days before he died. He found the
skin very cold, the respiration feeble and slow, but otherwise natural;
but the effluvia from the breath, and perhaps the skin, were extremely
offensive. During the greater part of the latter week of his life the
parents say there was a considerable discharge of foul reddish matter
from the lungs. To this perhaps the offensive smell referred to may be
chiefly attributed. The pulse was regular, but slow and feeble, and the
arteries extremely contracted. The radial artery, for example, could be
distinctly felt like a small, hard thread, communicating almost a wiry
feel.
"The alvine evacuations were rare; it is believed that he passed several
weeks without any, but the secretion of urine seemed more regular. He
died after fasting fifty-three days. On dissection the stomach was found
loose and flabby. The gall bladder was distended with a dark,
muddy-looking bile. The mesentery, stomach and intestines were
excessively thin and transparent. There was no fat in the omentum."
In cases of complete abstinence, the phenomena--to several of which
attention has already been called--are very striking. The respiration
becomes slow until just before death, when, as Chossat observes, there
is often a quickening of the respiratory movements. The exhaled breath
has a peculiarly sickening and fetid odor. The pulse loses in force and
frequency.
The blood becomes reduced in quantity to such an extent sometimes that,
as observed by Collard and Martigny,[25] incisions may be made in
various parts of the bodies of animals suffering from inanition without
there being any haemorrhage.
The animal temperature falls, according to Chossat, 8 deg. per day until the
day of death, when it reaches 14 deg.; and at the moment life departs, the
loss suddenly becomes 30 deg..
All the secretions are diminished in quantity. This is especially shown
as regards the saliva and urine. Even open sores cease to secrete pus.
At first there is pain, the seat of which is referred to the stomach,
and which pain in the beginning, being simply a feeling of emptiness,
rapidly assumes a gnawing or tearing character. But before long this
fades away and it does not appear that in the middle and final stages of
inanition there is any suffering which can be called a pain, or which
can be fixed in any definite part of the body.
The mental faculties are profoundly affected. A high state of delirium
supervenes, and there are often hallucinations. These sometimes relate
to food, which appears to the sufferer to be spread out before him in
the most seducing manner. All nobility of character disappears, and
selfishness and brutality govern. Finally the delirium becomes low and
muttering, the bodily weakness becomes excessive, walking, or even
standing, is impossible, the sufferer loses all sensation, and death
ensues.
But probably no part of the subject is of more interest than that which
relates to the association of inanition with hysteria. As is well known
by physicians, the existence of this latter condition enables many to
bear partial, or even complete deprivation of food longer and with less
apparent suffering than would be possible with individuals in good
health.
That Miss Fancher is subject to hysteria is very evident from a
consideration of the clinical history of her case, and hence it is to
be expected that she can endure long fasts without much inconvenience.
It is just possible that she might, by remaining quietly in bed in a
state of partial or complete trance--a hysterical condition in which the
waste of the tissues is greatly reduced--exist for a month without
either food or drink, and therefore the proposition which I made to her
friends contains no exacting condition. But when it is gravely said that
"for a period of nearly fourteen years she has lived absolutely without
food or nourishment of any kind," we are forced to declare, in the
interest of science, that the statement is necessarily absolutely devoid
of truth. Subsequent statements, as we have seen, modify this fourteen
years' claim very materially, and really leave it in doubt whether there
was any abstinence at all.
But I think it may safely be believed that Miss Fancher has indulged in
frequent long fasts. Hysteria is very frequently marked, not only by the
ability to endure lengthened periods of abstinence, but by the abolition
of all desire for food, to such an extent that the sight or even idea of
aliment of any kind excites loathing and disgust. M. Lasegue,[26] in a
very interesting memoir, has discussed this part of the subject with
great precision, and has shown that though such patients take very
little food they do take some, and that eventually they experience all
the symptoms of inanition. He has never seen death result from the
abstinence, for as soon as the condition becomes decidedly unpleasant
the patient resumes gradually her normal alimentation.
In a case recently under my care, a young lady twenty-three years of
age became hysterical in consequence of domestic troubles, and losing
all desire for food, took nothing daily but a single cup of chocolate.
She persevered in this restricted diet for twenty-nine days, although
during the last eight or ten she gave decided evidences of starvation.
She became emaciated, her temperature fell, especially in the
extremities, her breath was offensive, her menstruation ceased, and
there was such a marked sense of discomfort that she began to crave
food, not, as she said, because her appetite had returned, but because
she was afraid she would die. Still she resisted till, on the thirtieth
day, she begged for a little beef tea, and from that moment her appetite
returned to her, and by the end of another week, she was eating her
ordinary quantity and variety of food.
Now, in this case, though the amount of nutriment taken daily was small,
it was of such a character as to be well able to sustain life. The half
pint of chocolate contained milk and sugar, besides the highly
nutritious chocolate, with its carbonaceous and nitrogenous matters, and
yet a month was the extreme limit of endurance.
That a state of inanition exists in Miss Fancher is not to be doubted.
The extreme emaciation, the reduced bodily temperature, the contracted
stomach and intestines, the great bodily weakness, all show that she is
not sufficiently nourished. In her case there is apparently not only an
absence of appetite but a positive disgust for food; and another symptom
often present in inanition--vomiting when nutriment is taken into the
stomach--appears also to be a prominent feature. It is probable that
there is likewise a notable diminution in the amount of urine excreted,
as this is a common accompaniment of hysterical manifestations such as
hers. In some instances the function appears to be almost entirely
arrested, as was the fact in a case described by M. Charcot,[27] and in
two which have come under my own observation.
There is nothing remarkable in the admitted fact that Miss Fancher eats
very little. We have seen how existence can be kept up on greatly
reduced quantities of food, and under circumstances such as those
governing her case, for periods which would be impossible in healthy
persons. No one yet under any conditions, whether of hysteria or trance
or assumed miraculous interference, has, to the satisfaction of
competent and disinterested investigators, lived even two months without
the ingestion of any food whatever. As to going nearly fourteen years in
a state of abstinence--a statement in her behalf which many persons
believe to be true--I can only say that all the teachings of science and
of experience are against the claim. No one who had the most superficial
idea of what knowledge is and how facts can be proven, would for a
moment accept such a preposterous story, no matter by whom asserted.
The whole subject is one which is to be examined into and determined
like any other matter, and yet, when a proposition is made to
investigate by skilled observers the remarkable claim put forward, it is
met with abuse and misrepresentation, as if these people thought that
all they had to do was to make an assertion of a phenomenon which,
according to what we know of nature, is absurd and impossible, to have
it at once accepted by those who know, by painful experience, how
doubtful all things are till they are proven, and how difficult it is
to get satisfactory evidence of the most simple event in physiology or
pathology. No one doubts the abstract possibility of a human being
living without food, for, bearing in mind the discoveries that are
constantly being made, nothing can be regarded as absolutely impossible
outside the domain of mathematics. Two and two cannot make six, neither
can two distinct bodies occupy the same space at the same time, nor the
square of the hypothenuse be otherwise than equal to the sum of the
squares of the other two sides of a right-angled triangle.