Ex Libris 
 C. K. OGDEN
 
 THE NEW LIBRARY OF MEDICINE 
 EDITED BY C. W. SALEEBY, M.D., F.R.S.E. 
 
 FUNCTIONAL NERVE DISEASES
 
 FUNCTIONAL NERVE 
 DISEASES 
 
 A. T. SCHOFIELD, M.D 
 
 HON. PHYS., FRIEDENHEIM HOSPITAL 
 
 LIFE IS NOT FORCE, IT IS COMBINING POWER. ' IT IS THE PRODUCT 
 AND PRESENCE OF MIND ' " 
 
 PROFESSOR BASCOM 
 
 WITH THREE DIAGRAMS 
 
 METHUEN & CO. 
 
 36 ESSEX STREET W C. 
 
 LONDON
 
 First Published in igo8
 
 PREFACE 
 
 THE subject of Functional Nerve Diseases 
 has been here approached from a somewhat 
 novel standpoint. Hitherto these diseases have 
 been treated pretty much after the same method 
 as all other diseases, and only the most casual 
 allusions have been made to Psychic treatment 
 in connection with them. Once we recognise 
 that the description "functional" really means 
 "psychic," just as "organic" means "physical," 
 we shall agree that diseases in this former cate- 
 gory stand in close and necessary connection 
 with the relation of mind to disease. 
 
 It is quite certain that mind has taken a 
 large share in the causation of many of these 
 Functional Nerve Diseases ; and it is therefore 
 not unreasonable to expect that it should play 
 a considerable part in their cure. 
 
 A. T. S. 
 
 19 HARLEY ST., LONDON, W. 
 January, 1908
 
 CONTENTS 
 
 CHAPTER PAGE 
 
 I. INTRODUCTORY . . . . i 
 
 II. PSYCHOLOGY OF THE BRAIN. . . 17 
 
 III. GENERAL ^ETIOLOGY OF FUNCTIONAL NERVE 
 
 DISEASES . . . . 55 
 
 IV. ^ETIOLOGY OF HYSTERIA . . .73 
 V. PHYSICAL SYMPTOMS OF HYSTERIA . , 93 
 
 VI. PSYCHICAL SYMPTOMS OF HYSTERIA . . in 
 
 VII. ETIOLOGY OF NEURASTHENIA . . 126 
 
 VIII. SYMPTOMS OF NEURASTHENIA . . . 135 
 
 IX. DIAGNOSIS IN FUNCTIONAL NERVE DISEASES 156 
 
 X. PSYCHOTHERAPY .... 169 
 
 XI. THE REST CURE % . . . 199 
 
 XII. GENERAL TREATMENT . . . 234 
 
 XIII. NERVES IN CHILDHOOD , . . 258 
 
 XIV. OTHER FUNCTIONAL NERVE DISEASES . 270 
 XV. QUACKERY . * , 2 9 6 
 
 INDEX . . . . 317
 
 DIAGRAMS 
 
 PAGE 
 
 SENSORI-MOTOR ARCS . 2I 
 
 COURSE OF NERVE CURRENT 28 
 
 SUGGESTION . . .... . -193
 
 FUNCTIONAL NERVE 
 DISEASES 
 
 CHAPTER I 
 
 INTRODUCTORY 
 
 U NOTIONAL nerve diseases occupy a 
 -L vague, ill-defined and unscientific territory. 
 No two writers can agree upon what they mean 
 by the phrase, or arrive at the same conclusions 
 on the diseases to be included, while many take 
 refuge in avoiding the subject altogether. 
 
 The word " disease " is vague enough in 
 itself. It is defined as " a deviation from the 
 standard of health in any of the functions or 
 component materials of the body," but this is 
 surely misleading, for we all experience countless 
 deviations in function and component materials 
 that do not constitute disease. " Disease," says 
 H. Campbell, "is an abnormal mode of life." 
 There is not much help here, for there are many 
 abnormal modes of life that do not constitute 
 disease. Clifford Allbutt, in despair, takes
 
 2 FUNCTIONAL NERVE DISEASES 
 
 refuge in a remarkable simile and says, " To 
 define disease is to build a wall round a stick, 
 round nothing, in fact, that needs definition." 
 
 There can be no doubt that in disease there 
 is a deviation from the normal state, though 
 this cannot be taken as its definition, and to 
 measure any deviation from health, the bounds 
 of the latter must first be known ; and here 
 we encounter one of the first practical difficulties 
 met with by the student of functional nerve 
 diseases. It is easy, of course, to diagnose 
 deviations from health when you have before 
 you a case of small-pox with a copious eruption 
 or croupous pneumonia with a high temperature ; 
 but when a patient enters your room with a 
 nervous, jerky manner and complains of weak- 
 ness and loss of memory, how is it possible to 
 measure the departure from health, or even 
 diagnose the condition as abnormal without 
 knowing the normal ? It is essential in dealing 
 with functional disease that some conception 
 be first formed of what the patient regards 
 as health, for in no two people is the standard 
 alike, nor can it be fixed by the doctor ; and 
 amongst none does it vary so much as with 
 nerve sufferers. 1 
 
 1 Carlyle, in a letter dated February 25, 1859, sa Y s on 
 health : 
 "It is curious to remark that ' Heilig ' in our old
 
 INTRODUCTORY 3 
 
 To return to disease. The gradations 
 between health and disease are not infinite in 
 number, nor are they all equally well marked ; 
 and though as a fact Natura nihil facit per saltum, 
 nevertheless in clinical medicine the saltus 
 is often sufficiently well marked for diagnosis, 
 which otherwise would be impossible. Disease 
 is a perturbation that contains no elements (save 
 an invading germ) essentially different from 
 health, but elements presented in a new form 
 and in disorder ; hence diseases are frequently 
 called disorders. They cannot be classified 
 into genera and species. Certain morphological 
 groups are found with sufficient connecting 
 links for broad classification, but intermediate 
 types are always cropping up. When there is any 
 distinct proclivity to any special group of diseases 
 we speak of a diathesis, which signifies any 
 bodily condition, however induced, in virtue 
 of which the individual is, through a long period 
 or his whole life, prone to suffer from some 
 special type of disease. A diathesis is generally 
 hereditary, but may be acquired. 
 
 Teutonic speech is both holy and also healthy j that the 
 words holy and healthy, as our antique fathers understood 
 them, are one and the same. 
 
 " We, sure enough, have completely contrived to divorce 
 holiness (as we call it) from health, and have been reaping 
 the fruits very plentifully during these fifteen hundred 
 years."
 
 4 FUNCTIONAL NERVE DISEASES 
 
 Temperament is another old but useful con- 
 cept that sums up the combined psychical and 
 physical peculiarities of an individual, exclusive of 
 any definite tendency to disease. Diathesis may 
 therefore be called the pathological temperament. 
 
 Temperaments have been classed in various 
 ways. One of the most useful is into four 
 bilious, sanguine, lymphatic, and nervous. There 
 is no need to describe these here, especially as 
 they rest on no scientific basis, but I may briefly 
 sum up the classical features of the one with 
 which we have to do here the nervous. 
 
 In this temperament the nervous and psychic 
 element so prevails over the somatic and physical 
 that full control over the former is difficult. The 
 skin may be dark and earthy, or pale, or delicately 
 tinted ^with colour in fact, of any shade and is 
 often hot and dry. The skull may be large in 
 proportion to the face, the features small, the 
 eyes quick, large, and lustrous, the muscles 
 spare, the veins large, the face characterised by 
 energy and intensity of thought and feeling, the 
 movements hasty, often abrupt and violent, or 
 else languid. The hands and feet are small, the 
 frame slender and delicate. Insomnia is common, 
 and also addiction to some form of stimulant tea, 
 coffee, or alcohol. This class is specially prone 
 to functional nervous disorders. They always 
 seem either to be able to do more than they are
 
 INTRODUCTORY 5 
 
 doing or to be doing more than they are able. 
 There is a general want of balance as well as of 
 control. The character on one side is often 
 admirable for its powers of mind, depth of 
 emotion, and lofty imagination ; while on the 
 other it may be disfigured by some vice or 
 unruly passion. To this class belong the most 
 intellectual of the race, the wittiest, the cleverest, 
 the most attractive the leaders of mankind. 
 These are the poets, the men of letters, the 
 students, the professors, and the statesmen. 
 Their great danger is loss of self-control. They 
 feel pain acutely ; nevertheless they can at times 
 endure long fatigue and privation. 
 
 Before leaving diseases we must glance at one 
 more conception of it which was well stated by 
 Sir F. Treves at Edinburgh in 1905. He says, 
 " The prevailing idea of disease is something evil 
 in origin, evil in intention, evil in effect. The 
 popular view is that it is a calamity, and such is 
 the attitude of the medical man." " Disease," he 
 proceeds, " is not one of the ills the flesh is heir 
 to, but one of the good gifts ; for its motive is 
 benevolent and protective. If it were not for 
 ' disease ' in the popular sense, the human race 
 would soon be extinct " (!). 
 
 Such a view is, of course, not only wildly 
 paradoxical, but, without a good deal of explana- 
 tion, extremely incorrect. It is quite evident that
 
 6 FUNCTIONAL NERVE DISEASES 
 
 what Sir Frederick speaks of is not disease itself 
 at all (whatever that may be), but its symptoms. 
 For, as most diseases are now zymotic, it is 
 abundantly clear that the germs are neither 
 benevolent nor protective, but the reverse. It is 
 the symptoms set up by their presence which are, 
 as Sir Frederick points out, the result of good 
 motives (implying mind) that are beneficent ; 
 and few people absolutely confuse the one with the 
 other. Sir Frederick would be more intelligible 
 if he had used the French word " mal-adie," which 
 does imply evil rather than disease (French des, 
 without, aise, ease), which expresses no opinion. 
 My object in quoting this view is not only to 
 show the purposive character of symptoms as 
 recognised ; but I may also point out that while 
 their beneficial character is seen even in Neuras- 
 thenia, it is absent, and for a very special reason, 
 in Hysteria. We shall see why this is so when 
 we come to consider these diseases. 
 
 To sum up, then. Disease is the correlative of 
 health, and both words are incapable of accurate 
 definition. To know the presence of the former, 
 one must be acquainted with the " norm " of the 
 body, which is the same in no two cases ; and 
 this knowledge is especially essential in functional 
 nerve disease. 
 
 If the definition of disease be so unsatisfactory 
 and indefinite, I fear we shall find the words
 
 INTRODUCTORY 7 
 
 " functional nerve" still more so. In the first 
 place they constitute the most recent additions 
 to our great family of benefactors (Treves), and 
 their features are as yet unformed and hard to 
 recognise. Nervous sufferers undoubtedly are a 
 numerous class, and this from two causes, one 
 of which is not fully recognised. Modern civilisa- 
 tion has not only destroyed for ever the leisure 
 and quiet of simple country life, but on the one 
 hand, by its perpetual hustle and competition, has 
 put an ever-increasing strain on the nervous 
 system, while on the other (and it is this that 
 requires to be recognised) it always tends to 
 preserve and propagate the weak stock by a care 
 of the unfit that was formerly unknown. Func- 
 tional nerve sufferers are thus the direct and 
 indirect products of our age in increasing 
 numbers. 
 
 This class of disease is indeed sweeping over 
 civilised society like a plague. Dr. Goodhart 
 even ten years ago, remarked : "as the world 
 grows older it tends to grow more nervous." I do 
 not see how it can well be otherwise. It is 
 brain pitted against brain, and ever increasingly 
 so. It is not liver against liver, or heart against 
 heart, or only indirectly so. Of course, medical 
 men, accustomed to hypertrophied hearts and 
 similar instances of adaptation to meet increased 
 1 Dr. Goodhart, Lancet, October 30, 1897.
 
 8 FUNCTIONAL NERVE DISEASES 
 
 strain, argue, and rightly, that the brain of man is 
 quietly evolving to higher powers, and becoming 
 better and better able to resist the pressure of 
 its environment. This may be so, but still 
 break-downs must be most frequent where the 
 strain is greatest, and the battlefield of life is 
 increasingly on a psychic rather than a physical 
 plane. 
 
 Functional nerve diseases, ranging in their 
 effects from slight physical defects to severe 
 mental disturbances, are at any rate increasing 
 by leaps and bounds ; and there is scarcely a 
 family in this country but has suffered in some of 
 its members from this trouble in one way or 
 another. 
 
 In classification, functional nerve diseases 
 labour under the disadvantage that, no organic 
 change being known, they must be grouped by 
 their symptoms, and no clear definition can be 
 given of any disease until its pathological basis is 
 known. 
 
 All diseases are either organic or functional 
 that is, classed according to physical or psychic 
 signs : for all structural changes are materialistic, 
 or changes of physique ; whereas all functional 
 changes are vital, psychic, and connected with 
 life. Organic changes exist when life has 
 passed, but functional changes have then all 
 disappeared. This distinction is profound, and
 
 INTRODUCTORY 9 
 
 obviously bears radically on the true under- 
 standing and treatment of this entire class. 
 The diseases I here speak of are necessarily 
 grouped according to their psychic phenomena, 
 and not according to physical changes. The 
 ego, or personality, is psychic, and the mind 
 is one, and hence in these diseases the person 
 himself is ill in a sense often not found in other 
 diseases, and it is in functional nerve disease 
 where that saying "If one member suffer, all the 
 members suffer with it," is profoundly true in a 
 way it is not in many organic diseases. 
 
 There can, of course, be no change in functional 
 activity, by increase, diminution, or perversion, 
 without coincident changes in the plasmode. 
 Hence, strictly speaking, there can be no such 
 thing as pure functional disease as distinct from 
 structural disease, any more than there can be 
 any expression of mind apart from the body. 
 Disease, au fond, has always a material basis, 
 whether recognisable or not, and " functional " 
 and " organic " are but expressions of our 
 ignorance that will one day be superfluous. 
 
 It is important to see this, and that, inasmuch 
 as our propositions regarding diseases are but 
 tentative and provisional, if they are prematurely 
 crystallised into laws and dogmas they cramp all 
 thought and obscure the truth. This is especially 
 true in functional nerve diseases.
 
 io FUNCTIONAL NERVE DISEASES 
 
 In dealing with these we must be equipped 
 with a due sense of proportion between physio- 
 logical and psychological action, and above all 
 other requirements possess an abundant supply 
 of that rare sense miscalled " common." Doctors 
 are so impressed with their role as physicians of 
 the body that they are often at a loss when they 
 have to deal with these diseases, that so combine 
 the physical with the psychic. The study of 
 these nerve diseases requires reasoning as well as 
 observing powers, and it is a curious fact that 
 while the former are but little cultivated in our 
 modern schools, the latter are fostered to an 
 amazing extent. 
 
 It is impossible in any case to be a physician 
 for the body alone, and yet Professor Drummond 
 (Durham University) is still (1906) able to make 
 this remarkable statement : " Instruction con- 
 cerning these matters (psycho-physical) forms no 
 part of the curriculum of medical students nor of 
 the training of the nurse. We examine a patient 
 from head to foot with instruments of precision, 
 but often forget to cast a glance at the combined 
 psycho-physical personality. In functional nerve 
 disease such an omission is fatal to success. 
 Indeed, the difference between the veterinary art 
 and medicine is only that of the clientele, once the 
 mind is left out." 
 
 All functional nerve diseases have a psychic
 
 INTRODUCTORY 11 
 
 element that requires recognition and psychic 
 treatment. 
 
 There are pure psychoses or insanities neuro- 
 psychoses, such as hysteria, and neuroses, such as 
 neurasthenia. Insanities were formerly thought 
 to be possessions of evil spirits, to be cast out, 
 and only slowly were classed as diseases ; and in 
 the same way nerve diseases have been since 
 supposed, not unfrequently by medical men, to 
 be possessions of lying and evil spirits which 
 friends have tried in vain to cast out, and are 
 now being classed as diseases. The Middle 
 Ages drove away these evil spirits by exorcisms ; 
 the most modern method is to cast out the 
 pathogenic idea by suggestion. 
 
 Before the present recognition of functional 
 nerve diseases as a distinct class, the various 
 symptoms now grouped under Neurasthenia, 
 Hysteria, &c., were treated as distinct diseases, 
 and labelled cephalgia, rachialgia, dyspepsia, &c. 
 Now the mental link that binds them all together 
 is discovered, and this makes the unity. 
 
 Of course, there is always variety of type. 
 When we consider that no two nervous systems 
 are ever alike, it must specially be so in functional 
 nerve diseases. If one hundred children taught 
 in the same school by the same schoolmaster 
 write a hundred different hands, and if no two of 
 their finger-tips are alike in their marking, it is
 
 12 FUNCTIONAL NERVE DISEASES 
 
 evident that, whether the disease be more psychic 
 or physical, in either case the varieties will be 
 endless, and all that can be done is to classify 
 loosely without rigid boundaries. 
 
 There can be no doubt of the great importance 
 of this class of disease. In the first place, the 
 personality itself of the individual is ever more or 
 less profoundly affected. In the second place, 
 the central nervous organism whereby the 
 psychic expresses itself physically is diseased ; 
 and thirdly, inasmuch as this nervous organism 
 presides over every system in the body, and 
 especially over the cardiac-vascular, on which life 
 itself depends, this and other systems become 
 deranged, though, fortunately, not often to the 
 extent of causing a fatal end. 
 
 It must not be imagined for a moment, because 
 functional nerve diseases have not long been 
 known as such, that " nerves " are, as is some 
 times supposed, a modern invention. They have 
 flourished under many names, in all ages, and 
 amongst all peoples. 
 
 What we now call neurasthenia has been 
 variously termed vapours, nervous fever, nervous 
 debility, general neuralgia, neurospasm, nervous 
 wasting, cerebro-cardiac neuropathy, nervous 
 cachexia, general neurosis, and, if partial, 
 topoalgia, rachialgia, &c. 
 
 When we come down to the present time and
 
 INTRODUCTORY 13 
 
 attempt to make a list of what are Functional 
 Nerve Diseases and what are not, we find our- 
 selves in inextricable confusion. In the nomen- 
 clature of diseases by the London Royal College 
 of Physicians I find a list of one hundred and 
 thirty-nine nervous diseases given. When I 
 say, however, that amongst them are included 
 bedsores, convulsions, hypersesthesia, anaesthesia, 
 stammering, hiccough, &c., it is evident our 
 list may be of less dimensions. The other 
 extreme is perhaps reached by Dr. Clouston, who 
 says that clinically there are four types of 
 Functional Nerve Disease : 
 
 1. Feigned disease, malingering, &c. 
 
 2. Functional disease dependent on obvious 
 organic origin. 
 
 3. Neurasthenia. 
 
 4. Hysteria. 
 
 With regard to even these four the ground is 
 not clear ; for the first is surely not a disease at 
 all, but a fraud, the appropriate treatment being a 
 cell in a prison rather than a bed in a hospital. 
 
 The second includes a large class open to 
 question as to their right to be classed as Func- 
 tional Nervous Diseases. 
 
 Nos. 3 and 4 are, of course, the two diseases 
 that by universal consent belong to the category. 
 
 Another list includes twenty or more arranged 
 as follows :
 
 FUNCTIONAL NERVE DISEASES 
 
 FUNCTIONAL NERVE DISEASES. 
 
 i. Neuroses of 
 primary de- 
 generation. 
 
 2. Acquired 
 neuroses. 
 
 a. Primary neurasthenia, hy pochondria. 
 
 b. Epilepsy. 
 
 c. Hysteria major. 
 
 d. Hereditary chorea. 
 
 e. General spasmodic tic. 
 
 / i. Chorea, 
 ii. Tetany. 
 iii. Rabies, 
 iv. Tremors. 
 v. Neuralgia, 
 i. Neurasthenia, 
 ii. Hysteria, 
 iii. Exophthalmic 
 
 goitre, 
 iv. Occupation 
 
 neuroses. 
 
 c. Acquired de- ( i. Tic doloureux. 
 
 generation I ii. Local spasmodic 
 neuroses. | tics. 
 
 I iii. Paralysis agitans. 
 
 d. Muscle, vasomotor, trophic and sleep 
 
 disorders. 
 
 a. 
 
 From infec- 1 
 
 
 tion and -I 
 
 
 poisons. 
 
 b. 
 
 Exhaustion 
 
 
 and nerve 
 
 
 shocks. 
 
 This list appears to me a sample of the evil of 
 attempting to accurately tabulate this class of 
 disease, of which in most instances the pathology 
 is too obscure to justify any such arrangement. 
 Who, for instance, can accurately distinguish the 
 two hysterias, the two neurasthenias, or the 
 pathology of general and local tics ? 
 
 A list of functional nerve diseases of doubtful 
 organic origin (mostly spinal) is as follows :
 
 INTRODUCTORY 15 
 
 Tetanus. Ideal paralysis. 
 
 Tetany. Chorea. 
 
 Torticollis. Spinal neurasthenia. 
 
 Hydrophobia. Toxic spinal paraplegia. 
 
 Paralysis agitans. General paralysis of the 
 Writer's cramp. insane. 
 
 Functional spinal paralysis. 
 
 Tetanus and hydrophobia and general 
 paralysis of the insane must obviously be 
 excluded, both going beyond mere disturbance 
 of function, and as far outside the category of 
 functional nerve disease as angina pectoris. 
 
 Tetany and paralysis agitans occupy a doubt- 
 ful position and might be included ; others are 
 mere varieties of neurasthenia or hysteria. 
 
 After due consideration of this perplexing 
 subject I have decided to include twelve func- 
 tional neuroses in my list, six of which are more 
 or less doubtful. The first six are : 
 Hysteria. 
 Neurasthenia. 
 Hypochondria. 
 Occupation neuroses. 
 Paralysis agitans. 
 Neuralgia. 
 And the six doubtful are : 
 
 Migraine, selected as the headache that can 
 be classed as a disease and not only a 
 symptom.
 
 16 FUNCTIONAL NERVE DISEASES 
 
 Chorea. 
 
 Torticollis a doubtful disease. 
 Tetany. 
 
 Vertigo (not true Meniere's disease). 
 Exophthalmic goitre, whose increasingly 
 obscure pathology entitles it to be 
 classed among Functional Nerve 
 Diseases. 
 
 This list makes no claim whatever to scientific 
 accuracy, and probably no one else would make 
 the same list. But as so far I have found no two 
 writers who agree in their lists, which include all 
 numbers of diseases from 4 to 139, I am not 
 peculiar in this.
 
 CHAPTER II 
 
 PSYCHOLOGY OF THE BRAIN 
 
 IT has been well said that, as a rule, the brain 
 only concerns the ordinary physician on its 
 physiological and anatomical side, as in the case 
 of anaemia, hypersemia, hemorrhages, new growths, 
 inflammations, and lesions of all sorts, its func- 
 tional disorders being mostly handed over to the 
 alienist ; though we must be quite clear that our 
 present subject of functional nerve disease forms 
 no part of the domain of the specialists in 
 lunacy. It will, indeed, soon be found that not 
 only pre-eminently in nerve diseases, but in all 
 other classes of disease, the study of the functions 
 of the mind connected with them becomes more 
 and more the province of the general physician. 
 
 I have said " functions of the mind" pur- 
 posively, though I well know how very difficult it 
 is to draw the line between mind and brain in 
 their actions. 
 
 The intelligible connection of the two is well 
 expressed by Dr. Browne : "The great character 
 of current opinion appears to be that wherever 
 there is nerve there is psychical function, actual
 
 i8 FUNCTIONAL NERVE DISEASES 
 
 or potential, which may rise within the range of 
 consciousness. Not only is there apparently 
 inseparable connection during life between the 
 nervous structures and mental phenomena, but 
 the latter are clearly dependent on the former. 
 The ordinary condition of the nervous system is 
 like that of a moderately-charged battery that 
 can be discharged by the completion of the 
 circuit and recharged by the blood. The will 
 can complete the charged circuit. Mental causes 
 can produce physical effects and physical causes 
 mental effects." 
 
 I would here point out, however, that though 
 we may be absolutely certain that (as Professor 
 Bain puts it) with all our mental processes there 
 is an unbroken natural physical succession, it by 
 no means necessarily follows, as Dr. Browne 
 suggests, 1 that with every physical change in 
 the brain there is a necessary mental change. 
 It may be so, but this sequence has not so far 
 been generally recognised or proved, and it is 
 probable that vast numbers of minor vasomotor, 
 nutritive, functional, and other changes of the 
 brain do not affect the mind ; whereas, on the 
 other hand, it is perfectly certain that there is no 
 mind action, however slight, that does not produce 
 (I do not say arise from) some physical change. 
 
 1 Dr. W. A. F. Browne, in Journal of Mental Science, 
 vol. xii. p. 321.
 
 PSYCHOLOGY OF THE BRAIN 19 
 
 Herbert Spencer says : " No thought, no 
 feeling, is ever manifested save as the result of a 
 physical force. This principle may now almost be 
 said to be a scientific commonplace." l 
 
 Having thus marked the intimate connection 
 and interdependence of mind and brain, we must, 
 to keep the balance of truth, equally insist on the 
 radical distinction between the two. " The intelli- 
 gence of men," says Calderwood, "as known in 
 personal consciousness, is of a nature entirely dis- 
 tinct from any sensory apparatus. Mind is not 
 a mere product of cerebral evolution." 2 
 
 Again Herbert Spencer sounds a timely note 
 of warning : " Here, indeed, we arrive at the 
 barrier which needs to be perpetually pointed out 
 alike to those who seek materialistic explanations 
 of mental phenomena and to those who are 
 alarmed lest such explanations may be found. 
 The last class prove by their fears, almost as 
 much as the first prove by their hopes, that they 
 believe that mind may possibly be interpreted 
 in terms of matter, whereas . . . there is not 
 the remotest possibility of so interpreting it. For 
 the concept or form of matter is but the symbol 
 of some form of power absolutely and for ever 
 unknown to us. Mind is also unknowable, and 
 
 1 Herbert Spencer, " First Principles of Psychology." 
 
 2 Professor Calderwood, "Relations of Mind and Body," 
 P- 307-
 
 20 FUNCTIONAL NERVE DISEASES 
 
 the simplest form under which we can think of 
 its substance is but a symbol of something 
 that can never be rendered into thought. Never- 
 theless, were we compelled to choose between 
 translating mental phenomena into physical 
 phenomena or translating physical phenomena 
 into mental phenomena, the latter alternative 
 would seem the most acceptable." I 
 
 This again, like so many utterances, is much 
 more correct in what it affirms than in what it 
 denies. Truth is so much greater than our- 
 selves that it is well for the most profound 
 philosopher to remember the maxim, "Affirm, 
 and deny not," and especially " Never prophesy." 
 Already Herbert Spencer's assertion that the 
 power of which matter is the symbol must be 
 "absolutely and for ever unknown" is partially 
 disproved by Lord Kelvin, who has rendered 
 it reasonably certain that the force of which 
 it is the symbol is electricity, and that elec- 
 trons seem as clearly the meeting-point of 
 force and matter as neurons are of mind and 
 brain. 
 
 For our purpose of considering the function 
 of mind, besides the obvious divisions of the 
 brain into greater and lesser, or cerebrum and 
 cerebellum, and into two halves, right and left, 
 
 1 Herbert Spencer, " First Principles of Psychology," 
 2nd edition p. 63.
 
 I.CORTEXOR UPPER BRAIN 
 
 CO RTEX r cs"s | o 
 
 \j /no t or ^ ^ r T 
 
 U 
 
 ^SPIRIT 
 
 A .enjory nen* current proceeding from <s P I N A I 
 
 : Skin. c.. en. the Spinal Cord, and 5 T I IN A L 
 
 M I I 
 
 2 '^, 
 BRAIN 
 
 OR LOWER BRAIN 
 
 Natura, 
 DIAGRAM OF 
 DIVISIONS OF BRAIN & HERVE ACTION 
 
 Spinal Reflex; or it may 
 Medulla and be changed at t, being 
 Batumi Reflex; <x it mar proceed to i 
 Steal Ganglu and ber changed at 8, being 
 
 DIAGRAM OF SENSORI -MOTOR ARCS.
 
 22 FUNCTIONAL NERVE DISEASES 
 
 we may divide the cerebrum (see diagram) into 
 three regions, consisting from above downwards 
 of cortex or surface brain, basal ganglia or 
 mid-brain, and medulla or lower brain, each of 
 these containing a large proportion of the active 
 agent in brain work known as grey matter, 
 which consists of masses of neurons, with little 
 neuroglia. The medulla or lower brain connects 
 the spinal cord below with the mid-brain above, 
 and is " the co-ordinating centre of most asso- 
 ciated movements." J It is, in fact, the organising 
 centre for carrying on all the processes connected 
 with the passive or vegetable life of the body 
 as contrasted with the active or animal life. 
 All the processes carried on here are habitually 
 far below the level of consciousness. 
 
 The basal ganglia of the mid-brain are princi- 
 pally three in number : the corpora quadrigemina, 
 connected with sight ; the corpora striata, un- 
 doubtedly with motion, and the optic thalami, 
 probably with sensation. 2 
 
 In this mid-brain we see the organisation 
 of the functions of animal life subject to, or of 
 an inferior order to, the highest centres and 
 conducted without consciousness. 
 
 Lastly, we come to the cortex or surface 
 
 1 D. Ferrier, " Functions of the Brain." 
 
 2 Some, notably Dr. Edridge Green, have recently con- 
 nected these with memory.
 
 PSYCHOLOGY OF THE BRAIN 23 
 
 brain, the seat of conscious mentality and the 
 source of all voluntary actions. 
 
 The cortex is the sphere of conscious sen- 
 sation, though we are by no means conscious 
 of all that takes place even in the cortex ; for 
 innumerable sensations may, and probably do, 
 continually reach it of which we are wholly or 
 partially unconscious ; in many cases, of course, 
 this is accounted for by non-attention. On the 
 other hand, it would appear from recent re- 
 searches that it is not possible to be conscious 
 of any currents that do not reach the surface of 
 the brain. 
 
 The broad distinction between these three 
 great cerebral divisions as respectively the seat 
 of the Spirit, or directing intelligence ; the Soul, 
 or the mere active animal life ; and the Body, 
 or the mere physical existence, has been abun- 
 dantly shown by experiments which are detailed 
 in our text-books. Voit's classic experiments 
 on pigeons, where removal of the upper brain 
 destroyed intelligence, that of the mid-brain 
 active animal life, while the pigeon still existed 
 as long as the lower brain was undisturbed, 
 are too well known to be detailed here. 
 
 The phenomena of drunkenness are equally 
 instructive, where, according to the law that the 
 most highly and recently developed centre is 
 the first to be affected, the alcoholic poison first
 
 24 FUNCTIONAL NERVE DISEASES 
 
 paralyses the intelligence and cortical activity, 
 then the active animal life, while, inasmuch as 
 this includes the paralysis of the arm that raises 
 the fatal glass to the lips, the third or lower 
 brain is left untouched, and mere existence 
 without movement or intelligence persists. Of 
 course, if a further dose is administered by others, 
 or, as in some rare instances, is taken rapidly by 
 the drunkard before the arm paralysis sets in, 
 the dose may prove fatal and reach the lower 
 brain, and the man become not merely "dead" 
 drunk, but dead. 
 
 With regard to there being two hemispheres, 
 right and left, Gall, Spurzheim, Dr. A. L. Wigan, 
 Sir H. Holland, Hughlings Jackson, and Brown 
 Se*quard conclude we have two brains united for 
 common action, and that we have probably two 
 minds acting normally in perfect harmony, but 
 which can and do act separately in many con- 
 ditions, as in unilateral injury, double perception 
 of the same word or event, which is connected 
 with the sense of humour, &c. As regards minute 
 anatomy, it appears that by means of Golgi's 
 methods of silver staining brain cells the fol- 
 lowing facts, which I may briefly recapitulate, 
 are established. Each cell has a mass of small 
 branching fibres called dendrites and one large 
 axial fibre called a neuraxon, which soon becomes 
 medullated. The cell with its fibres is called
 
 PSYCHOLOGY OF THE BRAIN 25 
 
 a neuron, and with regard to it, it appears that 
 the molecular movements in the dendrites are 
 towards the cell and in the neuraxon from it, 
 or afferent and efferent ; and it is generally the 
 terminal of a neuraxon that is connected with a 
 dendrite. This gives an anatomical basis for 
 the psychic acts of feeling, voluntary motion, 
 and association, &c. " Max Schultze observed 
 also the passage of the fibrils (of which the sup- 
 posed homogeneous axis cylinder of nerves is 
 now proved to be composed) through the (brain) 
 nerve cells without any interruption. That has 
 also been securely demonstrated and proved by 
 the new method of Golgi. So that we have this 
 astounding transformation in that which we know 
 of nerve mechanism : we have in every axis 
 cylinder a bundle of separate conducting fibrils, 
 and we have these fibrils passing uninterruptedly 
 through the nerve cells to the branching pro- 
 cesses, and ending in the terminations of their 
 branches. From that discovery there follows a 
 most momentous fact, which is of signal impor- 
 tance to us, and yet which seems imperfectly 
 recognised by many who are working at the 
 subject. Those fibrils passing continuously 
 through the cell body can only conduct through 
 the cell body. Our old conception, so simple, 
 so attractive, that the nerve impulses originate 
 in the cells fascinating from the analogy
 
 26 FUNCTIONAL NERVE DISEASES 
 
 of the cell body and a tiny battery origina- 
 ting a current all that entirely disappears. 
 Moreover, if we find this continuity of the 
 fibrils distinct in some cases, we feel at once 
 that it is one of those fundamental structural 
 arrangements which must be universal, and we 
 must once for all give up the idea that the 
 nerve cells are sources of nerve impulse." : To 
 return : " The will determines, but the automatic 
 apparatus executes. First, the ideal and creator 
 centres in the cortex ; then the semi-automatic 
 action of the corpora striata. Impulse is trans- 
 mitted thence through the anterior tracts of the 
 crura cerebri, the anterior pyramidal columns, 
 the anterior portion of the olivary bodies and 
 anterior columns of the spinal cord." 2 
 
 It appears that, apart from the cortex, the 
 nerve paths in the lower parts of the brain 
 consist of the sensori-motor arcs (see diagram), 
 the nerve currents arriving at the hinder part of 
 the brain by the posterior part of the cord, and 
 leaving the anterior ganglia, notably the corpora 
 striata, and descending down the front of the 
 spinal cord, in the resulting motor impulse. To 
 use now the words of Dr. Alexander Hill : " On 
 
 1 Sir W. R. Cowers in British Medical Journal, 
 November 6, 1897, p. 1359. 
 
 2 Hack Tuke, " Influence of the Mind on the Body," 
 ii. 145-
 
 PSYCHOLOGY OF THE BRAIN 27 
 
 these arcs, which collectively make up the lower 
 system, are superadded arcs, the longer of which 
 lie in the higher grey matter (of the cortex) ; at 
 the same time, therefore, that an impulse flows 
 across the spinal cord as a simple reflex action, 
 a certain part of this impulse is also diverted to 
 the brain along fibres which ascend in the outer 
 part of the spinal cord ; and from the brain 
 descending fibres carry the impulse back again 
 td the lower arc. One thing is quite certain, 
 namely, that the routes which are the most 
 frequently used are the most open, and there- 
 fore the most easily traversed." 1 
 
 All this means, speaking generally, that a nerve 
 current arriving at the brain may take one of 
 three courses either directly originating uncon- 
 scious action in the lower brain, or, travelling 
 in a short arc by the mid-brain, producing un- 
 conscious action there, or, proceeding further 
 in a long arc by the cortex, ending in conscious 
 action. In connection with this, it may be 
 observed that the cranial nerves have all two 
 deep origins the one in the basal ganglia of the 
 mid, or unconscious brain, and the other in the 
 cortex, or upper conscious brain. 
 
 This is graphically shown by the diagram of 
 the letter "A," where a and b are respectively the 
 
 1 Professor A. Hill, Cantab., Paper on " Reflex Action." 
 Proceedings of the Victoria Institute, 1893.
 
 28 FUNCTIONAL NERVE DISEASES 
 
 origin of the afferent current and the terminus of 
 the efferent, c and d the afferent and the efferent 
 unconscious mid-brain centres, and e and/" the con- 
 scious cortical centres. The mid-brain short-circuit 
 is shown by the bar from c to d. Thus a current 
 
 Conscious Cortical 
 
 Terminus Origin 
 
 may travel from a to b by c and d unconsciously, 
 or by e and f consciously. It is clearly under- 
 stood, however, that these "arcs" are purely 
 hypothetical. 
 
 The number of combinations of cells and 
 brain-paths and cell connections in the brain is, 
 of course, innumerable, so that the possibilities 
 of the human brain are practically inexhaustible. 
 
 " John Stuart Mill," Sir J. C. Browne tells us, 
 " was distressed at one period of his life by the 
 reflection that the time must come when all 
 possible musical combinations of the five tones 
 and two semitones of the octave will be exhausted
 
 PSYCHOLOGY OF THE BRAIN 29 
 
 and there will be no new music in the world. As 
 there are at least one thousand six hundred 
 million neurons in an average brain a brain 
 population exceeding the population of the globe 
 each with a tone of its own, there need be no 
 apprehension that we shall ever run short of new 
 tunes in mental music. The neurons which con- 
 stitute a medium for the exhibition of the psychical 
 powers differ from each other quantitatively and 
 qualitatively, and are capable of an infinity of re- 
 arrangements, so individuality is safe and human 
 nature will never be called upon to repeat itself. 
 And individuality is not confined to the neurons : 
 it spreads to the finger-tips. Dealing with finger- 
 prints, Dr. Garson says : 
 
 " ' I have never seen the impression of any 
 finger of two persons alike in all respects ; there 
 are always some points of difference when details 
 are examined ; nor have I ever seen two fingers 
 of one person exactly alike among the many 
 thousands I have examined.'" 
 
 Before leaving the physiology of the brain we 
 must note that, as far as our present knowledge 
 extends, neurons once destroyed can never be 
 restored, and it is this that makes organic nerve 
 disease so serious. Instead of organic and 
 functional nerve disease, we might almost speak 
 of incurable and curable. 
 
 So much, then, for an outline of the brain
 
 30 FUNCTIONAL NERVE DISEASES 
 
 machinery. The point that must be settled next 
 is whether this nervous mechanism produces 
 those psychic phenomena we call mind, as the 
 liver secretes bile, or whether there is not a 
 spiritual entity the mind which acts upon and 
 expresses itself by means of this machinery as 
 a musician on a piano. 
 
 Are we, in short, in relation to this question, 
 monists and materialists, or dualists and vitalists? 
 "The assumption," says Professor Ladd, 1 "that 
 the mind is a real being which can be acted upon 
 by the brain, and which can act on the body 
 through the brain, is the only one compatible with 
 all the facts of experience." 
 
 "Life," says Professor Beale, a dualist, "is a 
 force or property of a peculiar kind temporarily 
 influencing matter, but entirely different from it, 
 and in no way correlated with any other force." 
 The late Duke of Argyll says: " Life is the cause 
 of organisation, and not its product." 
 
 This book is written from the dualist and 
 vitalist standpoint ; that is, in the belief that 
 mind is not a product of matter, but distinct from 
 it, and that life is mind in action. From all time 
 dualists have sought to correlate psychical and 
 physical action. For instance, some think the 
 psychical and the physical are like two (Cartesian) 
 clocks, abysmally apart, which, when wound up, 
 
 1 Professor Ladd, " The Philosophy of Mind," p. 476.
 
 PSYCHOLOGY OF THE BRAIN 31 
 
 nevertheless correspond tick for tick. This posi- 
 tion is well stated by Crichton Browne. He 
 says: "These mental actions are incorrectly 
 spoken of as the functions of the brain, for they 
 certainly cannot hold the same relation to that 
 organ that movement does to the muscles or bile 
 to the liver. Nothing can be derived from 
 motion but another motion, nothing from mental 
 process but another mental process; and thus the 
 facts of consciousness can never be explained by 
 molecular changes in the brain, and all that we 
 can do is to fall back on an hypothesis of psycho- 
 physical parallelism, which assumes concomitant 
 variations in brain and mind. There is a 
 physical universe, of which only a fragment is 
 known to us ; there is a psychical universe, in 
 a corner of which we live and move and have our 
 being. We may picture these to ourselves as 
 circles which impinge on each other at the first 
 moment of conscious existence, which intersect 
 more and more as life goes on, their largest inter- 
 section (including but a small segment of each) 
 being reached when life is at its full, which then 
 withdraw from each other as old age sets in, and 
 part company at death. But, whatever image we 
 adopt, we must hold fast to the truth that mind 
 and matter are distinct essences, irreconcilable in 
 their nature though mysteriously accordant in 
 their operations ; that only in the elementary
 
 32 FUNCTIONAL NERVE DISEASES 
 
 processes of mind, made up of sensory and 
 motor elements, has correspondence with physi- 
 cal changes in the brain been traced out." 1 On 
 the other hand, Huxley says : " Life is a form 
 or mode of ordinary force," and Professor W. 
 James that "the simple and radical conception 
 dawns upon the mind that mental action may 
 be uniformly and absolutely a function of brain 
 action as effect to cause." 2 " This conception," 
 he continues, " is the 'working hypothesis' which 
 underlies all the 'physiological psychology' of 
 recent years." 
 
 To adopt one theory is to be proclaimed a 
 dualist ; to adopt the other, a monist, and the 
 former position appears to the writer certainly to 
 be preferred of the two ; though neither position 
 contains the whole of the truth, while each 
 contains a part. 
 
 For instance, the abysmal distance between 
 mind and matter is shown in that, while "physi- 
 cal phenomena are phenomena in space, psychical 
 phenomena are phenomena in time only, "3 for it 
 is a fundamental thought to grasp that mind 
 cannot have a "seat," as it has not any extension 
 in space, having no relation with it that we know 
 
 1 Sir J. C. Browne, British Medical Journal, October 
 9, 1897. 
 
 2 W. James, " Psychology," p. 6. 
 
 3 James Sully, " Human Mind," p. 7.
 
 PSYCHOLOGY OF THE BRAIN 33 
 
 of. It does not cover a surface or fill a volume. 
 It is only related to time. In this we follow, 
 of course, the popular assumption that time and 
 space are essentially different, neglecting certain 
 wild speculations as to time being, after all, 
 a spatial extension (in a fourth dimension). 
 
 Dr. Harry Campbell 1 tends to the monist 
 theory when he says : " The sum of the chemi- 
 cal changes of protoplasm constitutes life " ; 
 but then, two pages further on, he also says 
 "the atomic theory is now placed on a firm 
 basis." This was in 1889. But much water has 
 flowed under the bridges since then, and not only 
 has radium upset the atomic theory, but the 
 spiritual has reasserted itself over the material, 
 so it is possible that these monistic views may 
 also change. In this connection it is not a little 
 significant that though such thinkers as Kant, 
 Virchow, Du Bois Raymond, W. Wundt, and 
 C. E. Baer all began life as monists, they all 
 in later life, and with matured experience, became 
 dualists. 
 
 That life involves mind has, of course, like 
 all else, been vigorously disputed and equally 
 vigorously affirmed. " Life," says Professor 
 Bascom, " is not force : it is combining power. 
 It is the product and presence of mind" 2 No 
 
 1 H. Campbell, " Causation of Disease," 1889, p. 6. 
 
 a Professor Bascom, " Comparative Psychology," p. 58.
 
 34 FUNCTIONAL NERVE DISEASES 
 
 mechanical process can indeed ever adequately 
 represent or account for the processes of life, and 
 yet life is not in itself a force ; it is a capacity 
 to use force for unique ends. 
 
 The extent to which the " mind " may be 
 employed as the first cause of purposive move- 
 ments in organisms is a very difficult question to 
 solve. There can be no doubt that the actual 
 agents in such movements are the natural forces, 
 but behind these the directing and starting power 
 seems to be psychic. " From the first move- 
 ment," says Dr. R. Dunn in the Journal of 
 Mental Science, " when the primordial cell-germ 
 of a human organism comes into being, the entire 
 individual is present, fitted for human destiny. 
 From the same moment matter, life and mind are 
 never for an instant separated, their union con- 
 stituting the essential work of our present exist- 
 ence." Again, "one cannot forbear assuming 
 in the vital process of each individual organism, 
 an idea which continually supports and re- 
 news the organism." J Carpenter goes further 
 still : " The convertibility of physical forces 
 and correlation of these with the vital, and the 
 intricacy of that nexus between mental and bodily 
 activity which cannot be analysed, all leads up- 
 wards towards one and the same conclusion the 
 source of all power is mind. And that philo- 
 1 F. Kirchener, " Psychology," p. 141.
 
 PSYCHOLOGY OF THE BRAIN 35 
 
 sophical conclusion is the apex of the pyramid 
 which has its foundation in the primitive instincts 
 of humanity." l 
 
 Besides attributing vital cell action to mind, 
 attempts have recently been made definitely to 
 indicate the exact location, if not of mind, which 
 has no space-extension, at any rate of its activity. 
 The general idea undoubtedly is that the sphere 
 of psychic action in cells is the nucleus. " The 
 nuclear plasm, i.e., the chromatic granules, are 
 endowed with psychic power." " The brain or 
 soul of the cell is the chromatin, as is now widely 
 believed among cytologists. In it inhere the 
 psychic and hereditary powers, and if it be 
 removed from a cell, the rest of the protoplasm 
 behaves automatically. The cell moves mechani- 
 cally, cannot reconstruct itself, and finally wears 
 down and decomposes. Chromatin has the 
 power of interpreting stimuli, and its reactions 
 are intelligently directed towards the preservation 
 of its own life." 2 Chromatin or chromoplasm 
 is the stained part of the nucleus, which is made 
 up also of a chromatic and a nuclear membrane. 
 
 To sum up, we are face to face to-day with 
 two distinct schools of thought the materialists, 
 
 1 W. B. Carpenter, " Mental Physiology," 4th edition. 
 
 2 Professor Nelson, in American Journal of Psychology, 
 iii. 369. See also " Beitragen von Kenntniss den Physio- 
 logie und Biologic den Protozoen," i. See also Stolnikow's 
 " Vorgange in den Leben zellen."
 
 36 FUNCTIONAL NERVE DISEASES 
 
 that deny a distinct mind, and the vitalists, that 
 assert its existence. 
 
 Sir J. C. Browne ' puts the whole case so well 
 that I will venture to quote his words before 
 finally leaving the subject : " An organism is 
 only an organism because its mutually dependent 
 parts partake of a common and inherited life, and 
 co-ordination involves a disposing and arranging 
 intelligence. Can we imagine the gastric juice 
 interesting itself in the welfare of the organism 
 in its peptic performance, or entering into an 
 agreement with the pancreas as to the sequence 
 of the respective secretions? Can we believe that 
 any concourse of physical and chemical processes 
 have ever by their interaction excogitated the 
 human body? The architectural idea must pre- 
 cede the building, but the materials of which the 
 body is built up are supposed to have somehow 
 elected the regulating power also by hypothesis 
 physical and chemical in nature which deter- 
 mines the balance between them and so controls 
 growth ; that is to say, the bricks and the mortar 
 have combined to create the architect, composed 
 of bricks and mortar, who is to pile them up in 
 coherence, in accordance with a definite plan. 
 And not only so, but they have elected an 
 architect capable of carrying out, not one plan, 
 
 1 Sir J. C. Browne in British Medical Journal, October 
 13, 1906-
 
 PSYCHOLOGY OF THE BRAIN 37 
 
 but an elaborate and metabolical design corre- 
 sponding with the different stages of life of the 
 organism ; for if there be nothing in living things 
 but physical and chemical processes, then these 
 must be capable of carrying out the archetypal 
 idea inherent in every living thing through all 
 its different phases, of adhering strictly to that 
 in each of the infinite variety of living things, 
 and of remaining constant to entirely divergent 
 archetypal ideas in one environment. In the 
 simplest forms of life, the protozoa, we have 
 as, for instance, in the Foraminifera minute 
 specks of undifferentiated protoplasm in all 
 respects identical as regards physical and 
 chemical properties and processes, lying side by 
 side in the same pool, displaying a high degree 
 of sensibility, hunting their prey, distinguishing 
 living from dead animalculae, seeking out mates 
 for conjugation, and producing with unerring 
 regularity shells of entirely different patterns, 
 some piano-spiral and some helicoidal ; and in 
 the highest forms of life we have specks of un- 
 differentiated protoplasm performing feats still 
 more incompatible with any physical or chemical 
 conceptions. 
 
 " That the brain is the theatre of physical 
 and chemical processes corresponding with the 
 sensorial and motor functions is no new fact, 
 and that these are of an electrical type has
 
 38 FUNCTIONAL NERVE DISEASES 
 
 long been thought probable, but the fresh de- 
 parture is the denial of anything beyond these. 
 We are to be reduced [by the materialistic 
 school] to neural process with no mental process 
 overarching it. We are to believe that all 
 changes and discharges in the brain, including 
 those called inhibitory and corresponding with 
 volition or will, are produced solely by centripetal 
 impulses derived from physical and chemical 
 changes, occurring in the external world, within 
 the body or in the blood. Nothing takes place 
 in the brain beyond the propagation of changes 
 that have been brought to it, and cerebral and 
 therefore psychical energy consists only in the 
 occurrence in a colloidal electrolytic structure of 
 great chemical complexity of changes identical 
 with those that occur in the non-living world. 
 Man is therefore simply a reflex arc a fortuitous 
 bundle of sensations, or rather of impressions, for 
 all meaning has been abstracted from sensation, 
 and words are but sounds, visions patches of 
 colour. The self or ego is an illusion. What 
 we have been accustomed to call the soul is only 
 a succession of movements in a colloidal electro- 
 lytic structure. 
 
 " The conception of living phenomena of the 
 neo-materialist is confined to physical and chemi- 
 cal processes, with two further aspects of these, 
 the automatic machinery for their co-ordination
 
 PSYCHOLOGY OF THE BRAIN 39 
 
 and the raison d'etre of their occurrence, which is 
 the welfare of the organism ; and the definition 
 of his purpose thus put by himself is self- 
 destructive, for if animal life be but a fortuitous 
 assemblage of blending and contending physical 
 and chemical forces it is impossible to suppose 
 that these could ever by mutual consent evolve 
 a regulator that is to adjust and control their 
 relations, or concern themselves about the wel- 
 fare of the organism as a whole. It is an abuse 
 of language to describe as an organism what is 
 a mere temporary assemblage of physical and 
 chemical processes, and co-ordination necessarily 
 implies a power higher than the processes co- 
 ordinated. The higher animals, it is asserted, 
 are composed of various parts, linked together by 
 automatic physical mechanisms of great delicacy, 
 which once developed were retained and per- 
 fected in proportion as they efficiently regulated 
 the various bodily activities, and co-ordinated 
 them for the welfare of the whole organism. 
 But the obvious questions suggest themselves. 
 How came these delicate automatic physical 
 mechanisms to be developed, and by whom or 
 what was the work of retention and perfection 
 and the correlative work of rejection carried on ? 
 If these mechanisms are at the top of the tree, 
 what dominates them ? Quis custodiet ipsos 
 custodes ?
 
 40 FUNCTIONAL NERVE DISEASES 
 
 " Let there be no mistake. The neo-materialists 
 having dissipated the phantom of vitality leave 
 us plants and animals, more or less complicated 
 arrangements of proteid substances, responding 
 in a very simple way to the ordinary physical 
 forces that we see around us. They leave us 
 the brain, a mass of glue-like substance, nine- 
 tenths water with a little phosphorus thrown 
 in, traversed by waves of physical forces and 
 nothing more. They leave us man, a motor-car, 
 self-made and self-started, with no passengers 
 and no chauffeur, moved by a series of explosions 
 or redistributions of energy, and rushing on to 
 inevitable destruction. 
 
 " Lord Kelvin, the foremost living man of 
 science, whose deep insight and unerring per- 
 spicacity have been proved in a hundred fields, 
 has spoken out clearly on the knotty point 
 I have been submitting to you. Addressing a 
 body of medical students, he said, ' Do not 
 imagine that by any hocus-pocus of electricity 
 and viscous fluids you can make a living cell. 
 You must never think of the living men, women, 
 and children with whom you will have to deal in 
 your daily work as mere laboratory chemical 
 specimens, but as human beings.' " 
 
 The three spheres of brain action knowing, 
 feeling, and willing may be just briefly touched 
 upon here, extending as they do into the un-
 
 PSYCHOLOGY OF THE BRAIN 41 
 
 conscious regions of mind of which we are about 
 to speak. The sphere of intellect and reason, or 
 knowing, consists of the reception, digesting, 
 arranging, and storing knowledge of all sorts, 
 and may be looked on mainly as centripetal in 
 character. The second, the aesthetic sense or 
 emotions, or feeling, consists of our central 
 sensibilities ; while the third, or the willing, 
 consists in expressing the activities of the soul 
 in outward action and is therefore mainly 
 centrifugal. There is no need to discuss these at 
 length. We shall come across them in discussing 
 the various diseases that affect them. 
 
 The last point which now remains for dis- 
 cussion is the extent of mind beyond conscious- 
 ness, for to understand this is essential in 
 discussing functional nerve diseases. 
 
 I will therefore seek, as briefly as may be, to 
 give evidence in support of Professor James's 
 definition of mind, which goes far beyond con- 
 sciousness, where he lays down that "psychic 
 action consists of the pursuit of definite ends 
 with choice of means." 
 
 Speaking of the classic frog, immortalised in 
 every physiology, which, when the thigh had 
 been cauterised with acid and the foot of the 
 same side had been cut off, stroked the place with 
 the other foot after the removal of the brain 
 cortex, James further says : "If purpose remains
 
 42 FUNCTIONAL NERVE DISEASES 
 
 the same where the means are different (as in 
 such a case), there is mind." l With this definition 
 the fact of unconscious mind action needs little 
 further proof; for in this case all those higher 
 centres that alone could possibly be associated 
 with consciousness had been removed. Flourens' 
 hens and Voit's pigeons and generations of 
 rabbits and guinea-pigs have all added their 
 dumb testimony to the fact that psychic acts can 
 be performed when all the highest conscious 
 psychic centres have been removed, and can 
 do so, not as the result of having formed some 
 artificial sensori-motor reflex by dint of frequent 
 repetition, but by performing acts for the first 
 time as the results of unusual nervous stimuli. 
 
 It may be said, Why fight over words ? If 
 English psychologists in the main agree to limit 
 mind to consciousness, in order possibly to 
 prevent the extension of the word to the 
 faculties of lower animals, what does it matter, 
 and what difference does it make? 
 
 Well, let us look at the question fairly. 
 Words, after all, are not worth fighting for in 
 
 1 Sir M. Forster in his " Physiology," part iii., pp. 980- 
 981 (yth edition), doubts the association of any intelligence 
 with the " choice " shown by the frog in this case. G. H. 
 Lewes, I may point out, removed the whole brain from 
 a frog, after which " there was no lack of spontaneous 
 movement," and the animal remained quite lively.
 
 PSYCHOLOGY OF THE BRAIN 43 
 
 themselves ; it is the thought that underlies them 
 that is of importance. If you say "mind" and 
 mean thereby the phenomena that centre round 
 consciousness only, and I say " mind " and mean 
 all those phenomena, conscious or unconscious, 
 that are not material, characterised generally also 
 by purpose and the adaptation of means to ends, 
 we mean two very different things. In both 
 these cases we necessarily restrict our remarks to 
 human beings, for it is the misfortune of the 
 narrower and pure introspective psychology that 
 it cannot prove or even admit consciousness, nor, 
 therefore, mind, in any being with whom it cannot 
 exchange thoughts, though both may be present. 
 Of course, this cuts both ways, and, strictly 
 speaking, it is equally impossible to prove un- 
 consciousness. The secondary consciousness, 
 shown in so many hypnotic experiments, of the 
 deeper personality which is revealed when ordi- 
 nary consciousness is in abeyance, may exist. 
 But we still retain the term " unconscious mind " 
 here as the best available term, seeing that we 
 use the word " consciousness " simply in its 
 common signification, as referring exclusively to 
 the ordinary consciousness of a healthy man, and 
 not to any possible subsidiary consciousness of 
 which he is not conscious. 
 
 But the great evil of the limitation of "mind" 
 to consciousness is, as pointed out elsewhere,
 
 44 FUNCTIONAL NERVE DISEASES 
 
 that its adherents, in common with materialists, 
 Haeckelian monists, Jacksonian parallelists, et hoc 
 genus omne, unite in declaring that all extra- 
 conscious processes are purely the " functional 
 activity of the brain " ! No doubt, what Ebbing- 
 haus calls " the vulgar prejudice of the absolute 
 distinction between mind and matter" may bias 
 the writer in common with others, but it is well 
 to note that the point does not rest there. 
 
 If even we should grant, with Ebbinghaus 
 and Spinoza, that mind and matter are but two 
 aspects of the same thing, the names then refer 
 merely to aspects that is, to appearances ; and 
 if we are to believe that purpose, adaptation, 
 and what we call signs of intelligence are the 
 marks of the " mind's " appearance, we still reach 
 our definition of mind. 
 
 If, on the other hand, we are, as already 
 declared, staunch dualists, where, then, does the 
 " conscious psychologist " stand ? Between the 
 horns of a dilemma. He must either relegate all 
 processes below consciousness to material agencies 
 a concession of no value to the materialist or 
 to any one else or he must destroy the force of 
 words ; for no amount of distinctions he may 
 draw between consciousness, self-consciousness, 
 dim consciousness, &c., can alter the fact that 
 processes as purely mental in character proceed 
 entirely out of all consciousness as truly as
 
 PSYCHOLOGY OF THE BRAIN 45 
 
 in it. 1 It is no question of choice ; it is a 
 matter of absolute necessity, felt by every writer 
 on kindred subjects, that we should have some 
 intelligible term to distinguish the remarkable 
 force so active in nerve diseases ; and it is not 
 to fight about words, but on account of the 
 necessity of an understanding of the full scope 
 of mind that I write this. 
 
 We have, as a matter of fact, no intermediate 
 word that is intelligible to describe anything 
 between the conscious mental and the material or 
 mechanical ; such terms as " Nature" or " Physi- 
 ology" being unintelligible. 2 We are therefore 
 forced either to describe psychic processes as 
 
 1 "Unconsciousness is no bar to livingness. Our con- 
 scious actions are a drop in the sea as compared with 
 our unconscious ones. Could we know all the life that is 
 in us by way of circulation, nutrition, breathing, waste and 
 repair, we should learn what an infinitesimally small part 
 consciousness plays in our present existence ; yet our 
 unconscious life is as truly life as our conscious life, and 
 though it is unconscious to itself it emerges into an indirect 
 and vicarious consciousness in our other and conscious 
 self, which exists but in virtue of our unconscious self." 
 " Essays on Life, Art, and Science " (re-edited 1904), 
 by Samuel Butler, author of " Erewhon," &c. (Grant 
 Richards.) 
 
 2 Sydenham gives the following definition of " Nature " : 
 " As often as I mention Nature I mean a certain complex 
 of natural causes which are governed by the best counsel 
 in performing their operations and in accomplishing their 
 effects . . . namely, the Supreme Deity, by whose power 
 all things are produced."
 
 46 FUNCTIONAL NERVE DISEASES 
 
 mechanical which are not accompanied by con- 
 sciousness, or to extend the word " mind " as 
 suggested. I have previously stated that the 
 unity in diversity shown by the body as a whole 
 as much postulates a central guiding power as 
 the evolutions of an army prove the existence 
 of a commander-in-chief. It is curious to see 
 that G. H. Lewes, in his remarkable work on 
 physiology, admits the need of the officers, but 
 denies the necessity of a general. He says I : 
 "There is unity, there is a consensus of the 
 whole organism ... it is due to organic sub- 
 ordination ... all act together ... as all parts 
 of an army act together, by officers and disci- 
 pline. The unity is an aggregate of forces, not 
 a presiding force." 
 
 This makes the body a confederation or a 
 syndicate, not a unity, and thus stops just short 
 of the truth. 
 
 I may now, with advantage, quote Professor 
 James's exact words (to which I have already 
 alluded) in his description of a science erected 
 on an artificial basis, and ignoring the essential 
 unity that underlies all mental action. These 
 are the words 2 : " Psychology is but a string of 
 raw facts, a little gossip and wrangle about 
 opinions, a little classification and generalisation 
 
 1 G. H. Lewes, " Physiology of Common Life," ii. 421. 
 8 W. James, " Principles of Psychology," i. 468,
 
 PSYCHOLOGY OF THE BRAIN 47 
 
 on the mere descriptive level, a strong prejudice 
 that we have states of mind, and that our brain 
 conditions them ; but not a single law in the 
 sense in which physics shows us laws. At present 
 psychology is in the condition of physics before 
 Galileo and the laws of motion or chemistry 
 before Lavoisier." 
 
 Dr. J. Macpherson, of Edinburgh, points out the 
 reason of this chaos l : " The futility of psychology 
 to account for the majority of mental reactions 
 is largely due to the attempt to explain them 
 by terms of consciousness." A psychology so hide- 
 bound lands us in endless difficulties. Bastian 
 cogently remarks 2 that "if we are, as so many 
 philosophers tell us, to regard the sphere of 
 mind as co-extensive with the sphere of con- 
 sciousness, we shall find mind reduced to a mere 
 imperfect disjointed series of agglomerations of 
 feelings and conscious states of various kinds 
 while a multitude of existent and intermediate 
 nerve actions would have no claim to be included 
 under this category." 
 
 The doctrine of a mind limited to conscious- 
 ness produces in man the "conscious auto- 
 maton " of Hughes and others. These affirm 
 that emotions are laid on the surface of the man 
 as colours on a tile mosaic, and cannot affect 
 
 1 Dr. J. Macpherson, " Mental Afflictions" (1899), p. 97. 
 
 2 C. Bastian, " Brain as an Organ of Mind/' p. 146.
 
 48 FUNCTIONAL NERVE DISEASES 
 
 the body in any way. I can only say that any 
 view more disastrous to the successful treatment 
 of disease could not well be conceived. Clifford 
 also follows with the same idea, that all uncon- 
 scious actions must be mechanical and automatic. 
 
 But with the best scientists the days of the 
 " conscious automaton " are gone. The necessity, 
 indeed, of invoking a " Nature " with a capital 
 N shows this. There was a time in physiology, 
 not so long since, when it was thought that a 
 mechanical law of diffusion and osmosis accounted 
 for the absorption of oxygen and of food. We 
 know now that both are the result of some 
 vital action which is one of the complex 
 properties of the epithelial cells that line the 
 lungs and the digestive tract. These pursue 
 a selective and purposive end with a persistence 
 that no mechanical theory can explain ; nor is 
 it accounted for by the fact, so insisted on by 
 G. H. Lewes, that the vital phenomena displayed 
 by the human machine depend upon it differing 
 from ordinary machines in being essentially a 
 sensory mechanism. 
 
 Consciousness after all only represents what 
 I see of my mind ; but surely there are many 
 ways of detecting its presence besides sight, 
 and one might as well limit the body to what 
 one can see of it, ignoring those parts that are 
 discerned by touch, as make consciousness the
 
 PSYCHOLOGY OF THE BRAIN 49 
 
 only proof of mind. We can, of course, see the 
 image of our faces in a glass, but we can just 
 as clearly see the unconscious mind reflected 
 in actions, and we have no more right to deny 
 the existence of the one than the other. To 
 say you cannot know you think or feel unless 
 you are conscious, is to say one cannot tell a 
 man is a watchmaker unless one actually sees 
 him make the watch ; whereas one reaches this 
 conclusion by seeing the watch itself which he 
 has made. In like manner, the results of un- 
 conscious thought seen in consciousness prove the 
 existence of the unconscious mind. We must 
 not only get rid of the idea that consciousness 
 is mind, but also that it is the only proof of 
 mind. Mind, in fact, may be conscious, sub- 
 conscious, or unconscious. The second state 
 may be brought into consciousness by effort, the 
 last cannot. 
 
 Once this is seen, the difficulty felt from all 
 time as to the recognition of some unconscious 
 mental power that governs physical life dis- 
 appears. The ancients ever sought to under- 
 stand the unconscious mind, and in modern 
 writings we see everywhere men and women 
 groping in search of it. 
 
 The "unconscious mind" is, then, the best 
 term I can find for this power which we all 
 have to recognise in medicine, and specially
 
 SO FUNCTIONAL NERVE DISEASES 
 
 in functional nerve disease ; and I use the 
 phrase in the same way that we say "the sun 
 sets," as convenient and descriptive, but possibly 
 not as purely scientific as it sounds ; for psycho- 
 logy is as yet, as we have seen, a science in 
 its (rather elderly) infancy. Once the unity of 
 mind is apprehended even dimly, it paves the 
 way for the gradual displacement of conscious- 
 ness as its synonym. Of course the struggle is 
 long and severe, and every shift has been made 
 by those who cling to the old formula to explain 
 that the unconscious is after all the conscious, 
 or at any rate is subconscious or subliminal 
 consciousness or secondary consciousness ; in 
 short, is a consciousness of which we are not 
 conscious. So gallantly will men fight for an 
 old creed in terms that show the cause is 
 already lost. 
 
 It needs no words of mine to prove that when 
 psychologists are reduced to such shifts it is 
 a sure sign the truth is pressing hard upon them, 
 and must ere long lead to a still further revision 
 of their phraseology, so as to admit wholly 
 unconscious mental processes, and thus lead them 
 up eventually, if logical, to the position of the 
 more advanced teachers, and to recognise the 
 grand psychic unity, and the fact that mind is 
 mind, whether illumined by the fitful rays of 
 consciousness or not.
 
 PSYCHOLOGY OF THE BRAIN 51 
 
 The terms " conscious mind " and " unconscious 
 mind " are in themselves misleading, and give 
 the idea there are two minds, and thus obscure 
 its essential unity. I only use the latter term 
 here provisionally until "mind" means all mind, 
 and not only, as now, a small part of it. The 
 mind is one ; but, as I have said, while one 
 part is in constant illumination, another is never 
 lighted by consciousness ; between the two 
 stretches a tract of uncertain extent that is 
 sometimes in light and sometimes in darkness 
 the subconscious region. 
 
 Our conscious mind, as compared with the 
 unconscious mind, has been likened to the visible 
 spectrum of the sun's rays, as compared with 
 the invisible part which stretches indefinitely 
 on either side. We know now that the chief 
 part of heat comes from the ultra-red rays 
 that show no light, and the main part of the 
 chemical changes in the vegetable world are 
 the result of the ultra-violet rays at the other 
 end of the spectrum, which are equally invisible 
 to the eye and are only recognised by their 
 potent effects. Indeed, as these invisible rays 
 extend indefinitely on both sides of the visible 
 spectrum, so we may say that the mind includes 
 not only the visible or conscious part, and what 
 we have termed the subconscious, that lies below 
 or at the red end, but the supra-conscious mind,
 
 52 FUNCTIONAL NERVE DISEASES 
 
 that lies beyond at the violet end all the 
 regions of higher soul and spirit life, of which 
 we are only at times vaguely conscious, but which 
 always exist and contain our most abstract and 
 spiritual faculties as surely as the subconscious 
 links us to the body on the other, both supra- 
 and sub-conscious being parts of the unconscious 
 mind. Of course, speaking of regions and levels 
 is merely figurative, the non-extension of mind 
 in space being a fundamental doctrine. I would 
 include in the supra-conscious such a faculty 
 as conscience, which is surely a half-unconscious 
 faculty. The supra-conscious, like the subcon- 
 scious, is best apprehended when the conscious 
 mind is not active. Visions, meditations, prayers, 
 and even dreams have been undoubtedly occa- 
 sions of the working of the spirit apart from the 
 action of reason or conscious mind. 
 
 I have dwelt somewhat fully on this theme of 
 the " unconscious mind " because it is perhaps 
 one of greater practical importance to physicians 
 than is any other point in the psychology of the 
 brain. B"t to the student of nerve diseases, as 
 we have said, this knowledge is essential, for 
 these two reasons first, that almost all the 
 action of the mind upon the body, as a factor 
 in disease or therapeutics, is exercised uncon- 
 sciously ; and, secondly, that most of the action 
 of the physician's mind and personality upon his
 
 PSYCHOLOGY OF THE BRAIN 53 
 
 patients is also unconscious. The limits of the 
 powers of the conscious mind in either of these 
 two actions are extremely narrow and well- 
 defined, whereas unconscious mental action is 
 indefinite and extensive. A physician, therefore, 
 who only recognises the former, and is compelled 
 by his creed to ignore the latter, necessarily 
 stands at a great disadvantage ; we are forced, 
 in fact, with regard to this matter, to use the 
 words of Bastian : 
 
 "This is no question of choice, but one of 
 absolute necessity. The meaning of the word 
 'mind' must be considerably enlarged so as to 
 include ... as mental phenomena, the functional 
 results of all nerve action l . . . whether these 
 nerve actions are accompanied by a recognised 
 conscious phasis or no. Let us enlarge our 
 conception and definition of mind. Let us 
 openly profess that which has already been 
 tacitly implied by many. Instead of supposing 
 that mind and consciousness are co-extensive, 
 let us make mind include all unconscious nerve 
 action. We must inevitably come to this, and 
 the doctrine of ' unconscious cerebration ' (Car- 
 penter) has served to pave the way to it. And 
 we are coming to it rapidly, and once we reach 
 
 1 C. Bastian, " Brain as an Organ of Mind," p. 148. We 
 must distinguish between nerve action and the result of 
 nerve action, of which the passage speaks.
 
 54 FUNCTIONAL NERVE DISEASES 
 
 it all difficulty as to the mental factor in medicine 
 will disappear." 
 
 I hope that this somewhat tedious examination 
 of our position with regard to mind and matter 
 and the extension of mind itself may not have 
 so wearied the reader as to discourage him in 
 his study of the interesting diseases we are about 
 to describe.
 
 CHAPTER III 
 
 GENERAL ETIOLOGY OF FUNCTIONAL NERVE 
 DISEASE 
 
 DIS-EASE, according to its etymology, is 
 not a word particularly applicable to the 
 special affections we are here studying. Zymotic 
 diseases of all sorts involving fever are typical 
 dis-eases, but so little is this the case in functional 
 nerve derangements that the patient is often quite 
 unconscious he is ill. 
 
 The commencement of nervous ill-health is 
 almost impossible to detect ; and while in in- 
 fluenza, pneumonia, and all the fevers it is 
 perfectly easy to say whether you are well or 
 ill, in even somewhat advanced cases of nervous 
 disease it is often so difficult that the sufferer 
 himself is not always sure whether his troubles 
 are real or imaginary ; and it is this difficulty, 
 perhaps, that partly accounts for the different 
 way in which friends and doctor often regard, 
 or used to regard, the sufferer from functional 
 diseases from that of any other ailment. The
 
 56 FUNCTIONAL NERVE DISEASES 
 
 simple question as to whether a man is well or 
 ill, in the absence of any standard of health, is 
 often impossible to answer where no obvious 
 physical signs of disease exist. Even where 
 symptoms of distinct " nervousness " are ob- 
 served, the further question remains as to 
 whether these may not be perfectly compatible 
 with what the patient regards as "health," 
 though the doctor may not ; and simply express 
 his normal condition. In nine cases out of ten 
 it is absolutely necessary first to accept the 
 patient's own standard of what he calls health 
 in a way that would not be dreamt of in 
 diagnosing any other class of disease, and then 
 to discover in what ways he finds he differs from 
 his own " normal." 
 
 Even then our difficulties are only just com- 
 mencing, for the symptoms themselves are 
 illusive, vague, and contradictory. Being largely 
 subjective they may not exist at all outside the 
 imagination, or, even if they do, in most favour- 
 able cases they are unconsciously distorted or 
 exaggerated by the prolonged introspection with 
 which they have been studied. 
 
 I consider that to get a real grasp and true 
 estimate of an average functional nerve case in 
 all its bearings requires greater judgment and 
 tact, powers of analysis and synthesis, and 
 applied common sense, than in the case of any
 
 GENERAL ETIOLOGY 57 
 
 other disease whatever ; to say nothing of a 
 patience practically inexhaustible. It is well, 
 therefore, in entering on this brief study of 
 functional nerve diseases, to appreciate something 
 of the inherent difficulties of the task. 
 
 Not only is the fact of the illness and its 
 symptoms most difficult to understand, but the 
 range of this class of cases is immense. It 
 embraces all the psychopathies that lie between 
 normal health and insanity, and these are well- 
 nigh innumerable in variety, though roughly 
 grouped for our convenience into three or four 
 great classes. 
 
 Of course, between nervous affections and 
 insanities there is a great gulf fixed ; and it is 
 well in practice to emphasise this as much as 
 possible with patients, both for their comfort 
 and cure. At the same time there are connect- 
 ing links that bridge the gulf, and the insane 
 may have functional nerve troubles, and vice 
 versd. Still, there is not so much likelihood 
 of neurasthenics becoming insane as for the 
 healthy to become neurasthenic. But our 
 greatest difficulties confront us when we try 
 to examine the causes of these diseases. 
 
 There is no doubt that cell, organ, and body 
 do not, strictly speaking, act, but react, and react 
 to stimuli, the ultimate source of which is mind. 
 But how varied are these stimuli, normal and
 
 58 FUNCTIONAL NERVE DISEASES 
 
 abnormal ! They may be internal or external to 
 the cell, the organ, or the body that reacts. 
 They may start in the periphery, in any tissue 
 of the organism, or in the cell bodies themselves. 
 They may apparently be of mechanical, chemical, 
 or what we must call purely vital (i.e., mental) 
 origin. They may be physiological or patho- 
 logical in character. Nearly every functional 
 derangement may be due to physical or psychic 
 causes, e.g., pain, palpitation, vomiting, &c. 
 
 We must ever remember that the body is not 
 only an intricate reflex mechanism, but a vital 
 laboratory of the most complex compounds in 
 the world, full of differing and subtle activities. 
 
 Each cell contains hidden but intense forces 
 continuously working, which in abnormal mani- 
 festation may disturb or destroy the organic 
 life in various ways. Considering how many 
 chemical actions occur in each of the bodily 
 functions of assimilation, respiration, digestion, 
 secretion, excretion, generation, &c., all proceed- 
 ing in health so harmoniously as to secure a 
 unity of being, yet each liable to innumerable 
 disorders, the eternal wonder is that the balance 
 of health is maintained so continuously and con- 
 stantly as it is. 
 
 In the performance of its functions every cell 
 and every organ produces poisons that must be 
 eliminated, and which, if not, may become some
 
 GENERAL AETIOLOGY 59 
 
 of the hidden causes of functional nerve disease. 
 The breath of man, his excretions, the fatigue- 
 products of his organs, the bye-products of his 
 digestion, are all more or less virulent poisons, 
 and must be got rid of. Before the proteid 
 molecule can be decomposed and built up into 
 living tissue such poisons are formed that the 
 organism is ever liable to autosepsis. The 
 intestinal canal always contains numerous dif- 
 ferent poisons ; and if autosepsis does arise, it 
 is by no means certain that some definite disease 
 such as gout or rheumatism may result, but only 
 too common that it may cause instead some vague 
 disturbance of the higher nerve centres. 
 
 When we find that 90 per cent, of neurotics 
 are dyspeptic, and that in 72 per cent, dyspepsia 
 has preceded the nerve symptoms for a long 
 period of generally several years, we may well 
 assert that a fertile cause of functional nerve 
 disease are the toxins produced by indigestion. 
 
 Besides these chemical poisons, recent re- 
 searches have revealed an almost innumerable 
 army of hostile microbes in addition to the few 
 that cause the well-marked zymotic diseases 
 whose products are the obscure causes of many 
 so-called functional troubles. 
 
 Some germs, such as those of influenza, 
 specially attack the higher nervous centres. 
 Indeed, the present increase of nervous diseases
 
 60 FUNCTIONAL NERVE DISEASES 
 
 is due far more to the prevalence of influenza 
 than to increased pressure of life. 
 
 External chemical poisons also produce marked 
 nervous effect. 
 
 Lead attacks the motor neurons, arsenic the 
 sensory, and alcohol the higher cortical centres. 
 
 Lead, mercury, arsenic, antimony, and phos- 
 phorus are all marked nerve poisons. 
 
 These various causes I have enumerated pro- 
 duce functional nerve diseases ; and yet the word 
 " functional " must not exclude the existence of 
 organic lesions, but is used because the organic 
 changes cannot often be traced at all, or only 
 doubtfully, under the strongest microscopes, while 
 the functional lesion is gross and obvious. 
 
 The same microscopic changes may also pro- 
 duce the most diverse functional results. By the 
 Nissl process the swelling of the nucleus and 
 other cell changes are seen to be the same in 
 the poisoning of tetanus and strychnine. 
 
 In functional disease the underlying change is 
 often in the association of cells rather than their 
 structure, for we must remember that the associa- 
 tion of neurons is not organic but functional, and 
 that some disassociation of neurons probably 
 underlies all forms of functional nerve disease. 
 
 It is curious to review the various conceptions 
 that have been formed respecting functional nerve 
 diseases and their aetiology.
 
 GENERAL .ETIOLOGY 61 
 
 In 1765 R. Whyte, of Edinburgh, was, I 
 believe, the first clearly to distinguish between 
 hysteria, neurasthenia, and hypochondria. Arndt 
 considered these due to defective development 
 of the nervous system, Von Ziemssen to functional 
 debility, Lowenfeld to non-development of the 
 vascular supply of the brain, Erb to the stress 
 of modern life, and Beard to overcivilisation. 
 Others have ascribed nervous diseases to general 
 hypersesthesia, to gout, to enteroptosis ; while 
 Mitchell Clark regards them as disturbances of 
 the cortical grey matter, and Graham Brown of 
 the upper motor neurons (especially in chorea, 
 tetany, &c.). In America nearly half of all 
 cases have an ascertained hereditary predis- 
 position. 
 
 From all these opinions it will have become 
 quite evident that no arbitrary or final list of 
 predisposing and exciting causes can be made of 
 functional nerve diseases. The one I have here 
 compiled from practical experience possesses, 
 therefore, no great value, nor is it in any way 
 dogmatic, though it may seem to gather together 
 the most salient features in the general aetiology 
 of these diseases. 
 
 The predisposing causes of functional nerve 
 diseases are : ( i ) Age, young adults being most 
 generally liable. (2) Occupations and sur- 
 roundings, sedentary indoor monotonous work
 
 62 FUNCTIONAL NERVE DISEASES 
 
 being the worst. Surroundings include seasons, 
 and it is worth remarking that while unbalanced 
 nervous systems seem worse in spring, depression 
 and melancholia is rife in the autumn ; moderate 
 dry cold (such as prevails then) being said by 
 Professor Dubois (Berne) to engender sadness. 
 (3) Malnutrition ; this is a very great predis- 
 posing cause, and exists in over 50 per cent, 
 of all cases. (4) Heredity ; this is a much less 
 common cause. Epilepsy, asthma, hysteria, 
 neurasthenia, insanity, suicide, megrim, ex- 
 ophthalmic goitre, alcoholism, and morphinism 
 are all strongly hereditary. The hereditary 
 physique is sometimes an index of nervous pre- 
 disposition. In the neurotic the chin is often 
 abnormal, being either too heavy and prominent 
 or almost absent. I do not give sex, as I con- 
 sider in functional diseases generally both sexes 
 are almost equally liable. 
 
 To these four general predisposing causes may 
 perhaps be added four others that predispose to 
 special varieties of nerve disease : (i) Slight 
 structural changes not readily demonstrated, as 
 in paralysis agitans ; (2) defective nutrition of 
 nerve centres, as in neurasthenia ; (3) irregular 
 blood supply, as in flushing, blushing ; (4) de- 
 fective control centres, as in hysteria. 
 
 Turning to the exciting causes of functional 
 nerve disease, the list is rather long, and cannot
 
 GENERAL ETIOLOGY 63 
 
 be reduced below ten, of which five are major 
 and five minor. 
 
 The first and principal section includes poisons, 
 fatigue, overstrain, suggestion, and sexual causes. 
 We will briefly consider these. 
 
 i. Poisons. These may be divided into 
 chemical and vital. The chemical poisons in- 
 clude those formed within the body (autosepsis) 
 and those that enter from without. 
 
 As I have pointed out, poisons of every sort are 
 the normal product of digestion, and when these 
 are not absorbed nerve disturbances commonly 
 result. But in dyspepsia there is always some 
 failure in this direction, and hence stomach ever 
 affects brain, and owing to its delicate nervous 
 mechanism stomach is ever affected by brain. 
 Nowhere is what is called "the vicious circle" 
 better illustrated than in the close connection of 
 dyspepsia with functional nerve disease, first as 
 cause and then as effect. 
 
 Gout may be regarded as a special form of 
 dyspepsia, and the diagnosis of nerve diseases as 
 suppressed gout is far too common and often 
 incorrect. Gout is not an infrequent cause of 
 disordered nerves, but before this aetiology is 
 given there should be clear evidence of the 
 gout apart from the nerve symptoms. 
 
 Constipation, by retaining poisonous products 
 within the system, is as much neglected as a
 
 64 FUNCTIONAL NERVE DISEASES 
 
 cause as gout is over-emphasised. There can 
 be no doubt whatever of the lowering of the 
 nervous tone by the absorption of these auto- 
 toxins into the blood and the circulation of this 
 impure blood in the brain. 
 
 We see even in a bilious attack, where some 
 unresolved digestive poisonous products are 
 allowed to circulate in the blood, how the higher 
 nerve centres are at once affected, and depression 
 and debility ensue. Besides these manufactured 
 poisons, others from without are exciting causes 
 of functional nerve disease, and the most promi- 
 nent of these is alcohol. This drug, in direct 
 proportion to the size of the dose, poisons both 
 the cerebral and sympathetic systems. In small 
 closes the resulting paralysis is temporary, and 
 rapidly passes away. In larger and continued 
 doses a secondary irritative process goes on 
 which produces a growth of fibrous tissue 
 amongst the delicate nervous and glandular 
 tissues, destroying in part the organic functions 
 all over the body, and profoundly modifying the 
 function of the nervous system in the brain 
 and elsewhere. Besides alcohol there are many 
 poisonous drugs which, taken in excess, injure 
 the cortex in various ways. Vital poisons include 
 all varieties of micro-organisms, which, by their 
 products within the body, produce the various 
 epidemic fevers, &c. Influenza may be taken as
 
 GENERAL AETIOLOGY 65 
 
 a type of such disease occasioned by a microbe 
 whose products profoundly affect (as a poison) 
 the higher nerve centres and form the exciting 
 cause of all sorts of functional nerve disease, 
 sometimes even of mania. This first group of 
 poisons, therefore, probably forms the most 
 powerful exciting cause of these diseases. 
 
 2. Fatigue. This may be of mind or body, or 
 both, and readily leads to functional disease when 
 there is a predisposition either from heredity or 
 malnutrition. It is the result of all forms of over- 
 work, and therefore a common cause of nerve 
 troubles amongst the poor. Excessive exercise, 
 such as cycling, may indeed not only produce 
 every form of functional nerve disease, but even 
 mental aberration. Fatigue always tends to 
 induce depression and pessimism. 
 
 In nervous people the idea or autosuggestion 
 of fatigue doubles the actual exhaustion ; as, on 
 the other hand, good spirits can lessen fatigue by 
 removing such suggestions, as in a band with a 
 regiment. 
 
 There is no doubt that heredity plays a great 
 part in predisposing to mental fatigue or over- 
 strain. In itself mental work, without worry, is 
 the least fatiguing of any. 
 
 Prolonged amateur nursing, suckling, frequent 
 child-bearing are common causes of nerve disease 
 through fatigue.
 
 66 FUNCTIONAL NERVE DISEASES 
 
 Fatigue may be the result of the general rush 
 in which we live, with insufficient rest. Pro- 
 fessor James, in his " Psychology," makes some 
 admirable remarks about the hurry of life. He 
 notices how little time we give to quiet medita- 
 tion or to the absence of thought. The Hindoos 
 have long made a special study, art, science, and 
 religion of meditation and abstraction. I shall 
 speak more fully of this cause in the aetiology of 
 neurasthenia. 
 
 3. Overstrain. I have put this in a distinct 
 class from fatigue because, although the result of 
 overstrain may be fatigue, it is reached not so 
 much by steady work as by sudden and improper 
 pressure upon the nerve centres. This overstrain 
 may be physical, as in rowing in a 'Varsity eight, 
 or in cases of eyestrain by excessive reading. 
 More frequently, as a cause of functional nerve 
 disease, it is psychical in character, as in worry 
 of all sorts (which exhausts the nerve centres so 
 much more readily than work), in competitive 
 examinations, and above all in the emotions. 
 Indeed, the combination of intellectual and 
 emotional overstrain in competitive examinations 
 constantly leads to nerve disease. Two things, 
 religion and love, play upon the emotions often in 
 a most disastrous way, especially when the nerve 
 centres are ill-balanced or not under sufficient 
 control. Emotional overstrain is the worst form
 
 GENERAL ETIOLOGY 67 
 
 of strain, and is an exceedingly common cause of 
 functional nerve disease. 
 
 4- Suggestion. This may be from oneself 
 (autosuggestion), or from others. As a cause 
 of functional nerve disease it is most frequently 
 the former. It is the result of over-introspection, 
 of reading or hearing of disease, or of seeing it 
 when in a morbid state. It must, of course, 
 be combined with a strong predisposing cause, 
 generally hereditary. I may note in passing 
 that though the cause is obviously purely psychic, 
 it may often be removed, in spite of what has 
 been said to the contrary, by material measures. 
 I shall say more about this as a special cause 
 when speaking of hysteria. 
 
 5. Sexual Causes. The one most frequently 
 now connected with functional disease is some 
 form of masturbation. When we consider that 
 99 per cent, of boys are at some time or other 
 addicted to this vice, and yet how few are victims 
 of nervous disease, we see at once that as an 
 exciting cause it is greatly overrated ; and I may 
 add that even where it is a cause it is due to its 
 psychic rather than to its physical results, unless 
 it has been pursued to unusual excess. 1 It may 
 be said that all abnormalities of the sexual act, 
 which need not be here enumerated, tend to 
 
 1 It must be remembered that this vice is not uncommon 
 amongst girls.
 
 68 FUNCTIONAL NERVE DISEASES 
 
 result in nerve disturbance through the mental 
 trouble and anxiety and distress that accom- 
 panies them ; but, on the whole, I consider that 
 these as causes are overestimated. What I am 
 convinced is underestimated, especially amongst 
 women, as an exciting sexual cause, is enforced 
 celibacy. I say amongst women, not because 
 they have stronger passions, but because of the 
 great difference of their position in this respect. 
 
 It is not, of course, always possible to trace or 
 prove that this is the exciting cause, but in deal- 
 ing with any nerve case in unmarried women, 
 especially between thirty and forty-five, this must 
 never be forgotten as a probable powerful factor 
 in the case. It is, I fear, not unnecessary to 
 remark that this subject has not always been 
 approached by medical men with that refine- 
 ment and sympathetic feeling that is necessary ; 
 and the profession has been not unjustly blamed 
 for tending to speak of nerve affections as wholly 
 due to this one cause in women. Such is obviously 
 so untrue that it does not need proof here ; but 
 while strongly protesting against this coarse and 
 unscientific view, I must insist upon the potency 
 of this as a factor, and not in women only, but in 
 a less degree in men. 
 
 It is obvious that, as a rule, no such strain of 
 celibacy is placed upon them, as most men could 
 marry, if they wished, at any time. In women,
 
 GENERAL .ETIOLOGY 69 
 
 however, pure and blameless in life, silent tragedies 
 are for ever being enacted, especially in this 
 country, from want of any opportunity of enter- 
 ing upon the marriage state. Surely there are 
 features in Eastern life worthy of consideration in 
 this connection. There every marriageable woman 
 has, to say the least, a chance of marriage, and 
 even on the Continent the arrangements are 
 better and the facilities are greater than in 
 England. Nowhere (save, perhaps, in the States) 
 are so many fine women, perfectly suited to make 
 admirable wives and mothers, doomed against 
 their wish to perpetual celibacy as here. 
 
 The five minor exciting causes are as follows : 
 i. Insomnia. Of course, this leads to fatigue, 
 and yet it is best placed in a class by itself as the 
 chief of the minor causes of nerve disease. No 
 doubt, individuals differ widely in their need of 
 sleep for healthy nerve action, varying naturally 
 from four, or even three, hours in the twenty- 
 four, up to ten or twelve. The amount needed 
 is determined partly by heredity and partly by 
 the nature of the life and work. In this, as 
 in most other exciting causes, it must ever be 
 remembered that real though the evil be, it is 
 at least doubled by autosuggestion. If a man 
 does not mind lying awake, half its evils go. 
 Of course, in addition, patients, as a rule, rather 
 under than over estimate the time they sleep.
 
 70 FUNCTIONAL NERVE DISEASES 
 
 2. Shock. This is quite capable of producing 
 a severe attack of neurasthenia or hysteria (in 
 those prone to it) in twenty-four hours which may 
 take months or years to recover from. A sudden 
 death, accident, or sudden disappointment in love, 
 or reverse of fortune may all produce long-con- 
 tinued disease if there be predisposition. 
 
 3. Pain. This, if long-continued and wearing, 
 may set up nervous disease really by overstrain 
 of the nervous system. In the same way any 
 long-continued drain on the system by ulcers or 
 discharges may act similarly. 
 
 4. Early stages of organic nerve disease, such as 
 Graves' and Raynaud's disease, disseminated 
 sclerosis, exophthalmic goitre, or Basedow's 
 disease. Of course, in all these cases the point 
 is to recognise the organic disease which 
 underlies the other. 
 
 5. Misplacement of organs, including general 
 enteroptosis, nephroptosis or floating kidney, 
 uterine flexions and displacements. 
 
 No doubt these have been greatly exaggerated 
 by some as exciting causes, but they do exist in 
 many cases, and are often contributory causes. 
 I have before me a pamphlet by Dr. Suckling, of 
 Birmingham, detailing many cases of melancholia 
 relieved or cured by nephropexy, or replacement 
 and fixing of a dropped kidney. The evils pro- 
 ducing nervous and even mental trouble are in
 
 GENERAL ETIOLOGY 71 
 
 these cases (i) mechanical, caused by traction or 
 pressure on bloodvessels, sympathetic, and other 
 nerves and organs, and (2) toxic, by retention of 
 urine in the kidney and uretur, and I may add (3) 
 psychic, by fear of consequences and other vague 
 dreads. In the same way misplacement of other 
 abdominal organs contributes to nervous troubles 
 through similar causes. 
 
 The only point is that while enteroptosis is 
 undoubtedly a cause, its importance must not be 
 exaggerated. 
 
 Anaemia, so often classed as an exciting cause 
 of nervousness, is not a true cause, and even 
 when advanced does not as a rule lead to nervous 
 symptoms. 
 
 We must remember before closing this chapter 
 that the subjects of functional nerve disease are 
 by no means always drawn from the same class, 
 either mental, moral, or physical. We find 
 sufferers amongst the greatest and the least, the 
 noblest and the basest, the strongest and the 
 weakest, amongst men and women. The same 
 elements, after all, exist in great men and neuro- 
 paths : only in the former there is power to 
 subordinate the means to the end, and to keep 
 the ideas noble and the habits excellent. Ner- 
 vousness, after all, is often an excess of self- 
 consciousness of a normal quality. 
 
 The evil, which is of course a form of auto-
 
 72 FUNCTIONAL NERVE DISEASES 
 
 suggestion, consists in bringing into consciousness 
 what should be left in unconsciousness. It may 
 often be more than this, but this at least is ever 
 present. There is generally in these introspective 
 patients, also, a predisposition both from tempera- 
 ment and heredity. Dr. Rennie, amongst others, 
 points this out strongly, 1 and asks us to observe 
 how frequently it is a cause of hysteria, particu- 
 larly in young women. He also reminds us that 
 the offspring of persons who are alcoholic, or 
 insane, or neurotic, frequently inherit unstable 
 cortical centres, and furnishes us with some 
 remarkable illustrations of defective and perverted 
 functional nervous activities. 
 
 1 Dr. Rennie, British Medical Journal, May 4, 1901.
 
 CHAPTER IV 
 
 AETIOLOGY OF HYSTERIA 
 
 IN reaching now the first of the special nerve 
 diseases of which I have to speak, I am 
 confronted with a special difficulty. Hysteria is 
 a word that covers symptoms so various that we 
 may almost speak of one class of them neuro- 
 mimesis, or the mimicry of disease by nerve 
 agency as a distinct disease. 
 
 Hysteria as elaborated in France, and largely 
 accepted by America and England, means a 
 functional nerve disease characterised by narrowed 
 consciousness of common (anaesthesia) and special 
 sensation (narrowed field of vision) and by con- 
 vulsive seizures. But in a large number of cases 
 here these symptoms are not in the least well 
 marked, and are, indeed, at times entirely absent, 
 while another class of symptoms characterise the 
 disease; and that is the wholly involuntary 
 mimicry, with extraordinary accuracy, of almost 
 every variety of disease, producing symptoms 
 through the unconscious mind wholly impossible
 
 74 FUNCTIONAL NERVE DISEASES 
 
 of production by any voluntary effort or will- 
 power, such as local swellings and contractions, 
 effusions, high temperatures, &c. These phe- 
 nomena are collectively called neuromimesis. 
 
 Sir James Paget 1 says : " Cases of neuromimesis 
 are commonly included under the name ' hysteria,' 
 but in many of them none of the distinctive symp- 
 toms of hysteria are ever observed ; and from all 
 of them it is desirable this name should be 
 abolished." 
 
 But there is a real difficulty in this, inasmuch as 
 in many cases the two classes of symptoms are 
 combined, and at present we must be content to 
 include the two groups as belonging to one 
 disease. 
 
 It is clinically convenient to include neuro- 
 mimesis with hysteria, as both are diseases of the 
 unconscious mind, but as a matter of fact what I 
 shall have to say on hysteria applies far more to 
 the nervous mimicry of organic disease than to 
 narrowed sensations and convulsive seizures. 
 
 Let us consider, then, for a moment the process 
 by which in "hysteria" disease is caused by mental 
 action ; and to do this we must, I fear, recapitulate 
 some well-known facts. In the first place we note 
 that our brain not only acts, as I have shown, by 
 the will and by ideas of which we are conscious, 
 but is continuously vibrating with ideas, memories, 
 1 Sir J. Paget, Lancet, 1873, ii. 512.
 
 ETIOLOGY OF HYSTERIA 75 
 
 and trains of thought of which we are unconscious. 
 It is so even with regard to common sensation. 
 
 A very small proportion of the afferent currents 
 arriving at the brain produce conscious sensations 
 of any kind. If the term "unconscious sensa- 
 tions " be objected to, let " unconscious irritation " 
 be substituted, for they certainly produce the 
 same effects on the unconscious mind which in 
 the conscious we term sensation ; and furthermore, 
 I have shown elsewhere 1 that sensations can be 
 produced by the unconscious mind, arrested by it, 
 and can themselves produce psychical and physical 
 effects through its agency. 
 
 Professor W. James, in his " Psychology," 
 remarks : " One of the most extraordinary facts 
 of our life is that, although we are besieged by 
 impressions from our whole sensory surface, we 
 notice so very small a part of them. . . . Yet 
 the physical impressions which do not count are 
 there as much as those that do." 
 
 " For all these impressions," says Barrett, 2 
 " whether we are conscious of them or not, leave 
 some mark behind. They weave a perceptible or 
 imperceptible thread into the fabric of our life ; 
 they make a greater or less indent upon our 
 personality. We know that this is the case, for 
 
 1 See " The Unconscious Mind " (Schofield), 2nd edition, 
 Hodder & Stoughton. 
 
 2 Professor Barrett (Dublin), Humanitarian, 1895.
 
 76 FUNCTIONAL NERVE DISEASES 
 
 impressions of which we were unconscious at the 
 time often emerge when the attention is with- 
 drawn from things around, as in states of illness, 
 in dream, or in reverie." Dr. Waldstein also 
 says : " There is hardly a moment . . . when the 
 nerve endings in the skin are not constantly 
 assailed by sensations of pressure, of temperature, 
 of the flux or reflux of the blood supply." 
 
 Perhaps an illustration will help here. 
 
 If you concentrate your attention on any part 
 of your body, you become aware of sensations in 
 it that escaped your attention before, but were 
 equally there present. If with a feather I lightly 
 tickle the back of your neck at the time you are en- 
 gaged in very earnest conversation, the vibration 
 aroused in the brain sensory centre is unnoticed 
 by you ; yet if I call your attention to the part it 
 is noticed at once. By increasing the stimulus 
 I can make the waves of vibration set in action 
 other centres involuntary ones, such as cause 
 a shaking or shuddering of the neck, or voluntary, 
 such as turning the head round or moving 
 away. 
 
 If you are asleep I may tickle your foot, so that 
 you draw the leg away and you wake up. In this 
 case you are probably conscious of moving your 
 leg, but the stimulus that made you do it was too 
 slight to reach consciousness. We may thus be 
 conscious of a transferred vibration leading to
 
 AETIOLOGY OF HYSTERIA 77 
 
 action or sensation, and yet be ignorant of the 
 cause that set it going. 
 
 Memories, again, will involuntarily, and it may 
 be unconsciously, arouse both feelings and actions. 
 One may have smelt the strong scent of some 
 flower when some critical event took place a 
 proposal of marriage or some sudden news : 
 henceforth, whenever the topic is touched on, the 
 very scent or vibrations of the nerve of smell that 
 represent it may be exactly reproduced. A certain 
 field may recall a certain song we used to sing 
 as we crossed it on our way to school. The 
 thoughts of old Anglo-Indians often set the vibra- 
 tions of Eastern sights and sounds in action again 
 in the old centres. 
 
 Observe in all these cases we are considering 
 natural associations, not vibrations deliberately 
 set up by the will in an unusual way. You can, 
 as shown already, think of a green field when in a 
 drawing-room until you set in vibration the centre 
 of sight and see the green grass, or the centre of 
 hearing and hear the lowing of the cattle and the 
 hum of the insects. This is much easier if there 
 are no distracting sounds and if you close your 
 eyes ; and still more so if there are some insects 
 actually humming in the room. But the memories 
 I speak of are wholly unconscious ones. 
 
 Let us now sum up our results, taking a definite 
 case, say of a pain in the little finger. This pain
 
 78 FUNCTIONAL NERVE DISEASES 
 
 is felt in the little finger, we say, though we really 
 know that the only seat of any sensation is in the 
 brain. It is there, at the central termination of 
 the ulnar nerve which leads from the little finger, 
 that all the vibrations take place of which the 
 mind becomes conscious, and which it calls pain ; 
 whenever these vibrations take place in the nerve 
 centre belonging to the little finger in the brain, 
 the mind always refers the sensation to the com- 
 mencement of the nerve in the little finger, what- 
 ever may be the real origin. 
 
 In the same way, if in your house the hall-door 
 bell rings, you say there is some one at the hall 
 door ; if the drawing-room bell, there is some one 
 there ; and yet such may not be the case. I may 
 have pulled the door-bell wire inside the hall as I 
 passed down the kitchen stairs, or a rat may have 
 moved it, or I may have struck the bell itself and 
 made it ring, or a shock of earthquake may have 
 shaken it, or a strong gust of wind ; and yet, 
 although these causes are so various, you, in the 
 kitchen, always say, " There is some one at the 
 front door." 
 
 It is so in the body, (i) The little finger is 
 pricked there is pain in the little finger. (2) 
 The ulnar nerve itself is pressed on somewhere in 
 its course there is pain in the little finger. The 
 hand may be cut off, and still, if the nerve be 
 irritated in the stump by pressure, the man feels
 
 AETIOLOGY OF HYSTERIA 79 
 
 the pain in his imaginary little finger as truly and 
 vividly as if it were still actually there. (3) Or, 
 again, there may be a tumour in the brain 
 pressing on the nerve centre in the brain of the 
 ulnar nerve, and the most acute pain is felt in the 
 little finger. All these instances are from direct 
 irritation of the nerve in some part of its course. 
 But, as we have seen, we may go much further. 
 The hall-door bell wire may have got caught with 
 the drawing-room one, so that when the latter is 
 pulled it is the hall-door bell that rings ; the vibra- 
 tion is thus transferred. So in the brain. (4) I 
 may set to work and think of my little finger, and 
 so start sensations in it which, if not actual pain, 
 are still sensations. But if I have the idea it is 
 injured, though it may not be, I may feel the pain 
 acutely from an idea alone. (5) But, again, the 
 pain may have been originally caused by an 
 abscess in the little finger, and afterwards kept up 
 long after the abscess was gone by the ideal 
 centre. (6) Associations may cause pain, as 
 seeing others with crushed little fingers ; or, (7) 
 memories, conscious or unconscious, of crushed 
 little fingers may also start and keep up this pain. 
 Observe, then, the varied causes with the same 
 effect , or, as we may say, the varied actions with 
 the same reaction. Only, in conclusion, we may 
 add that while in health it is generally easy to 
 discriminate between pain in the little finger
 
 8o FUNCTIONAL NERVE DISEASES 
 
 caused by injury to the little finger and that set 
 up in other ways, in nerve disease it is not. 
 Nay, it is sometimes impossible not only to the 
 sufferer, but to the doctor who attends him. It 
 has been well said : " We think as we feel, or 
 think we feel ; and we feel as we think. If we 
 feel a pain, we think we are ill ; and if we think 
 we are ill, we feel ill." If my ideal centre 
 vibrates with the thought of crossing the Channel 
 in rough weather, and pictures the nausea that 
 would then be felt, the vibrations are transmitted 
 to the terminal centres of the sensory nerves 
 running from the stomach, I actually feel sick 
 from communication with a sensory centre ; and, 
 possibly, if of a highly nervous organisation, may 
 actually be sick from transference to a motor 
 centre. 
 
 Real feelings and real acts can be started in 
 entirely ideal centres. If we think intensely of 
 any part of the body long enough, we feel sensa- 
 tions in that part. If we think of a good dinner 
 our mouths water. We shiver whether we only 
 think of cold or actually feel cold. The sensation 
 of pain can be produced as really and vividly by 
 thoughts or ideas alone as light in the eye by 
 striking it. In short, every sensation of the body 
 ordinarily produced from without can also be 
 produced from within. These ideal vibrations, 
 acting on motor and other centres, are quite
 
 AETIOLOGY OF HYSTERIA 81 
 
 different from the action of a motor centre by 
 the direct impulse of the will, the action being in 
 the latter case voluntary and in the former in- 
 voluntary. So far, I have only spoken of ideas 
 of which we are conscious, so that, although the 
 modes of exciting these motor and sensory 
 centres are abnormal, we know them to be so, and 
 hence are not deceived and do not deceive others 
 into believing them to be natural. 
 
 Thus, when our teeth are on edge from dis- 
 cordant sounds, we do not go to the dentist ; if 
 we are sick from ideas, we do not think we are 
 dyspeptic ; if we hear noises in the ear, we do 
 not look for them externally ; if we shiver from 
 thinking of cold, we do not put on more clothing ; 
 but this is because we are conscious that the 
 cause is mental in other words, of the action of 
 the mind. It is quite otherwise where the sensa- 
 tion is caused by mind action of which we are 
 wholly unconscious ; the conscious part of the 
 mind, being at the same time cognisant of the 
 symptoms but ignorant of the cause, naturally 
 attributes it to the disease most likely to pro- 
 duce it. 
 
 With regard to the excitation of feelings by 
 the action of the mind, John Hunter says: "I 
 am confident that I can fix my attention to any 
 part until I have a sensation in that part." 
 The transition is easy from the irritation of
 
 82 FUNCTIONAL NERVE DISEASES 
 
 real sensations and those actually produced 
 by expectation in the ideal centres, only we 
 must remember the mind produces sensation by 
 ideas, not ideas of sensation. The difference is 
 enormous. 
 
 " Whatever mental or bodily state can be 
 excited through the senses from without may 
 arise from within, from imagination proper." l 
 
 Braid took four men between forty and fifty 
 years of age and told them to fix their attention 
 on their hands for five minutes. One, a member 
 of the Royal Academy, felt intense cold in the 
 hand ; an author, darting and pricking pains ; a 
 major felt heat ; a scientific man had the arm 
 cataleptically fixed to the table. 2 
 The sensations in the hand by thought are 
 produced probably by real vasomotor changes 
 in the hand, set up by the mental excitation of 
 the sensory centre in the brain. 
 
 The sensation of the teeth on edge may 
 be excited by an acid on the teeth (normal 
 irritation), by scraping glass (transference from 
 auditory nerve, which lies by the side of the 
 nerve from the teeth, in a bony canal), by seeing 
 glass about to be scraped (transference from 
 optic nerve by association), or by the mere 
 thought of it being done (transference from the 
 
 1 Hack Tuke, " Mind and Body," 2nd edition, i. 30. 
 3 Braid, u Hypnotism," xx. 93.
 
 .ETIOLOGY OF HYSTERIA 83 
 
 ideal centres). In each of these cases the mouth 
 may be filled with saliva. 
 
 So much for the general causation of physical 
 phenomena by mental action, which, although it 
 explains much of the possible processes by which 
 hysteria may be caused, does not much advance 
 its specific aetiology. The whole subject is con- 
 fessedly so chaotic and obscure that I make no 
 apology for turning aside for a moment to give a 
 few suggestions on the aetiology of hysteria that 
 have been made by students of the subject, before 
 briefly summing up my own views. 
 
 Dr. G. E. Rennie says : l " Now, there has 
 been much discussion as to the nature of this 
 form of functional nerve disease. There are 
 some who would attribute the condition to 
 functional degradation in certain parts of the 
 brain or spinal cord : the occurrence of an 
 hysterical hemi-anaesthesia in hemiplegia would 
 on this theory be due to some vasomotor spasm 
 in the cortical areas of sensation or motion. An 
 attack of paraplegia would be due to some impair- 
 ment in nutrition of the cells of the anterior 
 cornua. But this explanation will hardly meet 
 all the facts, since the sudden transference of a 
 hemi-anaesthesia from one side of the body to the 
 other under the influence of a magnet or some 
 
 1 Dr. G. E. Rennie, British Medical Journal, May 4, 
 1901.
 
 84 FUNCTIONAL NERVE DISEASES 
 
 special metal could hardly be explained by any 
 such coarse pathology. 
 
 " The entirely opposite theory regards all 
 these phenomena as essentially dependent upon 
 psychical states ; and functional disturbance or 
 degradation of the lower centres is not recognised. 
 Now, I think that we can get a clearer idea or 
 conception of hysterical nerve disease by regard- 
 ing it as partly mental and partly physical, the 
 underlying physical state being allied to the 
 hypnotic state." 
 
 Sir S. Wilks l regards hysteria as of the nature 
 of an explosion. He says : " Nature having no 
 outlet for the superfluous energies, the whole 
 system becomes disordered." Here Nature (our 
 well-known female deity) stands for the " uncon- 
 scious mind." Dr. Ormerod 2 says vaguely it "is 
 due to a supposition of vasomotor spasms, or 
 defective nutrition of nervous elements." Sir R. 
 Reynolds, Charcot, and others, say it depends on 
 idea, or is ideogenic. These ideas being un- 
 conscious, they imply its origin is the unconscious 
 mind. 
 
 Janet considers "the anaesthesia and amnesia 
 in hysteria arise, not from physical failure in 
 
 1 Sir S. Wilks, "Diseases of the Nervous System," p. 365, 
 quoted by Dr. Herman, " Diseases of Women," p. 30. 
 
 2 Dr. Ormerod in Clifford Allbutt's "System of 
 Medicine."
 
 ETIOLOGY OF HYSTERIA 85 
 
 mind or brain, but from psychic failure to grasp 
 or attend to sensation ; in short, a contraction of 
 the field of consciousness, as the contraction in 
 hysteria of the field of vision from the same 
 cause. The impressions, therefore, cease to rise 
 above a lower sphere (unconscious mind) and 
 tend to foster at the expense of consciousness 
 a ' secondary ' subconscious mental state. The 
 elements of such a state exist in all of us " ; and 
 may I add that this state is here called the 
 " unconscious mind " ? 
 
 Professor Biener (Vienna) considers r that the 
 " sundering of consciousness " exists in rudi- 
 mentary fashion in every case of hysteria. The 
 foundation and condition precedent to hysteria is 
 the existence of hypnoid states (or what he would 
 call "unconscious consciousness "). 
 
 Now we I think more intelligibly under- 
 stand by this " sundering of consciousness " the 
 distinction between the conscious and the un- 
 conscious mind ; and the hypnoid state is the 
 revelation by its effects of the powers, not of 
 "unconscious consciousness,"- but of the uncon- 
 scious mind ; while the consciousness of the ego is 
 partly in abeyance or its powers impaired. 
 
 Sir James Paget says 2 : "If you study 
 
 1 Professor Biener (Vienna) Neurologisches Centralblatt, 
 January, 1893. 
 
 2 Sir James Paget, Lancet, 1873, ii. 513.
 
 86 FUNCTIONAL NERVE DISEASES 
 
 neuromimesis from its mental side, you may 
 easily find reason for believing it [the result of] 
 mere mental error, rather than the erroneous 
 working of sensory and motor centres ; but to 
 regard all mimicries of organic disease as 
 essentially mental errors is bad pathology and 
 worse practice. In some mimicries it is hard 
 to discern any mental influence at all, such as in 
 distension, constipation, &c. Some are found in 
 ignorant and slow-minded people." 
 
 This is an admirably reasoned passage to show 
 that the conscious mind is certainly not the active 
 agent in most neuromimetic cases ; and hence 
 Sir James, limiting mind to consciousness, can 
 recognise no mental action at all, and falls back 
 on the erroneous working of sensory and motor 
 centres. But is not the agent that sets these 
 centres working erroneously purposive and 
 mental, and should we not call it the unconscious 
 mind ? 
 
 Eichhorst : says that "hysteria is properly 
 attributed to disturbances in the cerebral cortex." 
 Briquet, 2 in the best work published on hysteria, 
 holds that the seat of hysteria " is the brain and 
 not the uterus." Page shows that the brain 
 (unconscious mind) is the cause of the railway 
 
 1 Professor Eichhorst, " Practice of Medicine," 1901. 
 
 2 See "Twentieth Century Practice of Medicine," x. 
 454-
 
 ETIOLOGY OF HYSTERIA 87 
 
 spine, and that it is not due, as Erichsen and 
 Erb thought, to inflammation of the spinal cord. 
 Bernheim says l : " How can memory set up a 
 disease it has never seen ? The disease 
 [hysteria] must be in the psychic centres, but 
 unconsciously ; possibly a disease of sesthesodic 
 cells of the cerebral hemisphere " (a new name for 
 the unconscious mind). 
 
 I may conclude these quotations with the far- 
 reaching views of Dr. Buzzard, who has done so 
 much in the aetiology of this disease ; and I 
 make no apology for quoting his words in extenso. 
 He says: 2 "Hysteria is a term the etymology 
 of which is misleading. It is often improperly 
 applied to cases of simple malingering, and others 
 which do not admit of ready explanation. Its 
 use is best restricted to a condition of the nervous 
 system fairly defined, but the internal pathology 
 of which is not known ; characterised by the occur- 
 rence of convulsive seizures and by departures 
 from normal functions of various organs, leading 
 to very numerous and often perplexing symptoms. 
 
 " These are apt to simulate those commonly 
 arising from definite alterations of structure, but 
 differ from the latter in the fact that they may 
 often, even when at their worst, be removed 
 
 1 Professor Bernheim, Brain, xvi. 190. 
 a Dr. Buzzard, " Quain's Dictionary of Medicine," 1883, 
 1.678.
 
 88 FUNCTIONAL NERVE DISEASES 
 
 instantaneously, usually under the influence of 
 strong emotion. It would seem that there is a 
 disturbed or congenitally defective condition of 
 the cerebral substance, involving in all cases the 
 highest nervous centres, and in various examples 
 extending more or less also to some of those 
 which preside over automatic phenomena. Partial 
 or complete suspension of inhibitory influence 
 would appear to be the most patent result of 
 the condition, whatever it is, and this is recog- 
 nised as well in regard to the mental as to the 
 more evidently physical processes belonging to 
 cerebral function. 
 
 " A laugh which cannot be checked, but con- 
 tinues until tears flow or the limbs become 
 convulsed, is a typical example of such a sus- 
 pension of control, and, if studied, throws light 
 upon the nature of a considerable portion of the 
 phenomena of hysteria. The jerking expirations 
 of laughter arise from excitation of the respiratory 
 centre, and when this excitation, uncontrolled by 
 higher centres, acquires an abnormal strength, it 
 extends to other parts of the medulla oblongata 
 and spinal cord, and produces general convul- 
 sions. It overflows, as it were, into other 
 nervous centres, which in health would receive 
 none of the exciting impulse. Between the 
 lowest (automatic) functions of the cerebro- 
 spinal system and the highest (psychical) there
 
 ETIOLOGY OF HYSTERIA 89 
 
 is an ever-increasing complex system of excito- 
 motor processes, which may be in part, or wholly, 
 under the pathological influence, whatever it be " 
 (the unconscious mind?). "Hence the bizarre 
 character of the hysterical phenomena, and the 
 circumstance that the symptoms always include 
 modifications of those processes which underlie 
 the mental faculties. The suspension of the 
 power of control possessed by the higher centres 
 explains the irregular movements, spasms, and 
 convulsions. Hyperaesthesia and pain are de- 
 pendent, probably, in hysteria, upon such a 
 molecular change being initiated in the sensory 
 ganglionic centres as is ordinarily propagated 
 from the periphery " ! (This, due to the uncon- 
 scious mind, I have described a few pages back.) 
 " Hysterical paralysis, on the other hand, signi- 
 fies that the power of the highest centres in 
 liberating movements is in abeyance. In 
 hysterical anaesthesia it is probably feeling or 
 sensory perception and not the function of the 
 sensory apparatus that is in abeyance, whilst the 
 reflex actions which result from excitation of 
 sensory nerves are performed in an orderly 
 manner. A patient may work a needle with 
 fingers which can be touched or pricked without 
 the act being felt. Tactile impressions are con- 
 veyed to the ganglionic centre by the afferent 
 nerves, so that the muscles are contracted. What
 
 90 FUNCTIONAL NERVE DISEASES 
 
 is wanted is the participation of those higher 
 centres in which consciousness runs parallel to 
 this physiological action." 
 
 In addition to these views, Mobius and Sir 
 J. Russell, Reynolds considered that hysteria was 
 caused by ideas, or ideogenic, Charcot by hyp- 
 notic suggestion, Janet by contracted fields of 
 consciousness. 
 
 To sum up : the pathology of hysteria rests 
 upon a twofold basis the functional derange- 
 ment or disease of the unconscious mind (the 
 sphere of extra-conscious psychic action) and 
 the loss of control of the higher cortical centres. 
 There is no doubt that "hysteria is essentially a 
 psychosis" (Professor Dana) as distinguished 
 from neurasthenia, which is mainly a neurosis. 
 There is in hysteria no real chain of causation 
 any more than one can trace hereditary qualities 
 by pedigrees drawn in the male line. Bearing 
 this in mind, we may consider, amongst special 
 predisposing causes of hysteria : 
 
 1. Race. The Semitic races, and especially 
 the Jews, are very liable to hysteria, and the 
 Latin more than the Saxon races. In Germany 
 and France emotional as distinguished from 
 mimetic hysteria is much more common than 
 in England. No race is exempt from it. 
 
 2. Sex. Women suffer more from hysteria 
 than men, while in children the numbers of each
 
 .ETIOLOGY OF HYSTERIA 91 
 
 sex are equal. In Germany there is i man to 
 17 women ; in France i man to 3 women. 
 
 3. Age. We get 8 per cent, of cases under 
 10; 50 per cent., 10-20; 28 per cent., 20-30; 
 10 per cent., 30-40 ; 3 per cent., 40-50 ; and 
 i per cent., 50-60. It is most common in 
 women 15-25, in men 20-30, in children 10-15. 
 Generally it is most common in adolescence, and 
 next in early adult life. 
 
 4. Heredity. Seventy per cent, of hysterics 
 are hereditary, and hysteria seems to descend 
 mostly through the mother. Charcot says that 
 heredity is the sole predisposing cause, and that 
 all others are exciting. There can be no doubt 
 that the best prophylactic in hysteria is to forbid 
 the marriage of lunatics, epileptics, and drunkards. 
 Epidemic outbreaks of hysteria amongst groups 
 of workpeople and others, however, show that 
 heredity is not an essential factor. 
 
 Exciting causes include many we have con- 
 sidered as general causes of nerve disease 
 toxins and poisons of various sorts, including 
 alcohol, lead, and mercury, profound exhaustion, 
 and some organic nerve diseases. 
 
 Mentally, powerful emotion, especially fear, is 
 said to be the most potent single exciting factor. 
 Also grief, shock, love, sight of accidents and 
 traumatism of all sorts, specially railway acci- 
 dents.
 
 92 FUNCTIONAL NERVE DISEASES 
 
 Constant introspection, which is an attempt to 
 bring the unconscious into consciousness, is a 
 fertile source of mimetic hysteria. Sexual causes 
 are not so common as is thought. Sex excesses 
 are occasional causes in men and boys, especially 
 solitary vice ; but their influence in women is not 
 great. Disorders of genital organs are present 
 in many cases, but it is estimated that at least 
 half of hysterical sufferers are free from any such 
 disease ; nevertheless, masturbation is a common 
 cause of hystero-epilepsy in women. 
 
 Persistent hysteria has followed a single dream. 
 
 With regard to anaemia, chlorosis, weak health, 
 and the onset of the catamenia in their relation 
 to hysteria, they must be regarded rather as 
 coincidences than causes. 
 
 There can be no doubt of the evil of a badly 
 regulated and self-centred life, when there is 
 predisposition to any form of nerve disease, in 
 increasing the number of the victims to hysteria ; 
 but the whole subject of the true aetiology of this 
 mysterious disease is as obscure as its pathology, 
 and no dogmatism is at present possible. 
 
 With regard to religion, it may be said that the 
 trustful, patient, altruistic spirit of true Chris- 
 tianity is opposed to hysteria, while terrorism, 
 mysticism, self-introspection, and excitement 
 foster it.
 
 CHAPTER V 
 
 PHYSICAL SYMPTOMS OF HYSTERIA 
 
 IN now attempting a survey of this disease, 
 including both emotional and mimetic 
 varieties, we must again commence the chapter 
 in the usual manner by saying that owing to an 
 entire absence of any pathology no dogmatism is 
 possible or desirable. 
 
 Clinically, hysteria is as distinct a disease as 
 epilepsy, and evidently depends on some changes, 
 which cannot yet be proved, in the cerebral 
 cortex and other districts of the brain ; for it 
 must be remembered that the body has been 
 repeatedly searched from head to foot for some 
 organic cause of hysteria, but in vain. 
 
 Hysteria has already been divided in the 
 previous chapter into emotional and mimetic. 
 It has also been divided into major and minor. 
 
 Hysteria major includes both of my divisions, 
 and the symptoms include neuromimesis, paralysis, 
 narrowed consciousness, and fits. 
 
 Hysteria minor has none of these symptoms,
 
 94 FUNCTIONAL NERVE DISEASES 
 
 but general loss of control and exaltation of 
 emotional centres, pains, and emotional crises 
 not amounting to fits, with the passing of copious 
 pale urine. It is common in young women and 
 children, and in many cases is an early stage of 
 the graver disease. 
 
 Hysterical physical symptoms generally include 
 disorders of sensation, locomotion, circulation, 
 digestion, excretion and secretion, respiration, 
 special sensation, and of the nervous system. 
 
 We will consider these in their order, but 
 before doing so may just allude to certain 
 symptoms that have been termed stigmata, 
 especially in France. They are three or four 
 in number, thus : 
 
 1. Anaesthesia. 
 
 2. Concentric limits of vision. 
 
 3. Hystero-genetic zones. 
 Or: 
 
 1. Diseases of conscious sensation. 
 
 2. Contraction of visual field. 
 
 3. Hystero-genetic zones. 
 
 4. Convulsions. 
 
 It must be remembered that in England, at 
 any rate, these "stigmata" are by no means so 
 common or so well marked as at the Salpetriere, 
 and that the disease itself is perfectly developed 
 in their entire absence.
 
 PHYSICAL SYMPTOMS OF HYSTERIA 95 
 
 The fits or convulsions may be merely con- 
 vulsive, or may be accompanied by large and 
 curious movements, or there may be a cataleptic 
 condition, in which all sensation and voluntary 
 motion disappears, and only partial consciousness 
 remains, while the muscles are in a peculiar con- 
 dition, so that fixed positions of body and limbs 
 can be moulded at will, the muscles being not 
 rigid but plastic. I only allude to these varieties 
 now, and shall have more to say about them 
 later on. 
 
 i. Sensory Symptoms. The most common is 
 some form of anaesthesia, of which, as a rule, the 
 patient is unconscious until his notice is called to 
 it. Of course, this is at first the rule in all 
 anaesthesias, but when following a well-marked 
 organic lesion, such as some cerebral disturbance 
 (hemorrhage, &c.), it is as a rule quickly dis- 
 covered, being suspected and looked for; whereas 
 in hysteria, not being expected, it is, as a rule, 
 undetected by the patient and often by the 
 doctor. This anaesthesia is most varied in 
 character. It is seldom general, and not very 
 often hemi-anaesthetic. It is most common in 
 patches that have to be looked for, with well- 
 defined borders, and commonly patches of hyper- 
 aesthesia in between. The whole (as in all hysteric 
 symptoms) seems to speak of scattered cortical 
 disorder rather than of a localised lesion.
 
 96 FUNCTIONAL NERVE DISEASES 
 
 These patches or plaques of anaesthesia are 
 more common than anatomical areas of lost 
 sensation. We get also segmental anaesthesia, 
 where the areas are in bands one below another ; 
 moveable or transferred anaesthesias, where a 
 patch on one side alternates with a patch on 
 the other. 
 
 We have also so-called "glove," "stocking," 
 "mitten," and "garter" anaesthesias, which 
 explain themselves. 
 
 The degree, depth, and character of the 
 anaesthesia varies greatly. 
 
 There may be loss of sensation to touch and 
 pain, and yet faradic sensation and somatic sensa- 
 tion and sense of position, weight, temperature. 
 Or any of these may be lost and the rest retained. 
 There may be no sense of temperature or pain, 
 and yet touch may be felt. 
 
 The only way to discover the character and 
 extent of the anaesthesia is to cover the eyes or 
 avert the face so that the part cannot be seen, 
 and test for temperature, touch, weight, position, 
 electricity, and common sensation. 
 
 A patient told to say " Yes " when she feels a 
 prick and " No " when she does not will often 
 say " No," showing that the anaesthesia, though 
 present, is not complete, or possibly there may 
 ohly be the idea (subconsciously) of anaesthesia. 
 This anaesthesia, though proved to be imperfect,
 
 PHYSICAL SYMPTOMS OF HYSTERIA 97 
 
 persists in sleep, showing that at any rate it is 
 not a mere product of the conscious mind and 
 fraudulent in character. It must be remembered 
 that in the anaesthesias, as in all other hysteric 
 symptoms, there are ever inexplicable contradic- 
 tions, that to the tyro are ever suggestions of 
 fraud, and that can yet be conclusively proved to 
 be produced unconsciously by the patient. In 
 hysteria Binet shows that sometimes the anaes- 
 thesia does not extend below the level of con- 
 sciousness, implying that at others it does. To 
 some, of course, this may seem nonsense, as at 
 first sight unconscious sensation seems a contra- 
 diction of terms, and therefore a double con- 
 sciousness has been postulated to get over the 
 difficulty. It really matters little whether you 
 call the unconscious a second consciousness or 
 not ; on one point we are all agreed, that the 
 two "consciousnesses" are unconscious, at any 
 rate, with relation to each other. 
 
 G. H. Lewes points out that " unconsciousness 
 is a sentient state not the entire absence of 
 consciousness we ascribe to a machine." "It 
 is correct," says James Mill, "to draw a line 
 between feeling and knowing that we feel." Pro- 
 fessor James remarks, as quoted in Chapter IV., 
 that few impressions of the countless number that 
 are made are noticed by us ; and James Sully 
 and Wundt make similar remarks. Bearing in
 
 98 FUNCTIONAL NERVE DISEASES 
 
 mind, therefore, that there is such a thing as 
 unconscious sensation, or at any rate feeling, we 
 will be prepared to understand better Binet's 
 experiments in hysterical anaesthesia. 
 
 If a pencil or pair of scissors be placed in an 
 entirely anaesthetic (hysterical) hand behind a 
 screen, so that the patient has no knowledge 
 of what is being done (the hand being proved 
 by experiment to be entirely insensible to pinch- 
 ing, pricking, burning, touch, and the faradic 
 current), it is found that the hand will grasp 
 each appropriately; in the one case prepared 
 to write, in the other to cut a clear proof that, 
 though severed by hysteria from consciousness, 
 unconscious sensation is still there, and that an 
 unconscious mental process is going on. This 
 is specially clear if it be the left hand, which is 
 not accustomed to hold pencil or scissors, that is 
 experimented upon. Here there is no ready- 
 formed habit to help the action when the 
 articles are recognised by sensation, and uncon- 
 scious reasoning power must be postulated. 
 
 If a pen be placed in the anaesthetic hand and 
 a word is traced with it, the hand being held, 
 then if left alone the hand itself will frequently 
 trace out the word five or six times. If then the 
 patient's hand be held again, and some very 
 familiar word, such as the patient's name, be 
 written with it, with the addition of an extra
 
 PHYSICAL SYMPTOMS OF HYSTERIA 99 
 
 letter, and then the patient left, the hand in 
 retracing the word will perceptibly hesitate at 
 the extra letter, showing the action of the 
 unconscious mind, and after two or three times 
 will omit it altogether. If this same hand be 
 pricked with one pin it will trace a single point ; 
 if with two, then two. 
 
 All this tends to show that in hysteria there is 
 some real but erratic interference with conscious 
 sensation. 
 
 In the same way we get hypersesthetic patches 
 and zones (generally in the ovarian region), limbs, 
 &c., when we may have pain and tenderness, 
 which may be cutaneous or subcutaneous. The 
 common regions are the inguinal, epigastric, infra- 
 mammary, and spinal ; the head is rarer, and the 
 limbs very rare. Pain and tenderness generally 
 are more common in the left half of the body. 
 We also get perverted sensation, where a hot 
 object is felt to be quite cold, and vice versa. 
 
 Another sensation frequently described by 
 hysterics is that of cold water trickling down 
 the spine, and is sometimes accompanied by a 
 nervous shivering. 
 
 Certain tender spots have been called by 
 Richer " hysterogenetic zones," and these form 
 one of the three or four (French) stigmata. 
 One of the most frequent seats for this special 
 tenderness, as I have said, is the ovarian region,
 
 ioo FUNCTIONAL NERVE DISEASES 
 
 where it is commonly deep seated. Pressure on 
 such a " zone " may not only cause characteristic 
 fits, but other special symptoms, such as pseudo- 
 angina, 
 
 2. Locomotor Symptoms. Paralysis of various 
 sorts is common in hysteria. There may be 
 hemiplegia or paraplegia, or general loss of 
 power (paresis). 
 
 In the paralysis we observe that no special 
 muscles are attacked. However prolonged, there 
 is no fibrillar twitching, no loss of reflexes, no de- 
 generation, though there may be some wasting 
 from disuse. 
 
 Hysterical paraplegia is common, and may be 
 flaccid or rigid, and is often anaesthetic as well. 
 The limbs may be extended and limp or drawn 
 up to the groins. There may be pain over the 
 sacrum, and retention of urine in such cases is 
 common. 
 
 In these cases the knee-jerk is never absent 
 but exaggerated, and the great toe, on tickling the 
 sole, is flexed, not extended, as in Babinski's sign. 
 
 In hysteria, paraplegia is brought on by 
 emotion with special ease. Even in health 
 nothing is more common in emotional natures 
 than sudden loss of power in the legs. I have 
 had to support the tottering steps of a lady in 
 perfect health along the platform of a station on 
 the receipt of bad news ; and, in common with
 
 PHYSICAL SYMPTOMS OF HYSTERIA 101 
 
 many others after severe influenza, have experi- 
 enced weakness in the legs almost amounting 
 to paresis. In hysteria such feelings are followed 
 by progressive loss of power. 
 
 Hysterical hemiplegia is most common on the 
 left side, and face and tongue escape. In these 
 cases also the knee-jerk is exaggerated. 
 
 Hysterical monoplegia may be flaccid or 
 spasmodic, often with anaesthesia and but little 
 atrophy. 
 
 In hysterical paralysis there may be only loss 
 of movement when the eyes are closed, or there 
 may be loss of power only over one group of 
 muscles, or over one definite action. 
 
 Certain forms of hysterical ataxy or loss of 
 some special movement are called " astasia- 
 abasia." This is the loss of some particular 
 movement in a leg, such as walking, while the 
 patient can still hop or jump. 
 
 The paralysis in astasia-abasia is clearly 
 emotional. The patients can move freely in 
 bed, and can do anything but some one special 
 movement or action. 
 
 We also get hysterical contractions and spasms 
 of all sorts. The onset is rapid and the attack 
 severe. It may be extensive in area, and is not 
 relieved during sleep. It is readily produced in 
 hysterical subjects on slight irritation. 
 
 One form is that of the muscles of mastication, 

 
 102 FUNCTIONAL NERVE DISEASES 
 
 and is called "trismus." In this the teeth cannot 
 be separated more than a quarter of an inch, and 
 the patient is fed round the sides of the mouth. 
 We also get torticollis, kyphosis, limb contrac- 
 tions, &c. These may last for years, with or 
 without pain. 
 
 We get also a mixture of sensory and motor 
 lesions in hysteria such as we never find in 
 organic disease. 
 
 Hysterical tremors are not very common. 
 They may be local or unilateral. Hysterical 
 tremors often resemble disseminated sclerosis, 
 but they differ in continuing when at rest and 
 after any object has been grasped. 
 
 Hysterical tremors cease in sleep. 
 
 Amyasthenia in hysteria is a temporary weak- 
 ness in arms or legs, with sudden onset. Hys- 
 terical chorea is slightly purposive in its 
 movements. 
 
 Neuromimesis shows itself in hysteria specially 
 in the joints, spine, breasts. 
 
 Hysterical club-foot and spinal curvature are 
 common ; but of all this class of case I will 
 speak more fully later on. 
 
 3. Circulatory Symptoms. In hysteria we 
 get cardiac palpitation, dilatation of arteries, with 
 marked and distressing palpitation in various 
 parts of the body, rapid pulse (slow pulse is 
 quite rare).
 
 PHYSICAL SYMPTOMS OF HYSTERIA 103 
 
 We get hysterical angina, differing from true 
 by moaning, screaming, and restlessness, and often 
 occurring at night in sleep. 
 
 We also get hysterical subcutaneous hemor- 
 rhages (ecchymoses), or, on the other hand, 
 ischaemia, or bloodlessness on pricking, a 
 common sign in anaesthetic areas, showing the 
 profound disturbance in these parts, which no 
 imagination or fraud could produce. 
 
 We also get well-authenticated hyperpyrexias 
 reaching 112 and 118 (Allbutt, vol. viii. 
 p. 113), which would be absolutely fatal in any 
 other disease ; and lastly, we may get a tem- 
 perature of 1 08 in one axilla and 98 in the 
 other. We also get " nervous " fever with tem- 
 perature over 1 00, and, like fever in tubercle, 
 low or normal each morning and high at night. 
 It may last for a day or two or for years, and is 
 not uncommon in hysteria major. 
 
 Hysterical oedema is often seen. It may be 
 unilateral or general, white or blue, and may last 
 for years. 
 
 There is sometimes a marked failure of skin 
 nutrition, so that the hair falls off and the skin 
 is dry. Sometimes we get urticaria and other 
 skin affections. The ecchymoses I have spoken 
 of sometimes occur in definite places, as in the 
 palms of the hands, when they may constitute 
 the so-called religious stigmata.
 
 104 FUNCTIONAL NERVE DISEASES 
 
 4. Dyspeptic Symptoms. Here we get a 
 marked difference from neurasthenia, where 
 these are constant and important. In hysteria, 
 anorexia nervosa is not uncommon, with fasting, 
 vomiting, and emaciation. Dysphagia is common, 
 and gastralgia, tympanites and meteorism and 
 noisy eructations often so severe that the patient 
 cannot mix in society. Marked cases of reversed 
 peristalsis are not uncommon. I may recall one 
 from the London Hospital. Early in 1897 a 
 woman was admitted into the hospital with 
 fcecal vomiting. Her abdomen was covered 
 with the scars of various laparotomies made in 
 order to discover the cause. The whole of the 
 abdominal contents had been carefully examined, 
 but as the vomiting persisted, a fresh opening 
 was made, and the colon specially overhauled. 
 All the viscera were healthy, nevertheless the 
 fcecal vomiting was genuine. Most careful 
 experiments were conducted by surgeon and 
 house-surgeon, and yielded almost incredible 
 results. Two ounces of castor oil introduced 
 into the rectum were vomited with fcecal matter 
 in from ten to fifteen minutes. Half a pint of 
 water stained with methyl blue, introduced into 
 the rectum, as well as some solid bodies, were 
 vomited in about the same time. The cause of 
 this vomiting was purely and simply hysterical, 
 and was combined with high and capricious
 
 PHYSICAL SYMPTOMS OF HYSTERIA 105 
 
 temperature. Both were cured by psycho- 
 therapeutics only, and the woman was dis- 
 charged perfectly well. Here we get a remark- 
 able instance of the power of the unconscious 
 mind over the body. There was no organic 
 cause ; the cure was effected without the removal 
 of any physical irritant or the operation of any 
 physical means. The cause was mental and 
 yet unconscious, and the cure was mental. No 
 conscious mental will or fraud could have pro- 
 duced reversed peristalsis. If any doubt this let 
 them try, and they will come to Sir James Paget's 
 conclusion, that they at any rate have not the 
 power. The woman had no idea the cause was 
 mental. There is no question here of mere 
 severance of consciousness and voluntary action 
 as in anaesthesias and paralyses. Here is a 
 wholly abnormal and destructive and really 
 insane action of the power that governs the 
 unconscious mechanism of the body, which I 
 call the unconscious mind ; and it is these and 
 similar cases that have led me to believe that 
 while insanity is a disease of consciousness, 
 hysteria is an insanity of unconsciousness. 
 Besides the above, we have in hysteria round 
 gastric ulcers, which are not uncommon. 
 
 It must be remarked that all the digestive 
 symptoms in hysteria are bizarre and extra- 
 ordinary, and seldom simply dyspeptic, as in
 
 106 FUNCTIONAL NERVE DISEASES 
 
 neurasthenia. At times anorexia appears to be the 
 primary symptom and the cause of the disease. 
 
 5. Excretory and Secretory Symptoms. In 
 hysteria retention is common, and the catheter 
 should never be used to relieve it. Incontinence 
 is much rarer. " Floating " kidney, especially on 
 the right side, is a common accompaniment, but 
 is also common in neurasthenia. We also get 
 hysterical anuria, lasting; it may be, for seven 
 days without resulting symptoms of autosepsis. 
 We get local sweating in patches, and also 
 generally onesided hyperidrosis. Mastodynia is 
 common. 
 
 6. Respiratory Symptoms. Amongst symptoms 
 in these organs we may mention hysterical cough 
 and hysterical aphonia as being very common. 
 Mutism (absolute aphasia) and partial aphasia 
 are also common. Dyspnoea is also common, 
 sometimes arising from hysterical spasm of glottis 
 and sometimes from spasm of diaphragm. 
 
 7. Symptoms in the Special Senses. We get 
 as one of the most marked stigmata (French) 
 contraction of the field of vision. The acuteness 
 of vision at the yellow spot remains normal in 
 these cases and the sight is good, and the 
 patient remains unconscious of the limitation of 
 his visual field. We also get amaurosis of either 
 eye, and central scotoma, double vision, and other 
 abnormalities.
 
 PHYSICAL SYMPTOMS OF HYSTERIA 107 
 
 ' Blepharospasm of one or both lids is common, 
 also hysterical ptosis, and all yield to psychic 
 treatment. 
 
 Janet wisely suggests that what is contracted 
 is the field of consciousness generally, though 
 capriciously ; hence, mentally, we get loss of 
 memory and words, and sensorily, local anaes- 
 thesias. 
 
 Visually we get a contracted field, and then 
 similarly we get the auditory, olfactory, and 
 gustatory fields narrowed and loss of hearing, 
 smell, and taste. Taste may be perverted instead 
 of lost, and smell may be lost in one nostril or both. 
 
 Hearing may also be perverted, and tinnitus 
 is common. 
 
 The visual symptoms are similar in their nature 
 and varying degree to those of anaesthesia, as the 
 following experiments show. In the amaurotic 
 hysteric eye, when conscious vision is lost, un- 
 conscious vision is proved by Flee's box, which, 
 like a stereoscope, is placed before the eyes, and 
 is so constructed that the left eye sees the right 
 image and the right eye the left. In this case, if 
 the right eye be blind, the patient will declare he 
 sees the left image, which in this instrument, 
 though believed to be seen by the left eye, is 
 really seen by the right. 
 
 Another plan is by a pair of spectacles with 
 green glass over right eye and red over left. Six
 
 io8 FUNCTIONAL NERVE DISEASES 
 
 large letters printed in white on black ground are 
 placed in front, A, C, and E being covered with 
 green glass, and B, D, and F with red. Now 
 green and red make black, and three letters only 
 can be seen by right eye A, C, and E ; and three 
 only by left B, D, and F, so that if one eye be 
 blind only three letters can possibly be seen. 
 Nevertheless, the hysteric patient, thinking it 
 possible, will declare she sees the six letters with 
 the one eye. Here, then, is apparent without 
 real fraud, that can only be explained by the 
 action of the unconscious mind. Binet declares 
 that when an hysteric is looking at letters too far 
 off to be seen even by a sound eye, the anaes- 
 thetic hand can be seen to trace those letters the 
 eye cannot (consciously) see. 
 
 Professor Sidis confirms this, and has seen the 
 hand write " Margie " for " Mary," thus show- 
 ing conscious effort and purpose. 
 
 Binet is a careful observer, and therefore I 
 think this phenomenon worth recording. Pro- 
 fessor Sidis has conducted many similar experi- 
 ments with the anaesthetic hand and the amaurotic 
 eye, and claims to have established in these hys- 
 terical cases unconscious feeling, memory, purpose, 
 and judgment. 
 
 8. Nervous Symptoms. It must be remem- 
 bered here that loss of control is characteristic of 
 hysteria, and this leads in the lower centres to
 
 PHYSICAL SYMPTOMS OF HYSTERIA 109 
 
 excess of action, and often in the higher to para- 
 lysis of action, such as aphasia, paralysis, &c. 
 Fits may be severe or slight. They occur in 
 about half of all hysterical patients. In hysterical 
 fits there is complete loss of self-control, but only 
 partial loss of consciousness. In hysterical fits 
 the movements are not meaningless, purposeless 
 spasms, but purposive convulsive acts. The 
 patient does not hurt herself in falling, nor is the 
 tongue bitten, or urine passed involuntarily, as in 
 epileptic seizures. 
 
 The aura is generally from the ovarian region, 
 solar plexus, globus, or clavus. 
 
 In mild seizures there is generally globus and 
 incontrollable convulsive laughter and tears 
 (emotional crises). 
 
 Hysterical fits are often followed by trances or 
 cataleptic conditions of plastic rigidity, which may 
 last for hours or weeks. There is sometimes 
 somnambulism and dual consciousness. It may 
 be remarked here with regard to the psychical 
 cause which really underlies all the physical 
 symptoms of hysteria that, while it is readily 
 conceded in all physical and nervous affections 
 of the head (headache, insomnia, &c.), it is not 
 with regard to affections of the rest of the body 
 paralysis, dyspepsia, and the like, where, however, 
 it is just as real. 
 
 Catalepsy, which I have alluded to, is a variety
 
 i io FUNCTIONAL NERVE DISEASES 
 
 of hysteria characterised specially by loss of power 
 with attacks of peculiar plastic rigidity (flexibilitas 
 cerea), during which the limbs can be moulded 
 into almost any attitude. The consciousness is 
 often in abeyance. 
 
 The attacks are in paroxysms, and in the 
 intervals there are ordinary hysterical symptoms, 
 or in some cases these may be absent and the 
 patient appear well. It occurs in the nervously 
 exhausted, and an emotional crisis or shock or 
 blow may bring it on. 
 
 In profound catalepsy all consciousness is lost 
 and all sensation. The respiration is slow and 
 the heart weak. Catalepsy with profound melan- 
 choly in the intervals is known as katatonia, and 
 comes in the catalogue of mental diseases. The 
 rigidity in catalepsy is not fixed, as in tetany and 
 the tonic spasm of an ordinary hysterical fit. 
 
 The outlook is favourable if the condition is 
 good between the attacks. The attack can be 
 shortened by persistently placing the limbs in 
 extremely fatiguing though not painful positions. 
 Emetics such as apomorphine act as powerful 
 alteratives, and may prevent an impending 
 attack. Firm moral and mental treatment is, of 
 course, of the greatest value, and once the patient 
 recognises she is in strong, capable, and trust- 
 worthy hands, her unconscious mind is soon 
 reached, and improvement quickly ensues.
 
 CHAPTER VI 
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 
 
 IT may be well supposed that in the last 
 chapter the numerous symptoms of hysteria 
 given well-nigh exhausted the subject. The 
 psychical side of hysteria and its symptoms, how- 
 ever, are themselves of sufficient importance to 
 form the subject of another chapter, and we will 
 briefly consider them here. 
 
 In all functional nerve diseases it is of great 
 importance to analyse and clearly distinguish the 
 physical from the mental symptoms, though in 
 hysteria it is becoming increasingly clear to 
 students of the disease that the origin of both is 
 the same the unconscious mind, or that force 
 which in health co-ordinates, controls, and regu- 
 lates all somatic activities, and is even engaged in 
 keeping the body in health, and hence is called 
 by many the vis medicatrix natures. In this 
 disease alone this power is lessened, lost, or is 
 even active in a destructive direction ; so reversing 
 its normal functions, in fact, as to justify what I
 
 ii2 FUNCTIONAL NERVE DISEASES 
 
 have alluded to in the last chapter and fully set 
 forth elsewhere, that " a person whose conscious 
 mind is unsound is suffering from madness, while 
 one whose unconscious mind alone has gone 
 astray suffers from hysteria," and the distinction 
 is good. 1 The symptoms of hysteria bear, one 
 and all, a marked (unconscious) psychic impres- 
 sion. The body no doubt plays some part, and 
 it must ever be remembered that, as even psychic 
 symptoms can spring directly from mind or in- 
 directly from the body, so physical symptoms may 
 have a somatic or mental origin ; for instance, a 
 congested liver and mental trouble can both pro- 
 duce depression ; and on the other hand, an idea 
 or a ruptured bloodvessel can both produce 
 hemiplegia. Dr. Mitchell Clarke's definition of 
 hysteria is as follows : "A peculiar state of dis- 
 turbance of the central nervous system, affecting 
 primarily and most profoundly the highest cerebral 
 centres." 2 The chief fault of this definition is that 
 it is far too broad, and would equally include 
 almost any form of mania and insanity. 
 
 Dr. Clifford Allbutt, in accordance with what I 
 have advanced, says : " Hysteria would be a sort of 
 insanity, but to classify hysterical patients with 
 the insane would be an obvious clinical error" 
 
 1 See " The Management of a Nerve Patient " (Schofield), 
 p. 21. (Churchill.) 
 
 2 Dr. M. Clarke, " Hysteria and Neurasthenia," p. 5.
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 113 
 
 (only he does not say why). Janet looks on 
 hysteria as an action of the subconscious state, 
 with a limitation of the conscious psychic field as 
 in vision ; but Allbutt cannot accept this because 
 so little is known of the subconscious condition, 
 and because vascular, vasomotor, and nutritive 
 phenomena common in hysteria lie outside the 
 functions of the higher cerebral centres. This is 
 true as to consciousness, but they are all under 
 the central control of the unconscious mind. 
 Professor Dubois (Berne) says that hysteria is a 
 disease of the superior (conscious) ego, which is 
 weak, and also that psychoses are the true bases 
 of all neuroses ; but with neither of these state- 
 ments can I agree, for though, as I shall show, 
 the conscious ego is disturbed in hysteria, it is not 
 the source of the disease, and psychoses are as 
 often based on neuroses as vice versa. 
 
 There is no doubt that in hysteria, psychically 
 as well as physically, the field of consciousness is 
 limited, and limited in a most erratic manner. 
 
 But there is also some distinct mental 
 (conscious) aberration. There is no special 
 deceit or lying, but often general instability 
 of moral character. If there be deceit or lying, 
 it is as an accompanying symptom and not 
 as the foundation of the disease ; in short, it is 
 an effect and not the cause. There is often loss 
 of control of emotions, temper, will, &c. There
 
 114 FUNCTIONAL NERVE DISEASES 
 
 is a loss of mental perspective and the relative 
 size of facts. There is at times a change of 
 character, hysteria tending to make men 
 feminine and women masculine. There is at 
 times marked double consciousness. These and 
 other bizarre intellectual phenomena give the 
 idea of simulation and fraud, while all the time 
 the patient may be trying bravely to overcome 
 the disease. 
 
 No hysterical insanity (properly so called) 
 is known. 
 
 When we turn to the emotional side of 
 hysteria, we reach the most disturbed part of 
 the mental field. 
 
 It may be well to consider for a moment of 
 what emotion really consists, and whether its 
 origin is psychical or physical. Professor Dubois 
 (Berne) says that all emotion is psychical and 
 not physical, intellectual and not somatic. 
 
 Professor W. James, however, says that 
 emotion is a resultant of motor, vasomotor, and 
 glandular changes ; Lange that emotion is a 
 vasomotor reaction provoked directly by a 
 stimulus. Lange and James say that if a 
 mother weeps for her son the steps are not 
 (i) the idea, (2) the emotion from it, and (3) 
 the result (tears, &c.) ; but (i) the idea, (2) the 
 result, and (3) the emotion, which is the vague 
 consciousness of the vascular and physical
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 115 
 
 phenomena! They say that one mental state 
 does not produce another there is a physical 
 change interposed. We don't weep because 
 we are sorry, but we are sorry because we 
 weep. 
 
 Wundt, Irons, Lehman, Dubois, and others, 
 however, oppose these ideas. 
 
 I give the above to show that even with 
 clear thinkers the emotional source is at least 
 debatable, but I myself fully go with Wundt. 
 If it be the blush that makes us ashamed, 
 and not shame that makes us blush, why do 
 we not feel shame with amyl nitrite, when 
 we blush furiously ; or, with regard to tears, 
 why is there no grief when peeling onions, when 
 we weep profusely ? 
 
 Man is so made that he has mental feelings 
 (emotions) as well as ideas ; but how the one 
 produces the other we do not know : probably 
 by some faculty akin to apperception. 
 
 No doubt physical signs and emotion go 
 together ; but emotion is not absent because 
 there are no signs, but the signs are always 
 absent when there is no emotion. Signs are 
 not the cause but the effect of emotion ; post hoc 
 is propter hoc in this case. No doubt when the 
 psychic cause has produced physical effects 
 these may react and intensify the emotion. 
 Experience, however, shows on the other hand
 
 ii6 FUNCTIONAL NERVE DISEASES 
 
 that they often lessen it ! It must be remembered 
 that the idea causing emotion may be wholly 
 unconscious. 
 
 In hysterical patients the connection between 
 the idea and emotion is often not logical, 
 and emotions are constantly set loose and ex- 
 aggerated, with all their physical accom- 
 paniments, on little or no provocation. 
 
 Hysteria may, indeed, be described from 
 one point of view as an instable condition of 
 the emotional, vasomotor, and sympathetic 
 reflexes. 
 
 From the above argument it is clear that 
 emotion is here regarded as a mental phenomenon 
 and not as the resultant of any physical causes. 
 
 Speaki, g generally, the psychic symptoms 
 of hysteria have altered for the better by the 
 evolution of the race, and are not now so 
 pronounced or wild as in the Middle Ages. 
 
 In hysteria the symptoms, being obviously 
 under psychic influence, clearly point to some 
 mental disturbance ; and yet they are anomalous, 
 capricious, paroxysmal, contradictory, unnatural, 
 and imitative in a marked degree. They are 
 imitative, not only in closely following the 
 symptoms of some definite disease, but in being 
 arranged rather according to the popular ideas 
 of that disease than according to the scientific 
 facts : as, for example, in paralysis for special
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 117 
 
 movements, while full capacity for other 
 movements is retained by the same muscles. 
 All the time the conscious mind is clear and 
 reasonable, and the only possible explanation 
 therefore is that it is the unconscious mind 
 that is diseased and is the cause of the 
 symptoms. In men, as a rule, the symptoms 
 are not so well marked, nor does the disease 
 persist so long as in women, the check imposed 
 by reason over emotion being stronger in the 
 former than in the latter. In England I think 
 that hysteria is generally decreasing, while 
 neurasthenia is increasing. Certainly nowhere 
 can we now find such statistics as Briquet's, 
 who computed that one-quarter of all hospital 
 patients (in France) were hysterical ! 
 
 Neuromimesis, or the mimicry of disease, is 
 the last psychic phenomenon I shall speak of. 
 It is dependent upon the fact that autosuggestion 
 is really pathognomonic of hysteria. Suggesti- 
 bility is by far the most marked of the stigmata 
 of functional neuroses, and in hysteria there 
 appears a special response to suggestion, and 
 also to autosuggestion (especially if this be 
 of a bad nature). Apperception, too, is a 
 faculty largely developed in hysteria, and being 
 partly released from rational control, leads the 
 mind unconsciously with great rapidity to carry 
 out any thought, so that a suggested idea is
 
 ii8 FUNCTIONAL NERVE DISEASES 
 
 reproduced on the physical plane in a manner 
 quite incredible to those who have not witnessed 
 it. The tendency to any such sequence in 
 the non-hysterical is at once inhibited by the 
 higher conscious rational centres. Take, for 
 example, the well-known instance of a piece of 
 gummed stamp-paper placed, with the suggestion 
 that it will form a blister, on the foreheads of 
 two persons, one an advanced hysteric, the other 
 a normal individual. In the former case the 
 suggestion is greedily assimilated, and by 
 apperception a quick, but unconscious, chain 
 of thought acts on the physique and produces 
 a blister with all its features. In the latter case 
 the same suggestion, though equally understood, 
 fails to establish this chain, being at once 
 inhibited by the intellect. There is no doubt 
 that a critical reasoning faculty is the greatest 
 prophylactic against hysteria. 
 
 Neuromimesis may simulate any disease, but 
 as a rule is most common in spinal and joint 
 diseases, in tumours of all sorts, and in 
 affections of the special senses of speech and 
 of locomotion. 
 
 It must be understood that real diseases 
 are produced frequently by the mind, but such 
 are not included under the term " neuromimesis," 
 which is here taken as a symptom of hysteria. 
 What is puzzling is that in some cases there
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 119 
 
 is a real substratum with an added mimicry. 
 For instance, ordinary symptoms of fatigue, 
 pain, dyspepsia, &c., are often unconsciously 
 overlaid with mimetic symptoms of an exagger- 
 ated character. It must be remembered as to 
 fatigue that in nerve cases the strength really 
 is generally under rather than over taxed. 
 Hysteria may simulate its own stigmata ; or, on 
 the other hand, it may simulate neurasthenia, 
 and have all its signs, with the absence of its own 
 stigmata. The inexperienced mind may well be 
 excused for saying that in such cases such a 
 disease is to all intents and purposes neuras- 
 thenia, and not hysteria ; but there may still 
 be conclusive reasons for putting it in the latter 
 class. 
 
 I will now give very briefly one or two 
 instances of how suggestion works in these 
 neuromimetic cases. 
 
 Many arise by suggestion through accident. 
 
 A lady saw a heavy dish fall on her child's 
 hand, cutting off three of the fingers. She felt 
 great pain in her hand, and on examination 
 the corresponding three fingers were swollen and 
 inflamed. In twenty-four hours incisions were 
 made and pus evacuated. 
 
 Dr. Diaz, in the Medical and Surgical 
 Journal, speaks of a lady patient whose lips and 
 mouth were suddenly enormously swollen from
 
 120 FUNCTIONAL NERVE DISEASES 
 
 seeing a young child pass a sharp knife between 
 its lips. 
 
 Dr. de Fleury l tells us of " a girl who dreams 
 she is pursued by a man, and falls into a ditch 
 and breaks her legs. Next morning she wakes 
 bruised, and declares her legs are broken. It 
 is not so, but her legs are paralysed (by this 
 dream) for six months." De Fleury tells us 
 of another girl who, dreaming she was out- 
 raged, was full of local bruises and ecchymoses 
 next day. He says dreams can create physical 
 impressions by momentary paralysis of the 
 vasomotor mechanism. Whipple 2 tells us of 
 a man of thirty-five with a dull pain above 
 his ankle for twelve years, with swelling at 
 times, and always worse in a train. This was 
 caused by seeing a man crushed to death in a 
 train. 
 
 A gentleman known to me, seeing a friend 
 with stricture of the gullet, soon experienced 
 an increasing difficulty in swallowing, which 
 ultimately was a cause of death. No organic 
 cause was found. 
 
 In the Lancet for January, 1880, we read that 
 a gentleman (fifty-six) thought he had swallowed 
 his false teeth. He felt them in the pharynx. 
 There was a hard swelling behind the larynx, 
 
 1 De Fleury, " Medicine and Mind," p. 9. 
 > Whipple, " Mental Healing."
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 121 
 
 and a surgeon was telegraphed for. The 
 symptoms were most distressing and real, until 
 the missing teeth were found in a drawer. 
 
 Whipple tells us of a young woman with 
 a constant cough, from the idea she had sand 
 in her windpipe. Once she had been nearly 
 drowned in bathing, and swallowed some water 
 and sand, which she had thought of ever since. 
 In the London Hospital many cases of hysterical 
 abdominal tumours (supposed to be aortic 
 aneurisms) have been sent in for operation, 
 caused solely by the observed pulsations of the 
 abdominal aorta seen in thin people, and so 
 acting on their unconscious minds that the 
 abdominal muscles were actually contracted on 
 one side to simulate a tumour, which disappeared 
 temporarily under chloroform. A girl of ten 
 was struck on the left shoulder by a baby with 
 a stick. There was no mark, and the girl 
 would have forgotten it in a few hours, but a 
 doctor saw it and said : " That blow and pain are 
 serious. It is traumatic neuritis. I had rather 
 the girl had broken both arms." The pain lasted 
 for four years and extended to the back and 
 right arm (entirely by suggestion). 
 
 It will be observed here, and has been noticed 
 already, that the unfortunate word " hysteria," 
 which I intentionally use to include " neuro-
 
 122 FUNCTIONAL NERVE DISEASES 
 
 mimesis," actually covers a good deal more than 
 the mimicry of disease. In a good many in- 
 stances given here we find the mind producing 
 not so much mimicries of disease and death as 
 actual lesions and death itself. That is to say, the 
 power of the mind over the body goes far beyond 
 the mere production of mimicries, however 
 perfect these may be in their way. In these 
 we admit there is no real local lesion, but only 
 the unconscious simulation of it. But when we 
 find examples of inflamed fingers with evacuation 
 of pus, of bruises and ecchymoses, actual death, 
 haematemesis, and gangrene, we feel the word 
 " neuromimesis " has become well-nigh as elastic 
 as " hysteria" itself. And yet it would hardly 
 do to put these into a separate class. They are 
 but extreme and somewhat rare examples of the 
 power of the mind over the body, and the 
 generic term " hysteria " must at present cover 
 them all. 
 
 I may insert here one or two words respecting 
 traumatic hysteria. The symptoms in this may 
 be purely psychical and none the less real and 
 lasting. A woman thought she was struck by 
 lightning (a mile away) and was paralysed, 
 anaesthetic, and had hysterical fits. 
 
 In traumatic hysteria the following special 
 points may be noted : 
 
 i. The patient tends to recover.
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 123 
 
 2. In these cases early treatment undoubtedly 
 means quicker recovery. 
 
 3. As a rule some get quite well, no symptoms 
 being left, but more only partially, some 
 symptoms generally persisting. 
 
 4. The time of recovery varies with nature 
 of case, surroundings, treatment, amount and 
 result of litigation (in railway cases, &c.). 
 
 5. No improvement is seen while the case 
 is being tried. (This does not postulate " fraud.") 
 
 6. The longer it lasts the more fixed it 
 becomes by habit and the more difficult to 
 cure. 
 
 7. Stigmata may disappear after years. 
 
 8. Cases with bad mental symptoms are the 
 worst and last to recover. 
 
 9. Litigation prolongs the disease by sugges- 
 tion and autosuggestion. 
 
 Before closing the chapter, perhaps it may be 
 well briefly to summarise the leading symptoms 
 of hysteria in one list. Hysteria (using the 
 term broadly) is characterised by anaesthesias 
 in all parts of the body, in regions, patches, 
 sides, and limbs ; by visual anaesthesias resulting 
 in narrowed fields of vision ; by fits or paroxysms, 
 with or without incomplete loss of conscious- 
 ness and accompanied by clonic and occasionally 
 tonic spasms, tremors, convulsive movements, and 
 large contortions, sometimes of extreme violence,
 
 124 FUNCTIONAL NERVE DISEASES 
 
 with or without cries, foaming at the mouth, 
 clenching of hands, and other emotional signs ; 
 by dyssesthesias or pains in any joint in the 
 body, often in several in zones or patches, in 
 the head, the back, the heart, the abdomen, the 
 coccyx, the breast, the mucous membrane, the 
 organs of special sense, the limbs and the organs 
 of generation ; by paresis and paralysis of every 
 or any part of the body capable normally of 
 voluntary motion ; by contractions and wasting of 
 limbs or parts of limbs ; by tremors, continual and 
 intermittent ; by mental states ecstatic, vague, 
 demoniac, talkative, taciturn, &c. ; by dermatoses ; 
 by Raynaud's disease ; by urticaria, hypersemias 
 of skin and other eruptions ; by haemorrhages 
 from organs and under the skin in all parts 
 of the body ; by stigmata ; by muscular atrophies 
 (detected in lower limbs by absence of Babinski's 
 sign extension of big toe on tickling sole) ; by 
 pyrexias of all sorts ; by paraplegia, by hemi- 
 plegia, by tetany, by incoordination of muscular 
 movements, by swellings and tumours (perfectly 
 simulated) of all sorts, largely abdominal, fluc- 
 tuating, solid, or pulsatory according to the 
 variety, and of all sizes ; by abnormal gaits of 
 all kinds, by mutism, by stammering, by aphonia, 
 aphasia, amnesia, by coughs, by dyspnoea, by 
 dyspepsias, by gastric spasms and gastralgia, 
 by flatulence, by haematemesis, by anorexia, by
 
 PSYCHICAL SYMPTOMS OF HYSTERIA 125 
 
 vomiting, ordinary and faecal, by borborygmi, 
 by swollen joints, by dysuria, polyuria, anuria, 
 incontinence, or retention, by floating kidneys ; 
 also by more or less elaborate simulation of 
 various diseases, such as hip disease, asthma, 
 Pott's disease, &c. 
 
 Surely no other disease exists of such a 
 protean character !
 
 CHAPTER VII 
 
 ETIOLOGY OF NEURASTHENIA 
 
 TVTEURASTHENIA simply means nerve 
 JL Al weakness. The term itself was unknown 
 n England before 1886, though used earlier in 
 America and Germany. Bouchet, in 1857, was 
 the first who really described neurasthenia as a 
 distinct entity. This disease, in common with 
 other functional nerve troubles, has been some- 
 what in the condition of Noah's dove, at least 
 as described by Dr. Watts, for it has long 
 "flitted" between the "rough seas" of sus- 
 picion and the "stormy skies" of contempt, 
 seeking in vain a resting-place as a legitimate 
 disease. It was neither clearly physical so the 
 physician would have none of it, nor truly mental 
 so it was looked on with suspicion by the 
 alienist, and it was long in a parlous state. In- 
 deed, were it not for the genius of our medical 
 colleagues in France and the United States in 
 the investigation and recognition of hysteria 
 and neurasthenia, neither would have its present
 
 .ETIOLOGY OF NEURASTHENIA 127 
 
 place in medicine, and it is doubtful if the latter 
 would be yet recognised as a disease. Now, 
 however, I am glad to say the claims of func- 
 tional nerve disorders to full recognition as 
 genuine and distinct diseases are widely recog- 
 nised ; and probably the only survival of the 
 dark ages, now gone for ever, is in the apolo- 
 getic way in which many of these patients still 
 enter the doctor's consulting-room. 
 
 The causes of neurasthenia are innumerable ; 
 but the chief predisposing cause is a weak 
 nervous system through heredity or want of 
 nutrition, while the chief exciting cause is over- 
 strain of some sort. 
 
 Many cases of neurasthenia are put down to 
 over-education, though it is clear that develop- 
 ment of the nervous system makes for increased 
 control. But we must remember that in the 
 education of the child the true chronological 
 order should be the body first and the brain 
 after, and neglect of this is a large factor in 
 disease. It is found by Dr. Allbutt that neuras- 
 thenics are, after all, not more common in New 
 York than in London, or among the busy than 
 the idle. The disease abounds in such places 
 as Finland and the Yorkshire collieries. It is 
 common amongst factory hands in Yorkshire 
 and amongst working men in the States. It is 
 more common in the single than in the married.
 
 128 FUNCTIONAL NERVE DISEASES 
 
 Karl Petre"n, of Upsala, in the Deutsche 
 Zeitschrift fur Nervenheilkunde, Bd. xvii., re- 
 ports the results obtained in a recent investiga- 
 tion upon the frequency of neurasthenia in the 
 various grades of society. Contrary to usual 
 statements, he does not find a larger number of 
 cases in the upper than the lower classes. Out 
 of some 2,478 patients observed between 1895 
 and 1899, he met with 285 (11-5 per cent.) cases 
 of definite neurasthenia. These he resolves into 
 three groups: (i) artisans and peasants; (2) 
 tradespeople and under-officials ; (3) intellec- 
 tuals. 
 
 Von Hossling's table of the relative frequency 
 of neurasthenia in different occupations is as 
 follows : Working men, '05 ; clergy, i ; doc- 
 tors, 2 ; gentlemen, 2 ; artists, 3 ; officers, 4 ; 
 students, 6 ; professors, 7 ; clerks, 1 3 ; merchants 
 and manufacturers, 20. 
 
 In further division as to sex, in Sweden males 
 are easily first with (i) 14*8 per cent. ; (2) 13^2 
 per cent. ; (3) 13-3 per cent. As regards women 
 the numbers are (i) 11*4 per cent. ; (2) 6*6 per 
 cent., and (3) 6'6 per cent. In Sweden it there- 
 fore now appears that neurasthenia is more 
 prevalent amongst the working classes. Petr^n 
 thinks that as previous writers have drawn their 
 statistics on the one hand from the higher 
 classes, and on the other from clinics, the
 
 .ETIOLOGY OF NEURASTHENIA 129 
 
 results disagree, because many neurasthenics do 
 not come under hospital treatment, while those 
 of the former status readily consult their doctors. 
 That the disease is not primarily dependent upon 
 the rush of modern life seems apparent from the 
 fact that the greater number of cases come from 
 the provincial parts of Sweden, where life is very 
 simple and tranquil. As regards causation, 62 
 cases have followed family disappointments, 
 24 financial difficulties, and 47 overwork. 
 Twenty-nine cases occurred after influenza, 21 
 acknowledged venery or masturbation, and in 
 1 6 females it complicated pregnancy and the 
 puerperium ; 8 were directly traced to alcoholic 
 excesses, and 2 were produced by high tempera- 
 tures experienced during their avocation. A 
 prominent factor is that of hereditary alcoholism. 
 In the early days of the last century large quan- 
 tities of spirits, &c., were almost universally 
 consumed, and even where the alcoholic ten- 
 dency is not directly apparent, its influence is 
 still felt in the nervous equilibrium of the present 
 generation. Several cases are reported in which 
 cerebral arteriosclerosis was present. Hygienic 
 conditions also contribute to the increase among 
 the lower classes ; lack of proper nourishment, 
 insanitary dwellings, and monotony of existence 
 are amongst some of the causes that need atten- 
 tion in order to prevent its further extension.
 
 130 FUNCTIONAL NERVE DISEASES 
 
 Neurasthenia often arises in men from sexual 
 excesses, in women more commonly from the 
 strain of sexual life in child-bearing, &c. Her- 
 man 1 points out that "the protean symptoms of 
 Bennet, Tilt, and Graily Hewett, described by 
 them as being of a reflex nature from minor 
 diseases of the uterine organs, really arise from 
 the mind. It is not that a cervical erosion hurts 
 the nervous system, but that a weak nervous 
 system draws attention to the cervix, or rather 
 to the resulting leucorrhoea. Nervous women 
 as a class resist pain badly and feel it most 
 acutely. Still, though mental in origin, these 
 protean (really neurasthenic) symptoms are 
 benefited by local treatment. Diseases of the 
 womb may aggravate neurasthenia, but seldom 
 cause it per se." 
 
 In the eighteenth century neurasthenia figured 
 as the "vapours," and was attributed almost 
 exclusively to suppressed sexual passions. 
 
 Neurasthenic weakness is accompanied by 
 so many physical signs that it is persistently 
 thought to be of physical origin. A gynaecolo- 
 gist, as we have seen, attributed it to the sexual 
 organs, a stomach specialist to dyspepsia, a 
 general physician to gout, rheumatism, cholaemia, 
 &c. Dr. Golding Bird gives oxaluria as the 
 cause of most neurasthenic symptoms. 
 
 1 G. Herman, " Diseases of Women," p. n.
 
 .ETIOLOGY OF NEURASTHENIA 131 
 
 There is no doubt that abdominal troubles of 
 various sorts are common accompaniments of 
 neurasthenia, and at times an exciting cause. 
 It is true that gastric dilatation, for instance, 
 strongly predisposes to autosepsis, and auto- 
 sepsis is a common cause of neurasthenia. It 
 is also certain that cases of neurasthenia are 
 much more severe where there is a uric acid 
 diathesis. The uric acid diathesis is hard to 
 prove. There may be a deposit of free uric acid 
 from the urine and yet there may be no exces- 
 sive formation, but there are still some who think 
 this is the sole cause of neurasthenia. All sorts 
 of poisons (as we have seen in General Etiology, 
 Chapter III.) may cause neurasthenia. Pre- 
 eminent among them, and becoming increasingly 
 a sufficient cause for producing severe neuras- 
 thenia, is the deadly poison of influenza, the 
 results of which are so often appalling and may 
 last for years. A little suspected cause from 
 which it sometimes arises is excess in physical 
 contests. Under certain circumstances, as in 
 cycle races, foot races, boat races, this alone is a 
 sufficient cause. 
 
 These various exciting causes, with many 
 others I shall name, whether connected with 
 poisons, malnutrition, fatigue, or the emotions, 
 all act by producing exhaustion of the nerve 
 centres themselves. Neurasthenia has been
 
 132 FUNCTION L NERVE DISEASES 
 
 arbitrarily classified into primary, hysteric, ac- 
 quired, climacteric, traumatic, angiopathic, gravis, 
 and other varieties ; but such a list might be 
 extended indefinitely and has no value. It is, 
 however, useful and convenient to divide it into 
 cerebral and spinal, and of the two we may say 
 that in cerebral neurasthenia psychic symptoms 
 are the more predominant, whereas in spinal 
 neurasthenia it is the physical. 
 
 The cortical nerve cells appear most easily 
 fatigued, then the spinal nerve cells, and then 
 the nerves themselves. 
 
 There is direct evidence of fatigue in nerve 
 cells, for under the microscope the nucleus in 
 cells that have been very much used appears 
 irregular and jagged and stains deeply, while the 
 cell body is smaller and stains lightly. 
 
 Continuing our list of direct exciting causes, 
 neurasthenia may be produced by overwork of 
 the special sensory apparatus, as a prolonged 
 use of the eyes or ears, &c. It may be caused 
 by over-use of the emotions, as in love, ambition, 
 competition, religion, fear, anger, shock, &c. 
 Sudden shock, as in railway injuries, may cause 
 neurasthenia as severe as from long strain from 
 overwork or years of sick-nursing. 
 
 Neurasthenia may also, as I have said, be 
 caused by exhaustion of motor centres, as in 
 physical overwork, as in the sweated industries,
 
 ETIOLOGY OF NEURASTHENIA 133 
 
 in excessive work in mines, factories, dock- 
 yards, &c. 
 
 Although neurasthenia may be found in nearly 
 every brainworker's household, it is seldom the 
 outcome of ordinary work pure and simple. It 
 is the care and anxiety or worry added to the 
 hard work that most readily produce it. Clever 
 people get it by real overwork, and stupid people 
 by trying to compete in brain work with the 
 clever as, for example, clerks when suddenly 
 advanced to places of great responsibility. It 
 has been observed that neurasthenics are more 
 common in colleges and hysterics in schools ; the 
 cause probably being that at the school age 
 puberty the mind (unconscious) is more likely 
 to be unbalanced and erratic, whereas in colleges, 
 where there is more hard work, it is likely to be 
 overstrained. Of course the neurasthenia may be 
 so strongly hereditary that it is really due to the 
 latent primary mental causes made active by 
 some very slight cause, such as change of work, 
 or disappointment, or slight illness, and not to 
 mental causes produced by physical strain. 
 There is in such cases a radical weakness of the 
 mental system, with great deficiency in resisting 
 power. 
 
 We may sum up the leading exciting causes of 
 neurasthenia thus : 
 
 i. Poisons from influenza, dyspepsia, enteritis,
 
 134 FUNCTIONAL NERVE DISEASES 
 
 bad teeth, alcohol, drugs, zymotic and other 
 diseases. 
 
 2. Malnutrition from deficient food, wasting, 
 anorexia, &c. 
 
 3. Fatigue from overwork, worry, insomnia, 
 pain, sexual excesses, strain, &c. 
 
 4. Emotional strain from shock, grief, acci- 
 dent, religion, &c. 
 
 5. Reflex from enteroptosis, floating kidney, 
 eye-strain, bad environment, suggestion, cardiac 
 weakness, &c. 
 
 The principal and general predisposing cause is 
 undoubtedly heredity.
 
 CHAPTER VIII 
 
 SYMPTOMS OF NEURASTHENIA 
 
 XT EURASTHENIA is essentially a disease 
 -L il of modern civilisation and mainly of the 
 nineteenth and twentieth centuries ; and in this 
 lies one of its great distinctions from hysteria as 
 well as from all structural nerve diseases, which 
 are of great antiquity. Neurasthenia is a clinical 
 conception and not a pathological product, and 
 consists in a collection of symptoms, mostly 
 subjective, of which nervous debility itself is 
 perhaps the chief. 
 
 There is no doubt that collecting associated 
 groups of symptoms and then forming them into 
 a single entity or disease, such as neurasthenia, 
 influenza, &c., saves much time and study. It 
 must be remembered that in neurasthenia the 
 symptoms are far more subjective and less 
 obvious than in hysteria, and are mainly of a 
 nervous character. Dr. Beard, who may be called 
 the father of neurasthenia, and who wrote the 
 
 first systematic treatise on it, in 1868, says that 
 135
 
 136 FUNCTIONAL NERVE DISEASES 
 
 it is the most common, the most interesting, and 
 the most neglected nervous disease of modern 
 times, and has long been the Central Africa of 
 medicine. He says the best cases are never 
 found in hospitals, and in giving the following 
 general list of symptoms says that many of 
 them cannot be seen in a brief consultation, but 
 only after prolonged observation. The list 
 includes tender scalp, especially over left eyebrow, 
 dilated pupils, sick headache and other head 
 pains, pressure and heaviness in head, lightness of 
 head, congested conjunctivse (like conjunctivitis), 
 disorders of special senses (asthenopia, muscse 
 volitantes, noises in ears, subjective odours and 
 tastes), atony of voice, loss of mental control, 
 wandering of mind, irritability, hopelessness 
 (often more marked than in structural nerve 
 disease), morbid fears (topophobia a general 
 term, agoraphobia, claustrophobia, anthropo- 
 phobia, monophobia, pathophobia, pantaphobia, 
 mysophobia fear of contagion), blushing, 
 sweating, insomnia, drowsiness, tenderness of 
 teeth and gums, dyspepsia, flatulence, loud 
 rumblings, hand-sweating, salivation, dryness of 
 mouth, tenderness of spine, coccygodynia, pains 
 about body, heaviness of limbs, shooting pains, 
 pains in feet, palpitation, local spasms and 
 tremors, convulsive movements, cramps, neu- 
 ralgias, sensations of cold, shivering, numbness,
 
 SYMPTOMS OF NEURASTHENIA 137 
 
 hypersesthesia, itching, flushings, temporary para- 
 lyses, sudden exhaustion, seminal emissions, 
 urinary oxalates and phosphates, yawning, and 
 rapid decay of teeth. 
 
 Dr. Savill gives as a definition of neuras- 
 thenia irritable weakness of the entire nervous 
 system, characterised by hypersensitiveness of 
 the central sensorium, and (in the cerebral 
 form) also by headache, inaptitude for mental 
 work, disturbed sleep, and irritability of temper ; 
 and (in the spinal form) by general weakness, 
 vague pains, restlessness, nervousness, and 
 usually accompanied in both forms by various 
 vasomotor and sympathetic phenomena. 
 
 Charcot gives as neurasthenic stigmata pains 
 in head, vertigo, depression, inability for mental 
 work, insomnia, irritability, tremors, pain in back, 
 palpitation, dyspepsia, and sexual weakness. 
 
 Personally I have observed that neurasthenics 
 average about thirty years of age, and are pale, 
 wasted, have headaches, disturbed sleep rather 
 than insomnia, dyspepsia, vague fears and fears 
 of losing reason, flushings, pains at heart, pain 
 at base of spine, frequent pulse, lessened sexual 
 power, restlessness, irritability, timidity, defective 
 memory, inaptitude for mental work, vertigo, 
 excess of urine, and neuralgias of all sorts. 
 Of course, with such an enormous range of 
 symptoms the danger is to lose sight of the
 
 138 FUNCTIONAL NERVE DISEASES 
 
 disease altogether, to miss the wood in looking 
 at the trees. Thus, as we have seen in hys- 
 teria, a nervous patient is often treated for her 
 various symptoms. The gynaecologist notices 
 ulcerated cervix, versions, &c., and treats them 
 as the disease. The physician analyses the condi- 
 tion of the stomach, and notices dilatation, uric acid, 
 &c., and treats this, and so on ; and all the time 
 the neurasthenia is unrelieved. I shall have some- 
 thing to say about this common error when we 
 come to diagnosis. The most recent sketch of 
 hereditary neurasthenia is graphic. Dr. Carr 
 depicts r the hollow back and protuberant, 
 sagging abdomen, with a tendency to laxness 
 of all the abdominal viscera, the mobile heart 
 that shifts its apex several inches when its owner 
 lies on the same side, the vasomotor instability, 
 and the general appearance of "one born to 
 trouble." 
 
 Neurasthenia is of many varieties. It has been 
 classified according to aetiology, including tox- 
 aemia, malnutrition, fatigue, and emotional and 
 reflex causes ; also according to symptoms e.g., 
 general or cerebro-spinal neurasthenia cere- 
 bral, spinal, cardiac, gastro-intestinal, sexual. 
 
 The first or general is most common, and in it 
 the symptoms are half psychic and half physical. 
 In the second they are mainly psychic, and in 
 1 British Medical Journal, July 10, 1907.
 
 SYMPTOMS OF NEURASTHENIA 139 
 
 the third principally physical. Traumatic neuras- 
 thenia constitutes a distinct variety. It must be 
 remembered that spinal and cerebral irritation 
 are not separate diseases from neurasthenia, but 
 simply initial stages. Neurasthenics, again, have 
 been classified in psychical " types." There is the 
 depressed type, who hardly speaks ; the happy 
 variety, who cheerfully describes the most alarm- 
 ing symptoms ; the debilitated, who sits limp and 
 weak ; and the fussy, or Charcot's homme au petits 
 papiers, who has all written down, and insists on 
 reading it out to the long-suffering physician. 
 
 Some come for advice when the neurasthenia 
 is only incipient. They have only attacks of 
 nervousness sudden feelings of melancholy, 
 sinking, faintness from epigastrium or heart, 
 vague fears, dizziness, throbbing, flushing, 
 perspiration, and weakness. These correspond 
 in neurasthenia with hysteria minor. 
 
 In all these varieties it is well to proceed 
 with the examination of the patient in the same 
 definite order. The following is suggested : 
 
 1. What is complained of. 
 
 2. History and family history. 
 
 3. Muscular system (walking, weakness, 
 tremors, spasms, atrophy). 
 
 4. Reflexes deep, superficial, and organic. 
 
 5. Cerebral and mental symptoms. 
 
 6. Cutaneous sensibility and pains.
 
 140 FUNCTIONAL NERVE DISEASES 
 
 7. Special senses. 
 
 8. General trophic condition and weight. 
 
 9. Electric reactions. 
 
 If there be not time for all, 4, 6, and 9 
 may be omitted. Traumatic neurasthenia seems 
 often a combination of neurasthenia with 
 hysteria. Hysteria with neurasthenic symptoms 
 is also common. The patients often look well 
 and are thought to be impostors. Symptoms 
 are at their worst four to eight weeks after the 
 accidents. Among these we notice paraplegia, 
 monoplegia, pains in head, limbs, and spine, 
 pins and needles, numbness and anaesthesia, 
 cold and shivering, buzzing noises in head, 
 dull pain in eye, asthenopia, colour flashes, 
 and other special sense phenomena. 
 
 I must now without further delay briefly 
 review under their various heads the principal 
 of the protean symptoms I have enumerated. 
 
 i. General Nutrition. It has been said that 
 nervousness is really nervelessness ; but this 
 attempted epigram itself requires explanation, 
 for nervelessness does not mean absence of 
 nerves, but loss of nerve power. This loss of 
 nerve power is in most cases of neurasthenia 
 due to the impoverished physical condition, 
 for which the associated dyspepsia is mainly 
 responsible. 
 
 Of course, it may be said that physical weak-
 
 SYMPTOMS OF NEURASTHENIA 141 
 
 ness, however great, does not weaken the 
 mind, and is not unfrequently associated with 
 well-preserved nervous energy. Thinness and 
 weakness do not prove the presence of neuras- 
 thenia, but stoutness and strength certainly 
 prove the absence of any concurrent debility. 
 
 But whether the patient be fat or thin, undue 
 fatigue is one of the true stigmata of neuras- 
 thenia. 
 
 Of course, fatigue may be physical, mental, or 
 emotional, and the lassitude, weakness, headache, 
 &c., in neurasthenia must never be supposed 
 to be entirely or even generally the result of 
 overwork. 
 
 In most fatigue of neurasthenia there is a 
 varying nucleus of true fatigue, surrounded 
 with a mass of autosuggested fatigue as an 
 accretion. Suggested fatigue is not pretended 
 fatigue, but the fatigue of disease, with a psychic 
 and physical substratum in the brain. 
 
 It is almost always possible by careful clinical 
 examination to separate the real fatigue from the 
 autosuggested. 
 
 When the fatigue is associated with mal- 
 nutrition of a serious character (such as two to 
 four stones under normal weight) it is generally 
 only one of many other gastric, cardiac, and 
 cerebral symptoms. If we compare health to 
 a full stream and malnutrition to one nearly
 
 142 FUNCTIONAL NERVE DISEASES 
 
 dry, the fatigue would represent the feeble 
 stream creeping between the rocks at the bed of 
 the channel, while the rocks themselves would 
 represent the underlying troubles of heart, 
 stomach, brain, &c. When the stream is filled 
 up the fatigue, of course, absolutely goes, for the 
 water flows freely over the rocks ; but the other 
 troubles the dyspepsia, &c. may still be there, 
 only they are so hidden by the strong health as 
 to give no trouble till the stream runs low again, 
 when it will be found the rocks will all re- 
 appear. 
 
 2. Gastric and Intestinal Symptoms. These 
 are found in about 90 per cent, of all cases of 
 neurasthenia. Neurasthenic dyspepsia may arise 
 from 
 
 1. Gastric atony (cases of malnutrition, &c.). 
 
 2. Deficient HC1 (hypochlorhydria). 
 
 3. Excess HC1 (hyperchlorhydria). 
 Intestinal neuroses may arise from 
 
 1. Enteroptosis (common). 
 
 2. Mucous colitis (not very common). 
 
 3. Irregular bowels. 
 
 Atony of the stomach and bowels is the true 
 neurasthenic state of these organs, and corre- 
 sponds to the tired and weak feelings in the limbs 
 (amyasthenia). 
 
 Gastric atony is the most frequent symptom of 
 neurasthenia. It is a grave error to regard
 
 SYMPTOMS OF NEURASTHENIA 143 
 
 neurasthenia as an effect of gastric atony through 
 the absorption of dyspeptic toxins. The reason- 
 ing is unsound and puts effect for cause. Gastric 
 atony is generally accompanied with deficiency of 
 gastric juice, leading to constipation, &c. If 
 this be treated with a course of mineral waters, 
 there is great danger of gastric distension (which 
 accompanies atony) passing into true dilatation. 
 
 True atony is found in drunkards, great eaters, 
 too quick eaters, and in all overloaded stomachs. 
 In true atony catarrh of the stomach is the lead- 
 ing feature and the cause is easily ascertained. 
 In nervous atony catarrh is often absent and the 
 eating is little and slow. 
 
 Nervous atony may extend through the whole 
 gastro-intestinal canal, or be found in the 
 intestines only with a normal stomach. 
 
 Nervous atony is probably due to an irritation 
 of the nerves of stomach and bowels and to 
 a neuro- muscular paresis. It produces eructations 
 when fasting, swelling after food, so that the 
 sufferer has to undo the clothes, but not vomiting 
 except in hysteria. In nervous dyspepsia we 
 have cases of complete suppression of gastric 
 juice and the passing of undigested food into the 
 bowel, and still the general condition may be 
 good. Acid risings often show the commence- 
 ment of dilatation. 
 
 Gastric neurasthenia may not be due to
 
 144 FUNCTIONAL NERVE DISEASES 
 
 general neurasthenia, but to other debilitating 
 causes phthisical, albuminous, cardiac, &c. 
 
 Nervous anorexia is often due to direct mental 
 causes, and may have no physical basis. In 
 neurasthenia of the bowels only the actions 
 are irregular, with colic, tenesmus, and mucus ; 
 and the condition is never relieved till the 
 neurasthenia is recognised and cured. There 
 may be membranous colitis, but it is not common. 
 
 After a motion the bowels recover for a time, 
 and the patient feels quite well. This is pathog- 
 nomonic of nervous diarrhoea and the " nervous 
 rectum." In true intestinal catarrh the patient 
 feels always ill and weak and the face is 
 drawn and characteristic, while in nervous 
 enteritis the patient is often flourishing. We 
 also get with neurasthenia, enteroptosis, gastrop- 
 tosis, nephroptosis (floating kidney), prolapsed 
 uterus, and bladder, &c. 
 
 It must be noted that these gastro-intestinal 
 symptoms often occupy the patient's entire mind, 
 and unless the physician be careful he is often 
 liable to overlook the true cause the underlying 
 neurasthenia. 
 
 3. Sexual and Kidney Symptoms. In a list 
 of 360 private cases I recently analysed I I 
 find that I had 20*5 per cent, cases of 
 
 1 Schofield : " The Management of a Nerve Patient ' 
 (Churchills), p. 106.
 
 SYMPTOMS OF NEURASTHENIA 145 
 
 sexual neurasthenia amongst men compared with 
 3 per cent, amongst women. However promi- 
 nent sexual troubles may be as a cause in 
 hysteria, it is certain that in neurasthenia they 
 are only of importance amongst men. Here it 
 generally takes the form of debility (real or 
 supposed), arising from past or present masturba- 
 tion. Men are exceedingly nervous in these 
 matters, partly on account of the bad literature 
 on the subject, and partly from fear of impotence, 
 which is a far greater dread to them than sterility 
 is to women. Impotence is not uncommon in 
 neurasthenia, but is as a rule curable. The fear 
 of impotence is, however, as ten to one compared 
 with the fact. 
 
 Another bugbear is real or supposed seminal 
 losses. I say "supposed " because there is often 
 a sticky secretion from the prostate observed at 
 the end of micturition or defaecation, which is 
 slightly exhausting but is not semen and con- 
 tains no spermatozoa. 
 
 Amongst women self-abuse must ever be borne 
 in mind as a possible cause in neurasthenia ; the 
 fact can, however, as a rule only be established 
 with great difficulty. 
 
 I need not say that any suggestions of sexual 
 disease or malpractice made to discover symp- 
 toms are to be strongly deprecated as fraught 
 with danger in this sister disease to hysteria.
 
 146 FUNCTIONAL NERVE DISEASES 
 
 In neurasthenia we get slight glycosuria, 
 profuse polyuria, urates, phosphates, oxalates, 
 &c., which all disappear or are greatly reduced 
 under successful treatment. A healthy man 
 should urinate not more than five or six times 
 a day, but in neurasthenia the times are often 
 doubled. There is often intermittent glycosuria 
 which is very persistent. 
 
 One must beware in cases of neurasthenic 
 retention of treating the cause as psychic in a 
 routine way ; for it may be due to an anaesthetic 
 bladder (particularly if there be any hysteric 
 element) that does not feel when it is full, and 
 this introduces an element of danger, at any rate 
 in men. One must also beware, once more, of 
 treating any of these sexual or bladder troubles 
 as the disease itself, of which they are but 
 symptoms. 
 
 4. Motor Symptoms. There is no doubt that 
 muscular overstrain may produce neurasthenia, 
 nevertheless there are seldom in neurasthenia 
 any special muscular symptoms. The ergo- 
 graphic curves are not specially characteristic, 
 nor the results of the dynamometer ; though both, 
 measuring as they do the nerve energy as well as 
 the muscular contraction, are markedly dimin- 
 ished. Indeed, in advanced neurasthenia they 
 may be nil. In neurasthenia tremors and 
 rhythmical spasms are common, and these differ
 
 SYMPTOMS OF NEURASTHENIA 147 
 
 from those of disseminated sclerosis in being seen 
 when at rest. Severer motor spasms are called 
 " tics," and will be spoken of separately. Re- 
 flexes in neurasthenia are much exaggerated. A 
 blow anywhere from mid-thigh to mid-tibia may 
 produce a knee-jerk. We also get in neurasthenia 
 blepharospasm, twitching of eyelids or lid, both 
 clonic and tonic, but no Argyll- Robertson 
 phenomenon or other signs of organic lesions. 
 In the spine we get all sorts of weakness 
 (myelasthenia), slight curvatures, backache, pain 
 with tender spots, coccygodynia, tired legs, 
 limbache, &c. 
 
 And now, before passing on to the cerebral 
 and psychic symptoms, I will touch on various 
 scattered sensations, which I will group as 
 
 5. Local Symptoms. Strictly speaking, these 
 are of but two varieties subjective and objective, 
 pain in places in the body, and fear of places 
 in the environment topoalgia and topophobia. 
 The former may occur all over the body, 
 rachialgias and occipital patches being especially 
 common according to Charcot. In connection 
 with such patches we often get Mannkopf 's sign, 
 which is an increased pulse from steady pressure 
 on the tender part, with sometimes spasms and 
 vomiting. This must not be confounded with 
 the " crisogenic " point of hysteria. Of the 
 phobias I will speak in the next section.
 
 148 FUNCTIONAL NERVE DISEASES 
 
 Then we get some sensory weaknesses. There 
 are no definite anaesthesias in neurasthenia, thus 
 contrasting strongly with hysteria. 
 
 Ideas of heat are sometimes vague, as shown 
 by test-tubes of definite temperature ; but we 
 do not get the absurd contradictions of hysteria. 
 Judgment of weight and power of co-ordination 
 are deficient. Normally a person should detect a 
 difference of one-twelfth between two weights, 
 and also meet the finger-tips of two hands with 
 eyes shut ; neither can be done in advanced 
 neurasthenia. 
 
 Neurasthenia alone can produce paresis, con- 
 striction or dilatation of larynx. Here, again, if 
 the symptom be taken for the disease, local 
 treatment only aggravates the neurasthenia. 
 Neurasthenic laryngitis is generally worse at 
 night. 
 
 Heart attacks in neurasthenia consist of pain, 
 or pain and tachycardia (pseudo - angina), or 
 syncope (rare). The second is common and 
 often very distressing, though of no danger if 
 the nutrition be fairly good. Pseudo-angina has 
 none of the gravity of the real disease. We also 
 get a nervous cardiac asthenia. 
 
 6. Cerebral and Mental Symptoms. These 
 include hemi-paresis, unilateral head pain, mental 
 fatigue, and slight aberrations of all sorts, phobias, 
 hypochondria, depression and irritation, head-
 
 SYMPTOMS OF NEURASTHENIA 149 
 
 ache, insomnia, vertigo, &c. The brain alone 
 may be neurasthenic (cerebral neurasthenia), the 
 patient being robust, and active and athletic. 
 Such cases are easily curable if not hereditary. 
 
 The mental condition in neurasthenia is 
 generally due to prolonged mental emotion of 
 some sort, and is marked by being definitely 
 worse in the morning and better through the 
 day. In neurasthenic mental conditions one 
 gets rather altered (exaggerated or diminished) 
 reactions than new and abnormal conditions. 
 The great perversions (hysterical) of special 
 sensation, such as hearing from the back and 
 seeing from the elbow, are not found in 
 neurasthenia. 
 
 In neurasthenia all the centres of control are 
 weakened in varying degrees. There is always 
 abnormal introspection and always something 
 wrong. There is marked mental exhaustion and 
 absence of will-power (aboulia). There is want 
 of attention, loss of memory, and sometimes 
 slight delusions. 
 
 The mental perspective is disturbed or lost. 
 The loss of memory is often the cause of the 
 untruthfulness. The delusions of persecution, of 
 food, &c., may be so severe as to amount to a 
 monomania or slight moral insanity. 
 
 Paraphasia and amnesia (especially for names) 
 are varieties of aphasia common in neurasthenia.
 
 ISO FUNCTIONAL NERVE DISEASES 
 
 There is hypochondria with heaviness, fatigue, 
 inertia, but not any suicidal tendencies. 
 
 Other abnormal mental signs found are : 
 
 Onomatomania (obsession as to the use of 
 certain words). 
 
 Sitromania (inordinate love of food). 
 
 Oniomania (abnormal extravagance). 
 
 Insomnia is not constant in neurasthenia, 
 though a troublesome symptom when it does 
 occur. One cause that makes it common is 
 its constant association with photophobia and 
 dread of sound. 
 
 Nervous vertigo is common, often with tinnitus, 
 but it is not true aural vertigo. The headaches 
 so common in neurasthenia are characterised 
 more by pressure than pain, and feel like a tight 
 helmet (Charcot's " casque neurasthenique "). 
 
 It must be always remembered that many 
 neurasthenics live and move in an atmosphere 
 of autosuggestion, and Professor Dubois' (Berne) 
 suggestion that sensation may be created out of 
 nothing by a mental representation, is not only 
 true in hysterics but in neurasthenics. Numbers 
 of nervous people, for instance, have headaches 
 when they see hot pipes or stoves, from having 
 learned that hot air gives off bad gases. Many 
 are perfect fanatics about having the window 
 open at night. In most cases it is entirely 
 due to autosuggestion, and the windows can
 
 SYMPTOMS OF NEURASTHENIA 151 
 
 be closed after they go to sleep and opened 
 again before they wake without any incon- 
 venience. 
 
 Neurasthenics are often depressed if a cloud 
 passes over the sun and causes a sudden shade, 
 because of the association of sunlight with happi- 
 ness ; and yet they are quite happy in natural 
 shade, as of a tree or wall. 
 
 Let, however, tyros beware of hastily and 
 rashly assuming autosuggestion in nervous 
 maladies and symptoms. This is often done 
 with most disastrous results. Everything at 
 first should be credited to physical causes ; and 
 psychic causes, or autosuggestion, should never 
 be assumed without definite reason. 
 
 7. Symptoms of Fear. Although I have 
 alluded to these already under different heads, 
 they form a group large enough to be placed in 
 a class by themselves. Obsessions and phobias 
 of nervous origin must be distinguished from the 
 commencement of true mental disorder. As a 
 rule, though apparently so mental in character, 
 they are truly neurasthenic, and do not generally 
 lead on to mental disease. Obsessions, when not 
 primary intellectual conditions like " fixed ideas," 
 are only morbid fears of an aggravated sort. In 
 1 10 such cases of obsession the majority were 
 clearly neurasthenic in origin. Phobias and 
 obsessions are specially common after any sexual
 
 152 FUNCTIONAL NERVE DISEASES 
 
 disturbance or exhaustion, also as a result of 
 cerebral fatigue and poisoning of all sorts. 
 
 To enumerate the various phobias and obses- 
 sions would be to catalogue almost every visible 
 object and every possible condition. Amongst 
 those with which I am familiar are agoraphobia 
 (fear of open spaces), which seems some disorder 
 in the apprehension of space dimensions ; claustro- 
 phobia (fear of confined, crowded spaces), which 
 is really a fear of being shut in. Extreme 
 examples are a fear of locked railway carriages, 
 of closed windows, of even feeling "choky" at 
 the sight of a corked bottle, and of dreading 
 tight clothing. These two are quite common, 
 and are mingled in various ways under the 
 general name of topophobia (dread of places). 
 One sufferer cannot cross any very wide street, 
 nor, on the other hand, walk along any very 
 narrow one, where the houses are above a certain 
 height, nor visit certain spots in the town (for no 
 special reason). He can, however, do nearly all 
 these things if the streets or places are crowded 
 with people, and can cross a wide market-place 
 if there is a line of trees or fence to walk near, or 
 a cart to follow. 
 
 Claustrophobia is much more of a fixed obses- 
 sion than agoraphobia, the latter often being only 
 realised by the patient when he is half-way 
 across the open space, when he is seized with
 
 SYMPTOMS OF NEURASTHENIA 153 
 
 a trembling and cannot move a step, and may 
 fall down ; while the other is more dreaded 
 before he enters. 
 
 Anthropophobia is a dread of people and a 
 love of solitary places. 
 
 It must be remembered that phobias and 
 obsessions are seldom quite capricious, but are 
 often the reasoned products of apparent cause 
 and effect, though the premiss, or point of 
 departure, is wrong or exaggerated. 
 
 We get a fear of fire, fear of heights, fear 
 of blushing (very common), fear of spots on the 
 face (a perfect nightmare in one case), fear of 
 dirt, with perpetual washing of hands, face, and 
 body from morning to night; fear of water, with 
 absolute refusal to wash; fear of clothes (except 
 gloves and boots), because they get worn out 
 and it is impossible to decide on what to buy ; 
 fear of touching handles of doors, or dresses in 
 street, lest one might leave some dirt or infection 
 behind ; also the same fears from the opposite 
 reason of receiving some infection ; fear of looks 
 (eyes or nose or mouth too big, &c.), fear of 
 criminal assaults, obsession of criminal assaults 
 committed mentally by some unknown person, 
 fear of being watched, followed, poisoned, electri- 
 fied against one's will, whispered about in every 
 shop, suspected as bad character by every 
 doctor, and so on ; fears of disease of every
 
 154 FUNCTIONAL NERVE DISEASES 
 
 possible and impossible kind, dread of con- 
 stipation, fear of dying, fear of hell, and 
 religious obsession of all sorts, fear of having 
 influenced any one wrongly, fear of seeing 
 certain articles in shop windows, haunting 
 dreads that are undefined, fear of flats, of 
 fixed abodes, of lifts, cabs, trains, smells, morbid 
 conscientiousness leading to all sorts of troubles, 
 as replacing every pebble moved out of place in 
 walking up a gravel drive, dread of all strangers, 
 fear of family, dread of water (sea, lake, &c.). 
 
 One girl was in mortal terror because she 
 could never see a doll without a dread it would 
 speak ; another could never look in a glass lest 
 she should see she had no face ; another patient 
 (a man) could not dare to look at a boy's cap or 
 muffler for fear of uncontrollable sexual impulses, 
 and so on. 
 
 One might prolong the list for ever and narrate 
 many curious cases, but no good purpose would 
 be served : those I have given are what I have 
 met with. 
 
 I have said that, as a rule, these fears and 
 obsessions do not lead to mental disease, but we 
 must ever remember, on the other hand, that 
 neurasthenia, more or less prominent and pro- 
 longed, may be occasionally the prodrome of 
 insanity, melancholia, hysteria, general neuritis, 
 inebriety, morphinism, sexual disease, hay fever,
 
 SYMPTOMS OF NEURASTHENIA 155 
 
 exophthalmic goitre, disseminated sclerosis, dia- 
 betes, Bright's disease, organic spinal diseases, 
 and cerebral tumours. 
 
 Enough has been said to show the extra- 
 ordinary, comprehensive and inexhaustible list of 
 symptoms that have been conveniently grouped 
 under the one word " Neurasthenia."
 
 CHAPTER IX 
 
 DIAGNOSIS IN FUNCTIONAL NERVE DISEASES 
 
 I "HE diagnosis in functional nerve diseases 
 JL is exceptionally difficult in two ways : 
 first, in the diagnosis between functional and 
 organic disease ; and, secondly, in the diagnosis 
 between functional nerve disease and mental 
 disease. 
 
 In neuromimetic hysteria we get diseases 
 often so closely simulated unconsciously in every 
 particular that it seems impossible they should 
 not be organic, and particularly in the case of 
 tumours and paralyses. Sir A. Clark told me 
 long ago that he knew of at least fifty cases 'of 
 abdominal tumour sent in to his hospital for 
 operation every one of which was neuromimetic 
 and disappeared (temporarily) under chloroform. 
 
 And yet with all this likeness there is ever, to 
 careful and prolonged examination and observa- 
 tion, some incongruous point that attracts atten- 
 tion and establishes the diagnosis. Ordinarily the 
 patient seems far too well to be suffering from 
 156
 
 DIAGNOSIS 157 
 
 the apparent disease, the general nutrition is 
 often too good, and too few signs of suffering 
 are shown. Or there may be signs of emotional 
 hysteria manifested that point to the possible 
 functional character of the disease. Or its history 
 may be connected entirely with nervous causes. 
 
 It must, however, be remembered that this 
 last is not a point to be relied on alone ; 
 for it is well known that true organic disease 
 may originate from mental or nervous causes 
 only. Indeed, the condition of the nerves may 
 be an exciting or predisposing cause in nearly 
 every species of disease. The course, too, of the 
 disease is different from that of a real organic 
 lesion. In short, it may be laid down as true, 
 at any rate in my experience, that while there 
 are many cases that cannot be pronounced off- 
 hand functional or organic, there are few that 
 do not reveal their true character after a fort- 
 night's close observation. It must be remembered 
 that neurasthenia seldom leads to organic disease. 
 
 Another difficulty is with cases on the border- 
 land between nervous and mental disease. It 
 must be remembered that in mental disease we 
 very often get the same symptoms as in functional 
 and organic disease. In both we may have 
 hallucinations, illusions, and delusions ; in both 
 we may have depression or exaltation, and in 
 both we may have irrational acts.
 
 158 FUNCTIONAL NERVE DISEASES 
 
 And yet here again there is much to guide the 
 careful observer. The main general point that 
 settles the diagnosis in nine-tenths of the doubtful 
 cases is that in the sane there is knowledge of 
 the irrational conditions, in the insane there is 
 not. Light is also thrown here by the history 
 of the case and by other symptoms of nerve 
 trouble which greatly help in the diagnosis. 
 Of course there may be, and one often meets 
 with, a slight mental taint underlying well-marked 
 functional symptoms ; so that the disease may be 
 partly mental, though mainly nervous, or vice 
 versa. One important point remains to be noted 
 of a practical nature, and that is that wherever 
 there is any doubt of the disease being mental, 
 never fail to give the patient the benefit of it. 
 
 Returning to the diagnosis between functional 
 and organic nerve diseases, the following diseases 
 are among those that have been mistaken for 
 hysteria disseminated sclerosis (frequently), alco- 
 holic paralysis, locomotor ataxy, injuries to 
 spinal cord, hemiplegia, syringo-myelia, spinal 
 caries, facial paralysis, chorea, exophthalmic 
 goitre. 
 
 It must be remembered that in true dis- 
 seminated sclerosis there is tremor only on 
 intention and effort, there is "scanning" speech 
 and nystagmus, none of which are characteristic 
 of functional disease.
 
 DIAGNOSIS 159 
 
 In hysteria we never get optic neuritis or 
 atrophy, total absence of knee-jerk, true nys- 
 tagmus, or continued ankle clonus, but in true 
 spinal atrophies we do. Unilateral exaggeration 
 of knee-jerk and tendon reflex, or total absence 
 of reflexes, is always organic. 
 
 Organic symptoms are fixed, stable, or pro- 
 gressive ; functional are capricious and variable. 
 
 The general rule is that in all organic spinal 
 diseases the reflexes are lessened, in functional 
 diseases they are increased, but of course there 
 are exceptions. 
 
 Babinski's phenomenon is a most valuable 
 diagnostic test, and has been in more than one 
 case of mine the only possible ground for 
 diagnosis. I have not yet been led astray by it. 
 The only trouble is that frequently the sole is so 
 insensitive that no reflex occurs. As is known, 
 it consists in the extension of the big toe on 
 tickling the sole in organic disease, instead of 
 the normal flexion as in functional. This exten- 
 sion is said to depend on disease of the pyramidal 
 tract. 
 
 Hysterical paraplegia most resembles dis- 
 seminated sclerosis. In the former bed sores are 
 very rare, in the latter more common. 
 
 In organic hemiplegia you cannot straighten 
 the whole of the affected limb at the same time ; 
 in hysterical you can. In organic hemiplegia the
 
 160 FUNCTIONAL NERVE DISEASES 
 
 limb is circumducted in walking; in functional it 
 is dragged. 
 
 In organic hemiplegia face and tongue are 
 generally affected ; not so in functional. 
 
 The following short list contains some other 
 organic diseases, in addition to those already 
 given, most likely to be thought hysterical : 
 Slight epilepsy and meningitis, early stages of 
 brain tumours, cerebellar disease, Friedriech's 
 ataxy, and paraplegia. 
 
 Turning from paralyses, our next point is the 
 diagnosis between functional and other organic 
 diseases. Lead poisoning has symptoms strongly 
 resembling hysteria ; the distinction is the blue 
 line round the gums in the former. 
 
 Pseudo angina pectoris is diagnosed from true 
 angina by its lessened real severity and longer 
 duration with greater agitation, also by a less- 
 marked fear of impending death, and by the 
 aura being less frequent. 
 
 Functional tachycardia requires care in diag- 
 nosis from organic heart disease. 
 
 Graves' disease is like functional nerve disease, 
 only in the former the exophthalmos and enlarged 
 thyroid are well marked. One gets, however, 
 true cases of exophthalmic goitre with very little 
 thyroid enlargement. The best distinction is 
 often the progress of the case. 
 
 Traumatic neuroses are simulated by malinger-
 
 DIAGNOSIS 161 
 
 ing on the one hand and disseminated sclerosis 
 on the other. It is because this spinal disease is 
 disseminated that its symptoms are so protean as 
 to be difficult of diagnosis. 
 
 In uric acid poisoning from kidney failure there 
 are often functional nerve symptoms and much 
 emotional disturbance, lasting perhaps for months, 
 with, frequently, almost normal health between, 
 so that often Bright's disease is mistaken for a 
 functional disorder. 
 
 Abnormal physical physiological peculiarities 
 and idiosyncrasies are also mistaken for 
 hysterical disease. I have a case of a boy 
 to whom the smallest trace of egg is poison, 
 and it is only after careful investigation that 
 the idea of hysteria is eliminated. 
 
 The next difficulty is the diagnosis between 
 nervous and mental disease. The great dis- 
 tinction is, as I have said, a broad one. However 
 overspread with delusion, illusion, and depression 
 the nervous sufferer may be, he is always 
 conscious of his condition, and you clearly see 
 that the brain as a whole is sound. 
 
 True melancholia is, of course, an insanity, 
 and some neurasthenic depressions come very 
 near it. 
 
 Melancholies are invariably suicidal, even if 
 the disease be apparently slight, and can never 
 be trusted ; whereas depressed neurasthenics
 
 162 FUNCTIONAL NERVE DISEASES 
 
 are only occasionally so, and as a rule can be 
 trusted. Melancholies have fixed ideas of great 
 tenacity, with the entire absence of any grounds 
 for them ; this is not seen in the same way in 
 neurasthenia. The depression in neurasthenia 
 may be as much without any known cause as in 
 melancholia, and may come on periodically, or at 
 varying intervals, and last for different periods of 
 time. In these cases there is nearly always some 
 hereditary tendency and some want of mental 
 balance, though there is no real insanity. 
 
 Hypochondria has been described as hysteria 
 in the male sex. I do not altogether go with 
 this, as there is much hysteria in men that is not 
 hypochondria. In hypochondria the gloom is 
 caused by introspection of some physical con- 
 dition. Not so in melancholic or neurasthenic 
 depression. 
 
 No doubt it is most common in men, and 
 especially in connection with the sexual organs ; 
 while hysteria is more common in women. 
 
 In hypochondria there is conscious fear of 
 disease ; in hysteria, unconscious simulation of it. 
 
 In connection with nervous and mental diseases 
 two points should be noted. The one is, as I 
 have already said, that some severe and incurable 
 varieties of insanity commence as simple neuroses, 
 especially dementia pnecox, in which I have 
 seen some remarkable simulation of functional
 
 DIAGNOSIS 163 
 
 nerve disease. The other is that hysteria major 
 may pass (in those predisposed) directly into 
 insanity. 
 
 Constant vigilance is therefore needed in the 
 diagnosis, and especially in the prognosis, of all 
 functional nerve diseases of a serious nature, 
 lest on the one hand they should turn out to be 
 organic, or on the other truly mental ; in either 
 case the prognosis is entirely altered for the 
 worse. 
 
 We must now consider the diagnosis between 
 different varieties of functional nerve disease, and 
 principally between neurasthenia and hysteria. 
 
 In the first place a patient may suffer both 
 from hysteria and neurasthenia simultaneously. 
 An inherited tendency (as Herman has pointed 
 out) to hysteria may remain latent until some 
 depressing influence brings on neurasthenia, or a 
 patient already the subject of hysterical disease 
 may become neurasthenic also ; according to 
 Binschwanger there are not only cases in which 
 hysteria and neurasthenia are combined, but 
 there is a mixed form something between hys- 
 teria and neurasthenia. But these are German 
 subtleties into which we cannot enter here. 
 
 We must also set aside the idea that neuras- 
 thenia is a male hysteria, and that the latter is 
 merely a feminine variety of the former. Such 
 is not the case. Hysteria is essentially of psychic
 
 164 FUNCTIONAL NERVE DISEASES 
 
 origin, and is not usually directly connected with 
 fatigue and malnutrition ; whereas neurasthenia 
 constantly is, and has not at all the same mental 
 character as hysteria. 
 
 The cause is much more readily ascertained in 
 neurasthenia (and may be purely physical) than it 
 is in hysteria. Hysteria is a much older and 
 also a more stubborn disease than neurasthenia. 
 At the same time it may disappear suddenly, 
 while neurasthenia never does. 
 
 The stigmata of hysteria are more markedly 
 physical than in neurasthenia, notwithstanding 
 that the disease has a more psychic origin. 
 
 The symptoms in hysteria, as I have already 
 pointed out, are essentially bizarre and often 
 contradictory ; those in neurasthenia are vaguer, 
 but more natural. The most interesting class 
 of symptoms in hysteria is neuromimesis ; in 
 neurasthenia, the various phobias. 
 
 A well-marked case of the one cannot be mis- 
 taken for the other, and in the rest, the history 
 of the case and its heredity, and close observation 
 for a few days, will clear up the difficulty, save 
 where both diseases are concurrent. 
 
 I may say a word here of some importance in 
 the diagnosis of functional nerve diseases, and 
 that is as to the diagnosis that should be given 
 to the patient. 
 
 Your own private diagnosis in an over-
 
 DIAGNOSIS 165 
 
 whelming majority of cases, however many 
 physical ailments may be complained of, will be 
 "functional nervous disorder." You may see 
 yourself that it is the cause, and all the physical 
 troubles are the effect, but you will not as a rule 
 say so. 
 
 You will probably put it the other way about, 
 and remember, in a vicious circle, it is an open 
 question which is cause and which is effect. 
 Dyspepsia causes "nerves," and "nerves" cause 
 dyspepsia, and so each reacts on the other, and 
 which is cause and which is effect is not always 
 easy to say. 
 
 Remember that your diagnosis is not in these 
 cases so much a question of skill as it is of tact. 
 
 So long as you know it, and can confide it to 
 the doctor or the patient's friends (with caution), 
 your duty is to present that side of it to the 
 patient that will most conduce to cure. 
 
 If she be a patient with a horror of nerves, and 
 a feeling of disgrace if they are mentioned (as 
 you will often find), you will strongly emphasise 
 the physical side, and treat it rather as the cause, 
 and if any " nerves " are complained of, these as 
 the effect. If, on the other hand, the patient 
 rather fancies having "nerves," and is fearful of 
 physical ailments, you can emphasise the former, 
 and treat the latter as mere effects, which will 
 soon disappear when the other gets right. In
 
 166 FUNCTIONAL NERVE DISEASES 
 
 neither case are you wrong ; for it is certain that 
 when either goes the other will disappear also. 
 
 To put it scientifically and broadly, it is your 
 wisdom and practice at this stage of your relation- 
 ship with your patient to go as far as possible 
 with her views, in order that when confidence is 
 completely established you may bring her round to 
 yours. A violent onslaught on her prejudices at 
 this period is nearly sure to defeat its object and 
 fail to bring her to reason, whereas, later on, it 
 may be quite successful. 
 
 A very good illustration of this, and one that 
 we may consider here, is gout and neurasthe- 
 nia, which somehow are constantly connected. 
 There must be some reason why I see so many 
 nerve patients who have been told they have 
 "suppressed gout." 
 
 Indeed, I think we get here a very good 
 illustration of the vicious circle. Neurasthenia, 
 dyspepsia, uric acid, neurasthenia, form a com- 
 plete circle ; and which is cause and which effect 
 would puzzle any one. 
 
 Neurasthenia doubtless weakens digestion, and 
 bad digestion produces uric acid (which is sup- 
 pressed gout), and uric acid in the blood deranges 
 the nerves. 
 
 Of course, in this light, a diagnosis of sup- 
 pressed gout is as good as that of neurasthenia ; 
 but, as we shall see when we come to treatment,
 
 DIAGNOSIS 167 
 
 however we may confuse cause and effect in the 
 diagnosis, we must never do so in treatment, but 
 always, whenever possible, treat the nervous 
 elemenjt as the fundamental cause. 
 
 I may illustrate this by two cases I have 
 recently treated. Both were diagnosed as 
 " suppressed gout," and not only so, were treated 
 for it, leaving the neurasthenia alone. Diets were 
 ordered, all sorts of food cut off, and in two years 
 the patients no doubt were free from uric acid, but 
 were nervous wrecks from starvation and weak- 
 ness. Still, the "gout" was gone. Now, it would 
 have mattered little whether the diagnosis was 
 " suppressed gout " or neurasthenia, so long as 
 the treatment was directed to the latter, but un- 
 fortunately it was not hence the failure. 
 
 If uric acid be formed, there are two ways of 
 removing it ; the common one, which was adopted 
 here, and is very often practised, is to eliminate 
 uric acid from the diet. The other is so to build 
 up the system, and especially so to strengthen 
 the digestive organs, as to be able to take any 
 ordinary food without producing uric acid at all. 
 
 This is by far the better way, because in it the 
 person, and not merely the disease, is treated ; 
 and the neurasthenia, which was probably the 
 worst evil, is cured. No doubt it requires some 
 courage to follow a previous diagnosis of "sup- 
 pressed gout" with one of " neurasthenia," and
 
 168 FUNCTIONAL NERVE DISEASES 
 
 explain that the "gout" is merely a symptom 
 that will disappear ; but, whether this is done or 
 not, there is no doubt that treatment must be 
 directed to the true underlying cause, which in all 
 nervous cases is the nerves. 
 
 The diagnosis you arrive at, as I have said, is a 
 question of skill, the form in which you com- 
 municate it is a question of tact, and it is an 
 open question which of the two is the more 
 important for the welfare of the patient. Happy 
 is the man who can combine both, and who does 
 not, as is so common, despise the latter on account 
 of his excellence in the former.
 
 CHAPTER X 
 
 PSYCHOTHERAPY 
 
 PSYCHOTHERAPY has existed and been 
 practised consciously and unconsciously 
 through all ages. To know how to use it 
 successfully has always demanded the highest 
 qualities of the greatest physicians. 
 
 Psychotherapy is useful in all diseases, but it 
 is essential in functional nerve disease ; and, 
 owing greatly to the recognition of this, in no 
 department of medicine has there been so rapid 
 and general an advance as in the treatment of 
 these ailments by such physicians as practise 
 psychotherapy. Too many, however, still bom- 
 bard these cases with drugs of many sorts, in the 
 hope that some may hit the mark. I have a 
 record of one case where nearly one hundred 
 distinct varieties were fired into a harmless old 
 gentleman of seventy. In neuroses, more than 
 in any other diseases, we don't cure sicknesses, 
 but sick people ; and we must, therefore, 
 
 individualise and bring into prominence the 
 169
 
 i7o FUNCTIONAL NERVE DISEASES 
 
 psychic factor to an extent not necessary in all 
 diseases. In hysteria, especially, one might say 
 the primary curative agent is psychic and all 
 others are auxiliary : in neurasthenia it is not so. 
 The reason for this I have already suggested, 
 and it is as follows : In hysteria the chief cause 
 is psychic, and therefore the treatment is psychic, 
 though the symptoms are mainly physical. In 
 neurasthenia, on the contrary, the cause is largely 
 physical, and therefore the treatment is so, 
 though the symptoms are principally psychic. 
 
 It must of course be remembered that pyscho- 
 therapeutics can be used whether the disease has 
 a psychic or physical origin, but in the former 
 case it is essential. Binet has introduced 
 psychotherapy in the treatment of the insane, 
 and this is being increasingly used. 
 
 In speaking of mental therapeutics it must not 
 for a moment be imagined that I include under 
 this head all the quack practice that abounds 
 under the term "mental healing." As I have 
 said before, several forms of this are so contrary 
 to common sense, and so mixed up with pseudo- 
 religioji, as to be most objectionable to medical 
 men. Mental therapeutics, properly applied, 
 cannot, however, be omitted in any treatment of 
 nerve disease, and a knowledge of their great 
 value is essential to every physician who would 
 excel in the cure of these disorders. Psycho-
 
 PSYCHOTHERAPY 171 
 
 therapy, though universally used, more or less, is 
 seldom spoken of or studied scientifically by the 
 profession, and is not much in favour even 
 amongst the very men who (often unconsciously) 
 so largely use it. 
 
 It is, of course, as I have implied, the connec- 
 tion of mental therapeutics directly with faith 
 healing, mental science healing in all its 
 many varieties, and indirectly with liquid elec- 
 tricities, billionth dilutions, and quack remedies 
 of all sorts, that has so far deterred the pro- 
 fession from examining its wonderful powers 
 very closely. I feel quite sure, however, that all 
 such reasons will fall to the ground when the fact 
 of the unconscious mind and its power over the 
 body is admitted clearly and definitely by 
 scientific men ; and once its powers become 
 generally recognised they will at last, after long 
 neglect, be made the subject of serious 
 study. 
 
 Still, the prejudice very naturally exists, to the 
 great loss of the profession, though I have no 
 doubt it is gradually disappearing. 
 
 I think there are in all probability several 
 reasons why so many of us distrust and dislike 
 the very idea of mental therapeutics, only one of 
 which I have touched on. May I suggest half a 
 dozen more that occur to me at the moment ? 
 The idea is distrusted and disliked
 
 172 FUNCTIONAL NERVE DISEASES 
 
 1. Because 
 
 "So many please 
 
 To think their duty is to cure disease ; 
 'Forgetful' (too often) of this lesson still 
 'Tis not the body, but the man is ill." 
 
 A man whose sole idea is to fight disease, 
 though trained in all the science of the schools, 
 may still be oblivious of the physician's noblest 
 work, and may well "pass by on the other side " 
 the subject before us. 
 
 2. Another reason is the deep mistrust with 
 which the ordinary British mind, even when 
 fairly educated, regards the advent of any new 
 theories and ideas ; in this differing essentially 
 from the German and American types. 
 
 3. A third is because of its possible connection 
 with hypnotism, which is still in very doubtful 
 favour in the best medical circles. 
 
 4. A fourth, because (limiting the mind to con- 
 sciousness) they find by experience how little can 
 be effected in cure by conscious efforts of mind, 
 however determined. 
 
 5. A fifth, because the Zeitgeist the spirit of 
 the (medical) age is against it. Scientific 
 diagnosis and clinical work naturally lead to 
 scientific cures ; anything else is more or less 
 suspected. 
 
 6. And lastly, because there is no real oppor- 
 tunity of studying this subject, which forms no
 
 PSYCHOTHERAPY 173 
 
 part of the medical curriculum at college or 
 hospital, 1 and of which no text-book exists. 
 
 It seems to me these six reasons are amply 
 sufficient to account for the way mental thera- 
 peutics are regarded by the majority of us to-day. 
 
 If this be the case, we can understand better 
 how such a therapeutic agent should have been 
 so ignored, and why from so few of our leading 
 surgeons and physicians we hear of the influence 
 of the human mind, whose powers pretty well 
 balance the whole Pharmacopoeia. In the 
 British Medical Journal we find this remark- 
 able admission : 2 " Disease of the body is so 
 much influenced by the mind that in each case we 
 have to understand the patient quite as much as 
 the malady. This is not learnt at hospitals." Or, 
 in other words, one-half at least of the science 
 of therapeutics is not "learnt at hospitals," 
 doubtless for the reasons given above. But does 
 any medical man, after all, really doubt these 
 mental powers? Is he not aware of the 
 ingredient " faith," which, if added to his pre- 
 scriptions, makes them often all-powerful for 
 good ? Does he not know experimentally the 
 value of strongly asserting that the medicine will 
 produce such and such effects as a powerful 
 means of securing them? 
 
 1 It is hoped this will soon be remedied. 
 
 2 British Medical Journal, Educ. Number, autumn, 1897.
 
 174 FUNCTIONAL NERVE DISEASES 
 
 Surely the reasons we have given why mental 
 science is neglected are not sufficient cause for its 
 being pooh-poohed and ignored as it is ! It has 
 its laws of action, its limitations, its powers for 
 good and for evil ; would it not clearly help the 
 medical student if these were indicated to him by 
 his lawful teachers, instead of his gleaning them 
 uncertainly from the undoubted successes of the 
 large army of irregulars? 
 
 We are, however, inclined to think that, after 
 all, a silent revolution is slowly taking place in 
 the minds of medical men, and that our present 
 text-books on disease, content with merely 
 prescribing endless selections and combinations 
 of nauseous drugs, and dismissing any mental 
 cure in a single line as unworthy of serious con- 
 sideration, will in time be replaced by others 
 containing views more worthy of the century in 
 which we live. 
 
 For although these drugs are still administered, 
 but few medical men now believe that they are 
 the entire cause of the cure ; for very gradually 
 it is beginning to dawn upon us that most 
 nervous diseases at any rate are easily and 
 naturally treated by mental therapeutics, and that 
 the still persistent efforts to cure them by the 
 stomach are neither reliable nor rational. 
 
 It ill becomes, therefore, the medical man, who 
 recognises in these cases that it is the mind that
 
 PSYCHOTHERAPY 175 
 
 cures, to decry any form of faith cure, however 
 little its process may be understood by him in 
 detail. We have seen that the powers of the 
 conscious mind over the body are well-nigh 
 immeasurable ; and knowing, as we now do, that 
 our old division into functional and organic 
 disease is merely the expression of our ignorance, 
 and that all diseases, even hysterical, involve 
 organic disturbance somewhere, we are prepared 
 to believe that faith and other unorthodox cures, 
 putting into operation such a powerful agent as 
 the unconscious mind, or, if you prefer the formula, 
 "the force of nature," are not necessarily limited 
 to so-called functional diseases at all. 
 
 There are at least four ways by which mental 
 therapeutics can be applied to disease. 
 
 1. By the direct active power of the uncon- 
 scious mind inherent in itself, and generally 
 called the vis medicatrix naturce. 
 
 2. By the unconscious mind influenced directly 
 by surrounding personalities or other unconscious 
 agencies acting as indirect suggestions. 
 
 3. By the unconscious mind influenced in- 
 directly through the conscious, which has faith 
 in persons, systems, places, &c. 
 
 4. By the unconscious mind indirectly acted on 
 by the conscious by distinct effort in determi- 
 nation to get well, to shake off illness, ignore 
 pain, &c.
 
 176 FUNCTIONAL NERVE DISEASES 
 
 Dr. Clouston remarks with regard to this 
 subject generally : l "If mind and brain so power- 
 fully affect the conditions of disease, one naturally 
 turns to them in looking for means of cure. And 
 beyond all question we can often get effectual 
 help there. Half the diseases that kill, as I have 
 already said, do so because there is no sufficient 
 power in the organism to resist them. The 
 physiological commonly passes into the patho- 
 logical because the nerve energy is below par. 
 To check many diseased conditions we cannot 
 employ better therapeutics than to stimulate the 
 cortex and strengthen the mental energy. To 
 this end the first thing a good doctor does is to 
 inspire confidence in his patient. What is this 
 but a bit of psycho-therapeutics? And it is an 
 all-important one in many cases. So to condition 
 the patient that his brain and mind are kept up 
 to the very highest mark attainable, to remove 
 irritations (mental and nervous), and to distract 
 attention from a lowering to a cheerful view of 
 the whole situation, may make all the difference 
 between life and death in many a case. Hope 
 and a calm cheerfulness are often the best general 
 aids to healthy metabolism. We know that a joy- 
 ful emotion will at once fill the cortical capillaries. 
 It is a true cerebral stimulant. Aided by 
 
 1 Dr. Clouston, British Medical Journal, January 18, 
 1801,
 
 PSYCHOTHERAPY 177 
 
 medicinal cortical tonics and stimulants, like 
 strychnine, quinine, the mineral acids, &c., mental 
 stimulation is an undeniable adjuvant to the local 
 treatment of disease, and it is used largely by the 
 most successful physicians." 
 
 Bearing this in mind, we can better understand 
 the following from the Lancet : 
 
 " A malady induced by mental reflex can only 
 be cured by mental remedy. A full recognition 
 of the value rightly attaching to the mental treat- 
 ment of physical ailments will improve the useful- 
 ness of the physician and materially assist in the 
 recovery of his patients. In disease, functional 
 or organic, the therapeutic value of faith and 
 hope, though not in our text-books, is often enough 
 to turn the scale in favour of recovery." l 
 
 As I write these lines a volume on the treat- 
 ment of nervous diseases by Dr. Graham Brown, 
 of Edinburgh, is placed in my hands, and I am 
 much pleased to read these words, which indicate 
 a distinct advance in one text-book as regards 
 therapeutics : " We now come, in the considera- 
 tion of the general treatment of hysteria, to that 
 factor which is probably of the highest importance 
 of all, and which ought to dominate the whole 
 management of the case namely, the use of 
 suggestion on the part of the physician." 
 
 We have high authority for the virtue con- 
 1 Editorial, Lancet, 1883, i. 19.
 
 i;8 FUNCTIONAL NERVE DISEASES 
 
 nected with "a single eye," and there can be no 
 doubt that this 1 has been cultivated in the pro- 
 fession for the last thirty years to an alarming 
 extent. The single eye, which alone illumines so 
 many medical minds now, is scientific, mechanical, 
 practical, observant, and accurate. 
 
 But, after all, though a single eye has the great 
 advantage over two that it cannot squint, or be 
 distracted by looking at two things at once, it 
 has the enormous disadvantage of not possessing 
 stereoscopic vision ; which, in medicine, by obtain- 
 ing two different views of the patient at the same 
 time, sees him as a solid, living entity of three 
 dimensions, instead of viewing him on the flat as 
 a troublesome adjunct to his disease in two dimen- 
 sions. The single eye can, of course, see the 
 body at one time, and can also see the mind at 
 another, if the gaze be turned thither ; but it 
 cannot view both at the same moment and com- 
 bine them in the one picture of the living man. 
 " Now there is such a thing as stereoscopic 
 thinking the viewing subjects as well as objects 
 with our two eyes " ; 2 and we must look and 
 think stereoscopically if we would ever see or 
 
 1 By " this " it is obvious that I refer to the sight of one 
 eye, and not, as is often meant by the expression, the 
 single vision of two eyes as opposed to diplopia. 
 
 3 Dr. John Brown, " Horas Subsecivae," ist Series, 
 Art. u Locke and Sydenhara," p. xxiii.
 
 PSYCHOTHERAPY 179 
 
 know the truth. One eye on the mind and one 
 on the body ; one eye philosophic and imaginative, 
 and one scientific and observant; one theoretic 
 and one practical ; one seeing the invisible and 
 one the visible, constitute the double vision that 
 has ever characterised the leaders in every pro- 
 fession, and specially all really great physicians. 
 I have elsewhere produced abundant evidence to 
 prove this ; here, I am content to state the fact. 
 
 Let us, however, remember that medicine is 
 not only a science, but an art. The two have 
 been suggestively contrasted as follows : 
 
 In Medicine, 
 
 ART SCIENCE 
 
 has a method, has a system, 
 
 looks to function looks to structure 
 
 rather than structure, rather than function, 
 
 acts, speaks, 
 
 is unconscious, is conscious, 
 
 uses one eye. uses the other eye. 
 
 WISDOM in Medicine 
 
 uses both eyes, discerns solidity as well as surface, and, 
 viewing both sides, uses mind and body for the cure 
 of one man. 
 
 If we come, however, to compare the two 
 methods of cure, we must admit that mental 
 therapeutics may not only co-exist with physical, 
 but in neuroses are of greater importance. 
 Drugs, moreover, are sometimes given to relieve
 
 i8o FUNCTIONAL NERVE DISEASES 
 
 symptoms only, and symptoms, too, that might 
 be beneficial. Mental therapeutics are not aimed 
 at symptoms, but generally attack the root of 
 the disease or, at any rate, its mental root. 
 Alteratives for the mind are generally more im- 
 portant and efficacious than alteratives for the 
 body. There are mental analogues to iodide of 
 potassium. Again, not only are mental thera- 
 peutics ever a great resource and adjunct in 
 ordinary medicine, but there are some forms of 
 disease, as I have shown, where they constitute 
 the only remedy that is effectual. Moreover, in 
 every form of physical treatment faith is needed 
 by the patient if he is to follow it out well and 
 successfully. Every idea tends to act itself out, 
 and mental thought passes into the physical plane 
 unless inhibited. It is thus that faith and hope 
 and the picture of getting well act themselves out 
 physically in the patient and produce the effects 
 caused by the autosuggestions that faith inspires. 
 
 The cure of neuroses is rather by the per- 
 sonality than by prescriptions ; and a constant 
 interchange of psychic force and intelligence is 
 going on between a nerve patient and a physician 
 who is en rapport with him, of which neither is 
 probably aware. 
 
 Many patients, after a fortnight's treatment, 
 have said to me, in disappointment, that they had 
 expected to be cured through their minds, and
 
 PSYCHOTHERAPY 181 
 
 that I treated nothing but their bodies ; and I 
 have told them that, unknown to themselves, they 
 had been all the time under the influence of strong 
 mental therapeutics. There is no doubt that the 
 mental state of the neurasthenic has much to say 
 to his cure. The progress is frequently quite 
 irregular, and may stop at any stage capriciously, 
 and then, under some fresh mental stimulus, such 
 as an increase of faith, the cure proceeds rapidly. 
 
 Neurasthenics are more easily cured than 
 hysterics, and the latter have more tendency to 
 relapse. 
 
 All that I have said so far tends to show that 
 the proper treatment of functional nerve disease 
 is as much the work of trained skill as is disease 
 of the eye, ear, or throat, and that while much 
 can be done by any intelligent doctor in cure, there 
 are cases which require the skill and experience 
 of the specialist. 
 
 The treatment of functional nerve disease must 
 always be directed to the source of the trouble, 
 with, as a rule, neglect, more or less marked and 
 complete, of the symptoms ; but mental thera- 
 peutics have little result unless the patient believes 
 the symptoms are of nervous origin. 
 
 This treatment is so difficult to arrange, so 
 variable from day to day, so subtle in its methods, 
 that it can never be successfully delegated to 
 others, but must be personally organised and
 
 182 FUNCTIONAL NERVE DISEASES 
 
 carried out from start to finish. Moreover, each 
 case of functional nerve disease being, as I have 
 said, the treatment of a personality, is a separate 
 study ; thus differing essentially from the treat- 
 ment of ordinary organic disease, where the per- 
 sonality is of much less importance. Medicines, 
 natural remedies, and psychotherapeutics all play 
 their part, and must all co-operate in the cure. 
 
 The rest cure and the work cure are both good 
 in different cases. 
 
 In Hindoo life it is a practice to retire for at 
 least half an hour a day into silence, to relax all 
 muscles, take deep, quiet breaths, and think on 
 eternal things. Every Hindoo child is trained in 
 this from an early age. We in the West require 
 also some such periods of stated rest. There should 
 be a regular systole and diastole for the mind as 
 well as for the heart, besides that enforced in 
 sleep. And it may be partly because this is so 
 much neglected that the so-called " rest cure " is 
 in such vogue for neurasthenics. 
 
 The right psychic treatment of the neurasthenic 
 is important. At present he is often treated 
 either (i) too seriously, as when dyspeptic 
 symptoms are attributed to some serious gastric 
 trouble, or (2) too lightly, when the disease is 
 dismissed as nothing ; and both are disastrous. 
 
 It must be remembered that the main dis- 
 tinction between ordinary organic and functional
 
 PSYCHOTHERAPY 183 
 
 nerve diseases lies in the fact that the former are 
 generally incurable and the latter curable. 
 
 " Nervous," as a rule, means curable ; and this 
 should be well brought home to the patient's 
 consciousness. 
 
 Some, in treatment, persist in attacking the 
 prominent symptoms to cure the disease ; the true 
 way is, as I have said, to treat the disease, and 
 most of the symptoms will go, and then the rest 
 can easily be removed. There is no doubt that 
 the conjunction of an organic with a nervous 
 disease weakens the moral action of the physician 
 and hampers him in many ways. It is well not 
 to be too much troubled about it, and above all 
 to never admit to the patient the possibility of two 
 diseases at the same time. Try to put all the 
 symptoms under the one head. Note everything, 
 but resolutely treat on a neurotic basis. I have 
 seen a case cured, with Babinski's sign well 
 marked, by persistent pyschotherapeutics, which 
 were difficult to persevere in, in the face of it. 
 
 Another task is to repress excessive emotion, 
 one of the worst enemies of the neurasthenic, by 
 a healthy philosophy of life and strong moral 
 hygiene. 
 
 Some patients require abnormal pressure. Dr. 
 Weir Mitchell says that many have to be lugged, 
 scolded, teased, bribed, and decoyed into health ; 
 and several such cases rise to the mind. Many
 
 184 FUNCTIONAL NERVE DISEASES 
 
 dyspeptics go on suffering for years from mistaken 
 treatment who could be cured in a day by 
 something more forcible an electric shock or 
 some great trouble or joy. 
 
 Dr. Barras (Paris), after years of treatment 
 for gastric ulceration, was cured in a day by his 
 daughter getting phthisis! 
 
 Access of fatigue in walking, with dizziness, 
 pressure on head, and general debility, all 
 vanished in one case on seeing inlaid in an 
 entrance hall 
 
 " Honour to courage, to weakness shame." 
 
 It has been objected that in these cases medi- 
 cine-taking tends to fix the idea on the illness, 
 and is therefore bad ; but such is not the case. 
 Giving drugs does not fix the mind on the illness, 
 but upon the hope of a cure, which is a very 
 different thing. 
 
 In some cases hysterical paralysis is cured 
 without any local measures, and with great ease ; 
 in others it resists all treatment. In neurasthenia, 
 the relapses during cure are often most trying, 
 requiring great patience and fortitude. 
 
 At the same time, undue attention should never 
 be drawn to the disease in an hysterical patient. 
 Prolonged examination in great detail for clinical 
 purposes always injures such a patient, more or 
 less.
 
 PSYCHOTHERAPY 185 
 
 The application of psychotherapeutics varies 
 immensely. On the Continent it has become 
 more and more pure and direct in applica- 
 tion. 
 
 Professor Dejerine, at the Salp6triere, uses 
 " persuasion " as his chief method of cure, apart 
 from other treatment. Professor Dubois, of 
 Berne, is the able exponent of direct rational 
 cure. He has almost wholly abandoned indirect 
 suggestion, or drugs, or physical treatment, 
 and relies on direct psychic suggestion and 
 persuasion. 
 
 He points out that there is a great difference 
 between the man who allows himself to be under 
 the influence of the personality of a physician and 
 the man who acquires confidence by the clear ex- 
 position of the reason why he should believe ; but 
 I find the former so results from the latter that it 
 is impossible to separate the two. 
 
 He points out that no human brain can resist 
 the weight of pure reason. An appeal to reason 
 in a patient takes, no doubt, much longer than 
 writing a prescription, for it must be done 
 slowly and thoroughly to be effectual ; and pure 
 rational psychotherapy seems most successful 
 abroad. 
 
 It is only, of course, when the doctor has implicit 
 faith in psychic treatment that he can possibly 
 venture on direct statements of cure to a patient,
 
 186 FUNCTIONAL NERVE DISEASES 
 
 and give direct explanations of the psychic nature 
 of the disease. 
 
 In convulsive tics efforts of will are not so 
 effectual in cure as would seem at first thought ; 
 but quiet, rational explanation of the cause, and 
 neglect of the symptoms, rather than their re- 
 pression, generally succeeds. 
 
 In neurasthenic phobias, &c., the great point 
 is to get the idea well fixed in the patient's mind 
 that he can do the particular act he could not do, 
 before he tries to do it. He must not try and 
 fail, for this makes a bad suggestion. 
 
 Suggestion is an agent of mighty power, and in 
 this country, where rational explanations are not 
 so patiently listened to or so implicitly believed 
 in by patients, it forms the chief mode of using 
 psychotherapeutics. 
 
 Of suggestion, Dr. J. W. Springthorpe writes 
 in the Lancet : I " Few indeed are the medical 
 practitioners who daily prescribe ' suggestion ' as 
 well as diet, hygiene, and drugs. Yet the 
 physician who makes even the minimum effort in 
 this direction often does more for his patient than 
 his more highly qualified confrere who makes 
 none. To some, and they naturally the most 
 successful, this endeavour comes without con- 
 scious search, and improves with experience, but 
 in some measure it may be acquired by all, and 
 1 November 18, 1905.
 
 PSYCHOTHERAPY 187 
 
 no one who has become familiar with its powers 
 will henceforward be content to remain without 
 its constant aid." 
 
 Some regard suggestion as an influence on 
 others, some as the infusion of special ideas, 
 producing special actions in neurotics. 
 
 By suggestion is really meant the abrupt 
 entrance of ideas from without into the train of 
 conscious thought, which become part of the 
 mental stream, with results in action. 
 
 Suggestion is not persuasion or rational 
 explanation. The former is addressed in great 
 part to the unconscious mind, the latter to 
 consciousness. 
 
 Bechtren says that suggestion enters into the 
 understanding by the back stairs (unconsciously), 
 while logical persuasion knocks at the front door 
 (consciously). 
 
 All men (and women) are suggestible ; indeed, 
 suggestibility is a normal quality, not an ab- 
 normal, in everyone. 
 
 Human suggestibility, as distinguished from 
 that of mere environment, must be taken as a 
 fundamental factor in the treatment of functional 
 nerve disease. 
 
 Man is in some respects more marked as a 
 suggestible animal than even as a rational or a 
 sane one. Only about 3 per cent are absolutely 
 non-suggestible.
 
 188 FUNCTIONAL NERVE DISEASES 
 
 Suggestibility is not a symptom of hysteria 
 as so largely taught by Charcot. Men with 
 no trace of nervous disease are swayed by 
 suggestion every day that they live. Inferior 
 wine poured out of a bottle with a celebrated 
 brand on it will always seem better than it is, 
 and even a connoisseur of tobacco will have his 
 judgment influenced by a cigar with some well- 
 known band round it. 
 
 A very good way of testing suggestibility 
 is by making a patient hold the rheophores of 
 a battery, and then starting it with loud, rapid 
 vibrations but with no connection with the 
 handles. The vibrations are then felt in exact 
 proportion to the patient's suggestibility, there 
 being no current actually transmitted. 
 
 Suggestibility is, indeed, often easiest in the 
 sound and sane, more difficult in hysteria and 
 neurasthenia, while it is almost impossible in the 
 insane. 
 
 In suggestion, as I have said, it is the un- 
 conscious mind, not the conscious, that is 
 suggestible. Consciousness, to a large extent, 
 inhibits suggestion ; hence the value of semi- 
 consciousness, hypnotic states, and indirect 
 suggestions. 
 
 Professor Sidis, of New York, speaks of an 
 upper and lower consciousness, and postulates 
 unconscious choice and will centres that only
 
 PSYCHOTHERAPY 189 
 
 allow those impressions and impulses that are 
 favourable to the life of the organism to pursue 
 their course and pass up to the cortex, while it 
 nips the others " in the bud." 
 
 This does not appear to be correct, for bad 
 suggestions and impulses reach the cortex as 
 readily as good. Indeed, an impression ceases 
 to affect the cortex, not on account of its moral 
 value, but on account of its frequent repetition, 
 which eventually short-circuits the acquired re- 
 flex through the mid-brain. Suggestions may 
 thus be so frequently repeated as to lose all 
 value, once they are known to be suggestions. 
 
 Suggestive action is not, of course, confined 
 to unconsciousness. It may affect the mind 
 consciously alone, or the mind and the body 
 through the mind unconsciously. 
 
 Suggestion leads to conscious as well as un- 
 conscious action. Direct unconscious mental 
 control exists over all nutrition, and over the 
 action of all organs, and this is influenced largely 
 by the condition of the conscious mind ; hence the 
 value and action of suggestion. 
 
 In suggestion the ideas are accepted un- 
 critically, and it may be unconsciously, and 
 carried out, in a similar way, automatically. 
 Suggestion increases reflex, ideo- motor, and 
 sensory excitability. 
 
 That suggestion is most effectual which forms
 
 ipo FUNCTIONAL NERVE DISEASES 
 
 the last impression made on the patient, and 
 which has been often recapitulated ; for it is the 
 last impression that is the deepest and recurs 
 most in every way. 
 
 For all this, the suggestion of which I am 
 speaking must be entirely dissociated from 
 hypnotism, and conceived only as the implant- 
 ing of an idea consciously or unconsciously. 
 
 The best conditions for normal successful direct 
 suggestion are : 
 
 1. Perfect quiet and repose. 
 
 2. Distraction of attention to other matters. 
 
 3. Monotony of repetition. 
 
 4. Limitation of all voluntary movements. 
 
 5. Limitation of field of consciousness. 
 
 6. Inhibition of alien suggestions. 
 
 7. Immediate execution of suggested idea. 
 
 It need hardly be said that but few of these 
 conditions are usually fulfilled, but they all are 
 desirable. 
 
 The action of suggestion is most capricious 
 and can never be foretold. Of two patients with 
 nerve symptoms, one may recover with a single 
 suggestion, while another continues to suffer all 
 his life, and all suggestions are vain : and it is 
 impossible to tell at sight which will act thus. 
 
 Again, suggestion may at first absolutely seem 
 to fail, and no effect be traceable, and yet the 
 patient may afterwards be cured suddenly by a
 
 PSYCHOTHERAPY 191 
 
 single suggestion ; just like sudden conversion, as 
 in embracing a new faith. Again, suggestions 
 must vary inversely with the case to be 
 effectual. 
 
 To one neurasthenic you may magnify the 
 disease, while to another you may magnify your 
 own power of cure. The manner of suggestion, 
 too, is of importance. It is often found prac- 
 tically that suggestion to a third person in the 
 presence of the patient is more effectual than 
 when made directly to the patient. 
 
 The varieties of suggestion are as follows : 
 
 Suggestion with hypnotism. Suggestion consciously to 
 ,, without hypnot- patient. 
 
 ism. unconsciously to 
 
 direct. patient 
 
 indirect. ,, addressed to con- 
 
 ,, consciously to scious mind only, 
 
 physician. addressed to body 
 
 unconsciously to (unconsciously) 
 
 physician. through mind. 
 
 Auto-suggestion, conscious. 
 unconscious. 
 
 Amongst all these, the greatest interest attaches 
 to the relative value of direct and indirect sugges- 
 tion. 
 
 I am one who believes most in indirect sugges- 
 tion in psychotherapy. Direct suggestion of all 
 sorts most often fails amongst the educated 
 classes, at any rate.
 
 192 FUNCTIONAL NERVE DISEASES 
 
 Direct psychic suggestion, moreover, re- 
 quires far more from the physician, and is not 
 nearly so easy as indirect. I consider that in the 
 normal state a suggestion is more effectual the 
 more indirect it is, and the less so the more 
 directly it is made. 
 
 Professor Sidis, in his " Psychology," says 
 that normal suggestion varies in power directly 
 with its indirectness, and inversely to its 
 directness. 
 
 Dubois, on the other hand, considers that for 
 one cured by indirect psychotherapy there are ten 
 where the cases are prolonged by it, and he is all 
 in favour of direct suggestion. On the whole, 
 direct suggestion is best in hysteria, less so in 
 neurasthenia, and least of all in hypochondria. 
 
 The following is an interesting case : A girl 
 was seized with hysterical anorexia, dyspepsia, 
 and heart palpitation. At the time it happened 
 to be very cold, and the parents told her this was 
 the cause. From this hour she protected herself, 
 and in the hot summer stayed in bed, never 
 opened a window or touched cold water. She 
 kept her hands under the bedclothes and had to 
 put on gloves first (to avoid an attack) before she 
 dare put them out to take a glass of milk. The 
 patient was cured by exposing the autosugges- 
 tion directly not by good suggestion, but by the 
 truth.
 
 PSYCHOTHERAPY 
 
 193 
 
 The response may be mediate or immediate 
 To direct suggestion it is more often the latter 
 and to indirect, the former. 
 
 Direct (Cause). Indirect. 
 
 Immediate (Effect). Mediate 
 
 So far I have only considered suggestion made 
 objectively by a suggester, which may include 
 doctor, nurse, friend, or even the treatment or 
 environment. 
 
 Subjective or autosuggestion is another 
 variety altogether. 
 
 Autosuggestion is quite a different matter 
 from suggestibility, and is frequently strongly 
 marked in mental disease. In paranoia, as 
 Professor French shows, there is abnormal auto- 
 suggestion, which gives extraordinary significance 
 to unimportant details in the conduct of others. 
 These details, the paranoiac suggests to himself, 
 are purposive and of sinister design. Bad auto- 
 suggestions are much more common than good 
 suggestions. A man who is most susceptible to 
 the former is not necessarily susceptible to good 
 suggestions ; and we must remember that if good
 
 194 FUNCTIONAL NERVE DISEASES 
 
 autosuggestion may cure, bad autosuggestion 
 certainly can cause disease. Therefore, if pre- 
 vention be better than cure, it is best to be with- 
 out autosuggestion altogether. A man, there- 
 fore, incapable of it is probably on the whole 
 the best off. 
 
 It is said that every sensation of all five senses 
 is in its last analysis the product of autosuggestion. 
 
 Autosuggestion in those susceptible is ever 
 and everywhere at work. 
 
 All objects and foods affect us ; but when our 
 autosuggestion is in the same line as the natural 
 effect, the effect is doubled ; whenjn the opposite 
 line it is halved. The success of half our 
 dietaries is the result of autosuggestion. 
 
 Autosuggestion often supplements suggestion. 
 When we begin to make long statements to a 
 patient as to the disease, the prognosis, the effect 
 of treatment, &c., we may be making a grave 
 error and inflicting injury on the patient, as his 
 autosuggestion may increase the meaning of our 
 words to any extent. 
 
 If the fact of autosuggestion of evil can be 
 made plain to a patient, it often loses its force, 
 as in pain from electricity when it is proved no 
 current passed ; and the exposure of one error 
 of autosuggestion often leads the patient to detect 
 many others she may suffer from. No patient is, 
 however, cured, even if she has overcome the
 
 PSYCHOTHERAPY 195 
 
 results of her autosuggestion temporarily, unless 
 they are absolutely removed. Many suggestions 
 made by the doctor are so heterodox to the 
 patient that they are not assimilated, until later 
 on they become digested, and then as auto- 
 suggestions their effect is realised. 
 
 Before closing this chapter I must say one 
 word on hypnotism. 
 
 All hypnosis is effected by suggestion pure 
 and simple, sometimes combined with eye-strain, 
 more frequently not. 
 
 Patients are hypnotised by sensory impressions, 
 including vocal and other sounds, light and 
 bright objects, rubbing, and passes of the hands. 
 Also by fatigue and effort, as in forced and con- 
 strained positions. 
 
 Gazing at bright objects does not, however, 
 always induce hypnotic sleep. 
 
 At the Salpetriere a bright object is exhibited, 
 and if suddenly withdrawn catalepsy is induced, 
 if gradually, lethargy. In the first the eyes 
 remain open, in the second they are closed. If 
 the eyes are opened, then the patient passes into 
 catalepsy. 
 
 There are several stages in hypnotism. There 
 is (i) somnolence or sleepy condition, (2) light 
 sleep, and (3) somnambulism. 
 
 The Salpetriere considers that only those liable 
 to hysteria can be brought into this third stage.
 
 196 FUNCTIONAL NERVE DISEASES 
 
 At the school of Nancy (a home of hypnotism) 
 it is considered that none of the symptoms are 
 pathological, and that the whole are but stages 
 of an artificial trance in which the unconscious 
 mind can be easily reached. For in spite of 
 Professor Ziehen there is no doubt whatever that 
 mind is present in the actions of the hypnotic 
 state. The Salpe"triere, on the other hand, really 
 regards the hypnotic state itself as a symptom 
 of hysteria. Of course, if the hypnotic state be 
 in itself pathological, to induce it is to induce 
 an attack of hysteria ; but in this country no 
 such view is taken. 
 
 In hypnotism the functions of the conscious 
 will are in abeyance as well as full consciousness. 
 To explain such phenomena as the following, 
 Janet and others resort to the theory of a double 
 consciousness. He asks a hypnotised patient : 
 " Do you hear me ? " " No." " But to answer 
 one must hear." "Yes." "How, then, do you 
 manage ? " "I don't know." 
 
 The phenomena of hysteria are always losses 
 of some sort, either sensory or motor, including 
 temporary paralyses or spasms or hysteric fits, or 
 psychic, such as abolition of will with abnormal 
 stimulation of memory, which of course is a gain. 
 
 There are somatic phenomena, such as flush- 
 ings, slight rise of temperature. These symptoms 
 are of course but temporary, and disappear with
 
 PSYCHOTHERAPY 197 
 
 the hypnotic state. Sometimes, also, the cure 
 effected by the hypnotic hallucinations induced 
 by suggestion lasts only a short time, and after- 
 wards the disease returns. 
 
 The latest methods of hypnotising do not 
 necessarily induce sleep, or even attempt it. The 
 operator is quite content with the first stage of 
 sleepiness, which is induced merely by being in 
 a recumbent position in a quiet room and lying 
 perfectly still and passive with the mind at rest. 
 The operator then, sitting by the bed, with or 
 without holding the patient's hand, repeats his 
 suggestion of good in a monotonous voice over 
 and over again, or he may make the suggestion 
 and then sit in silence ; sometimes a hand is on 
 the forehead or over the solar plexus. The more 
 direct these suggestions are in this semi-hypnotic 
 state, the more effectual they seem to be. In 
 many cases a friend also sits in a corner of the 
 room without speaking. 
 
 I am bound to say the therapeutic results in 
 functional nerve diseases are very disappointing. 
 While in hypnotism we have a very remarkable 
 power, of value in diagnosis, and especially in 
 investigation of obscure mental states, in perform- 
 ing feats of memory and other wonders, in the 
 relief of pain, the fact remains that in connection 
 with functional nerve disease the patients are 
 very difficult to hypnotise, difficult to cure, and
 
 198 FUNCTIONAL NERVE DISEASES 
 
 when cured are very prone to relapse. At first 
 sight they seem typical cases for this treatment, 
 but in practice it is most disappointing. Person- 
 ally, I never hypnotise, and do not suppose I 
 could, but when necessary I send my cases to 
 well-known experts, and such is my experience. 
 One can only think from Continental records 
 that the difference of temperament accounts for 
 the greater results there. 
 
 The treatment is not without its evils and its 
 dangers. Some get a hypnotic habit, like opium- 
 eating, and they must continually have recourse 
 to it, others continue under influence afterwards, 
 and some have their maladies increased. 
 
 At any rate, in my opinion it is not a remedy 
 to be lightly used, nor one in which, in functional 
 nerve diseases, one can be very sanguine as to 
 results. At the same time one comes across 
 many cases of obsessions where one feels bound 
 to try it. 
 
 Even Professor Bernheim acknowledges that 
 very few nerve cases can be hypnotised. 
 
 Brewer and French believe that the basis of 
 hysteria is sexual, and that the subconscious 
 cause or idea may be brought into view and 
 successfully eradicated by hypnotism. With such 
 a view I cannot agree. Perhaps on the whole, 
 in nerve diseases, hypnotism is most effectual in 
 the production of sleep and in the relief of pain.
 
 CHAPTER XI 
 
 THE REST CURE 
 
 I ADOPT as title to this chapter, not without 
 hesitation, the popular term for all treat- 
 ment broadly based on the lines so scientifically 
 laid down by Dr. Weir Mitchell. The term 
 itself is a gross misnomer, as the treatment is 
 not, and was never intended to be, one of mere 
 " rest." 
 
 There are conditions and diseases that require 
 rest and nothing else ; but the treatment in bed 
 of functional nerve disease cannot by any stretch 
 of imagination be described as rest. Physio- 
 logically, the activity is extreme, and physically, 
 the patient "at rest" is made to go through 
 exercises said to equal walking nine miles a 
 day. There are, of course, all degrees of rest, 
 from the curtailing of excessive work to the 
 absolute relaxation of every muscle and of the 
 mind in isolation in bed. This latter, indeed, 
 forms an essential part of the cure, and the pas- 
 sive relaxing of every limb and muscle in bed
 
 200 FUNCTIONAL NERVE DISEASES 
 
 while lying perfectly still is by no means attained 
 by every patient. Still, it is aimed at, so that if 
 it be not a rest cure there is at least rest in 
 the cure. 
 
 There is no doubt that the general principles 
 of this cure are common property, and everyone 
 who has heard of Weir Mitchell thinks himself 
 fully competent to carry out this treatment. The 
 result is too frequently a great disaster. For the 
 first thing a doctor does now, who in his practice 
 comes across a case of (much disliked) functional 
 nerve disease, is to order "a rest cure," pretty 
 much as he would order a cab or a pill. The 
 result too often is failure, and not only failure, 
 but the patient remains uncured with a great 
 prejudice established against the One means 
 which, rightly used, can cure her ; and this is a 
 great disaster. 
 
 When I started this class of practice, soon after 
 Dr. Playfair, every case I saw was a virgin case, 
 and had not been tampered with in any way ; 
 and there was no difficulty whatever in getting 
 these patients to do exactly as they were ordered. 
 Nowadays you hardly see a case, and suggest 
 the patient going to bed, but what you find she 
 has had two or three futile "rest cures," and is 
 now a profound sceptic in the matter, and abso- 
 lutely refuses yet again to go through the trouble 
 and expense involved. Can anything be worse
 
 THE REST CURE 201 
 
 than to mismanage such an invaluable means of 
 cure? 
 
 I would therefore earnestly entreat all who 
 read these pages never to attempt a " rest cure " 
 without personal superintendence in the using of 
 every possible means to make it a success. And 
 also, I would ask them to discourage, what is 
 now so common, undergoing rest cures without 
 medical advice at all. All this tends to bring 
 into contempt, and to lessen the value of, a 
 therapeutic, the importance of which cannot be 
 overestimated. 
 
 What, then, is the cause that failure is so 
 common ? 
 
 The fundamental reason is that the medical 
 training of to-day, however thorough in many 
 directions, is of little use practically in these 
 cases, and takes no means whatever of im- 
 pressing on the student that the patient's mind 
 has any direct connection with the cure of his 
 disease, nor in any way showing how to influence 
 that mind for good. And it is these students, 
 as doctors, who make these egregious failures. 
 
 The fact is that patients are human beings, 
 and cures cannot be "machine made," but must 
 be hand made ; no two exactly alike, but the 
 treatment varied to suit the particular case or 
 individuality. The essence of success in the 
 " rest cure " lies in its details, and the way in
 
 202 FUNCTIONAL NERVE DISEASES 
 
 which the whole environment home, nurse, 
 masseuse, matron, doctor is made to suit the 
 case, and in the strong suggestive treatment that 
 accompanies it all through. What I mean exactly 
 will come out in the brief outline of this treatment 
 that I will now give, which is based upon the 
 description given of the rest cure in a previous 
 work of mine. 1 
 
 The treatment can, of course (with difficulty), 
 be carried on in the patient's own home but 
 success is never so assured, and the objections 
 are serious. 
 
 It is so difficult to secure quiet and isolation, 
 and the familiar surroundings are just so many 
 hindrances. 
 
 Wherever possible, therefore, a "home from 
 home " should be used. Personally, I do not 
 approve (for many reasons) of physicians running 
 their own homes. The best is to have one or 
 two homes in which you can have your own 
 way, and yet are not tied to, and above all, 
 have no pecuniary interest in. 
 
 The treatment is summarised thus by Weir 
 Mitchell : "(a) The patient is placed in a private 
 house (according to his means), and is best if 
 away from home, the room being sunshiny and 
 freely capable of ventilation. (b) The nurse 
 
 1 " The Management of a Nerve Patient " (Churchills, 
 1906).
 
 THE REST CURE 203 
 
 should be preferably young, of agreeable manner, 
 and a stranger to the patient. She should never 
 converse with the patient about symptoms or 
 treatment. She should be able to read aloud. 
 (c) Isolation is most important, and the more 
 distinctly hysterical the disease is, the more strict 
 the isolation must be. No letters are sent or 
 received. No visitors seen, and but three or four 
 persons enter the room the nurse, the physician, 
 the masseuse, and the servant, (d) In ordinary 
 cases six or eight weeks of isolation are long 
 enough, after which a single visitor may be 
 allowed. Letters may then be received or 
 written in the way of reward for good conduct. 
 This long isolation is necessary to break up 
 radically the habits of long invalidism. (e) Rest, 
 at first ill-borne and irksome, is well borne after 
 a week. At first, feeding should be done by the 
 nurse, and the patient overfed. All voluntary 
 movements should be forbidden, except getting 
 up for the bowels, &c. ; the circulation and the 
 thinking are thus kept at a low level, and one 
 result soon observed is the improvement of the 
 ability to sleep. (/) Diet : milk in small quan- 
 tities is given every three hours, skimmed, if 
 ordinary milk is not tolerated. On the fifth day 
 of treatment a chop or steak at mid-day is given. 
 From the sixth day onwards bread and butter and 
 eggs are allowed ; if milk is badly borne, broth
 
 204 FUNCTIONAL NERVE DISEASES 
 
 and jellies will give satisfaction, (g) Massage : 
 a separate masseuse is advisable. Massage 
 should begin on the third day with light massage 
 lasting twenty minutes and increasing daily to 
 deep massage lasting one hour or more. If the 
 patient is obese, long and deep massage is good ; 
 a second rubbing of the abdomen and spine by 
 the nurse before sleep is helpful. At the end 
 of the first week of treatment the patient will 
 begin to put on weight, but if this goes up too 
 fast, massage is not thorough enough, and should 
 be increased. Oil is not necessary to aid mass- 
 a g e - W Electricity : the slowly interrupted 
 faradic current should be applied to the 'motor 
 points ' all over the body, so as to contract every 
 muscle two or three times. This should be 
 continued for three-quarters of an hour, (z) Con- 
 stipation is treated with aloes and strychnine 
 pills, and for specially refractory cases hot in- 
 jections of castor oil per rectum may be given. 
 (k) Insomnia is diminished by massage before 
 bedtime. Hypnotics should be avoided, and the 
 wet-pack or abdominal compress first tried. 
 (/) After the first week the patient is allowed 
 to sit up fifteen minutes, the next day twenty 
 minutes, &c. In a fortnight he is allowed to 
 walk in the room after passive movements of the 
 legs have been carried out ; Swedish movements 
 complete the exercise and cure."
 
 THE REST CURE 205 
 
 This regime deserves close consideration as 
 coming from the illustrious founder of this system 
 of cure, and is perhaps, with some exceptions, 1 
 as good a one as could be devised ; but I do 
 not believe in any fixed routine, and the above 
 has to be widely varied in different cases. You 
 cannot set a rudder to steer a ship across the 
 Atlantic, nor can you set with success one fixed 
 course for all nerve patients. For instance, I may 
 point out that a neurasthenic patient as a general 
 rule is made worse by fighting symptoms, and 
 yet is always willing to do so ; while in hysteria 
 the patient is better by so doing, but generally 
 unwilling ; the same rules cannot therefore apply. 
 
 Turning to my own experience in the rest cure, 
 I find that rest in bed is indicated as the first 
 step in all cases of nervous debility, exhaustion, 
 or break-down, cerebral and spinal neurasthenia, 
 malnutrition, hysteria, and neuromimesis, with 
 all their varying train of symptoms. Also in 
 some cases of nervous irritability, depression, 
 hypochondria, mixed organic and nerve disease, 
 mixed mental and nerve disease. 
 
 The rest in bed is accompanied by some or 
 
 1 Personally, I commence solid food much sooner than 
 the fifth day. I do not value broth or jellies in the cure 
 at all ; I begin massage sooner ; I give it twice a day 
 instead of once ; I find that many cannot bear such severe 
 electricity as to contract all the muscles, also that consti- 
 pation can be cured without medicine.
 
 206 FUNCTIONAL NERVE DISEASES 
 
 all of the following : rest in bed, food, massage, 
 electricity, mental therapeutics, nursing, occupa- 
 tion, isolation. I will consider these eight points 
 very briefly. 
 
 i. Rest in Bed. This should be absolute, 
 generally from a minimum of a fortnight to a 
 month or two i.e., the patient should only get 
 up (if ordered) to her bath and for daily relief. 
 The bed should not face the light, but preferably 
 be sideways to the window, so that the patient 
 can look out if she wishes, and yet has a good 
 light on her book or work. The bedstead 
 must never be less than three feet wide, and 
 preferably three feet six inches. There is a great 
 advantage in four feet six inches, as then the 
 patient has practically two beds, changed at will 
 without fatigue. Some patients cannot rest in a 
 narrow bed if always accustomed to a wide one. 
 
 In a nursing home, however, this is nearly 
 impossible to get, and I have had to cure some 
 cases in private hotels solely on this account. 
 The springs should be firm and not " sag " in 
 the middle, as so many of the cheap chain 
 springs do. These are not surgical cases, and 
 there is no objection to box springs, which are 
 most comfortable. But here again you generally 
 have to take the bed the home provides. The 
 mattress should be firm, elastic, and comfortable, 
 and this should not be taken for granted, but
 
 THE REST CURE ** 207 
 
 ascertained (in a nursing home nothing should 
 be taken for granted at first). The sheets, 
 pillows, blankets, &c., should all be what the 
 patient likes. I have had cases who had no 
 rest until they had their own pillows and fine 
 cambric sheets from home. Some, again, like 
 very light down covering, others heavy blankets 
 only. In all these cases, at first, at any rate, 
 harmless tastes should be indulged, and nothing 
 should be accounted trivial. It is sometimes 
 difficult for a patient in a state of tension to 
 rest in bed. These must be taught. Get her 
 to lie down, as Dr. Campbell advises, to relax 
 the entire muscular system, to take slow, deep 
 breaths, and to allow the mind to remain as far 
 as possible a blank. Test the state of the muscles 
 by lifting a limb ; and not till it drops in a per- 
 fectly limp, passive way has the required relaxa- 
 tion been reached. See that all the muscles of 
 the face are relaxed. As long as the brows are 
 knit, there is no mental repose. Let the patient 
 practise this until she can lie habitually in bed 
 in this relaxed condition. A little table, bright 
 with the patient's household gods, should stand 
 near. The room should look as little like a 
 nursing home as possible. Flowers about, a 
 little untidiness, and an absence of that aggrava- 
 ting squareness and aggressive cleanliness of 
 the ordinary surgical home are helpful. The
 
 208 FUNCTIONAL NERVE DISEASES 
 
 room should be capable of being stamped with 
 the individuality of the patient, so as to have a 
 " homey " feeling. It should be bright, airy, 
 and yet quiet ; and the quiet should not be 
 merely as regards noises outside, but inside the 
 house. I have known many cases marred for 
 want of attention to this latter point. There 
 should be no sounds or news of operations, &c., 
 conveyed to it, nor any smell of chloroform or 
 disinfectants. I myself like carpet on the floor ; 
 at any rate, in part. I do not think kamptulicon 
 is ideal for a bedroom, and we do not want 
 antiseptics here. 
 
 The artificial light should be good and bright, 
 and near the bed for reading. A shaded candle 
 or electric light should be available in the night 
 if wanted. The nurse should not sleep in the 
 room, save in special cases. 
 
 The rules of the home must not be so rigid 
 that the breakfast is necessarily at eight, or, 
 indeed, at any fixed hour. The patient must 
 not be waked for the grate to be cleaned, &c. 
 In short, the rules and the home must fit the 
 patient, and not the patient fit the rules. If the 
 case is soon to get up and go out for a time, the 
 room should not be up too many flights of stairs. 
 
 2. Food. This is required, whether the case 
 be Weir Mitchell or no. There are four sorts of 
 cases as regards food : those that require ordinary
 
 THE REST CURE 209 
 
 diet only ; those that require excess of ordinary 
 diet ; those that require less than ordinary diet, 
 and those that require special dietaries. I will 
 take these in order. 
 
 Those who require Ordinary Diet. These are 
 in a great minority. It is seldom you get a func- 
 tional nerve case where the nutrition is not wrong 
 in some way, and nearly always it is indigestion ; 
 in a few cases there is an excess of unhealthy 
 tissue, but the condition is seldom normal. In 
 this, as in all other cases, the food should always 
 be well cooked, served hot and punctually, with 
 sufficient variety. The breakfast should be 
 appetising, with nice bread, toast, good butter, 
 cream, marmalade, &c. The lunch should be 
 the principal meat-meal, with abundance of good 
 meat and fish, vegetables and bread, and good 
 milk, or suet or other puddings, and some good 
 fruit. 
 
 The afternoon tea should be well made, with 
 nice bread and butter and cake and cream. 
 
 The dinner should have soup or fish, lighter 
 meat, or fowl, or game, and vegetables and nice 
 puddings. 
 
 Tea, coffee, or cocoa for breakfast, water or 
 light wine for lunch and dinner, and in some 
 cases coffee after dinner. 
 
 A well-mixed dietary should not be departed 
 from without special reasons.
 
 210 FUNCTIONAL NERVE DISEASES 
 
 Then there are those who require excess of food. 
 These are three parts at least of your cases, and it 
 is with these you require the greatest skill. The 
 best plan is always to give nothing whatever at 
 first but a good half-pint of milk, hot or cold, 
 and diluted if wished, every two hours ; with no 
 food besides, except a dry biscuit, if hungry. 
 This may not agree with all, but it will with 
 most, including many who declare they cannot 
 take milk. If it does not agree, add lime water 
 or use Horlick's malted milk, or peptonise wholly 
 or in part at first ; but never rest until you have 
 got two or three quarts of ordinary milk taken 
 daily. This is your foundation-stone. 
 
 The next thing to add, I find, is a concentrated 
 meat-juice, digested by acid in the cold from 
 beefsteak, at the rate of 2 Ib. daily to make one 
 pint of the fluid. This may be divided into four 
 portions and treated as follows : a quarter of a 
 pint in a coloured glass, flavoured with salt or 
 celery-salt, with a tablespoonful of extract of 
 malt, and then whatever medicine is being 
 given (generally some form of strychnine and 
 iron), may be added to it. The whole is called by 
 me " carnomaltine," and by my patients " corpse- 
 reviver." We now have a basis to which foods, 
 properly so called, can be added. 
 
 This is best done at the rate of a meal a day, 
 after twenty-four to seventy-two hours of the
 
 THE REST CURE 211 
 
 liquid dietary that is, breakfast first, and after- 
 noon tea ; breakfast, lunch, and afternoon tea 
 the next day ; breakfast, lunch, afternoon tea and 
 dinner the next day ; and finally, breakfast, lunch, 
 afternoon tea, dinner, and supper. 
 
 This last meal should be taken at ten or half- 
 past, just before going to sleep, and should 
 consist of a pint basin of bread and milk, or 
 Quaker oats, or Force food, or Grape nuts, or 
 Benger's food, or suchlike preparations. 
 
 The quantity at each meal should be small at 
 first, but slightly increased each day steadily 
 and systematically and yet with discretion. If 
 there be any difficulty as to food the spectre of 
 " consumption " may be evoked, that makes 
 such a ready prey of the emaciated. 
 
 If a bilious attack or anything of the sort 
 intervenes, the diet should at once be lessened, 
 or a meal omitted, or in extreme cases the 
 patient should return to milk only, and start 
 again. It is the perseverance that succeeds, 
 combined with wise forbearance when necessary ; 
 in short, from first to last, it is " management." 
 
 The idea is that the patient should gain in 
 weight, after the first day or two, not less than 
 half a pound a day, or 3 Ib. a week, or a stone 
 per month. It is not advisable to try to go 
 faster than this, though, if the patient does so 
 with ease, no harm is done ; neither should the
 
 212 FUNCTIONAL NERVE DISEASES 
 
 patient go slower ; but if she does, and does not 
 mind giving double the time to the cure, the results 
 are quite satisfactory. On an average a patient 
 requires to put on from one to three stone. 
 
 If not bilious, one, two, or three eggs a day 
 can also be given, beaten up in the milk. 
 
 Small game, jellies, clear soup, and such foods 
 should not be given. They add no weight. 
 
 We must now consider those who require less 
 than ordinary diet. 
 
 I cannot do better than recall a case, for they 
 are not very common ; and personally, I never 
 look on a stout person with functional nerve- 
 disease so hopefully as on a thin one. We must 
 remember these patients want thinning and 
 strengthening, with (for the sake of the nerves) 
 entire rest in bed. 
 
 Of course, the Salisbury diet (if the kidneys 
 are quite sound) accomplishes this, and I have 
 used it in some cases. But the diet of minced 
 beef and hot water is so unnatural, and to many 
 so repulsive after a time, however well cooked, 
 that one does not resort to it save in case of need. 
 
 In the case I allude to, I gave two quarts, 
 not of skim milk, which still retains a lot of cream, 
 but "separated," which has all the casein intact 
 and no cream whatever. I gave a diet of meat, 
 some vegetables, one slice of hard thin toast, 
 tea, stewed fruit, with saxin for sugar all
 
 THE REST CURE 213 
 
 through, the patient to lose half a pound a day 
 as a maximum (not minimum, as in other cases) 
 until the proper weight was reached. I took 
 in this way nearly three stone off a young girl 
 of twenty, keeping her strong and well all the 
 time. In many cases the result can be attained 
 simply by a reduction of ordinary diet, and as 
 this is generally successful in light cases, I have 
 included these under ordinary dietaries. 
 
 Lastly, there are those who require special 
 dietaries. These include some of the rheumatic 
 and the gouty, the diabetic, the dysenteric, 
 nephritic, and other cases. 
 
 In the first two you may often, with advantage, 
 humour the case for a time by eliminating beef 
 and sugar, but you can never regard them as 
 cured until an ordinary diet can be assimilated. 
 A person permanently on a special diet is not in 
 health, strictly speaking. I do not think I need 
 here describe the special dietaries required in 
 each case, as these form rather a part of general 
 medicine, which I do not wish to touch in this 
 monograph. 
 
 I merely call attention to fact here that the 
 cure of functional nerve diseases, when mixed 
 with organic disease, may require special dietaries 
 in their earlier stages, at any rate ; and these 
 ought therefore to be given. 
 
 But as a rule in all possible cases the ordinary
 
 2i 4 FUNCTIONAL NERVE DISEASES 
 
 diet of a healthy individual should be given, 
 the only difference being in the quantity. I am 
 quite aware that an easy path to a so-called 
 cure is found in eliminating from the diet what 
 causes dyspepsia or " uric acid." But I term the 
 cure "so-called," because I do not think it is 
 really a cure when a weakness, such as dys- 
 pepsia or "uric acid" formation undoubtedly is, 
 is pandered to instead of being removed. 
 
 To my mind a better way is to strengthen the 
 nervous and digestive systems so as to overcome 
 these disabilities, and force the digestive organs 
 to do what they could not do, and thus make 
 them assimilate ordinary food instead of cutting 
 it off. 
 
 I am the enemy and not the friend of fads in 
 the way of diet, and I consider great evil has 
 been wrought, and nervous dyspepsia made 
 permanent in many cases, by the easy plan of 
 writing out special dietaries. 
 
 As a rule we have nothing to do in functional 
 nerve disease with febrile attacks; should these 
 occur, of course liquid food only must at once 
 be given. 
 
 We may now leave the food and pass on to 
 the next feature of the treatment. 
 
 3. Massage. This is necessary in all cases, 
 but not always for the same reason. It is 
 primarily given to digest the food. The tradi-
 
 THE REST CURE 215 
 
 tion on which it is based is that two hours' 
 massage a day is equivalent to walking nine 
 miles, and a person should walk about a mile 
 a day for every stone he weighs. I have never 
 known on what calculation this is based ; but, 
 anyhow, two hours a day is the full amount ever 
 given. 1 Massage varies very much in quality, 
 besides being of two distinct varieties Swedish 
 and English. There is no doubt in my mind 
 (nor, I think, in any one else's) that the Swedes 
 are the more thoroughly taught, the more work- 
 manlike, and the more efficient ; but the English 
 are often quieter, more amenable, and able to 
 exercise greater mental influence as well. I 
 find, practically, that some much prefer the 
 Swedish and others the English form, and both 
 do well. Having ever before me the great 
 influence of the mind over the body all through 
 this cure, I am of opinion that, providing both 
 are done thoroughly well, that system will answer 
 best where the personality of the masseuse is most 
 agreeable to the patient. I fear this sounds, 
 like much else, rather unorthodox, but it is 
 founded on long and wide experience. When 
 there are special symptoms, such as weak muscles, 
 wasting, heart and liver trouble, &c., the massage 
 must be specialised, and suitable movements and 
 
 1 I know, however, one enthusiast who gives his patients 
 six quarts of milk and four hours' massage a day !
 
 2i6 FUNCTIONAL NERVE DISEASES 
 
 exercises added to it. Perhaps the most useful 
 of these are the " Widerstandung Gymnastik," 
 or the resisted exercises, of which there are a 
 great variety with either the patient resisting 
 the masseuse or vice versa and which range in 
 importance from the bending against resistance of 
 a single finger-joint to the flexion of the thigh or 
 the whole body. 
 
 The effect of the massage, general or specialised, 
 will, of course, be carefully watched by you ; and 
 speaking in general terms, if the bowels become 
 regular, all the food is digested, and the patient 
 gains strength and likes the masseuse, you have 
 every reason to be satisfied. 
 
 4. Electricity. Here I want to give those who 
 wish to manage a nerve patient in the most 
 effective manner a most important hint, and it is 
 this : I have said enough already to show how 
 much I think a wise physician can do to assist a 
 nerve patient to use her unconscious mind, and 
 thus overcome her weaknesses when sufficient 
 physical rest and strength have been given. 
 
 Indeed, the physician's presence, words, counsel, 
 and encouragement are (as I shall show fully later 
 on) large factors in determining the cure. Now, 
 it is awkward to come daily and sit by a patient 
 and simply talk, with nothing whatever to do. 
 Your medical inquiries and instructions do not 
 take long. What you want is opportunity for
 
 THE REST CURE 217 
 
 quiet talk with your patient, both to get at her 
 mind and to make her understand yours. Here 
 electricity comes in as a perfect boon. 1 1 is well, 
 therefore, never to let a nurse or masseuse give it 
 or speak about it, and to keep it absolutely in 
 your own hands. The electricity that is most 
 generally used is a slowly interrupted faradic 
 current of as much strength as the patient can 
 bear without pain, given all over the body, which 
 for this purpose is divided into six parts four 
 limbs, stomach, and back. The two well wetted 
 (salt and hot water) rheophores can be used, or 
 the wet pad laid over the solar plexus, or on the 
 lumbar spine, and one rheophore used. It is well 
 to have the nurse out of the room but within call. 
 You have now your opportunity. You are giving 
 the patient treatment which she can understand 
 and appreciate ; but at the same time you can help 
 her mind immensely to aid her body. More than 
 that, you can in many cases so alter her outlook on 
 life that she will not relapse when she leaves you ; 
 you can also help her to help herself. But I by 
 no means think that the importance of electricity 
 consists only in its mental value (which is placed 
 by Mobius at four-fifths and by Eulenburg at one- 
 fifth of its total effect) or the opportunity it gives 
 for wise counsel. It has been shown to have a 
 marked effect on muscular tone, on the circulation, 
 and on the nervous system, all of a beneficial
 
 218 FUNCTIONAL NERVE DISEASES 
 
 nature. Rightly used, I consider it, in the triple 
 way I have stated, one of the most useful agents we 
 have. But all depends upon the physician taking 
 his proper place as the healer and the inspirer, 
 and recognising that the chief factor in the cure is 
 not the rest or the food, the massage or the 
 electricity, but in many cases himself. 
 
 5. Mental Therapeutics. I have already 
 spoken so fully of these in all their varieties 
 in the chapter on psychotherapeutics that it 
 only remains for me here to give a few brief 
 hints applicable to this treatment in bed. I have 
 indicated what a good opportunity electricity 
 affords to a wise physician for good suggestion, 
 but it must not be imagined that he is the only 
 agent. The home, the nurse, the treatment 
 itself, the masseuse, if worth anything, all com- 
 bine in suggesting cure and relief. 
 
 One may say at once that in this cure the rest, 
 isolation, and feeding are all secondary in insur- 
 ing success to the mental attitude of the patient ; 
 and that it is the ignorance of this central fact 
 that is the chief cause of failure. The rest treat- 
 ment is one long suggestion throughout on its 
 mental side, and persuasion and hygienic ideas 
 are the chief curative agents. It must, of course, 
 be remembered that only food, rest, and elec- 
 tricity can create vital force. Encouragement 
 and mental ideas per se no more increase strength
 
 THE REST CURE 219 
 
 than anger or alcohol. Fresh muscular or men- 
 tal power is not given by these ; they only enable 
 all that is there to be more readily expended. It 
 must clearly be understood that the fresh power 
 from good news, good will, alcohol, or even 
 anger, is never dynamogeny, or the accession of 
 fresh force, but dynamophany, or the expression 
 of latent force. Daily conversations with the 
 patient are all-powerful if rightly directed. One 
 must, of course, touch the patient's mind, and 
 this sometimes takes days to effect ; until then, 
 however, you are only beating the air. There 
 must also not be too much zeal, the patient must 
 not be overtreated ; and the directness of the 
 suggestions must ever be guided by the recep- 
 tivity of the patient ; in fact, one must feel one's 
 way. While much is noticed, much must be 
 neglected, such as attention to slight symptoms, 
 though even in these with some it pays best to 
 treat them with great respect. The mental side 
 of the physical treatment must not be forgotten ; 
 and no surprise need be felt at remarkable results 
 following the most inadequate physical means, 
 provided they seem effectual to the patient 's mind. 
 For instance, faradisation of the urethra is thus 
 one of the best cures for incontinence, however un- 
 scientific. Of course, at times pure direct mental 
 treatment can be used with success, as in the 
 case of well-marked local pain, which can often
 
 220 FUNCTIONAL NERVE DISEASES 
 
 be cured for the time by the doctor placing his 
 hand firmly on the spot, and assuring the patient 
 it is getting better until it goes. 
 
 I must not, however, pursue this fascinating 
 subject further here, having treated it so fully 
 elsewhere, J only repeating that no rest cure that 
 does not definitely and intelligently include real 
 psychic treatment is likely to be successful in 
 cases presenting any difficulty. 
 
 It is perhaps as well here (though one would 
 hope it unnecessary) to point out in the strongest 
 way the absolute necessity, while using such 
 powers, of maintaining, naturally and without 
 effort, the loftiest moral standpoint, with a single 
 eye to the patient's recovery, and an absolute 
 determination to let no factor enter into your 
 intercourse with her but what is distinctly of 
 therapeutic value. This by no means limits 
 your conversation to medical subjects, which are 
 often of no therapeutic value at all. 
 
 Physicians have ever maintained a lofty code 
 of ethics in these matters, but it has been made 
 easier in ordinary cases by an aloofness from 
 personal interest in the patient and a heavy pro- 
 
 1 " Unconscious Therapeutics, or the Personality of the 
 Physician" (Churchills), 2nd edition. " The Force of 
 Mind, or the Mental Factor in Medicine " (Churchills), 
 3rd edition. "The Unconscious Mind" (Hodder & 
 Stoughton), 2nd edition.
 
 THE REST CURE 221 
 
 fessional air. All this defensive armour must be 
 laid aside if you yourself are to help the patient ; 
 hence, all the more earnest and constant watch- 
 fulness and care are needed that the freedom of 
 the intercourse, on which its power and success 
 depend, should never degenerate into familiarity 
 or licence. Here, I think, comes in the force of 
 Professor Nothnagel's dictum, " Only a good 
 man can be a good doctor." 
 
 6. The Nursing. If this factor in the case 
 goes wrong, the patient will very likely not be 
 cured. 
 
 You are surprised in some cases to find you 
 make no progress physically or psychically, and 
 then you discover that the nurse has been secretly 
 undermining your influence. Do not think this 
 impossible, because it is not at all uncommon. 
 This is one reason for having the nurse out of 
 the room when you chat to the patient. You 
 have an opportunity then of hearing the patient's 
 real opinion about the house, nurses, &c., which 
 is always good to hear, but need not be heeded. 
 But you will soon find out if the nurse is really 
 loyal. Of course, when she is not, I do not for 
 a moment think it is necessarily from any bad 
 motive. She very likely does not understand 
 your methods or aims, and therefore regales the 
 patient with stories of the much wiser methods 
 adopted by other doctors. It may be all well
 
 222 FUNCTIONAL NERVE DISEASES 
 
 meant, but it is none the less pernicious, and 
 hinders the patient getting well. Always be sure 
 the nurse is absolutely loyal, not for your sake, 
 which matters little, but for the patient's. 
 
 In most cases it is a great advantage to have 
 a special nurse that is, one who has no other 
 case to look after. This gives her at once an 
 interest and an importance that make her twice 
 as attentive to the welfare of the patient, besides 
 having much more time to read, play games, &c. 
 
 Now as regards the qualifications of a nerve 
 nurse. 
 
 I consider the nurse who can nurse a nerve 
 case efficiently has reached the very highest place 
 in the profession. There is not the least doubt 
 that the nurse who has the power of meeting the 
 vagaries of a diseased mind or exhausted nerves 
 successfully has reached the summit of con- 
 summate tact and intellectual power. A good 
 surgical nurse represents the highest form of 
 mechanical skill, but the training that will turn 
 out a surgical nurse to perfection will not make 
 a good nerve nurse unless it be carefully supple- 
 mented afterwards. A nerve nurse has a very 
 great deal to do with the recovery of her patient. 
 She is nearer to giving medical aid than other 
 nurses, because the medical aid a doctor gives 
 is by no means confined to his prescriptions : it 
 means tact and skill, and the mental touch by
 
 THE REST CURE 223 
 
 which he can reach the patient's ailments. In all 
 this the nurse can do a good deal ; in fact, she 
 can really do more in one way than the doctor, 
 because, however skilled a doctor may be, he is 
 only with the patient for short periods of time, 
 whereas the nurse is there continuously. 
 
 The nerve nurse, of course, loses a great part 
 of her usefulness if she theorises, if she tries to 
 run ideas of her own on the patient. In all 
 cases, of course, a nurse should always be unselfish 
 and true, but in nerve cases it is everything. I 
 do not say that a nurse can ever neglect to give 
 her patient medicine and food at the right times, 
 but the nursing proper that a nerve nurse gives 
 to her patient is really in her unvarying patience 
 and kindness, brightness, and cheerfulness. I 
 might use a familiar expression in connection 
 with this subject, and say " A nerve nurse is 
 born, not made," but I prefer to say that she is 
 born as "well as made. I think a person under- 
 taking the career of a nerve nurse should first 
 make sure that she has the qualities of sympathy 
 and tact. Then she must go through a course of 
 hospital training, and after that she should try 
 to study nerve diseases so as to understand 
 their gravity and reality. Thus she may hope to 
 develop into that most wonderful of all women 
 a nerve nurse. 
 
 What a nurse is is of far more importance in
 
 224 FUNCTIONAL NERVE DISEASES 
 
 nerve cases than in any other. Tact is mental 
 touch. Just as the touch on a patient's hand will 
 often quiet and soothe him, so mental touch on 
 a patient's mind may do inestimable good. You 
 may spend a week in a patient's room and yet 
 feel you have never touched her ; there is an 
 unseen barrier between you and her, but, once 
 you can get in touch with her, from that moment 
 the barrier disappears and your power begins. 
 There must be this tact or mental touch. 
 
 The most essential quality in nerve nursing is 
 patience, but, as a matter of fact, a nerve nurse 
 who understands what she is doing cannot be 
 impatient ; she loses her capacity by impatience. 
 
 In the first place, when she grasps the reality 
 of the patient's suffering, and that the suffering, 
 though it may be mental rather than physical, as 
 in a broken bone or diseased joint, is still more 
 painful than these more hard to bear she 
 ceases to be impatient, she knows that the diffi- 
 culty of the case is due to the patient's disease. 
 To know is to pardon, and is to have patience. 
 We are impatient with the things we do not 
 understand. 
 
 Nerve nurses worthy of the name do not 
 get impatient for two reasons : 
 
 1. They understand the reality and gravity of 
 their patient's sufferings. 
 
 2. They know what discipline of character
 
 THE REST CURE 225 
 
 they are undergoing and the value it is to 
 themselves. 
 
 Another qualification of a nerve nurse is that 
 she should understand the immense value of her 
 unconscious influence, and how what she does 
 acts upon the patient. 
 
 It does not matter much what a nurse is to a 
 patient delirious in pneumonia or with any 
 similar complaint, but in functional nerve 
 disease it is of the first importance. 
 
 Then a nurse should be of a sanguine tem- 
 perament. There are nurses who seem to be 
 made in a minor key ; these should not attempt 
 nerve nursing. 
 
 One fault of the amateur nerve nurse is that 
 she often tries to soothe her patient with plati- 
 tudes. Nothing can be more irritating, especially 
 to highly educated people, and nerve patients 
 almost invariably belong to this class. Better 
 to say one thing that comes from the heart than 
 a thousand from the mouth alone. She should 
 also never talk about other patients to the one 
 she is nursing. 
 
 A nerve nurse, unless she has been rightly 
 trained, often thinks that she must go against 
 her patient in everything she says. Go with the 
 patient at first, and not against her, and gradually 
 lead her to see that this is right and that is 
 wrong. Sympathise with her, let her feel that
 
 226 FUNCTIONAL NERVE DISEASES 
 
 you understand her. Say to her " Yes, it is 
 very trying, very hard to bear " ; so it is to her, 
 but add to this : " Don't you think if we did so- 
 and-so it would make it better?" Carry her with 
 you in your wise counsels, not contradicting her, 
 but drawing her mind along with yours into the 
 pathway of health. 
 
 Another important factor is the skill with 
 which the nurse is able to keep her patient 
 occupied. 
 
 Here are one or two hints to nurses of 
 practical value : 
 
 1. Have a good working watch, keep it right, 
 live by it, and let your patient do so. 
 
 2. Don't make a suggestion to your patient 
 without consideration. Discuss it, and try to 
 carry it out if agreed upon. Nothing is more 
 trying than many and various discussions about 
 plans. Spend time and trouble privately in 
 thinking before you open your mouth. 
 
 3. Do not discuss trivialities which can be 
 done in silence. 
 
 4. Be quite definite. Try to be a mental 
 support, not a broken reed. 
 
 5. Always keep your dignity and your 
 patient's. Imagine it where it is not. 
 
 6. Never discuss unnecessarily morbid or dis- 
 tressing subjects, nor, in trying to make your 
 patient forget her troubles, add your own to them.
 
 THE REST CURE 227 
 
 7. Too little talking is better than too much. 
 
 8. Know when to leave speech to nature when 
 out of doors. Walking and talking combined is 
 often too trying for a convalescent. 
 
 It may be, of course, that the caprice of the 
 patient obliges you to change a nurse who 
 is perfect in herself. Still, there are times when 
 this must be done for the patient's good, but 
 there are others when it must not be done, for the 
 same reason. It is for you to decide, without 
 fear or favour. Never, never let your considera- 
 tion for the matron, the nurse, the masseuse, 
 and the friends, and least of all for yourself, 
 obscure for one moment your single object of 
 curing the patient. Always and in every way 
 consider her first, which does not by any means 
 involve always giving in to her. 
 
 7. Occupation. This is a matter the impor- 
 tance of which varies much with the individual 
 case. Some occupy themselves ; with others it 
 does not much matter whether they are occupied 
 or not. 
 
 But in all cases of excessive introspection, 
 of depression, of excitement, constant occupa- 
 tion for the mind must be found. Books, papers, 
 pictures are, of course, available. Then there 
 are all the varied occupations possible in bed, 
 every one of which I have used at different times 
 knitting, embroidery, lace work, string work,
 
 228 FUNCTIONAL NERVE DISEASES 
 
 wool work (waistcoats, slippers, &c.), netting 
 fine and coarse, for fishing-nets pillow lace, 
 artificial flower making, paper hat making, dress- 
 ing dolls, making scrap-books, albums, raised 
 Braille-type books for the blind, sketching, 
 making fancy articles for bazaars, making mats 
 and rugs of wool, patchwork quilts, developing 
 photos, &c. Also all sorts of games can be 
 played with the nurses. As I have said, some 
 patients give no trouble, while with others you 
 have to exert the utmost ingenuity to keep them 
 busy. It is best to have a teacher in these cases 
 who will give definite lessons at a stated time, 
 and insist on so much practice each day. With 
 these cases everything must be done by rule, 
 and the time-table must not only include all 
 food, &c., but all occupations. Success in finding 
 an occupation in which the patient takes a real 
 interest is of the greatest value in the cure ; and 
 no trouble is too great to succeed in this respect. 
 Other employment is in stated exercises for five 
 or ten minutes night and morning with a Terry's 
 (steel-spring) or Whitley's (rubber) exerciser, 
 or one of Sandow's, such as his " Symme- 
 trion." 
 
 8. Isolation. This is the last detail connected 
 with the rest cure, and must not be carried 
 out, any more than any other, on hard and 
 fast lines. In all cases of hysteria proper, of
 
 THE REST CURE 229 
 
 exhaustion and true nervous debility, it is 
 absolutely necessary for from a fortnight to a 
 month. In many others it may be advisable. 
 When complete it involves an entire severance 
 from the outside world, letters, callers, messages 
 being all forbidden. In lighter cases of other 
 varieties of nervous disease, it need not always 
 be complete if objected to. If not objected 
 to, it is nearly always best to seclude the 
 patient. 
 
 The only instances where friends are helpful 
 early in the cure at stated times are when all 
 attempts at employment fail, or the depression is 
 very profound, and when a discreet visitor can 
 be relied on to amuse and distract, and not talk 
 about ailments. But, as a rule, the nursing staff 
 is able to cope with these difficulties without 
 outside help. It happens, sometimes, they are 
 not, and this just shows the folly of cast-iron 
 rules. 
 
 Your golden rule is, of course, to conserve 
 all nerve force, and not let it be spent, even 
 physically, on relations and friends. In many 
 cases the patient at once begins to improve 
 when isolation is enforced, and never will 
 otherwise. 
 
 In others it is impossible. The patient would 
 not come at all if separated wholly from mother 
 or husband. Many doctors refuse cases on
 
 2 3 o FUNCTIONAL NERVE DISEASES 
 
 these terms, but I have cured many when the 
 mother has come every day, or the husband. 
 The latter is most undesirable, but does not 
 always make cure impossible, as is often 
 supposed. 
 
 Sometimes if the relative may come the first 
 day or two, he can be cut off after ; but wherever 
 possible the best plan is a clear cut from the 
 first. Letters also must neither be written nor 
 received. 
 
 In regulating all these cases, where any 
 objection is made, the best plan is, as before, to 
 say : " Well, anyhow, you'll keep quite quiet for 
 a fortnight till we see how you get on, and then 
 we can arrange for you to see a friend, if you 
 have turned the corner." 
 
 When in your judgment friends may be seen, 
 the golden rule is, the patient is to see only those 
 she wishes to see, not those who wish to see her. 
 At first one visitor in the week, then oftener, 
 and then longer at a time all depends on the 
 case. 
 
 Make the patient understand and feel that 
 every regulation is made expressly for her, and 
 is not a part of a preconceived routine. Of 
 course, you sometimes have patients who must 
 write some business letters or see some one on 
 business. If it mus,t be, it must ; therefore 
 allow it, but give them distinctly to understand
 
 THE REST CURE 231 
 
 that they must be prepared to stay in a little 
 longer to make up. 
 
 It is not good policy ever to allow more than 
 one visitor at a time. It is very wearing for the 
 patient. The afternoon is, of course, the time 
 for these visits. 
 
 These scattered hints are elementary, but may 
 not be wholly useless, as in these cases it is the 
 small details successfully arranged that lead to 
 great results. 
 
 Dercum advises that the patient be weighed 
 only once in three weeks, others weigh every 
 other day ; in my practice I find once a week on 
 same day and hour best, the patient only being 
 told the result when advisable. 
 
 Special troubles in this cure are insomnia, 
 dyspepsia, and constipation. The first must be 
 combated by massage, suitable food at night, such 
 as hot malted milk, by compresses (wet) round 
 abdomen, and, if necessary, by judicious use of 
 drugs. The second, by massage, electricity, 
 mental suggestion, drugs, but never by dieting 
 if possible. The difficulty must be overcome 
 when practicable. As to the last, there can be no 
 doubt it is a great matter to procure regular 
 action of the bowels, and if the patient regards it 
 as such, and is willing to take the pains required, 
 you may assure her that you will establish a 
 regular action without medicine that shall last the
 
 232 FUNCTIONAL NERVE DISEASES 
 
 rest of her life. So far, we may suppose, she 
 never has an action without a pill, and then only 
 irregularly. If she be quite willing, you must get 
 the nurse on her mettle too, and then you give 
 your instructions. A definite hour is to be 
 selected for the action such an hour as not 
 only suits the present conditions, but that will 
 fit in with home life afterwards, say 8.45. The 
 bowels are henceforth to be opened at that hour, 
 and at no other. Whatever the inclination to go 
 before, it is to be resisted. Five minutes before 
 the appointed time the patient is to be solemnly 
 got out of bed, robed in dressing-gown, and 
 taken to the closet, whatever her feelings. 
 
 At first, to insure success, a simple pill of 
 cascara or some vegetable laxative is to be 
 given the night before, to make it easy, but 
 the hour is not to pass without the bowels being 
 opened. If there seems no likelihood of this 
 naturally, a glycerine suppository is to be given ; 
 or better, some glycerine injected (^ss). If this 
 fails an enema is to be given, and the desired 
 result obtained. Then, not before, the patient 
 can return to her room. Of course, at first there 
 is often a fight, but it must at all costs be made 
 and victory secured. With all due solemnity, and 
 a strict regard to the exactness of the hour, the 
 process is repeated each morning. 
 
 There are extreme cases where to insure
 
 THE REST CURE 233 
 
 success it may be necessary for a while for the 
 doctor to time his visits at this hour, and so 
 to throw the influence of his presence into the 
 scale. 
 
 After a week or so the aperient may probably 
 be left off, and vigorous massage be sufficient. 
 
 After some weeks a natural desire will be 
 felt at the exact time, and from this time only 
 steady perseverance is required to form the 
 fixed habit for life. 
 
 I could adduce numberless cases at all ages, 
 from early childhood to a lady seventy-four years 
 of age, whose rectum was so inactive that a 
 trained nurse was kept in the house solely to 
 evacuate it artificially, and who yet established 
 a perfect habit in six weeks. 
 
 Of course, no day must be missed, and the 
 hour never varied. 
 
 I think on the whole I have earned more 
 gratitude from patients by forming this habit 
 in bad cases of simple constipation than in any 
 other way.
 
 CHAPTER XII 
 
 GENERAL TREATMENT 
 
 IT must be remembered that the rest cure 
 is ostensibly a physical cure ; and that 
 though, as I have shown, to be successful, 
 mental therapeutics must be combined with it, 
 nevertheless the central idea that governs every 
 variety of Weir Mitchell treatment is to remove 
 any possible basis of a physical nature that there 
 may be for the nervous disease. If, however, 
 when all this has been done and the patient is 
 brought into a perfectly healthy bodily state, it 
 turns out that the nervous condition is still 
 only partly relieved, it is obvious that some 
 further treatment of a different nature must be 
 employed to complete the cure. The reason 
 for such a state of things is either that the 
 nervous exhaustion or disease is so deep-seated 
 and obstinate, or the methods of suggestion 
 have been so feeble and inadequate, that the 
 mental cure has not proceeded hand in hand 
 with the physical. Whatever the cause, how-
 
 GENERAL TREATMENT 235 
 
 ever, something more must be done. I propose, 
 therefore, first of all to consider generally the 
 further therapeutics that may be necessary to 
 complete the cure that the physical treatment 
 has begun, and also to look at other forms 
 of cure applicable to cases of functional nerve 
 disease for whom " the rest cure " is not 
 adapted. 
 
 I will next consider the treatment of dyspepsia, 
 which torms such a prominent symptom in ner- 
 vous diseases, and finally examine the real merits 
 of water and electricity in their application to 
 these cases. 
 
 It will be noticed, no doubt, that while I have 
 spoken of the aetiology and symptoms of hysteria 
 and neurasthenia separately, so far I have made 
 no distinction in considering their treatment. It 
 will be well just here to say a word or two 
 as to this. 
 
 There is no doubt that "the rest cure" is the 
 first treatment needed in all functional nerve 
 cases connected with malnutrition ; not, as I 
 have shown, only with a view of building up 
 the organism into a healthy physical state, but 
 because it affords unrivalled psychical oppor- 
 tunities to the wise physician to alter the mental 
 outlook and correct the bad suggestions that 
 have largely contributed to the disease. Of 
 course, " the rest cure " is so modified in
 
 236 FUNCTIONAL NERVE DISEASES 
 
 different cases as to be hardly recognisable as 
 the same treatment. In simple neurasthenia, 
 however extreme, for instance, perfect rest 
 in bed and isolation is the rule, whereas with 
 a restless hypochondriac or hysteric, friends and 
 outdoor exercise may be needed each day. There 
 must be no hard-and-fast rule whatever ; every 
 detail must be intelligently varied and adapted 
 to each individual case. 
 
 The most impossible and hopeless cases are 
 the intelligent and opinionated class, who have 
 long been in contact with doctors, and who have 
 hitherto succeeded in converting every form of 
 treatment into a failure (to their secret satis- 
 faction), and thus vindicating their own opinion 
 that their case is hopeless. Still forced by their 
 friends to try once more, they come to you, and 
 you will fail too, unless you can succeed in touch- 
 ing some hidden chord unreached by others, which 
 places their minds on your side, for in these 
 cases pre-eminently the cure is psychical. It 
 will be observed that in all the treatment I sug- 
 gest I limit the psychical to suggestion, direct 
 and indirect, from physician, nurse, treatment, 
 environment, &c., without any use of hypnotism 
 or special influence of any sort, reserving such 
 for use by a specialist in those extreme cases 
 where all his powers have failed. 
 
 Speaking generally, the neuromimetic symp-
 
 GENERAL TREATMENT 237 
 
 toms in hysteria disappear quickest when the 
 treatment neglects them entirely and ostenta- 
 tiously, while at the same time unconsciously 
 the patient is encouraged to move the paralysed 
 limb or to see with the blind eye. No rule, 
 however, holds good for all ; for a minority 
 recover best with elaborate treatment for the 
 affected part, as in simulated organic disease. 
 
 I have cured hysterical abdominal tumours 
 effectively and permanently that have persisted 
 for years by giving an anaesthetic, when the 
 tumour temporarily disappears ; when a rigid 
 plaster of Paris bandage is firmly adjusted while 
 the patient is unconscious, which physically pre- 
 vents the re-formation of the tumour. This is 
 kept on for a month or two, by which time 
 the unconscious mind ceases to attempt its 
 reproduction. I have purposely given no records 
 of cases and cures here, as they abound ad 
 nauseam in other books, and after all are of 
 little value and often misleading; for while the 
 case and cure can be described, the personality 
 of the patient cannot ; and it is the variety in 
 this respect that makes the same treatment 
 successful in one case and a complete failure 
 in another, where the disease is the same but 
 the personality differs. It is best, therefore, in 
 a manual like this, to be content with laying 
 down general principles of cure.
 
 238 FUNCTIONAL NERVE DISEASES 
 
 I will now proceed to consider the further 
 treatment of such cases as " the rest cure " 
 has not wholly relieved. 
 
 It is sometimes found, after all that can be 
 done in a home, that the depression or some 
 other symptom will not yield to the treatment. 
 I have had many of these cases, and after 
 building them up physically have still found 
 these symptoms persist. Some more active 
 plan must then be tried. I have combined a 
 partial rest cure in some of these cases with 
 every conceivable variety of occupation. It 
 must be remembered the healthy individual 
 requires some mental stimulus and emotional 
 excitement, and that failure to stay entirely in 
 bed may, after all, be a healthy sign. Brisk 
 gymnastics every morning at a gymnasium ; 
 cycling each day; sight-seeing two or three 
 times a week ; hobbies of all sorts wood- 
 carving at a studio ; metal working and 
 enamelled jewellery making ; leather work ; 
 embossing and colouring ; bookbinding ; stone- 
 carving ; fencing ; golf and hockey ; visiting 
 places and writing essays on things seen ; boat- 
 ing and motoring (which is of special value in 
 irritable nerves and insomnia. Several cases 
 of severe neurasthenia and persistent insomnia 
 amongst artists, barristers, &c., have been cured 
 by constant use of a motor-car). One of the best
 
 GENERAL TREATMENT 239 
 
 cures, in certain cases, is washing. I have sent 
 delicate lady-patients to a laundry kept by ladies ; 
 and there they have had to work hard, unnoticed 
 and apparently uncared for, until the depression 
 has passed away. It is astonishing what a 
 discipline this is, and, if thoroughly carried out, 
 the good it does. 
 
 Gardening in some cases is almost an equal 
 relief, and can be well taught in London. 
 Domestic economy is also well taught nowa- 
 days, and is a great relief to some over- 
 wrought brains. Drawing, painting, botany, 
 geology, and zoology are all good subjects. 
 Other patients I have employed in parcel for- 
 warding, secretarial work, typewriting, short- 
 hand, and in other ways too numerous to 
 mention. Never be without a resource, and 
 always retain the patient's confidence, so that 
 she may take up what you recommend with 
 hope and vigour. 
 
 In other cases, again, extraneous aid is 
 needed. That persistent neuralgia of the head 
 calls for static electricity, and you have not got 
 one of those largest machines. She must there- 
 fore go where there is one, or for the high-fre- 
 quency current ; but all under your guidance and, 
 if possible, presence, which greatly aids the cure. 
 Or it may be a question of electric light or heat 
 for rheumatism, &c., and here again you must
 
 240 FUNCTIONAL NERVE DISEASES 
 
 guide and preside. Never, if possible, depute 
 your authority to others. So far, all I have said 
 is supplementary to the fundamental rest cure, 
 which is the basis of the treatment. 
 
 I now turn to the minority of cases in which, 
 for various reasons, no form of rest cure is useful 
 or available. No doubt much that I have 
 outlined does not convey the idea of rest, but 
 it is all connected with a large part of the 
 twenty-four hours being spent in bed. 
 
 Some (I confess mostly men, in my experience) 
 have a lazy sort of neurasthenia, combined with 
 fair nutrition, that speaks loudly of liver and 
 calls for no bed, but an active, regulated life, 
 away from home, with treatment. These must 
 be sent where there is a good masseur and a 
 clever nerve expert (not a doctor), to a cottage 
 or farmhouse, where there is plenty of work to 
 do. From morning till night each hour must 
 be given up to definite work in garden, farm, 
 stables, poultry yard, orchard, greenhouse, bees, 
 house, workshop, &c. and the patient often 
 worked till he is ready to drop. All this must 
 be combined with vigorous liver, &c., massage 
 and electricity. This, in the hands of some 
 cheerful, wise, and energetic person, capable of 
 carrying out all your orders, works wonders. You 
 cannot call the treatment by any name, I am 
 thankful to say, but there is a distinct class who
 
 GENERAL TREATMENT 241 
 
 require it and whom it cures. Some, of course, 
 want the mind worked a little as well, but it 
 is mostly reached through the body. Crotchety 
 people, morbid consciences, religious melan- 
 cholies, sexual hypochondriacs, are all helped 
 in this way, and some can be helped in no other 
 manner. What they want is this combination of 
 management with some physical treatment and 
 steady hard work. 
 
 Of course, this is not incompatible with travel. 
 In some, especially when the improvement has 
 begun, travel is clearly indicated. The evil 
 about it is that it has been so greatly abused. 
 Patients in the last stage of malnutrition and 
 nerve exhaustion are sent to travel over 
 Europe, with the worst results. What they want 
 first is two months in bed at rest, then the travel 
 would do real good. 
 
 A great deal, too, depends on where they go 
 and with whom they go. 
 
 It cannot be too clearly understood that Alpine 
 climates over eight thousand feet rarely suit any 
 nerve case, while some may absolutely lose 
 their reason, from the too great excitement of 
 the air. 
 
 The places best suited for these nerve cases 
 are from two thousand to five thousand feet in 
 height, all woods and forests, moorlands, and 
 with many, not all, the sea coast.
 
 242 FUNCTIONAL NERVE DISEASES 
 
 This travel can be undertaken alone or with 
 a skilled nurse-companion, according to the 
 severity of the case. Sometimes a small party 
 helps greatly to restore a healthy tone to the 
 mind. Of course, the tastes and idiosyncrasies 
 of the individual should be studied, and sport 
 provided if it is wished. That plan suits best 
 where the patient is happiest. 
 
 A voyage in some cases is better still, only be 
 careful here of melancholia. I shall never forget 
 taking a patient down to the Dunottar Castle at 
 the docks for a voyage to the Cape and back, and 
 introducing him to the then doctor of the ship. 
 He told me he would look after him with 
 pleasure, but that the patient would be sure to 
 jump overboard before he reached the Cape ; he 
 had had three who had done so. As a matter 
 of fact this one did not. If, therefore, there be 
 marked depression or melancholy, it is best to 
 keep to dry land with a skilled companion. In 
 many other cases, however, a voyage is the 
 thing. 
 
 One patient, with very overwrought nerves, I 
 sent for twelve months in sailing ships only, and 
 this effected a cure ; the patient, curiously 
 enough, employing himself with making a beauti- 
 ful collection of insects found at sea and caught 
 on deck (not in the cabin). There are many 
 favourite voyages, such as the Cape, the
 
 GENERAL TREATMENT 243 
 
 Mediterranean, the West Indies, and, for a long 
 voyage, New Zealand. 
 
 India and Cashmere are admirable but ex- 
 pensive remedies for some morbid conditions of 
 nerves, but in many cases India does not suit at 
 all. Turning back for a moment to bad cases of 
 depression, fixed ideas, minor delusions, and what 
 are known as borderland cases, but still on the 
 right side of the border, the system known as 
 " back to the land " is, to my knowledge, powerful 
 for good. These patients live pretty much in 
 common on a large farm, under skilled super- 
 intendence ; the life is bright and cheerful and 
 wonderfully free. The only point insisted on is 
 that all shall work to the utmost of their capa- 
 cities on the farm, in the fields or byres, 
 amongst cattle or crops, the women making 
 butter, &c., but each and all hard at work in the 
 open air all day long at natural toil, eating their 
 bread, literally, in the sweat of their brow. It 
 is extraordinary what a healthy effect actual 
 contact with the soil in the fields has in these 
 cases. For slighter cases, of course, there are 
 (for ladies) agricultural and gardening colleges, 
 notably Lady Warwick's at Studley Castle. 
 
 I have seen the greatest good result in mild 
 nerve cases from associated pleasure trips, where 
 a large party travel or cruise together on the 
 Continent or in the Mediterranean. Some
 
 244 FUNCTIONAL NERVE DISEASES 
 
 superior and exclusive individuals object to these, 
 and it is useless to press them ; but those who 
 like them derive far more benefit from them than 
 from solitary tours with one companion. 
 
 There are cases, of course, of delusions, 
 melancholias, &c., that cross the line and become 
 the care of alienists. There is no need of great 
 hurry in handing these over unless suicidal. 
 Wait, at any rate, until you are convinced not 
 only that the symptoms are, or have become, 
 clearly mental, but that there is no reasonable 
 hope for a restoration to health under your care. 
 
 Some with strong altruistic or religious 
 tendencies, not melancholies, are cured by being 
 immersed in Christian work among the poor. 
 Many of my patients have thus benefited. Any- 
 thing and everything that weans from introspec- 
 tion and morbidity is an agent for good. 
 
 Individual characteristics must be studied. 
 Some neurotics are anti-sccial and only improve 
 when no other invalids are near. As to exercise, 
 in cerebral neurasthenia it does good and is liked, 
 in spinal neurasthenia it fatigues. The latter, 
 therefore, requires much longer physical rest than 
 the former. In neurotics generally, exercise 
 should, if possible, combine mental rest; for 
 instance, mere walking often allows time for 
 ceaseless worry or brain work, whereas golf or 
 tennis or cycling does not.
 
 GENERAL TREATMENT 245 
 
 Neurasthenias differ immensely in their cura- 
 bility, though on the whole easier than hysteria. 
 Constitutional neurasthenia not due to special 
 causes is difficult to cure and may proceed to true 
 mental disease. Sthenic neurasthenias, where the 
 physique is over-nourished, are not easy to cure. 
 Even when combined with depression, such cases 
 are best relieved by exercise, saline aperients, 
 low diet and no stimulants. Dr. Whittle has 
 described a congestive neurasthenia with head 
 pressure and insomnia cured by twelve leeches 
 over the mastoid process. On the other hand it 
 must be remembered that the asthenia in neuras- 
 thenia is often exaggerated and is of psychic 
 origin. Phobias and other mental symptoms dis- 
 appear sooner than faults of character, and much- 
 time is often expended in trying to cure these 
 latter, which, after all, may not be pathological 
 but natural. Avoid as far as possible local sexual 
 treatment in men or women. 
 
 In the common case of ovarian pain there is 
 generally no disease of the ovary or any sexual 
 organ. 
 
 In such cases local treatment fails and may 
 be injurious. In neurasthenic pain local treat- 
 ment may do no particular harm ; but in hysteria 
 it is the worst possible treatment, fixing the 
 patient's attention on the symptom and thus 
 aggravating it. The only exception to the rule
 
 246 FUNCTIONAL NERVE DISEASES 
 
 is in such cases as when the evil has been 
 already done by injudicious local treatment ; in 
 such cases another variety of treatment may 
 relieve by suggestion. 
 
 In spasms and hysterical fits it is well to 
 explain to the patient that the onset depends often 
 on an idea, and on fear and expectation, and that 
 they are best lessened by cultivating a stoical 
 attitude and indifference. The same applies to 
 fear of death, contagion, and other phobias. 
 
 I now come to consider the special symptom of 
 dyspepsia. As a rule a patient believes that 
 all her nervous symptoms will disappear when' 
 the stomach is cured ; but it is not the dyspepsia 
 that produces the neurasthenia, but the neuras- 
 thenia that weakens the stomach, as well as all 
 other organs, and produces the dyspepsia. Once 
 neurasthenia is regarded as the result of 
 gastric trouble, the treatment becomes purely 
 medicinal, and the nervous trouble persists in 
 spite of all antiseptics and stomachics. 
 
 Moreover, antiseptic medicines never relieve 
 gastric catarrh of neurasthenic origin. In these 
 gastric affections the local remedies of any real 
 value are HC1 and washing out the stomach. 
 Atony and dilatation of stomach is often relieved 
 by dry diet and no liquid at meals ; while gastric 
 neurasthenia is always aggravated by mineral 
 waters. Dyspepsia seldom calls for the stomach
 
 GENERAL TREATMENT 247 
 
 pump and analysis of the gastric contents ; a 
 little common sense and a removal of the real 
 cause (generally psychic) will do far more. 
 
 " Nervous " bowels with constipation is due 
 rather to spasm than to muscular atony ; hence 
 in these cases belladonna, bromides, and mild 
 hydropathy does better than exciting treatment 
 by massage, purges, and cold douches, which 
 often aggravate the spasm. In such cases relief 
 is often obtained by slow injection of warm 
 water, after each stool, from a douche four feet 
 above the patient, the buttocks being raised. 
 To the water may be added camomile or valerian, 
 also salol and sodae bicarb. This often cures the 
 spasm. 
 
 Hysterical vomiting is often caused by passing 
 the stomach tube. It is often very persistent, 
 but otherwise is not serious, being constantly 
 associated with generally good nutrition. 
 
 In fits, pressure at the supra-orbital notch or 
 against roof of orbit is often more effective in 
 arresting an attack than pressure on the ovaries. 
 
 When they occur, leave them alone unless ex- 
 tremely prolonged and cataleptic, in which case 
 a strong farad ic current or subcutaneous injec- 
 tion of hyoscyamus is effectual. Hysterical 
 contractions and paralyses are also best neglected ; 
 or the contracted limb can be extended and set 
 in plaster of Paris splint.
 
 248 FUNCTIONAL NERVE DISEASES 
 
 Turning now to cures by water, we must con- 
 sider hydros, spas and baths. 
 
 Hydros have much to recommend them as 
 after-cures in these cases, and are most successful 
 in the cardiac and gastro-intestinal neurasthe- 
 nias. Situated generally in a well chosen and 
 bracing situation, well built and appointed, with 
 cheerful surroundings and visitors, they are 
 superior to hotels as a rule in their social influence, 
 and if under skilled medical supervision and 
 most careful control, the sea-baths and air-baths 
 and general regime are in the highest degree 
 helpful and stimulating. The modern hydro is, 
 I think, better adapted for convalescence than for 
 any very active treatment. 
 
 Not so the baths and spas at home and abroad. 
 Here very active treatment is the vogue and an 
 after-cure during convalescence often required. 
 Strathpeffer, H arrogate, Woodhall Spa, Nau- 
 heim, Aix and others will occur at once to the 
 mind as places where a pretty vigorous treatment 
 is carried out. 
 
 For nerves pure and simple, I recommend 
 Salso-Maggiore and Strathpeffer and the mud- 
 baths at both. For nerves and heart, Bad Nau- 
 heim. For nerves and rheumatism, Woodhall 
 Spa or Marienbad. I do not for a moment say 
 that I am prepared to prove that these particular 
 spas stand out in any proud pre-eminence
 
 GENERAL TREATMENT 249 
 
 above all others, but they are the first that occur 
 to me. 
 
 In all nervous cases the patient must on no 
 account stay with her own people, and a wise 
 nurse or companion is a sine qud non, who can 
 to some extent take your place, and is under 
 your orders. A severe course at one of these 
 spas should be followed up by an after-cure, if 
 iron is needed, at some such place as Schwalbach, 
 or if there be no special indication, in Norway, the 
 Black Forest, Tyrol or Engadine, according to 
 the taste and the season. 
 
 Coming to some details of hydropathic treat- 
 ment, I may say broadly that all hydropathy is 
 safe until one begins to use cold water, and here 
 care is required. 
 
 All cold treatment should be short and vigor- 
 ous, and a good reaction should be obtained. 
 Before hydropathic treatment is decided on, it 
 is essential to understand the exact amount of 
 nerve depression or exaltation of the patient. 
 
 Unless there be some pleasurable feeling and 
 a marked reaction, the cold douche can only 
 do harm. This douche is best when the patient 
 has had a brisk walk or has been in bed, or from 
 some cause is warmer than usual. It should 
 never be applied when the patient is cold, and 
 particularly if the patient is suffering from anaemia. 
 
 Nothing cures " nervous " bowels like the
 
 250 FUNCTIONAL NERVE DISEASES 
 
 dripping sheet, the wet pack, and the still or 
 running sitz-bath. The dripping sheet should 
 be well rubbed all over the patient, and should 
 be warm and soothing. 
 
 The wet pack should never be prolonged if the 
 patient is cold or uncomfortable. There should 
 be a wet cloth on the head and a hot bottle to 
 the feet if needed. The patient should perspire 
 freely. The pack is an admirable cure for un- 
 stable nerves and insomnia, especially in children 
 and young people. In some cases of over- 
 excitability and extreme irritability, and even in 
 slight delirium or mania, it acts like a charm. 
 
 It must ever be remembered that in mild and 
 commencing nerve cases hydropathy can often 
 cure more quickly than a Weir Mitchell course. 
 I should like specially to mention the great 
 value of the stomach compress in cases of 
 dyspepsia, distension and dilatation of the 
 stomach, as well as for insomnia. This com- 
 press is a coarse linen bandage twelve or fifteen 
 inches wide, long enough to go two and a half 
 times round the body, and covered with thin water- 
 proof for nearly half its length. The uncovered 
 half is soaked in warm water (or cold), and the 
 wet bandage wound round and covered with the 
 dry, and kept on in day for half an hour, or if 
 put on at night, till the morning. The water- 
 proof keeps it warm and comfortable. Mineral
 
 GENERAL TREATMENT 251 
 
 water cures should be avoided in cases of 
 nervous dyspepsia and dilatation, as the amount 
 of water taken only aggravates the evil. Sea- 
 bathing is generally too exciting for neuras- 
 thenics, save as an after-cure. 
 
 Electricity can be applied in various forms. 
 Those generally used include high frequency, 
 sinusoidal and polyphase, static, galvanic, fara- 
 dic, and the electric light. The galvanic and 
 faradic can be used in water (baths, &c.) with 
 great efficacy. 
 
 We are ignorant of the exact method of action 
 of any form of electricity ; but clinically we find 
 which form is best adapted for any particular 
 disease. 
 
 High frequency is perhaps the most uncertain 
 and capricious in its effects. Properly applied 
 it seldom does harm, but it is general in its 
 application, and cannot be localised. In a large 
 number of cases no benefit whatever is derived. 
 In others the most startling and unlooked-for 
 results follow, that cannot be wholly due to its 
 psychic value. It is indeed curious that such an 
 impressive remedy should not have more psychic 
 value. Some time ago I succeeded in curing a case 
 of diabetes, brought on by severe nerve shock, 
 that for years had resisted the most careful and 
 elaborate treatment. The sugar, which persisted 
 in large quantities, completely disappeared after
 
 252 FUNCTIONAL NERVE DISEASES 
 
 a short course of high frequency. Other such 
 cases have been recorded in Vienna and else- 
 where. 
 
 In functional nerve disease I confess it is 
 disappointing. 
 
 Of sinusoidal, polyphase and triphase electricity 
 I have no personal knowledge. Dr. Herschell I 
 is one of its chief exponents and recommends 
 it strongly in neurasthenia, especially in cases 
 of low arterial tension, as its effect is always 
 to raise the blood pressure. It seems to be of 
 value in treating nervous gastric atony and 
 also in obstinate constipation. The polyphase 
 current has a special power over unstriped muscle. 
 Static electricity, described in " Quain's Dictionary 
 of Medicine" in 1883 as practically obsolete in 
 therapeutics, has been revived, and found of 
 great value in nervous head affections and other 
 neurasthenic symptoms and neuralgias. The 
 new machine (Wimshurst's) is an influence rather 
 than a friction machine, and consists of two or 
 more glass or vulcanite plates with sectors of 
 tinfoil or brass revolving in opposite directions, 
 and the electricity is collected from them by 
 points and condensed on brass cylinders or in 
 Leyden jars. This current is small in volume, 
 but has a high electro-motive force. Static 
 
 1 Dr. Herschell, "Polyphase Currents in Electricity," 
 1903.
 
 GENERAL TREATMENT 253 
 
 electricity is more felt than high frequency and 
 is more effective. Generally it diminishes arterial 
 tension and slows the pulse. It relieves dys- 
 pnoea and increases respiratory metabolism ; but 
 specially it lessens nervous irritability and soothes 
 neuralgias, headaches, migraine, and the pains 
 of neuritis. It also induces diaphoresis. Some- 
 times the treatment is delightfully pleasant and 
 hardly felt, and at others unpleasant, or, with 
 the spark, even painful. The spark is effective 
 as a deep-acting counter-irritant for stiffened 
 and fixed joints, whether resulting from injury, 
 rheumatism, or rheumatic arthritis. X-ray treat- 
 ment can also be given by static machines, 
 and has the advantage that burning is almost 
 unknown. This is due to the small volume 
 of the current and the consequent necessity 
 of using "hard" tubes. It therefore requires a 
 long exposure to produce its effects. 
 
 Galvanic electricity is most useful, especially 
 in wasting and painful affections. The usual 
 current is 5 milliamperes from a battery of 15 
 to 20 Leclanche" cells fitted with a galvanometer 
 and reversible. As the required current is about 
 005 amperes, and the resistance of the body 
 varies from i to 5,000 ohms, the force of the 
 current must be of 5 to 25 volts. A Leclanche' 
 cell generally gives ij voltage. In reversing it is 
 always best to cut off the current to avoid shock.
 
 254 FUNCTIONAL NERVE DISEASES 
 
 In spinal neurasthenia the constant current is 
 of great efficacy. It must be remembered that 
 the ascending current dilates the vessels and 
 hence is good for an anaemic brain, while the 
 descending current contracts the vessels and 
 hence relieves the engorged brain. 
 
 Cramp of the stomach is often cured with 
 the anode on epigastrium and the kathode on the 
 spine, whence the pains radiate. Electric mas- 
 sage of the stomach also relieves. In gastric 
 atony the positive anode should be on the spine 
 and the negative kathode over the stomach. 
 The current thus applied is of great value. 
 
 The sympathetic system can be reached by 
 a large positive electrode on the stomach and 
 a small kathode over the superior cervical spinal 
 ganglion. The current should not be continued 
 for above two minutes, nor exceed 3 or 4 milli- 
 amperes. 
 
 For general directions for the use of both 
 galvanic and faradic electricity special manuals 
 should be consulted ; all that can be done here 
 is just to point out a few special features of value 
 in nerve disease. 
 
 On the whole the faradic current is most 
 applicable in functional nerve disease. It cer- 
 tainly gives the greatest psychic results, and this 
 for several reasons. 
 
 The noise and the pain impress the patient
 
 GENERAL TREATMENT 255 
 
 far more than the silent galvanic current, and 
 the resulting muscular contractions are evidence 
 of its power. But it is by no means wholly 
 psychic in effect, though, as I have said, its 
 exact mode of action cannot be explained. It 
 is probable that, applied either with two rheo- 
 phores some inches apart or with a wetted pad on 
 spine or epigastrium and one rheophore locally, it 
 stimulates the central nervous system accord- 
 ing to the part that is faradised. It has, of 
 course, obvious local effect in muscle action and 
 some effect on the vasomotor nerves and local 
 temperature. It also restores sensation to anaes- 
 thetic areas, especially if used with a metal brush. 
 Its force cannot, of course, be measured as in gal- 
 vanism, and one must be guided by the patient's 
 feelings, which should never be put on the strain. 
 The primary current acts more on the skin and 
 the waves all travel in one direction ; the 
 secondary penetrates more deeply, gives less 
 pain, and the waves alternate in direction. 
 This current is the best for general use in 
 functional nerve disease. 
 
 Direct electricity of any sort to the head 
 or heart is not without danger, and vertigo, 
 syncope, and other unpleasant results, may 
 follow. 
 
 With those who persistently still refuse to treat 
 the body in any way through the mind, electricity
 
 256 FUNCTIONAL NERVE DISEASES 
 
 of all forms is in little repute ; but by those who, 
 more enlightened, have no scruple in using this 
 all-powerful psychic force for the cure of the 
 patient, electricity is found to be a remedy of 
 great value, having, as I have said, distinct 
 physical effects as well as psychic. 
 
 With regard to drugs, there can be no doubt 
 they are of minor importance in these diseases. 
 Quinine, nux vomica, iron, and hypophosphates 
 are beneficial, but without proper rest, sleep, 
 food, and mental therapeutics they will not cure 
 the neurasthenic patient. If they do, the 
 neurasthenic condition is probably slight and 
 of recent origin, and most likely would have 
 recovered without drugs at all. 
 
 Generally speaking, strychnine in some form 
 is a most useful drug, far more so than quinine. 
 Easton's syrup is of never-failing value as a 
 general tonic, and the glycero-phosphates and 
 various preparations of coca and kola are of 
 value. Of the former I must mention the Esencia 
 di Coca as of much value as a substitute for coca 
 wine, which often leads to inebriety in nerve 
 cases. All the old nerve remedies valerian, 
 sumbul, asafcetida, zinc, &c. are still useful in 
 selected cases ; while for special symptoms the 
 usual remedies must not be neglected because 
 the disease happens to be nervous. Digitalis, 
 salicylates, phenacetin, opium are of great value,
 
 GENERAL TREATMENT 257 
 
 even in functional nerve diseases : for psycho- 
 therapy is not all. Ergot, arsenic, and cannabis 
 indica are all good in neurasthenia, and par- 
 ticularly in nervous headaches. Caffein with 
 phenacetin is almost a specific in neuralgia. For 
 insomnia, besides veronal, trional, paraldehyde, 
 and all the family of hypnotics, 15 grains of 
 bromide of soda or strontium in a bitter infusion, 
 and taken after each meal will often restore sleep 
 after a few days. 
 
 Salol, benzo-naphthol, carbolic acid are of 
 great value in septic and flatulent conditions of 
 stomach and bowels. 
 
 Ergot and opium relieve in nervous polyuria. 
 For constipation all the usual remedies are avail- 
 able until the trouble is cured. Calomel and 
 hyoscyamus seems to suit nearly all cases, and 
 never causes griping. But no one is satisfied 
 to continue these if the patient is under pro- 
 longed treatment. The time should always be 
 used to effect a complete cure of constipation, 
 which can nearly always be done providing 
 you have the full faith and co-operation of 
 the patient.
 
 CHAPTER XIII 
 
 NERVES IN CHILDHOOD 
 
 THERE can be no doubt that a large number 
 of neurasthenics and hysterics are the 
 direct result of the neglect and ignorance that 
 nervous children so often suffer from. As child- 
 life is better understood and treated we shall 
 find that many will be rescued from lives of 
 nervous misery by the proverbial "stitch in 
 time." I will therefore devote a short chapter 
 to a consideration of this subject. 
 
 The earliest condition that can directly pre- 
 dispose to functional nerve disease in children 
 is the health of the reproductive cells themselves 
 ovum and spermatozoon. There can be no 
 doubt, in the first place, that both germ and 
 sperm cells vary immensely in quality in the same 
 individual, and that some may contain all the 
 unbalanced nerve condition of some ancestor 
 and others none. Hence the great differences 
 one sees in families ; so that the production of 
 offspring with certain definite qualities is by no
 
 NERVES IN CHILDHOOD 259 
 
 means ensured by the congress of any two 
 individuals, but is actually determined by the 
 final union of one particular sperm cell with 
 some particular germ cells. The other point 
 is that the greatest and most common heredi- 
 tary cause of mental and nervous disturbance 
 is by poisoning and deterioration of the germ 
 through the action of alcohol. From one half 
 to three quarters of all idiots and epileptics 
 spring from drunken parentage, while Professor 
 Demme has shown that in 10 large drinking 
 families with 57 children, only 2 were normal ; 
 while in 10 temperate families with 61 children, 
 50 were normal. 
 
 The next important point is the state of both 
 the parents at the time of conception, and the 
 next is the condition of the mother during 
 gestation. There is no doubt that here we reach 
 great predisposing causes of disease that are little 
 thought of. It is the duty of every physician, 
 though one, no doubt, not easy to discharge, to 
 bring home to the minds of his patients the 
 important connection between the health and 
 condition of the parents and that of their 
 children. It is difficult to prove physiologically 
 how the two are connected, but clinically the 
 fact is established. Congress during intoxication 
 or periods of shock or intense mental excitement 
 is fraught with danger to the offspring. In the
 
 2<5o FUNCTIONAL NERVE DISEASES 
 
 same way no woman should become pregnant 
 who is herself at the time neurasthenic, or 
 suffering from disease or malnutrition ; and 
 every possible care should be taken during 
 gestation that spirit, soul, and body be all in 
 health, and kept free from shock. These are, of 
 course, counsels of perfection, but they should be 
 aimed at much more than they are at present. 
 
 One fears that the profession has, perhaps, 
 hardly realised the value of prophylactics in these 
 diseases, and how much may be averted by good 
 and wise counsels on these points if given in 
 time. Many a life is wrecked and doomed to 
 needless lifelong suffering through parental care- 
 lessness as to their own health and condition 
 at the time of conception and during pregnancy. 
 
 The next danger is teething, which often 
 causes a profound disturbance of the nervous 
 system. Convulsions from teething may lead 
 to nerve and mental diseases. Another early 
 danger is rickets, which often leads to an 
 absolute deficiency of intellect, as well as to 
 nervous disease. 
 
 During the period of the second dentition, from 
 seven to twelve, there is more nerve disturbance 
 than is generally suspected. Neuromimesis is 
 common at this period, and other hysterical 
 symptoms, also chorea. A look-out, however, 
 must be kept at this age for malingering, which
 
 NERVES IN CHILDHOOD 261 
 
 is common. All nervous troubles at this time 
 should at once be treated by relief from study 
 and an open-air country life. 
 
 Puberty is, however, the special time of great 
 danger, and the problem of the whole future life 
 as regards health is often settled in adolescence. 
 
 All hereditary pathological nervous tendencies 
 seem to come out in adolescence. At this time, 
 therefore, the child should be closely watched 
 for any well-known ancestral idiosyncrasies ; 
 and everything should be done to combat any 
 suspected or manifest nervous instability or 
 weakness. Special note should be taken of the 
 powers of the inhibitory centres, and these 
 should be strongly fostered, developed, and 
 exercised at this period. Self-restraint and self- 
 control are not only valuable moral qualities, but 
 invaluable prophylactics against nervous troubles. 
 
 It may be well here to give one or two figures 
 as to the development of a normal child for com- 
 parison with nervous children. A normal child 
 grows two to three inches a year, and increases 
 in weight from two to two and a half pounds per 
 inch of height. Standard tables of heights and 
 weights should be referred to, and any child 
 falling half a stone below that standard should 
 be seen to medically, also any exceeding their 
 standard by more than two inches without in- 
 crease of weight.
 
 262 FUNCTIONAL NERVE DISEASES 
 
 Turning to minor details, a normal child is said 
 to smile on the forty-fifth day, to utter vowels on 
 the sixtieth, to show reasoning powers by the 
 one-hundredth. It imitates at five months, shows 
 anger by the seventieth day, recognition at four 
 months, sympathy at six months, jealousy at 
 fifteen months, at which time it also speaks. 
 Postponement of speech after two years is ab- 
 normal, and should be noted ; also all speech 
 defects and stammering. 
 
 The brain at birth weighs thirteen and a half 
 ounces, and reaches nearly its full weight at 
 eight. The adult's brain weighs forty-nine 
 ounces ; at twenty-five it reaches perfection in 
 functional activity. 
 
 Neurotic children in Germany are almost 
 universally educated in families rather than in 
 large schools. 
 
 All emotional elements in such children should 
 be kept strongly in check ; and this is most 
 easily done by segregating these cases in small 
 unemotional circles. 
 
 Out of six hundred middle-class school children 
 30 per cent, were found to have neurasthenic 
 symptoms. The ages of these were interesting. 
 
 In the first, or infant class, one child was 
 neurasthenic as compared to three in the third, 
 four in the fourth, six in the sixth, seven in the 
 seventh, and nine in the eighth. Indeed, the
 
 NERVES IN CHILDHOOD 263 
 
 proportion rapidly increased, as might be ex- 
 pected, as the ages neared puberty, and the ratio 
 almost exactly corresponded with the number of 
 the class. Children suspected of hysterical ten- 
 dencies, and generally neurotic children, should 
 have special and constant care. Their lives 
 should be systematic, quiet, and unemotional. 
 They should be watched for sexual errors of 
 various sorts. All sources of excitement, in- 
 cluding music, should be strictly limited, while 
 their social and observant instincts should be 
 fostered and cultivated. 
 
 Under seven the great care should be the 
 development of the body on healthy lines by 
 home and country life. After seven the mind 
 should be watched, all precocity discouraged, and 
 all abnormalities checked. At the school age 
 there should be thorough co-ordination of mind 
 and body, and ceaseless muscular activity and 
 love of games. The food should be simple, light, 
 and abundant, mainly farinaceous, with milk and 
 fruit. The child should be fat, have plenty of 
 sleep ; love of nature and animals should be 
 encouraged. In adolescence the physical and 
 mental hygiene should be the most prominent 
 object in the parents' minds. 
 
 No direct religious dogmas should be taught 
 before seven, but deep reverence for good, and 
 for nature and God. Painful punishments are
 
 264 FUNCTIONAL NERVE DISEASES 
 
 not advisable for nervous children. The daily 
 regime should be simple and invigorating. 
 Cold sponging while standing in hot water, 
 regular meals, and regular hours for bed, and 
 open air all day long are important. 
 
 We now come to consider the symptoms of 
 nervous disease in children. 
 
 Physically, one notices any peculiarity in the 
 shape of the head as possibly significant of 
 nervous troubles, especially an abnormally large 
 or small head ; peculiarities about the ears, in 
 size, shape, and setting ; the boat-shaped, or 
 " keeled," forehead, where a vertical ridge is 
 seen in the middle line (owing to a retarded 
 union of the frontal bones) ; cleft palate, and 
 hare-lip, &c. 
 
 Look out both for backwardness and precocity, 
 for excess of emotion or the want of it, for in- 
 co-ordination or involuntary movements in short, 
 for all deviations from the normal. Nervous 
 children are frequently untruthful, quarrelsome, 
 untidy, dirty, sentimental, religious. They may 
 steal, have night terrors, sleep-walk, stammer, be 
 incontinent, sensitive, morbid, suffer from vertigo 
 and defective sight or hearing. They are subject 
 to sudden rises of temperature, and delirium even 
 with temperature under 100. They soon lose 
 self-control, there is nervous instability, inordinate 
 laughter or unnatural seriousness, mental lethargy,
 
 NERVES IN CHILDHOOD 265 
 
 dulness, hebetude. There may be love of soli- 
 tariness, sexual perversion or inversion, blushing, 
 restlessness, waywardness, abnormal cleverness, 
 asymmetry of head or body, melancholy. It 
 must be remembered with regard to these 
 children that moral action is always connected 
 with the power of the inhibitory centres in the 
 cortex of the brain. There is a definite con- 
 nection between stopping a rise of temperature 
 (unconscious action) and a cough (conscious) 
 and resisting the temptation to sin. Hence, in 
 nervous children the moral power is weakened 
 with the other powers that depend, like it, on 
 inhibition. 
 
 Dr. Clouston points out that the most common 
 and important mental change in nervous ado- 
 lescents is depression. In reality this is mental 
 pain, and is the analogue of neuralgia. It may 
 be periodic. 
 
 Nervous children are often very faddy, 
 irritable, often show inverted tastes coupled 
 with poor appetites, hate games, and love 
 solitary lives. 
 
 Still more marked signs are the avoidance of 
 bright light, of noise, transient fits of giddiness, 
 vomiting apart from food, change of disposition 
 and temper, horizontal wrinkles on forehead, bad 
 headaches, sleep-walking, sharp cries, taciturnity, 
 squinting, and frowning. All these may be
 
 266 FUNCTIONAL NERVE DISEASES 
 
 significant of organic, and not only of functional 
 nerve diseases. 
 
 Headaches especially are very common in 
 nervous children, and are constantly produced by 
 school life. They may be neuralgic and uni- 
 lateral, hyperaemic or congestive, anaemic or 
 toxic. 
 
 Megrim, or sick-headache, is perhaps the most 
 ordinary form of nervous headache and is common 
 from seven to twelve, at puberty, and in early 
 adult life. There is at the time great tension 
 and unstable equilibrium of the nerve forces, and 
 the cerebral paroxysm is a storm that restores 
 the balance. The headache (often intense) is 
 accompanied by giddiness, nausea, vomiting, 
 transient loss of vision, spots before the eyes, 
 bright or dark, zigzag or " fortification " visual 
 outlines, unilateral numbness and tingling, impair- 
 ment of speech, and confusion of thought. 
 
 When once the diagnosis of incipient nerve 
 disease is established on the evidence of several 
 of these symptoms, prompt measures must be 
 taken for cure. 
 
 With care, and if taken in time, a neurotic 
 child may develop into a strong normal adult. 
 The first duty is the full healthy development 
 of the body, and for this end neurotic children 
 must not be brought up in London or large 
 cities.
 
 NERVES IN CHILDHOOD 267 
 
 With neurotic children, the treatment after the 
 body is cared for is psychological rather than 
 medical. 
 
 There must be no corporal punishment. 
 Sentimentality must be suppressed. Illnesses 
 and depressing subjects must not be discussed 
 before these children. The onset of the cata- 
 menia should be explained. Religion should 
 be taught, free from introspection and senti- 
 mentality. All sexual abnormalities must be 
 carefully guarded against. The tone of the 
 school is more important with these children than 
 the teaching, and a good school is often better 
 than some sorts of home influence. There 
 must, of course, be no severe competitive ex- 
 aminations. 
 
 Remember that with healthy children worry 
 does not injure, but overwork does, whereas with 
 adults work does not injure, but worry does. 
 A neurotic child, however, is injured by both. 
 
 It has been found that tactile sensibility, as 
 shown by the legs of a compass on the skin, is 
 lessened one half by severe study in a neurotic 
 child. 
 
 Neurotic children must not be spoiled, and yet 
 there must be no iron rules. Make them think 
 and will, and not change their purpose. Combat 
 caprice, anger, jealousy, and other passions. 
 Make them endure pain.
 
 268 FUNCTIONAL NERVE DISEASES 
 
 Pain can be greatly alleviated in these children 
 by teaching them to repress the feeling of it. 
 
 Neglect their strong likes and dislikes within 
 reason. Accustom them to noises and light if 
 either is disliked. 
 
 Correct their hypersensitiveness to the opinion 
 of others. 
 
 Such children should not be much with neurotic 
 mothers. They should (if girls) be placed under 
 the control of a skilled and calm governess 
 who will not press them. The life should be 
 quiet and orderly, regulated by common sense, 
 with plenty of sun and air and games. No 
 evening parties or theatres. All subjective topics 
 or studies should be discouraged and all that is 
 objective encouraged. Animal pets and garden- 
 ing are good amusements. Neurotic children, 
 I may repeat, should not be kept together. 
 No quarrelling, bickering, or friction should 
 be allowed and the child should never be the 
 centre of attention. 
 
 Early skilled medical advice is essential once 
 the diagnosis of nervous disease is established. 
 
 The will of neurotic children should not be 
 broken, but directed aright. 
 
 The sleep should not be less than nine and a 
 half hours for boy or girl. 
 
 As a means of hygienic education for a neurotic 
 brain, Sloyd, or the accurate making of simple
 
 NERVES IN CHILDHOOD 269 
 
 articles of wood, is invaluable. The medical 
 treatment of neuroses in children is the same as 
 in adults, with that additional cheerfulness and 
 variety that their age demands. No special 
 instructions need therefore be given in addition 
 to these hints for home life and management, 
 which if carried out will often prevent the 
 necessity of actual medical treatment.
 
 CHAPTER XIV 
 
 OTHER FUNCTIONAL NERVE DISEASES 
 
 UNDER the head of Functional Nerve 
 Diseases, for reasons more or less arbitrary, 
 out of some 140 nervous diseases given in the 
 General Nomenclature of Diseases, I select, as 
 stated in Chapter I., twelve, of which so far I have 
 but spoken of two. Hysteria and neurasthenia 
 are of such importance that I have devoted some 
 twelve chapters to them, whereas the other ten I 
 propose to summarise in one. 
 
 The remaining four of the more direct func- 
 tional nerve troubles are craft palsies, or occupa- 
 tion neuroses, hypochondria, paralysis agitans, 
 and neuralgia, which, though hardly a disease in 
 itself, is often the only indication of nerve dis- 
 turbance in the system, and is sometimes of such 
 gravity as to justify a monograph. Of course 
 the word "functional " must not be pressed on its 
 positive side as always meaning a disturbance of 
 function. Rather must it be interpreted on its 
 negative side, as signifying an absence of any
 
 OTHER NERVE DISEASES 271 
 
 ascertained organic basis. The remaining six 
 are 
 
 Migraine, 
 
 Chorea, 
 
 Tics, in which is included torticollis, 
 
 Tetany, 
 
 Vertigo, and 
 
 Goitre (exophthalmic). 
 
 True Meniere's disease is no doubt of organic 
 origin, and I would therefore exclude it. Pure 
 vertigo, like neuralgia, may, of course, be classed 
 as a nerve symptom, yet it is often the sole 
 symptom, and is of such importance as to justify 
 its being treated by itself. 
 
 Of course, some of the above will doubtless be 
 shown ere long to be of definite organic origin, 
 such as migraine and chorea ; and then they 
 must be removed from the list of functional nerve 
 diseases. That is why I call this list arbitrary ; 
 because it cannot be proved either that it includes 
 all functional nerve diseases or that all that it does 
 include are functional. On matters so obscure it 
 is well to confess ignorance ; at any rate this 
 selection is no more arbitrary than other lists 
 given on distinguished authority, and alluded to 
 in the first chapter. 
 
 Dr. Beevor, for instance, includes epilepsy, 
 which is here excluded, as from the character 
 and constancy of its symptoms the true disease is
 
 272 FUNCTIONAL NERVE DISEASES 
 
 probably of organic origin. Moreover, it is simu- 
 lated in functional nerve disease by hysterical 
 epilepsy. Traumatic epilepsy or epileptiform 
 disease is still more obviously organic. 
 
 On the other hand, one large system of medi- 
 cine includes sea-sickness as a functional nerve 
 disease (Loomis and Thomas). To me it seems 
 that it is no more worthy of being classed as such 
 than mountain-sickness, or vertigo caused by rapid 
 rotation. 
 
 With this short apologia I will consider with 
 great brevity the diseases I have included. 
 
 There is hardly a trade which involves the 
 rapid and continued use in the same manner of 
 one part of the body but is liable to occupation 
 neuroses. 
 
 Men and women are both liable, but the latter 
 seem to recover from the disease more readily 
 than men. 
 
 Occupational neuroses are not caused by work, 
 but overwork, of the local part affected. Though 
 classed as functional, there is a supposed seat in 
 the grey matter of the cortex at the functional 
 centre, and here shrunken nuclei and cells have 
 been found. 
 
 After forty, craft palsy is more readily induced, 
 and may be partly due to degenerative changes 
 and not to overwork alone.
 
 OTHER NERVE DISEASES 273 
 
 Many craft palsies are due to the conscious 
 mind interfering with the unconscious mental 
 action in acquired reflexes. Most rapid writers 
 would "stammer "in their writing if they tried 
 consciously to form each letter. 
 
 In craft palsies careful examination almost 
 always reveals other defects of movement besides 
 the one complained of; therefore in all craft palsies 
 one should examine for degenerative and con- 
 genital defects, for ordinary disease, for different 
 movements on either side, tremors, wasting, loss 
 of grasp (by dynamometer), tenderness of nerve 
 trunk (compare both sides while the patient rests 
 both arms on the doctor's shoulders). If there be 
 tenderness there is neuritis. Look out also for 
 tender bones, rheumatism or gout in joints, and 
 tenosynovitis. During the examination the 
 patient should be bare to the waist, so that 
 all reflex muscle action may be noted. Then 
 carefully examine the affected part and test its 
 reaction (which is lessened by fatigue) to faradic 
 electricity. 
 
 It must not be forgotten in this connection that 
 fatigue neuroses must be looked out for as a not 
 uncommon complication in hysteria. 
 
 Writer's cramp is the most common of all 
 occupation neuroses, though hammer palsy, button- 
 maker's palsy (rotatory movements of fingers 
 Birmingham), piano-player's cramp, typewriter's
 
 274 FUNCTIONAL NERVE DISEASES 
 
 cramp, bricklayer's cramp (who can do anything 
 but use the trowel), violin cramp, tailor's cramp 
 (not of the legs, but inability to use the needle), 
 dairyman's cramp (who cannot milk the cows), and 
 heplastic palsy (which is the inability to use a 
 light hammer for penknives), are all well-known 
 varieties. It must be remembered that certain 
 acts where touch is not the agent can never 
 become wholly automatic, such as threading a 
 needle and hammering. Palsies from these are 
 partly due to cerebral fatigue. 
 
 The essence of the disease is the increasing 
 inability to do some complicated artificial act (such 
 as writing) that had become easily and subcon- 
 sciously performed by being long ago converted 
 from a purely voluntary act into an acquired 
 reflex. Owing to the failure of performing it, the 
 patient has again to begin with it as a voluntary 
 action, and in this experiences the greatest diffi- 
 culty. In writer's cramp this especial acquired 
 reflex is the one on which the patient's living 
 depends, and thus the disease becomes one of 
 great importance. 
 
 Perseverance in endeavouring to overcome this 
 disease by firmly grasping the pen and forcing 
 the hand only aggravates the palsy. Temporary 
 relief is obtained by using a pencil, with which 
 pressure can be made and on which the hand 
 can rest as on a walking-stick, instead of a pen ;
 
 OTHER NERVE DISEASES 275 
 
 by adopting novel methods of holding the pen ; 
 by moving the whole arm in writing, instead of 
 the fingers only ; by using pens with enormous 
 holders to be grasped in the fist; but all these 
 devices soon cease to help, the handwriting 
 becomes illegible, and eventually fails. And yet 
 the same hand can shave or sew and do other 
 delicate operations with perfect ease. Still, 
 .similar movements to writing often cannot be 
 performed, such as winding up a watch, &c. 
 
 In idiopathic cases no wasting or tremor of 
 the limb is found, and no true paralysis of any 
 muscle, only of the special function as a whole ; 
 it is the special co-ordination alone that has 
 failed. 
 
 Writer's palsy may be mistaken for paralysis 
 agitans, disseminated sclerosis, or lead palsy, or 
 vice versa. 
 
 Alcohol generally aggravates it. Rest was 
 long thought to be the only cure, and to this 
 may be added galvanic or static (not faradic) 
 electricity. The restoration to health by this 
 means is very slow, and sometimes there is no 
 improvement. 
 
 A much more hopeful method, and based, more- 
 over, on sound psychology, which I have found of 
 great value in allied diseases, is advocated by Dr. 
 T. S. Wilson. 1 He points out that the formation 
 1 See British Medical Journal, July 20, 1907.
 
 276 FUNCTIONAL NERVE DISEASES 
 
 of good habits is the surest way of overcoming 
 bad ones ; and this is peculiarly applicable in 
 habit neuroses and spasmodic wry-neck and other 
 tics, also in paralysis agitans. In writer's cramp 
 even and regular rhythmical movements, the 
 reverse of those that caused the trouble, must be 
 persevered in. It is suggested that extension of 
 wrist and arm while squeezing a large rubber ball 
 be alternated by opening out all the fingers placed 
 within an elastic ring while flexing wrist and 
 arm. 
 
 In wry-neck slow and regular movements of 
 head and neck by the nurse, with assistance from 
 patient fully stretching the muscles, must be 
 regularly given. 
 
 In spasmodic tics regular rhythmic exercise 
 with a Sandow's exerciser may completely cure ; 
 while in paralysis agitans the same exercises do 
 good. They should at first be continued nearly 
 all day, till there is a marked improvement, and 
 then at stated intervals. 
 
 In severe cases of writer's cramp the education 
 of the left hand to the work is often a practical 
 remedy. 
 
 Writer's cramp may be taken as a sample of all 
 other occupation neuroses, which differ in locality 
 only, not in kind. There is, however, a profes- 
 sional neuritis that has been confounded with 
 these professional neuroses. In the latter the
 
 OTHER NERVE DISEASES 277 
 
 cause is no doubt in the cortical centres engaged, 
 whereas in the former it is in the nerves and 
 muscles themselves. The cause is special fatigue 
 of the nerve, not by occupation primarily, but 
 by accident, as in overstrain, or from alcohol, 
 anaemia, malnutrition, diabetes, &c. It is, of 
 course, connected with occupation, and Parola, who 
 has investigated it, 1 includes most of the trades 
 and occupations that are liable to craft palsies, 
 which increases the difficulty of diagnosis. 
 
 There is pain in the nerve, tingling, itching, and 
 burning, together with paresis. In early stages 
 the disease mostly resembles syringomyelia, and 
 in some cases progressive muscular atrophy. 
 
 On the whole the prognosis is better in profes- 
 sional neuritis than in the professional neuroses. 
 
 Hypochondria is a psycho-neurosis consisting 
 essentially of an exces? of subjective sensations. 
 It is not melancholia ; for though in both there 
 may be extreme depression, in the former it rarely 
 leads to suicide, whereas in melancholia this is a 
 common result. Moreover, the latter disease does 
 not depend, as the former, on ideas of disease and 
 subjective sensations, but rather on ideas not con- 
 nected with physical but with psychic states, as in 
 religious melancholia. The term is, of course, 
 derived from an old idea of its connection with 
 1 Parola, // Morgagni, October, 1906.
 
 278 FUNCTIONAL NERVE DISEASES 
 
 the condition of the liver. It is no doubt a sign 
 of an unbalanced mind. 
 
 The most common variety of hypochondria is 
 the sexual, and this is found most in men, and 
 especially in the early decline of life. Any sudden 
 change of environment in mid-life, such as re- 
 tiring from business, is liable to bring it on. 
 
 In a hypochondriac every symptom, good as 
 well as bad, is distorted to contribute to the 
 disease idea. The patient keeps long lists of his 
 symptoms and is a depressed faddist, and often 
 wiser in his own eyes than all his doctors. He 
 never trusts a physician too far, and constantly 
 wanders from one to another. He often resigns 
 an appointment or retires from business to have 
 better leisure to study his symptoms, and in this 
 occupation, however distressing, he finds a gloomy 
 satisfaction. In some cases the health all the 
 time is perfect, in others there is some foundation 
 of fact to the imaginary superstructure. The 
 disorder is very chronic, and the prognosis de- 
 pends on the amount of hereditary tendency and 
 on the real causes being external rather than in- 
 ternal, and on the suddenness of the onset. 
 
 Success in treatment depends on the extent to 
 which the sound ideas of the doctor can be substi- 
 tuted for the unsound conceptions of the patient. 
 The treatment is mainlymoral in character, though 
 this may well be wrapped up in vigorous remedial
 
 OTHER NERVE DISEASES 279 
 
 measures calculated to improve and invigorate the 
 general health, and, in short, is much of the 
 same character that is required in hysteria and 
 neurasthenia. 
 
 Paralysis agitans, or shaking palsy, is also called 
 Parkinson's disease. There is constant shaking 
 with stiffness, and shaking palsy or paralysis is a 
 most descriptive name. It is twice as common in 
 men as in women. 
 
 It is due to heredity, emotion, wasting diseases, 
 senile changes, and injury. It is principally a 
 disease of advanced life. In many cases no 
 cause for its onset can be found. 
 
 No constant change in the nerve centres has 
 been found to account for it. 
 
 Three stages have been noted in the disease, 
 which always begins insidiously. In the first 
 stage, which lasts from two to five years, there are 
 occasional tremors in the hand or foot, gradually 
 increasing in severity and spreading to the other 
 side. It is rare for both arms to be involved 
 and the legs free. More commonly one arm 
 and leg on the same side are affected ; then both 
 hands, and lastly both legs. The expression on 
 the face becomes fixed and the body stiff and 
 moves as a whole: the fingers in moving seem 
 to be making pills, the thumb moving on the 
 index finger, and when at rest is in the position
 
 280 FUNCTIONAL NERVE DISEASES 
 
 of penholding. There is also vertigo, more or 
 less marked. 
 
 The second stage may last from ten to twenty 
 years. In it the head is bent forward and the 
 back rounded. The arms are bent and kept from 
 the sides, with the hands in front. The eyes turn, 
 but not the head, which also does not generally 
 shake. The steps are short and tripping, and the 
 movements slow ; the limbs are in a constant 
 tremor, which also shakes the body. The patient, 
 leaning forward, sometimes seems as if running, 
 the steps are so short, and have to be so quick to 
 maintain the balance. 
 
 In the third stage we get helplessness and rest- 
 lessness, atrophy, and fixed swollen joints, with 
 constant tremors. 
 
 There is also weakness and weariness of the 
 muscles from the first ; the patient is irritable, and 
 the speech sometimes affected. The utterance 
 becomes slow and difficult, and the tongue may 
 tremble. 
 
 The movements generally cease in sleep. By 
 force of will proper steps can be taken and the 
 tremor can be stopped, but not for long. 
 
 The progress of the disease is slow and erratic. 
 It is mostly incurable, but sometimes is arrested 
 in early stages. 
 
 The best treatment is the maintenance of the 
 general health at the highest pitch and the use of
 
 OTHER NERVE DISEASES 281 
 
 the galvanic current. In this disease moral treat- 
 ment is of little or no avail. Lately rhythmic 
 movements have been tried with great success, 
 as described a few pages back for writer's cramp. 
 
 Neuralgias are often confounded with neuritis. 
 In the present state of our knowledge one would 
 say that, though both involve pain in a nerve, 
 the cause in the former is functional, in the latter 
 organic. 
 
 Many so-called neuralgias, specially if inter- 
 costal, are really neuritis. Neuralgias are gene- 
 rally unilateral. 
 
 Neuralgias are frequently hereditary. Neu- 
 ralgic families are also prone to insanity, epilepsy, 
 and paralysis. 
 
 Trigeminal neuralgia is common with epilepti- 
 form paroxysms. 
 
 Neuralgia is due to all causes producing over- 
 fatigue, to exposure to cold (one-third of all cases), 
 also to nerve irritation and toxins. 
 
 Neuralgias are reflex, traumatic, herpetic, occu- 
 pation neuroses, hysteric, diabetic, gouty, rheu- 
 matic, anaemic, malarial, syphilitic, and senile, as in 
 tabes. They are also periodic and sometimes of 
 purely psychic origin. Influenza, local growths, 
 irritation from teeth, ears, &c., are also causes. 
 In neuralgia the pain is not due to inflammation. 
 
 Pathologically the pain path is clear from skin
 
 282 FUNCTIONAL NERVE DISEASES 
 
 to posterior horn of the spinal cord, and an injec- 
 tion of saline solution here destroys the sensation 
 of the skin area at the level supplied by it. The 
 pain may be due to peripheral causes by stimu- 
 lation. The pain is intense if the nerve be 
 healthy, and slight if diseased or disorganised, 
 as in paralysis. 
 
 On the other hand, the pain may be caused 
 centrally by other nerves, and reflected or referred 
 to the peripheral area. 
 
 If the pain does not rise into consciousness it is, 
 of course, not felt ; and if the consciousness be 
 already fully engaged, it often ceases temporarily 
 to be felt. This indicates the method of psychic 
 treatment. 
 
 Trigeminal neuralgia is generally known as tic 
 doloreux. 
 
 The pain is of all descriptions, and may be stab- 
 bing, darting, boring, burning, &c. It is often 
 violently spasmodic, causing cries of pain. In 
 long attacks the acute pain eventually subsides 
 into uneasiness, as the cortical afferent centre gets 
 exhausted, until, after an interval, the paroxysm 
 breaks out afresh. 
 
 Neuralgia has been divided generally into 
 superficial and visceral. 
 
 The former needs no description, and includes 
 all surface pains, from occipital neuralgia to 
 coccycodynia.
 
 OTHER NERVE DISEASES 283 
 
 The visceral include cardiac, uterine, ovarian, 
 gastric, nephritic, urethral, &c. The prognosis 
 generally is favourable, but it becomes less 
 curable with advancing age. The treatment in 
 the first place is to remove all malnutrition and 
 to see that the weight and all the functions are 
 normal, and that the body generally is in good 
 health. If neuralgia be, as has been said, " the 
 prayer of the body for healthy blood," it is likely 
 to disappear when this prayer is answered. 
 General remedies are many, and include drugs 
 such as gelsemium sempervirens for trigeminal 
 neuralgia (especially if connected with the teeth) ; 
 croton chlorate (5 to 20 grains), salicylates, anti- 
 pyrin, antifebrin (with caution), phenacetin, citrate 
 of caffein, and a compound of phenacetin with 
 citrate of caffein known as antikamnia. Toxins 
 and bacteria are washed out by stomach lavage 
 and bowel lavage, by weak saline solutions of 
 i per cent, injected slowly, warm, into the rectum 
 (S. Brown). Locally, veratrum in ointment or 
 aconitine ointment rubbed in the part till numb (if 
 skin is sound), belladonna liniment, chloroform 
 liniment, turpentine liniment, very hot fomenta- 
 tions, all do good. Respecting this latter it 
 may be said that, rightly used, heat can control 
 almost any pain. The right use is by having two 
 flannels wrung constantly out of boiling water, and 
 replacing each other on the part affected every
 
 284 FUNCTIONAL NERVE DISEASES 
 
 minute for a quarter of an hour or so. It requires 
 two people to do it properly, besides the patient. 
 
 A good application to follow it and prevent the 
 recurrence of the pain is an ointment made as 
 follows : 
 
 Menthol, 5! 
 Chloral, 555 
 Morph. hydr., gr. iii 
 Tr. aconiti, -^40 
 Lano-vaselin, ad. gss. 
 
 In hypodermics, begin with not more than one- 
 sixth grain morphia, and add a little atropine to 
 avoid nausea. 
 
 Another form of counter-irritation is by freez- 
 ing with ice or ethyl chloride. 
 Massage also often relieves. 
 For permanent cure the cause must be sought 
 out, and if possible removed, as the tendency of 
 neuralgia is always to recur. 
 
 Migraine, megrim, hemicrania, or sick-headache, 
 is sufficiently marked off from ordinary headaches 
 to constitute a distinct disease. Amongst ordi- 
 nary headaches we include toxsemic, neuralgic, 
 congestive, gastric, bilious, anaemic, exhaustive, 
 and neurasthenic. Migraine is characterised by 
 being periodic, unilateral, with sickness, with affec- 
 tion of sight and nerve symptoms. In bilious head- 
 aches we get sickness, but the headache is frontal
 
 OTHER NERVE DISEASES 285 
 
 and not unilateral. The chief cause is the heredi- 
 tary tendency to malnutrition and neurasthenia; 
 overwork, anxiety, grief, sexual excesses, bad air 
 and food, sedentary occupation are also causes. 
 It is rare in outdoor workers. The stages of the 
 disease consist of the premonitory symptoms and 
 the attack. The first consist chiefly of ocular 
 disturbances, such as bright serrated and zigzag 
 lines and imperfect vision, with coldness of the 
 extremities, lasting some minutes. This may be 
 all, or it may be succeeded by the headache. In 
 some cases the ocular symptoms are absent, in 
 others they are replaced by mental depression 
 and malaise. 
 
 The headache begins gradually, the head gets 
 hot and the feet cold. 
 
 The pain, of a boring character, generally is on 
 the opposite side from which the ocular disturb- 
 ance began. As the pain increases the eyes get 
 better, and nausea and vomiting set in. The 
 head throbs, though the face is pale, there is mental 
 lethargy, and the patient lies as if dead, till sleep 
 sets in and the attack passes off. It may not 
 return for days, weeks, or months. It generally 
 lasts from twelve to twenty-four hours. The skin 
 is hypersesthetic, and in this disease heat seems 
 to intensify the pain. The temporal arteries are 
 dilated, and compression of the carotid often 
 relieves the head.
 
 286 FUNCTIONAL NERVE DISEASES 
 
 There is no known pathology. 
 
 The treatment is between the attacks in the 
 premonitory stage and during the headache. In 
 the first place the cause should, if possible, be 
 removed, the bowels kept open, and nerve tonics, 
 especially strychnine, administered. Arsenic and 
 quinine are also useful ; i per cent, solution of nitro- 
 glycerine with ?n,v Tr. gelsemium t.d.s. between 
 the attacks is often of great value. The diet 
 should also be carefully regulated. 
 
 During the premonitory stage the patient 
 should lie in a darkened room, with the head low, 
 and some diffusive stimulant administered (alcohol 
 or sal volatile) ; bromide of ammonium, cold to the 
 temples, and a hot bottle to the feet are also good. 
 
 During the attack the room should be dark and 
 quite quiet, evaporating lotion applied to the 
 head and mustard and water to the feet, and effer- 
 vescent antipyrin or bromide of soda given 
 Guarana powder, gr. xv every half-hour, relieves, 
 and when the nausea has passed away nourishing 
 soup should be given ; opium is not generally 
 advisable. 
 
 Chorea, or St. Vitus' dance, is a cortical disease 
 generally classed as functional, but often believed 
 to be due to rheumatic toxins. It occurs in 
 about a quarter of neurotic or hysterical families. 
 It is rare under five years, most common from five
 
 OTHER NERVE DISEASES 287 
 
 to twenty years, with a maximum at twelve. It is 
 absent in middle life, and senile chorea is very 
 like paralysis agitans. Three girls are affected to 
 one boy. Chorea is common in the pregnancy of 
 young mothers up to twenty-five or thirty, and 
 most common in third month of first pregnancy ; 
 rare after second pregnancy. The cause, how- 
 ever, is so generally toxic, and it is so often asso- 
 ciated with rheumatism, that it will probably soon 
 be taken out of the category of functional nerve 
 diseases and definitely ascribed to toxins as- 
 sociated with the diplococcus of rheumatism. 
 Fright is an exciting cause, also a previous attack, 
 for it tends to recur after a few months or years. 
 Generally it comes on a week after the exciting 
 cause. Imitation is a cause in schools and 
 families, and it may become an epidemic. Injury 
 and worms are rarer causes. 
 
 Acute rheumatism is associated with one-third 
 of all cases. Heart disease is constantly associ- 
 ated with it. The pathology does not support the 
 idea that it is due to numerous emboli in the 
 cortex, as has been suggested. 
 
 The symptoms are irregular purposeless spasms 
 of the muscles, with want of co-ordination in volun- 
 tary movements and some physical and mental 
 weakness. This latter is most marked in those 
 attacks that come on about puberty. 
 
 The twitchings begin in the hands and lace.
 
 288 FUNCTIONAL NERVE DISEASES 
 
 They are irregular in time, force, and character. 
 In the jaw the teeth may be broken. They 
 are increased by all excitement and attempts at 
 voluntary movement, and are decreased by repose. 
 Respiration is apt to become uneven, and the 
 heart beat is made irregular by irregular respira- 
 tions. Half the cases are bilateral, but the 
 spasms are different on each side. The speech 
 is often jerky, the patient irritable and dull. The 
 convulsions are painless. There is often incon- 
 tinence. The temperature may be slightly raised 
 and the pulse-rate increased. Ansemia is a com- 
 mon complication. The murmur heard in the 
 heart is often due to anaemia, but endocarditis 
 is frequently developed during chorea, so the 
 heart must be carefully watched. Mitral regurgi- 
 tation may be left after chorea. The endocarditis 
 is generally very mild. Mild acute rheumatism 
 may also come on during its course. 
 
 True convulsions are rare in chorea. The 
 knee-jerk is not always present in chorea on 
 account of the spasm contracting the leg on 
 tapping it. 
 
 The symptoms are worse in the morning, and 
 the disease reaches its height in three or four 
 weeks. 
 
 We know much more about motor functional 
 nerve diseases, such as chorea, than about the 
 sensory (as neuralgia), because in the latter all
 
 OTHER NERVE DISEASES 289 
 
 depends on the description by the patient, in the 
 former on the observation of the doctor. The 
 disease must be diagnosed from spasmodic tic, in 
 which the movements are purposive, from dis- 
 seminated sclerosis, and from movements in 
 hysteria, and in old age from paralysis agitans. 
 
 The duration is from six weeks to six months 
 or more ; if not cured within six weeks it will 
 generally go on to as many months. It may 
 persist slightly for years. 
 
 The treatment throughout is empirical, and 
 consists in isolation, rest in bed, and arsenic. 
 Salicylates are of great use, and in using Fowler's 
 solution in increasing doses it is well to combine 
 it with syrup of the iodide of iron. 
 
 In grave cases chorea becomes progressive, 
 involving successive tracts ; and whereas usually 
 it is a disease soon recovered from, in these it 
 progresses to a fatal issue in ten to twenty years. 
 There is not, however, degeneration of the cortex. 
 
 Mental changes accompanied by high tempera- 
 ture (up to 104) may occur in grave cases of 
 chorea. 
 
 There is one terrible form called maniacal 
 chorea, said to be, fortunately, one of the rarest 
 diseases on earth. In chorea gravis some de- 
 lirium with delusions is not uncommon, and even 
 true chorea insaniens is but an exaggeration of 
 the chorea simplex of Sydenham. This is charac-
 
 290 FUNCTIONAL NERVE DISEASES 
 
 terised by mania and movements of the utmost 
 violence, and differs entirely from choreic insanity, 
 which Kraepelin describes as a quiet, senseless 
 state of hallucination with choreic movements. 
 
 Tics or spasms of muscles, including specially 
 spasmodic wry-neck, form a class of functional 
 nerve diseases by themselves. 
 
 Tics are divided into habit spasms, wry-neck, 
 and psychic tic. 
 
 In the first we get twitchings of the face, fore- 
 head, shoulders, &c., from habit. 
 
 All cases arise from incessant repetition of the 
 same act till it becomes quite involuntary. 
 
 These spasms cease during sleep. 
 
 Facial spasms are common in neurotic women 
 after forty-five, and may be partly due to irri- 
 tation from bad teeth, ear disease, &c. 
 
 Cases in women under thirty are often merely 
 hysterical symptoms and easily cured. In these, 
 and those classed as psychic, that come on from 
 purely mental causes, the disease is central and 
 is cured by psychotherapy. Spasmodic wry- 
 neck arises from injury, mental excitement, 
 neurasthenia and muscle strain. It often begins 
 as a "stiff neck," from cold or draught. The 
 least touch on the chin often puts the head quite 
 straight. The sterno-mastoid is really the muscle 
 at fault, but it must not be divided in spasmodic
 
 OTHER NERVE DISEASES 291 
 
 tic. Force increases the trouble ; suggestion is 
 what is needed, and I have cured a most obstinate 
 case of years' standing by a light instrument, prac- 
 tically invisible, that had a small arm resting near 
 the head on flexed side and another on chin on 
 opposite side. As long as the head was fairly 
 straight they did not touch, but as it inclined, the 
 pressure at once became uncomfortable, and sug- 
 gested the erect position was better. 
 
 As the spasm is often reflex, section of the 
 afferent sensory is often more effectual than of the 
 efferent motor nerve. 
 
 In obstinate cases, excision of part of the spinal 
 accessory has been successful. 
 
 Severe tic can be cured by putting the patient 
 under opium continuously for twenty-four hours 
 at least up to three weeks. This is better than 
 aconitine or hyoscine hydrobromate. 
 
 Sometimes an empirical cure can be made in 
 slight cases by severe faradisation of the sound 
 side. 
 
 A good treatment for tics in general, as well as 
 for hysterical chorea, is to make the patient per- 
 form a slow series of movements to the word of 
 command to overcome the spasm. The patient's 
 fears must first be overcome as far as possible by 
 psychotherapy, as failures are disastrous. I have 
 described this plan in writer's spasm. 
 
 Allied to spasms is a disease called astasia
 
 292 FUNCTIONAL NERVE DISEASES 
 
 abasia, which is not uncommon. In it, in the act 
 of walking the legs may suddenly give way, or if 
 sitting, the person may fall forward. There is no 
 loss of consciousness and the patient is quite well 
 again after a minute or two. It is chiefly found 
 in gouty people over forty, and is not dangerous, 
 though persistent. 
 
 Tetany, sometimes called pseudo-tetanus, is a 
 disease rare in England, though common in 
 Austria, and consists of bilateral tonic spasms of 
 the extremities with increased irritation of motor 
 nerves and muscles and sensory nerves. It comes 
 on *in infants (two to four years) and at puberty. 
 The causes are toxic, gastric, worms, pregnancy, 
 puerperal causes, acute fevers, alcohol, uraemia. 
 
 The disease is common as a sequela to measles 
 and influenza. Shoemakers are especially liable 
 to it, due to some toxin probably in the leather. 
 It often follows the loss of the thyroid gland. 
 There is no evidence that the cause lies in the 
 cerebral cortex. 
 
 It may be due (but this is not proved), to some 
 poison in the anterior horn of the spinal cord, 
 and so be allied to anterior polio-myelitis ; but at 
 present we class it as functional. 
 
 The hand is stretched out like an accoucheur's 
 hand, with the thumbs well flexed in the palm and 
 fingers and wrists slightly flexed.
 
 OTHER NERVE DISEASES 293 
 
 The symptoms begin with tingling and then 
 muscular spasm of hands and feet. It may 
 spread to the body. The spasm is generally of a 
 remittent type. 
 
 The pain is often intense before the cramp, and 
 the muscles are tender after. 
 
 It has to be diagnosed from tetanus, spinal 
 meningitis, tubercular meningitis, epilepsy, hys- 
 terical contraction and hysterical tetany. 
 
 Vertigo is of various sorts. We get ocular 
 vertigo, caused by ocular disorder ; aural ver- 
 tigo, or Meniere's disease, caused by labyrin- 
 thine disease, either irritative or destructive ; 
 gastric vertigo, which is, however, rare, and is 
 like a bilious attack. Most cases of Meniere's 
 disease used erroneously to be classed under this 
 head. 
 
 Other varieties are epileptic vertigo, the vertigo 
 of migraine, vertigo due to organic nerve dis- 
 ease, and lastly nervous vertigo, of which alone I 
 write here, all the other varieties being organic 
 in origin. 
 
 Even here, of course, vertigo, which is defined 
 as the consciousness of disordered equilibration, 
 is a symptom ; but where it is the only one 
 marked we treat it as a functional nerve disease. 
 It occurs in nervous people from overstrain, 
 worry, shock, sexual excesses : also from excess
 
 294 FUNCTIONAL NERVE DISEASES 
 
 of tobacco, alcohol, and tea. It is generally 
 slight, but may be felt even when lying flat or in 
 sleep. It is often worse in crowds or in an ele- 
 vated position. There may be buzzing in the 
 ears, but no deafness ; and there is no loss of 
 consciousness. It distresses the patient greatly, 
 and it is often feared as the precursor of grave 
 disease. The treatment follows the lines of that 
 in other functional nerve disorders. 
 
 Exophthalmic goitre, or Graves' disease, or 
 Basedow's disease used to be thought to be 
 entirely due to disease of the thyroid gland, but 
 later researches fail to establish this. Beevor 
 says it is a functional nerve disease of the central 
 nervous system. 
 
 This is a disease characterised by prominence 
 of the eyeballs, enlargement of the thyroid and 
 palpitation of the heart, and general symptoms 
 of nervousness. Prominence of the eyes, how- 
 ever, is absent in one-tenth of all cases and en- 
 largement of the thyroid in one-twelfth. Muscle 
 tremors are common. 
 
 Retraction of one or both upper eyelids (Stell- 
 wag's symptom) is common, and this causes 
 the eyes to appear more prominent than they 
 really are. 
 
 The disease is rare in men, but common in 
 women from twenty to thirty. There are changes
 
 OTHER NERVE DISEASES 295 
 
 in the temper and sometimes difficulty of breath- 
 ing. The disease is sometimes incurable, and at 
 all times patients only improve very gradually. 
 
 The treatment consists, as in all functional 
 disease, in first bringing the body generally into 
 the most healthy condition and then treating 
 the most prominent symptoms. The galvanic 
 current sometimes reduces the thyroid tumour. 
 
 Psychotherapeutics are of considerable value in 
 stimulating the nervous system and assisting 
 recovery.
 
 CHAPTER XV 
 
 QUACKERY 
 
 NOT long ago (July, 1905), in a remarkable 
 address on medicine, Sir J. Crichton 
 Browne spoke as follows : 
 
 "Is it, after all, mere fancy that a mental 
 atmosphere or effluence emanates from one per- 
 son to affect another, either soothing sympatheti- 
 cally or irritating antipathically ? Think, in this 
 relation, on the extraordinary (so-called) mag- 
 netic personalities which some persons possess, 
 and, again, on the contagious fire of emotion 
 which spreads swiftly and gathers volume in a 
 crowd of people, inflaming them, as the case may 
 be, either to deeds of mad fury or to corybantic 
 displays of religious fervour. 
 
 " Now, as fuller and exacter knowledge of the 
 reflex mechanism of the body adds to our means 
 of preventing and curing its disorders, and in- 
 creasing chemical knowledge points to scientific 
 therapeutics, so may a just conception of the 
 
 subtleties of the forces at work in mental action 
 
 296
 
 QUACKERY 297 
 
 inspire a more advised and methodical use of 
 the resources of mind to cure diseases of body. 
 Is it not from neglect to employ such intelligent 
 measures that patients fall into the hands of 
 nature-curers, Christian scientists, mesmerists, 
 and the like faith-instilling persons, and are 
 sometimes cured when drugs have failed ? And 
 is it not to the use of such means, albeit not 
 consciously formulated, that the popular prac- 
 titioner, whose small medical knowledge is the 
 smallest part of his skill, gains the co-operative 
 belief of his patient and owes his fashionable 
 success ? It is all very well to say that people 
 are ignorant, foolish, credulous. Of course they 
 are. The world would not have gone the way 
 it has gone were the immense majority not gladly 
 beguiled ; but if you would influence the fool for 
 his good, you must enter by sympathetic imagi- 
 nation into the fool's mind , and discern the 
 motives by which it can best be moved. And 
 it is still the fact that, as Cicero said of places 
 in his time, every place swarms with fools. Sick 
 persons, even when not foolish, are notably sick 
 in mind, and mostly need a mental tonic to stimu- 
 late their weakened vitality ; such inspiration 
 serving sometimes to animate the tissues to a 
 strength of vital resistance from which the 
 noxious bacillus retreats baffled yes, even 
 though it is greedy there and scents the fit
 
 298 FUNCTIONAL NERVE DISEASES 
 
 soil, it does not find the fit climate. Few drugs are 
 more helpful than hope, more deadly than despair." 
 
 I have italicised in the above the sentence 
 that lies at the root of the present success of 
 quackery, namely, the neglect of medical men 
 to employ intelligently the power of the mind 
 in healing the body. 
 
 Another important witness is in a sentence I 
 will quote from a letter of Sir James Paget's 
 to Sir Henry Acland, written in 1866, and is 
 as follows: 1 "What unsatisfactory . . . cases 
 these are ! This clever, charming, and widely- 
 known lady will some day disgrace us all by 
 being juggled out of her maladies by some bold 
 quack, who by mere force of assertion will give 
 her the will to bear, or forget, or suppress all the 
 turbulences of her nervous system." 
 
 Now, such a letter is absolutely invaluable, and 
 for this reason : Any conscious effort to reveal 
 one's mind or spirit mostly ends in failure. It 
 is when the conscious mind is directed elsewhere, 
 and the man is unaware of being observed, that 
 the unconscious mind shows us as in a mirror 
 the true soul, the real thoughts of the ego. A 
 casual letter to a friend reveals more, therefore, 
 in its unstudied phrases than an elaborate essay 
 
 1 " Sir Thomas Paget's Life and Letters " (Longmans, 
 4th edition, p. 277). Extract of letter to Sir H. Acland. 
 (I have given the whole extract.)
 
 QUACKERY 299 
 
 could do upon the subject. Every thoughtful 
 physician knows the real illuminating value of 
 letting a patient describe his symptoms in his 
 own language, however quaint, and how he 
 learns thereby more of the inner working of the 
 disease than by the most cunning phrases which 
 he puts into the patient's mouth. It is so here. 
 This illuminating letter pictures unconsciously, 
 as in a glass, the attitude of the medical mind 
 of 1866 towards mental therapeutics a mind 
 which is not so very much changed in 1907. 
 Many of my readers will find their own thoughts 
 reflected in it. Translated into bald prose, it sets 
 forth that the disgrace of the writer, of Sir 
 H. Acland, and other eminent colleagues, is 
 expected, owing to the power possessed by some 
 " bold quack " to cure an attractive patient of Sir 
 James Paget's through her mind by mere " force 
 of assertion," the process of cure apparently con- 
 sisting of the lady " being juggled out of her 
 maladies." 
 
 It may be asked, Why discuss this subject 
 at all in this manual? It is because functional 
 nerve diseases form perhaps three-fourths of the 
 diseases cured by quacks (as, indeed, would 
 naturally be supposed), and, therefore, it is im- 
 possible to pass by in silence an outside agency, 
 however irregular, that has so much to do with 
 the subject in hand.
 
 300 FUNCTIONAL NERVE DISEASES 
 
 If we proceed to review in a little more detail 
 this remarkable subject of quackery, I think we 
 shall understand somewhat better the reason of 
 the physician's agnostic attitude towards mental 
 therapeutics. We see he is beset on all sides by a 
 very army of irregulars, who, in spite of his edicts 
 and medical ethics, continue to defy the laws of 
 both ethics and science by stealing some of his 
 best patients, and, worse still, by curing them by 
 means which to him are wholly inadequate, after 
 the manner so graphically portrayed in this letter 
 from Sir James Paget. 
 
 One of the most extraordinary paradoxes 
 surely of to-day lies in the fact that, simultane- 
 ously with an advance in scientific medicine 
 wholly unparalleled in the world's history, there 
 is on every side a quackery that flourishes and 
 triumphs as much as, or more than, in the darkest 
 of the dark ages. 
 
 It is the general rule that as the true light 
 shines the darkness disappears. It is not so 
 here. Nor can it be said that it is in the less 
 civilised parts of the earth, where scientific 
 medicine is rare, that most quacks are found. 
 The reverse, strange to say, obtains. It is in 
 America, and in the most enlightened parts of 
 America it is in England, and in the heart of its 
 most intelligent centres that quackery flourishes. 
 I now speak of quackery pure and simple.
 
 QUACKERY 301 
 
 And this success is not for want of efforts 
 made to overcome it. Two things impress one 
 about quackery its extent and ancient origin 
 and the ineffectual fight against it. Eight pages 
 of the Index Catalogue of the Library of the 
 Surgeon-General's Office (U.S.A.) are taken up 
 with a bare list of books and pamphlets showing 
 up quackery, and each aiming to deal it the long- 
 evaded death-blow but they are all in vain. 
 
 A few years ago there was started most suc- 
 cessfully in London a system of curing, not one 
 or two, but all diseases by little bottles of 
 medicine (so-called) sold across the counter by 
 any chemist, the diagnosis being made by the 
 sufferer ! 
 
 But from the doctor's standpoint worse still 
 remains. Quackery would soon come to an end 
 and fade away before the spread of knowledge, 
 the decay of superstition under the fostering care 
 of the school board, and the higher educational 
 system, but for one thing. It can show real 
 cures, both undeniable and numerous, in spite of 
 the vast number that may not bear scrutiny. 
 
 This the physician cannot, alas ! deny, though 
 he may deplore it. After allowing full discount 
 for forged and false testimonials (which are not 
 so numerous as supposed), for purely imaginary 
 diseases and the credulity of mankind, and even 
 for the lesser functional disorders, there remains
 
 302 FUNCTIONAL NERVE DISEASES 
 
 behind a large residuum that cannot by any 
 ingenuity be explained away. At any rate, a 
 man believes he has suffered from some disease, 
 say rheumatism, for which, in the ordinary 
 course and the absence of the quack, he would 
 have gone to the nearest doctor, with the result 
 of a possible more or less tardy cure and the 
 certainty of a considerable bill. Whereas now, 
 the purchase for 7d. or is. i^d. of a small bottle 
 of something in a wrapper black with testi- 
 monials has already given relief, may be even 
 before it has been taken, from the mere reading 
 of the wonderful cures effected. The ignorant 
 charlatan may thus effect with his shallow mys- 
 teries what a great physician cannot do with his 
 science, because wonder and awe have a greater 
 therapeutic power than respect. In this case, of 
 course, the remedies used on both sides are here 
 regarded as inert. In practice, of course, such 
 is by no means the case, for I believe it is true 
 that many of our most useful medicines have 
 been discovered by quacks. 
 
 Now, it is quite possible that no one is more 
 surprised, as well as pleased, at the cures than 
 the quack vendor of the nostrum ; but it is not for 
 him to deny what he cannot account for, as the 
 doctor is often tempted to do, because his interest 
 is to magnify cures, which he promptly does. 
 
 It is therefore doubtless true that, in spite of
 
 QUACKERY 303 
 
 all our science, quackery flourishes ; and the 
 reason of it is by no means that all men are fools, 
 but that it undoubtedly effects numerous cures, 
 and some, as Sir James Paget suggests, that 
 have been attempted in vain by eminent scien- 
 tific men, the sufferers having only tried quackery 
 when all else has failed. It is also true that these 
 cures astonish perhaps equally the quack and the 
 doctor. 
 
 But let us go a little further, and glance at the 
 pseudo-religious quacks and faith-healers who 
 make a gain of the credulity and folly of mankind 
 without recourse to patent pills or is. ijd. medi- 
 cines. These are found everywhere, but abound 
 most, like the ordinary quack, not, as might be 
 supposed, in Russia, or in Turkey, or Poland, or 
 South America, or in shady corners of the civil- 
 ised world, but in the very focus of intellectual 
 and material life the United States of America. 
 
 The greatest of these latter-day mystics is 
 undoubtedly at present the " Rev." Mary Baker 
 Eddy, whose ponderous work on Christian 
 Science is the text-book of the entire sect, num- 
 bering some millions, here and in America and 
 elsewhere, of educated followers far above the 
 average in wealth and culture many, alas ! for- 
 merly having been among the most lucrative of 
 the physician's patients. This book is appointed 
 to be read by Mrs. Eddy in all her churches,
 
 304 FUNCTIONAL NERVE DISEASES 
 
 side by side with the Bible ; and in the great 
 central Temple at Boston, and in all their 
 churches, this work, " Science and Health," is 
 read every Sunday to crowded and attentive 
 congregations of upper-class educated people. 
 With their dogmas one need not interfere ; cures 
 are detailed and vouched for by the healed at 
 every meeting, and though to some judgments 
 Christian Science contains neither Christianity 
 nor science as generally understood, these cures 
 cannot all be doubted or explained away. 
 
 An account of another phase of quackery, 
 in Germany, gives a remarkable picture of the 
 vast field it covers in its very varied methods : 
 
 "The most important kind of charlatanism in 
 Germany at present [1907] is the Nature-cure, 
 which not only enjoys a widespread popularity, 
 and an authority which every make-believe scien- 
 tific movement easily exercises over the public, 
 but has all the advantages of a cleverly-directed 
 organisation. 
 
 " Formerly homceopathy did its best to impress 
 the public with the idea that it could and would 
 replace the old and rusty school medicine, whilst 
 in reality it was a sensation, and, when practised 
 by quacks, nothing but a clever evasion of exist- 
 ing laws. The same is now the case with those 
 who pretend to cure by means of Nature. 
 
 "Homceopathy traded on mysticism, and
 
 QUACKERY 305 
 
 Nature-curers take advantage of an enthusiasm 
 for Nature. The extent to which this form of 
 charlatanism has spread is apparent from the fact 
 that out of 4,104 German quacks in 1902, 3,761 
 were Nature-curers and 770 cured by means of 
 water, whilst only 262 employed homoeopathy, 
 145 worked by means of magnetism, 79 by 
 electricity, 77 by plant cures and drugs, 74 by 
 afflation, 37 by means of herb cures, 24 by oint- 
 ments, 23 by sun baths, 14 by hypnotism, 12 by 
 vegetarianism, 6 by Christian Science, 3 by the 
 laying-on of hands, 2 drove devils out, i spat on 
 his patients, and, lastly, i cured by blessing, i by 
 means of shirts, i by magnetic water, and i by 
 the 'oil of life.' It may be of interest to men- 
 tion, by the way, that out of these 4,104 quacks 
 464 that is to say, more than 1 1 per cent. had 
 previously been convicted, and 167 of them 
 several times ; 1 6 had done hard labour and 
 137 suffered imprisonment. Their standard of 
 education is characterised by mentioning that 
 out of 1,440 quacks about whom we are informed, 
 l ^35 (79 P er cent.) have enjoyed only the 
 lowest type of schooling, the Volksschulen ; there 
 were registered, among others, 201 craftsmen, 
 35 workmen, 286 peasants, and other agricultural 
 labourers. 
 
 " From the foregoing it will be observed that 
 the Nature-cure is the most popular swindle of
 
 306 FUNCTIONAL NERVE DISEASES 
 
 the present day. These quacks have not only 
 their methods in common, but ar call connected 
 by means of a widespread organisation, consist- 
 ing of some hundreds of clubs for the purpose of 
 promulgating Nature-cure. There are 885 clubs, 
 with 125,640 members; they profess to aim at 
 the enlightenment of the people with regard to 
 health and Nature-cure. Besides this, they 
 carry on a violent agitation against such things 
 as vaccination, serumtherapy, poisons, opera- 
 tions, and the whole medical science, assisted by 
 a few doctors who have become tools in the 
 hands of these quacks. They act as if striving 
 for the public to choose in what manner they will 
 be treated, and to protect them against the 
 'medical murderers and poisoners.' In reality, 
 of course, they are fighting solely for the privilege 
 of curing without any liabilities and trouble. 
 They 'wish to protect the race against the privi- 
 leges of the learned fool.' In reality they are 
 righting for the privilege of the unlearned fool. 
 By means of clever demagogy they have gained 
 considerable ground, and for this medical men 
 must undoubtedly take a certain share of blame. 
 Their disgust and indignation for the vile agi- 
 tators was justified, but their feeling of security 
 and superiority, which prevented timely interfer- 
 ence, was no doubt unwise. The monthly organ 
 of the united German Nature clubs has a circula-
 
 QUACKERY 307 
 
 tion of no less than 132,000; besides this there 
 exist sixty-nine other periodicals of the same 
 tendency." 
 
 Of the lower class of pseudo faith-healers we 
 hear of one in New Jersey with 15,000 more or 
 less educated patients in one week. Chicago has 
 been turned upside down by the late quack 
 Dowie, amongst others, who had the walls of the 
 largest hall in the city hung round with crutches, 
 splints, &c., presented by cured followers ; and, 
 indeed, all over the States the name of these 
 religious quacks and humbugs is legion, and 
 their harvest plenteous and golden. Now, 
 though populus vult decipi is undoubtedly true, 
 and though most men are fools, still cures are 
 effected not only by respectable quacks, but by 
 the most arrant knaves, as testified by most 
 reputable persons, and, curiously enough, largely 
 by the clergy. Many, indeed, are not lasting, 
 many are very trivial, and many may be said 
 to be due to hypnotic influence of one sort or 
 another. Turning now from quackery to the 
 province of medicine, let us examine some of its 
 procedure and see if we can ascertain in it and in 
 faith cures all over the world the one underlying 
 principle to which is due the perennial vitality 
 and success of quackery. To what shall we 
 attribute many of the cures by hypnotism in 
 Nancy and the Salpetriere ? The investigations
 
 308 FUNCTIONAL NERVE DISEASES 
 
 of the British Medical Journal have shown that 
 here we have to deal with a quite inestimable 
 amount of fraud and self-deception ; but observe, 
 we have now to examine the work of learned 
 professors, regular and registered physicians, and 
 not that of mere charlatans. We have, or had, 
 Charcot in France, and names of honour and 
 repute in this country, who testify to cures of all 
 sorts without medicine or physical means, but in 
 this case purely (if the word may be coined) by 
 "psychism," the force of suggestions sugges- 
 tions, too, which appear powerless when presented 
 directly to consciousness, and only highly effica- 
 cious when the patient is in the " hypnotic" state. 
 All these things are a riddle and most perplex- 
 ing, and when the last echo of the laughter of 
 derision and the last curve of the smile of con- 
 tempt have died away, there remains much to 
 make the physician of the period at least 
 thoughtful. 
 
 Again, what about homoeopathy, hydropathy, 
 Matteism, and all the many and flourishing 
 Swedish, German, Austrian, Italian, and other 
 special cures ? Are they all unworthy of the 
 name? By no means. Here a semi or pseudo 
 scientific basis is more or less attempted, many 
 excellent hygienic formulae are observed, which 
 elevate them above the mere rank quackery we 
 have written of. But the great point is that
 
 QUACKERY 309 
 
 cures, and remarkable cures too, are everywhere 
 effected. I may say here, indeed, that it is 
 impossible to say all these are what in our 
 ignorance at present we crudely class as " func- 
 tional " ; though, doubtless, most are. Is rheu- 
 matism, for instance, a functional or organic 
 disease? Is dropsy, is erythema, is eczema, is 
 paralysis ? Some hyperscientist may object that 
 some of these are symptoms and not diseases. 
 But what is a symptom and what is not a symp- 
 tom ? Nay, more, what is a disease ? And until 
 we can answer this last profound question, how 
 do we know whether it is functional, or organic, 
 or both ? Our own broad definition of the two 
 would be that " functional " disease is that which 
 is of psychic origin, " organic " that which is of 
 physical. At the bottom, no doubt, all diseases 
 involve some organic change somewhere. 
 
 But this is not all, in the way of inexplicable 
 cures. What about Lourdes ? or if that be a 
 centre of imposture, which it is, and yet isn't, 
 what about our own faith-healing centres and 
 others abroad, uncontaminated by the least 
 sympathy with Roman Catholicism or saint- 
 worship ? 
 
 As these may not be so well-known even to 
 the widely-informed physician, a detail or two 
 may be given, showing they at any rate exist. 
 
 A few years ago, in the Agricultural Hall,
 
 310 FUNCTIONAL NERVE DISEASES 
 
 Islington, a great conference of some two 
 thousand faith-healers was held, there being 
 then some hundred and twenty faith-healing 
 centres in' this kingdom alone, now probably 
 many more. In America there are some thirty 
 homes (one of which cost over .6,000, presented 
 by a " cured " patient) and innumerable centres. 
 There are several in Australia and many all over 
 Europe. A few years ago in New York and 
 Boston there was hardly a believer in faith- 
 healing and now there are thousands. Observe, 
 these have nothing to do with the Christian 
 Scientists on the one hand or the pseudo- 
 fraudulent faith-healers on the other, of whom 
 I have written. From a religious point of view, 
 these are orthodox, severely Protestant, and 
 mostly evangelical. 
 
 In one long list of two hundred and fifty pub- 
 lished cases of disease cured, we find five " con- 
 sumptive," one " diseased hip ; " five " abscess," 
 three "dyspepsia," four "internal complaint," two 
 "throat ulcer," seven "nervous debility," nine 
 "rheumatism," five "diseased heart," two "with- 
 ered arm," four "bronchitis," three "cancer," two 
 "paralysed arm," three "weak eyes," one "rup- 
 tured spine (?)," five "pains in the head." And 
 these are the results in one year at one small 
 chapel in the North of London ! The list causes 
 amusement and perhaps surprise ; and impatience
 
 QUACKERY 311 
 
 may be felt that such puerile details should be 
 here given. But to the poor sufferers it was any- 
 thing but puerile to be cured, or at any rate 
 relieved, from diseases from which they suffered, 
 or at any rate imagined they suffered, free of all 
 charge ; for none of these are money-making 
 agencies, whatever else they may be. 
 
 What about charm cures ? Perhaps scientists 
 innocently suppose these have died out. Not at 
 all ; for not only in the country districts, but it 
 may be in the humbler regions of the physician's 
 own house, they are implicitly believed in, and, 
 moreover, even here also are cures effected. 
 
 What about cures by relics and even by idols ? 
 I am told that undoubted cures are effected not 
 only by the Holy Coat of Treves, but all over the 
 world, notably in India, China, and Africa, by the 
 presence of actual idols. One in India is most 
 famous for its therapeutic power ; while large 
 temples in China are covered with votive offer- 
 ings from the " faith-healed." Trees, plants, 
 flowers, bits of animals, &c., have all their thera- 
 peutic powers. But the patience of our cul- 
 tured reader must not be too severely tried. 
 Turn, then, with relief to something more 
 respectable. 
 
 What about the "cures" at home and Conti- 
 nental spas, with their eternal round of sulphur 
 and iron waters and baths ? Does the doctor
 
 312 FUNCTIONAL NERVE DISEASES 
 
 attached to the spa, in his heart of hearts, believe 
 that all the cures which in these cases he cheer- 
 fully certifies to are effected by the waters, or 
 even the waters and the diet, or even the waters 
 and the diet and the air ; or does he not think 
 there must be a " something else " as well ? And 
 to come nearer home and into the centre of 
 all things, and the chamber of all his secrets : in 
 his own consulting-room and in his own practice, 
 is not the physician brought face to face with 
 cures, ay, and diseases too, the cause of which he 
 cannot account for ; and is he not often surprised 
 to find a continuation of the same treatment 
 originated by the local practitioner is, when con- 
 tinued by his august self, efficacious? And is 
 not the local practitioner not only surprised but 
 disgusted as well, to find such the case ? 
 
 But we have asked hard questions enough. We 
 will ask an easy one. What, then, is the one 
 effectual agency in quackery, in semi-scientific 
 cures of all sorts, in faith cures, in relic, charm, 
 and idol cures, in many spa and water cures, in 
 some doctors' cures perhaps in more than they 
 suspect ? After allowing fully for the intrinsic 
 value of the quack remedy, of the mystic for- 
 mula, of the millionth dilution, or of the prismatic 
 electricity ; for the sulphate of soda or magne- 
 sium, and even for the value of real B.P. drugs, 
 we must answer, It is mainly and primarily the
 
 QUACKERY 313 
 
 power of the unconscious mind over the body. 
 It is this, and this pre-eminently, that cures ; 
 it is this, and this pre-eminently, that is every- 
 where ignored (as stated in the sentence with 
 which I opened this chapter) however much other 
 minor factors may be extolled. 
 
 With regard to nerve diseases specially, Skey 
 says, speaking of hysteria : l "It may be as- 
 serted with truth that every part of the body 
 may become, under provocation, the seat of an 
 apparent disease that in reality does not exist ; 
 that it may, and often does, assume all the attri- 
 butes of reality with an exactness of imitation 
 which nothing short of careful and accurate 
 diagnosis can distinguish from the real disease. 
 Nevertheless, I unhesitatingly assert that real 
 disease is not found in a greater proportion than 
 one case in twenty ; and even this is a liberal 
 allotment." 
 
 That is to say, that the vast majority of ner- 
 vous diseases, being purely mental in their origin, 
 are cured most easily by mental remedies ; and 
 there is no doubt that these quack medicines, 
 extravagant doctrines, and varied fetishes afford 
 one and all real and true mental remedies to 
 those classes of minds that can receive them 
 and believe in them. Now, although all sick per- 
 sons do not run after quacks (for which we may 
 1 Skey, "Lectures on Hysteria," p. 44.
 
 3H FUNCTIONAL NERVE DISEASES 
 
 be thankful), yet it is true that all sick persons 
 may be benefited by mental medicines in some 
 form or other. 
 
 " It should be known," says Osgood Mason, 1 
 " far and wide, in the profession and out of it, 
 that there is a subjective, a psychic element 
 in the practice of the healing art, and it is in 
 that direction, rather than in the multiplication 
 of drugs, that the therapeutics of the future is 
 to be enriched." 
 
 The result of the neglect of this study has 
 naturally been profound ignorance of psycho- 
 therapeutics, and nowhere has this had more 
 disastrous practical effect in preventing cures, 
 aggravating disease, and disgusting patients 
 with legitimate medicine than in functional nerve 
 disease. 
 
 "To my notion," say Dr. Inman, 2 "there is 
 not in all medical history a more melancholy 
 chapter than that which treats of hysteria ; and 
 there are still extant in many books examples of 
 reasoning that are simply contemptible. Who, 
 for example, that knows the nature and character 
 of women, could believe that all of them, from 
 the highest to the lowest, had, without any 
 conspiracy amongst themselves, invented a set 
 
 1 Osgood Mason, " Hypnotism and Suggestion," p. 46. 
 * Dr. Inman, " On the Restoration of Health," pp. 500, 
 502.
 
 QUACKERY 315 
 
 of symptoms whose chief characteristics were 
 pain in the individual and mystery for the 
 doctor, and yet which at the same time should 
 be actualities and nonentities non-existent, yet 
 aggravated by sympathy and all dependent 
 more or less upon a desire to be married? 
 I can hardly write calmly when I think of the 
 obloquies heaped upon our females in certain 
 medical works : indignities, indeed, unsupported 
 by a tittle of valid evidence. With these ideas 
 was associated in the doctor's mind a belief 
 that hysterical sufferings were feigned, with a 
 view of eliciting sympathy, and deserved to be 
 treated in a rough manner and by disagree- 
 able medicaments. Upon many a sufferer hard 
 usage was inflicted, where gentle nursing was 
 needed, and a horrible compound of atrocious 
 drugs was ordered as medicine, where all that 
 was really required was good nutrition. Well 
 do I recall the unction with which a hospital 
 physician boasted to me of the efficacy of 
 his Mistura Diabolica, or Satanic Physic in 
 obstinate cases of hysteria." 
 
 There can be no doubt that the gradual rise 
 of the study of psychotherapeutics within the 
 ranks of the profession has altered much of this, 
 but enough remains to make me most urgent 
 in pressing the regular and systematic study 
 of psychotherapeutics and the general connec-
 
 316 FUNCTIONAL NERVE DISEASES 
 
 tion of mind and body in the aetiology and 
 treatment of disease, not only that we may 
 cease to lose so many of our best patients 
 from the successful inroads of quackery, but 
 that we may be able to treat more success- 
 fully those that remain to us, and especially 
 all who suffer from functional nerve disease. 
 
 Quackery truly will never disappear, and the 
 ignorant and faddist will always be its dupes ; 
 but thousands would never have dabbled in 
 it had they met in the ranks of the profession 
 with the intelligent practice of psychothera- 
 peutics. My final word, then, with relation to 
 functional nerve diseases is that we must recog- 
 nise that the very essence, the real corner-stone 
 of successful treatment, lies in the recognition of 
 the large psychic element that they contain, 
 and that no treatment can be deemed scientific 
 or will prove satisfactory that does not include 
 the intelligent practice of psychotherapy.
 
 INDEX 
 
 ABDOMINAL hysterical tumours, 121 
 Age and hysteria, 90 
 Agent in faith cures, 312 
 Allbutt, Dr. Clifford, on hysteria, 
 
 112 
 Anaemia in functional nerve disease, 
 
 7i 
 
 Anaesthesia, experiments in, 98 
 Application of mental therapeutics, 
 
 175 
 
 Arndt on neurasthenia, 6l 
 Aura in hysteria, 109 
 Autosepsis, 58 
 Autosuggestion, 193 
 
 BABINSKI'S phenomenon, 159 
 Barrett, Professor, on unconscious 
 
 sensation, 75 
 Bascom, Dr., on life, 33 
 Basedow's disease, 294 
 Bastian, Dr. C., on psychology, 47 
 
 on mind, 52-53 
 
 Beale, Dr. L., on life, 30 
 Beard, Dr., on neurasthenia, 6 1 
 Bechtren, Dr., on suggestion, 187 
 Bed in rest cure, 207 
 Bernheim, Dr., on hysteria, 87 
 Biener, Professor, on hysteria, 85 
 Braid on sensations, 82 
 Brain, action spheres of, 40 
 
 ,, cells, Golgi on, 24 
 
 ,, Max Schultze on, 25 
 
 ,, cortex of, 23 
 
 divisions of, 20 
 
 Brain, Dr. A. Hill on, 26 
 
 Sir J. Crichton Browne on, 
 
 31 
 
 Ladd on, 30 
 
 nerve paths in, 26 
 
 ,, Hack Tuke on, 26 
 
 psychology of, 17-54 
 Brains, two distinct, 34 
 Briquet on hysteria, 86 
 Brown, Dr., on physical culture, 18 
 Browne, Sir J. C., on materialists, 
 
 36 
 Buzzard, Dr., on hysteria, 87 
 
 CALDERWOOD, Dr., on psychic 
 
 action, 19 
 Campbell, Dr. H., on monists, 
 
 33 
 
 Care of neurotic children, 267 
 Carlyle on disease, 2 
 Carpenter on mind, 134 
 Catalepsy, 109 
 Causes of neurasthenia, 127 
 Cells, reaction of, 58 
 Cerebrum, divisions of, 22 
 Charcot on suggestion, 188 
 ,, on hysteria, 90 
 ,, on neurasthenic symptoms, 
 
 137 
 
 Charm-cures, 311 
 Childhood, nerves in, 258 
 Chorea and rheumatism, 269-287 
 symptoms in, 287 
 
 ,, treatment in, 289
 
 318 FUNCTIONAL NERVE DISEASES 
 
 Circulatory symptoms in hysteria, 
 
 1 02 
 Clarke, Dr. Mitchell, on hysteria, 
 
 112 
 
 Clifford Allbutt, Dr., on disease, I 
 Clouston, Dr., on functional nerve 
 
 disease, 13, 265 
 on mental diseases, 
 
 176 
 Conditions for successful suggestion, 
 
 190 
 Conscious and unconscious mind, 
 
 57 
 Conscious mind compared to the 
 
 spectrum, 51 
 
 Consciousness and suggestion, 196 
 ,, is mental vision, 48 
 
 Contracted consciousness in hysteria, 
 
 107 
 
 Cortex of brain, 23 
 Craft palsies, 272 
 Cramp, writer's, 273 
 Crichton-Browne, Sir J. C., on 
 quackery, 296 
 Sir J. C., on 
 
 brain, 31 
 
 Cure, the rest, 199-233 
 Cures by charms, 311 
 by faith, 310 
 by idols, 311 
 ,, by relics, 311 
 ,, of hysterical tumours, 237 
 
 DANA, Professor, on hysteria, 90 
 Danger in child training, 262 
 ,, of hypnotism, 198 
 ,, of puberty in children, 261 
 Definition of mind, Professor 
 
 James's, 41 
 Dejerine, Professor, on mental 
 
 therapeutics, 185 
 Demme, Professor, on hereditary 
 
 drunkards, 259 
 
 Diagnosis between functional nerve 
 disease and organic 
 nerve disease, 158 
 ,, for patient, 164 
 
 Diagnosis in functional nerve dis- 
 ease, 156-168 
 Difficult patients, 236 
 Direct suggestion, 192 
 
 ,, ,, Professor Dubois 
 
 on, 192 
 Disease, Carlyle on, 2 
 
 ,, Dr. H. Campbell on, I 
 ,, Dr. Clifford Allbutt on, 2 
 ,, Professor Drummond on, 
 
 10 
 
 ,, Sir F. Treves on, 5 
 by suggestion, 119 
 what it is, I 
 Distinction between functional and 
 
 organic disease, 8 
 Divisions of brain, 20 
 
 ,, of cerebrum, 22 
 Dream, paralysis from, 1 20 
 Drugs in functional nerve disease, 
 
 256 
 Drummond, Professor, on doctors, 
 
 10 
 
 Drunkenness, phenomena of, 23 
 Dualists and monists, 30 
 Dubois, Professor, on direct sug- 
 gestion, 192 
 
 ,, ,, on hysteria, 113 
 
 Duchenne's paralysis, 277 
 Dunn, Dr. R., on mind, 34 
 Dyspepsia and nerves, 59 
 
 ,, symptoms in hysteria, 
 
 104 
 ,, treatment of, 246 
 
 EBBINGHAUS on mind and matter, 
 
 44 
 
 Eichhorst on hysteria, 86 
 Electricity, galvanic, 260 
 
 ,, high frequency, 251 
 
 ,, in rest cure, 216 
 
 ,, sinusoidal, 252 
 
 static, 252 
 
 Emotion in hysteria, 116 
 
 ,, Professor James on, 114 
 Erb on neurasthenia, 61 
 Etiology of hysteria, 73-110
 
 INDEX 
 
 319 
 
 Etiology of functional nerve disease, 
 
 55-72 
 
 ,, of neurasthenia, 126,334 
 Examination of neurasthenic patient, 
 
 139 
 
 Excessive food in rest cure, 210 
 Exciting causes in neurasthenia, 132 
 ,, of functional nerve 
 
 disease, 62 
 
 Excretory symptoms in hysteria, 106 
 Exophthalmic goitre, 294 
 Experiments in anaesthesia, 98 
 
 FAILURE in rest cures, 200 
 Faith cures, 309 
 
 ,, -healing and mental thera- 
 peutics, 171 
 Fatigue in functional nerve disease, 
 
 65 
 
 Finger tips, Gallon on, 29 
 Fits and hysteria, 95 
 Food in rest cure, 208 
 Four varieties of temperament, 4 
 France, hysteria in, 73 
 Functional and organic, distinction 
 
 between, 8 
 
 Functional nerve disease, 14, 65 
 Functional nerve disease : 
 
 ansemia in, 72 
 
 Beard on, 63 
 
 Dr. Clouston's list of, 13 
 
 Dr. Clouston on, 265 
 
 diagnosis, 156-168 
 
 and displacement of organs, 76 
 
 drugs in, 256 
 
 etiology, 55 
 
 exciting causes, 62 
 
 gout in, 63 
 
 insomnia, 69 
 
 in children, 272 
 
 and organic nerve disease, 70 
 
 overstrain in, 66 
 
 pain in, 70 
 
 poisons in, 63 
 
 predisposing causes in, 6 1 
 
 sexual causes in, 67 
 
 shock in, 70 
 
 Functional nerve disease (contd.) 
 suggestion in, 67 
 treatment of, 316 
 value of travelling in, 241, 242 
 
 GALTON on finger-tips, 29 
 
 Galvanic electricity, 253 
 
 General nutrition in neurasthenia, 
 
 140 
 ,, treatment of functional 
 
 nerve disease, 234-257 
 Germany, nature cure in, 304 
 ,, quackery in, 304 
 ,, neurotic children in, 262 
 Golgi on brain cells, 24 
 Goodhart, Dr., on nervous disease, 7 
 Gout and functional nerve disease, 
 
 63 
 
 suppressed, 167 
 Cowers, Sir W., on brain cells, 26 
 Graham Brown,Dr., on mental thera- 
 peutics, 177 
 
 ,, ,, on neurasthenia, 61 
 
 Graves' disease, 294 
 
 HACK TUKE on the brain, 26 
 
 Hemicrania, 284 
 
 Hereditary drunkenness, Professor 
 
 Drummond on, 259 
 Heredity of hysteria, 90 
 High-frequency treatment, 257 
 Hossling, Von, on neurasthenia, 
 
 128 
 Hunter, John, on ideal sensations, 
 
 81 
 
 Huxley on life, 32 
 Hydropathic treatment, 253 
 
 ,, in functional 
 
 nerve disease, 
 248 
 
 Hyperpyrexia in hysteria, 103 
 Hypnotism, 195 
 
 and consciousness, 198 
 ,, dangers of, 198 
 ,, methods of, 197 
 Hypochondria, 162 
 
 ,, sexual, 278
 
 ^20 FUNCTIONAL NERVE DISEASES 
 
 Hysteria, and age, 90 
 
 aura in, 109 
 Bernheim on, 87 
 Binet on, 85 
 Briquet on, 86 
 Dr. Buzzard on, 87 
 tumours, cause of, 236 
 Dr. Rennie on cause of, 83 
 and character, 114 
 Charcot on, 90 
 circulatory symptoms, 192 
 Dr. Clifford Allbutt on, 1 1 2 
 contraction in, 107 
 Professor Dana on, 90 
 a distinct disease, 93 
 Professor Dubois on, 113 
 dyspeptic symptoms in, 
 
 104 
 
 emotion in, 116 
 Erichsenon, 87 
 etiology of, 73-110 
 in France, 73 
 and heredity, 90 
 hyperpyrexia, 103 
 and hysterogenic zones, 99 
 Janet on, 84 
 list of symptoms, 123 
 locomotory symptoms, 100 
 loss of sensation in, 95, 96 
 may kill, 122 
 in mental action, 74 
 Dr. Mitchell Clarke on, 
 
 112 
 
 Mobius on, 90 
 
 and neuromimesis, 74 
 
 nervous symptoms in, 108 
 
 Dr. Ormerod on, 84 
 
 Page on, 86 
 
 Sir J. Paget on, 74 
 
 and paralysis, 195 
 
 pathology of, 90 
 
 Sir J. Russell Reynolds on, 
 
 90 
 
 secretions, 106 
 secretory symptoms of, 106 
 and sex, 90 
 Dr. Skey on, 313 
 
 Hysteria, special class of symptoms 
 
 in, 116 
 
 symptoms of, 94 
 ,, stigmata, 94 
 ,, symptoms of in special 
 
 senses, 106 
 ,, traumatic, 122 
 ,, visual symptoms, 107 
 Hysterical abdominal tumours, 121 
 
 fits, 95 
 
 ,, cedema, 103 
 ,, paraplegia, 100 
 ,, tremors, 102 
 Hysterogenic zones, 99 
 Hypochondria, sexual, 278 
 stages in, 195 
 
 IDEAL pain, 79 
 
 ,, sensation, Dr. Hunter on, 81 
 Ideas cause real feelings, 80 
 Idol cures, 311 
 Importance of functional nerve 
 
 disease, 12 
 Inman, Dr., treatment of hysteria, 
 
 315 
 
 Insanity and nervous diseases, 59 
 Insomnia in functional nerve 
 
 disease, 69 
 
 Instructions for nerve nurses, 224 
 Introspection, Dr. Rennie on, 72 
 Isolation in rest cure, 228 
 
 JAMES, Professor, on unconscious 
 sensation, 75 
 
 ,, ,, on emotion, 1 14 
 
 ,, ,, on mind, 32 
 
 KELVIN, Lord, on Neo-Materialists, 
 40 
 
 LADD on brain, 30 
 
 Lady and dish, 119 
 
 Lancet on mental therapeutics, 177 
 
 Lewes, G. H., on life, 46 
 
 Life, Professor Bascom on, 33 
 
 ,, Huxley on, 32 
 
 ,, Beale on, 30
 
 INDEX 
 
 List of phobias, 152 
 
 of symptoms, 123 
 Lists of functional nerve diseases, 14 
 Local symptoms in neurasthenia* 
 
 147 
 
 Localisation of pains, 78 
 Locomotor ataxy, symptoms in, 100 
 Loss of sensation in hysteria, 96 
 Lowenfeldt on neurasthenia, 61 
 
 MACPHERSON, Dr., on psychology, 
 
 47 
 
 Mason, Osgood, on mental thera- 
 peutics, 314 
 
 Massage in rest cure, 216 
 Material basis of disease, 9 
 Materialists, Sir J. C. Browne on, 
 
 36 
 
 ,, and vitalists, 36 
 
 Max Schultze on brain cells, 25 
 Meaning of chromoplasm, 35 
 Medicine a science and art, 179 
 Melancholia, 161 
 Men, neurasthenia in, 130 
 Mental action in hysteria, 74 
 ,, therapeutics, 75 
 ,, ,, application of 
 
 at the Sal- 
 petriere, 185 
 ,, Dr. Clouston 
 
 on, 176 
 ,, ,, Dr. Dejerine 
 
 on, 185 
 
 ,, ,, Dr. Graham 
 
 Browne on, 
 177 
 
 and faith heal- 
 ing, 170 
 
 ,, ,, not mind heal- 
 
 ing, 170 
 ,, ,, Osgood Mason 
 
 on, 314 
 
 ,, ,, in rest cure, 218 
 
 ,, ,, suggestions in, 
 
 1 86 
 symptoms in neurasthenia, 
 
 149 
 Y 
 
 Mental vision, consciousness is, 48 
 
 Methods of hypnotising, 197 
 
 Migraine, 284 
 
 Mind, C. Bastian on, 53 
 ,, Carpenter on, 34 
 ,, cure, prejudices against, 171 
 , , definition of Professor James, 
 
 41 
 
 ,, Dr. R. Dunn on, 34 
 ,, Professor James on, 32 
 , , matter, Ebbinghaus on, 44 
 ,, unconscious, 43 
 
 Misplacement of organs in functional 
 nerve disease, 70 
 
 Mitchell Clarke on neurasthenia, 61 
 
 Mobius on hysteria, 90 
 
 Monists and dualists, 30 
 
 Monist theory, Dr. H. Campbell 
 
 on, 33 
 
 Motor symptoms in neurasthenia, 
 146 
 
 NATURE cure in Germany, 304 
 
 , , as the unconscious mind, 48 
 Neo-materialism, 40 
 
 ,, Lord Kelvin on, 40 
 
 Nerve currents in brain, 27 
 ,, diseases, increase of, 7 
 ,, ,, Dr. Goodhart on, 7 
 
 ,, nurse, 222 
 ,, ,, rules for, 226 
 
 ,, nurses, instruction for, 224 
 ,, paths in brain, 26 
 Nerves and dyspepsia, 59 
 ,, etiology of, 126 
 ,, in childhood, 258-269 
 , , and the nurse, 222 
 Nervous affections and insanity, 57 
 ,, symptoms in hysteria, 108 
 ,, temperament, 4 
 Neuralgia, 281 
 
 ,, visceral, 283 
 Neurasthenia, Arndt on, 61 
 
 ,, cerebral symptoms in, 
 
 148 
 
 ,, causes of, 127 
 
 ,, Dr. Whyte on, 61
 
 322 FUNCTIONAL NERVE DISEASES 
 
 Neurasthenia, exciting causes in, 132 
 ,, general nutrition in, 
 
 140 
 gastric symptoms in, 
 
 142 
 ,, Graham Browne on, 
 
 61 
 
 ,, in men, 130 
 
 ,, in Sweden, 128 
 
 ,, in stout people, 240 
 
 ,, in school - children, 
 
 262 
 
 ,, K. Petren on, 128 
 
 , , local symptoms in , 1 47 
 
 ,, Lowenfeldt on, 61 
 
 ,, mental symptoms in, 
 
 149 
 Dr. Mitchell Clarke 
 
 on, 6 1 
 ,, motor symptoms in, 
 
 145 
 ,, not a male hysteria, 
 
 162 
 
 ,, phobias in, 156 
 
 ,, poisons in, 133 
 
 ,, sexual symptoms in, 
 
 144 
 
 ,, symptoms of, 135-155 
 
 ,, and uri&acid, 131 
 
 varieties^of, 138 
 
 ,, various names of, 12 
 
 ,, Von Hossling on, 128 
 
 Neuromimesis in hysteria, 117 
 ,, and hysteria, 74 
 
 ,, Sir J. Paget on, 85 
 
 Neurons, number of, 29 
 Neurotic children in Germany, 262 
 
 ,, ,, care of, 267 
 
 Neurotics' occupation, 272 
 
 OCCUPATION in rest cure, 227 
 ,, in neurosis, 272 
 
 Ordinary diet in rest cure, 209 
 Organic nerve disease and functional 
 
 nerve disease, 70 
 Ormerod, Dr., on hysteria, 84 
 Other nervous diseases, 270-295 
 
 Overstrain in functional nerve 
 disease, 66 
 
 PAGE on hysteria, 86 
 
 Paget, Sir James, on hysteria, 74 
 ,, on quackery, 298 
 
 ,, ,, on neuromimesis, 
 
 85 
 
 Pain, ideal, 79 
 , , localisation of, 78 
 ,, neuralgia in, 282 
 ,, in functional nerve disease, 75 
 Palsies, craft, 272 
 Palsy, shaking, 279 
 Paralysis agitans, 279 
 ,, by a dream, 120 
 ,, Duchenne's, 272 
 ,, pain in, 282 
 Paraplegia, hysterical, IOO 
 Parkinson's disease, 279 
 Pathology of hysteria, 90 
 Personality, value of, 180 
 Petren, K., on neurasthenia, 128 
 Phenomena of drunkenness, 23 
 Phobias, list of, 152 
 
 ,, in neurasthenia, 151 
 Physical symptoms of hysteria, 93- 
 
 no 
 
 Pigeons, Voit's experiments on, 23 
 Poisons in functional nerve disease, 
 
 63 
 
 ,, in neurasthenia, 133 
 Predisposing causes of functional 
 
 nerve disease, 61 
 Prejudices against mind cure, 171 
 Pseudo faith healer, 305 
 Psychical action, Dr. Browne on, 18 
 ,, ,, Calderwood on, 19 
 
 ,, ,, Herbert Spencer 
 
 on, 19 
 
 ,, symptoms, 111-125 
 Psychology of the brain, 17-54 
 
 ,, Dr. Macpherson on, 47 
 Psychotherapy, 169-198 
 
 ,, essential, 169 
 
 not taught, 173 
 
 Puberty, danger of, 261
 
 INDEX 
 
 323 
 
 QUACKERY, 296-316 
 
 , , Sir J. Crichton Browne 
 
 on, 296 
 
 , , in Germany, 304 
 prosperity of, 299 
 
 Sir James Paget on, 
 
 298 
 Quacks, religious, 303 
 
 RACE and hysteria, 90 
 Reaction of cells, 58 
 Real feelings from ideas, 80 
 Relics, cures by, 311 
 Religious quacks, 303 
 Rennie on introspection, 72 
 
 ,, on cause of hysteria, 83 
 Rest cure, 199-233, 206 
 ,, ,, electricity in, 216 
 ,, ,, excessive food in, 210 
 ,, ,, failure in, 200 
 ,, ,, food in, 208 
 ,, isolation in, 228 
 ,, ,, massage in, 214 
 ,, ,, nursing in, 221 
 ,, ,, occupation in, 227 
 ,, ,, ordinary diet in, 209 
 ,, ,, restricted diet and, 212 
 ,, ,, special diet in, 214 
 ,, ,, troubles in, 231 
 
 ,, ,, visitors in, 230 
 ,, Dr. Weir Mitchell on, 
 
 202 
 Respiratory symptoms in hysteria, 
 
 106 
 
 Rheumatism and chorea, 287 
 Rules for nerve nursing, 226 
 Russell, Sir J., on hysteria, 90 
 
 ST. Virus's dance, 286 
 
 Saville, Dr., on neurasthenic symp- 
 toms, 137 
 
 School-children, neurasthenia in, 
 262 
 
 Seat of spirit, 23 
 
 Secretory symptoms in functional 
 nerve disease, 106 
 
 Sensation by idea, Braid on, 81 
 
 Sensory symptoms in hysteria, 95 
 
 Sex and hysteria, 90 
 
 Sexual causes in functional nerve 
 
 disease, 67 
 ,, symptoms in functional nerve 
 
 disease, 144 
 Shaking palsy, 279 
 Shock in functional nerve disease, jo 
 Sick-headaches, symptoms in, 285 
 Sidis, Professor, on suggestion, 188 
 Sinusoidal electricity, 252 
 Skeyon hysteria, 313 
 Sources of pain, 77 
 Spasmodic tic, 276 
 Special diet in rest cure, 214 
 
 ,, troubles in rest cure, 231 
 Spectrum, conscious mind as, 51 
 Spencer, H., on psychic action, 19 
 Spheres of brain, active, 40 
 Spirit, seat of, 23 
 
 Springthorpe, Dr. J. W., on sugges- 
 tion, 1 86 
 Stages in hypnotism, 195 
 
 ,, in paralysis agitans, 279 
 Static electricity, 252 
 Stigmata, hysterical, 94 
 Subjective suggestion, 193 
 Success of quackery, 300 
 Successful suggestion, conditions for, 
 
 190 
 
 Suggestion, Be'chtren on, 187 
 ,, Charcot on, 1 88 
 ,, direct, 192 
 ,, disease by, 119 
 ,, in functional nerve 
 
 disease, -67 
 ,, in mental therapeutics, 
 
 1 86 
 ,, Dr. J. W. Springthorpe 
 
 on, 186 
 
 ,, what it is, 187^ 
 Sundering of consciousness, 85 
 Suppressed gout, 167 
 Symptoms in sick-headache, 284 
 of chorea, 288 
 ,, of functional nerve dis- 
 ease in children, 264
 
 324 FUNCTIONAL NERVE DISEASES 
 
 Symptoms in hysteria, list of, 123 
 ,, of hysteria, 94 
 ,, of neurasthenia, 135-155 
 ,, special, in hysteria, 106 
 
 TEETH on edge, cause of, 82 
 Teething, danger of, 260 
 Temperament, nervous, 4 
 
 what it is, 4 
 
 Tetany, 292 
 Tic, 290 
 
 Traumatic hysteria, 122 
 Travelling in functional nerve 
 
 disease, 241 
 Treatment of chorea, 289 
 
 ,, of dyspepsia, 246 
 
 ,, of functional nerve 
 disease, 181 
 
 ,, of hysteria, Dr. Osgood 
 
 Mason on, 315 
 Tremors, hysterical, 102 
 Treves on disease, 5 
 Tumours, abdominal, 121 
 
 ,, hysterical, cure of, 237 
 Two distinct brains, 24 
 
 UNCONSCIOUS and conscious mind, 
 
 Si 
 
 ,, mind, 43 
 
 ,, ,, nature of, 48 
 
 Unconscious sensations : 
 Barrett on, 75 
 Professor James on, 75 
 Dr. Waldstein on, 76 
 
 Unity of mind, 50 
 
 Uric acid in neurasthenia, 131 
 
 VALUE of hobbies, 238 
 
 ,, of personality, 180 
 
 of rest, 182 
 
 ,, of stereoscopic vision, 178 
 Varieties of functional nerve disease, 
 ii 
 
 ,, of hysteria, 94 
 
 ,, of neuralgia, 281 
 
 ,, of neurasthenia, 138 
 
 ,, of suggestion, 191 
 Various names for neurasthenia, 12 
 Vertigo, 293 
 Vicious circle in functional nerve 
 
 disease, 166 
 Visceral neuralgia, 283 
 Visitors in rest cure, 230 
 Visual symptoms in hysteria, 107 
 Vitalists and materialists, 36 
 Voit's experiments on pigeons, 23 
 Voyages, value of, in functional 
 nerve disease, 242 
 
 WALDSTEIN, Dr., on unconscious 
 
 sensation, 76 
 Weir Mitchell, Dr., on rest cure, 
 
 202 
 
 Whyte, Dr., on neurasthenia, 61 
 Wilks, Sir S., on hysterics, 84 
 Writers' cramp, 273 
 Wry-neck, 276 
 Wundt on emotion, 115 
 
 UNWIN BROTHERS, LIMITED, THE GRESHAM PRESS, WOKING AND LONDON.
 
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 DRUGS AND DRUG HABITS. By H. SAINSBURY, M.D., 
 
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 34 
 
 MESSRS. METHUEN'S CATALOGUE 
 
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 FICTION 
 
 35 
 
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 FICTION 
 
 37 
 
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 Cr. Svo. Cloth, is. net. 
 
 Author of 'Miss Molly.' THE GREAT 
 
 RECONCILER. 
 Balfour (Andrew). VENGEANCE IS 
 
 MINE. 
 TO ARMS. 
 Baring-Gould (S.). MRS. CURGENVEN 
 
 OF CURGENVEN. 
 DOMITIA. 
 THE FROBISHERS. 
 CHRIS OF ALL SORTS. 
 DARTMOOR IDYLLS. 
 Barlow (Jane), Author of 'Irish Idylls. 1 
 FROM THE EAST UNTO THE 
 
 A CREEL OF IRISH STORIES. 
 THE FOUNDING OF FORTUNES. 
 THE LAND OF THE SHAMROCK. 
 Barr (Robert). THE VICTORS. 
 Bartran?(George). THIRTEEN EVEN- 
 
 Benson'(B. F.), Author of ' Dodo. ' THE 
 Bo^lef (CI. A Stewart). A STRETCH OFF 
 
 Brooke (Emm). THE POET'S CHILD. 
 BuHock (San F.). THE BARRYS. 
 
 THE CHARMER. 
 THE SQUIREEN. 
 
 THE CLASH 
 
 OF ARMS. 
 DENOUNCED. 
 FORTUNE 'S MY FOE. 
 A BRANDED NAME. 
 
 (Bernard). AT A WINTER'S 
 IRE. 
 Chesney (Weatherby). THE BAPTIST 
 
 THE BRANDED PRINCE. 
 
 THE FOUNDERED GALLEON. 
 
 JOHN TOPP. 
 
 THE MYSTERY OF A BUNGALOW. 
 
 Clifford (Mrs. W. K.). A FLASH OF 
 SUMMER. 
 
 Cobb, Thomas. A CHANGE OF FACE. 
 
 Collingwood (Harry). THE DOCTOR 
 OF THE 'JULIET.' 
 
 Cornford (L. Cope). SONS OF ADVER- 
 SITY. 
 
 Cotterell (Constance). THE VIRGIN 
 AND THE SCALES. 
 
 Crane (Stephen). WOUNDS IN THE 
 RAIN. 
 
 Denny (C. E.). THE ROMANCE OF 
 UPFOLD MANOR. 
 
 Dickinson (Evelyn). THE SIN OF 
 ANGELS. 
 
 Dlckson (Harris). THE BLACK WOLF'S 
 BREED. 
 
 Duncan (Sara J.). THE POOL IN THE 
 DESERT. 
 
 A VOYAGE OF CONSOLATION. Illus- 
 trated. 
 
 Embree (C. F.). A HEART OF FLAM E. 
 Illustrated. 
 
 Fenn (Q. Manvllle). AN ELECTRIC 
 SPARK. 
 
 A DOUBLE KNOT.
 
 u 
 
 MESSRS. METHUEN'S CATALOGUE 
 
 A DAUGHTER OF Will*. E. (Mr*. 
 
 AR 
 (O.X MORE KIN THAN 
 
 DAVID MARCH. 
 KEAMKR. 
 
 met (R. E.X. THE SWORD OF 
 
 VMKfe(M.E.X MISS ERIN. 
 ^M(TMX RICKERBYS FOLLY. 
 am* (DmtkeaX THINGS THAT 
 HAVE HAPPEXED. 
 
 KIXD. 
 
 (J. S.X DAI 
 
 -. .: -.-: ?.V : - 
 
 THE COXQCEST OF LONDON 
 SUPREME CRIME. 
 orX 
 
 THE DESPATCH 
 
 RIDER. 
 THE KLOOF BRIDE. 
 THE EXCA-S TREASURE. 
 On (!! ) MRS. CLYDE. 
 WORLDS PEOPLE. 
 
 F.V THE REDEMPTIOX OF 
 DA 
 
 MY STEWARD- 
 
 THE LITER- 
 
 H.V. AGALLAXT QUAKER. 
 (W. CterkX ABANDONED. 
 UTI . ROSEACH.. 
 
 AP^'CESS S ^SS^* fc * "X***- 
 I BARBARA'S MONEY. 
 t THE ENTHUSIAST. 
 k A GREAT LADY. 
 
 ..__ ,, THE LOVE THAT OVERCAME. 
 AXNEMAULE- THE MASTER OF BEECHWOOD. 
 UNDER SUSPiaOX. 
 
 FtaRtefW. E.I. AN OCTAVE. 
 
 MATTHEW AUSTIN. 
 
 THE DESPOTIC LADY. 
 
 mill lfffc.X THE LADY'S WALK. 
 
 SIR ROBERTS FORTUNE. 
 
 THE TWO MARY'S. 
 
 Py<en< (M. L.'. AX ENGLISHMAN. 
 
 P*m*j (Mrs. Fnmb. A MIXED MAR- 
 
 THE STRIKING 
 
 TIME AXD THE 
 AUNT BETHIA-S 
 FORTUXE^ DAR- 
 
 ROSALBA. 
 THE DIVERTED YIL- 
 
 OUT OF THE CYPRESS 
 
 P,,,, : 
 "SSSS EJ "- 
 
 FAXCY FREE. 
 
 A METAMORPHOSIS. 
 MARVELS AMD MYSTERIES. 
 
 3BE& 
 
 W.t THE CYNIC AND THE 
 
 j (L. T.X RESURGAM. 
 
 L ra n A un, 
 
 THE KNIGHT PUNC- 
 
 ShmMM <W. F.k. JIM TWELVES. 
 StepheM(R.N.X ANEXEMYOFTHE 
 
 (E. H.). ELMSLIE^DRAG NET. 
 (AilhaQ. THE SILVER POPPY. 
 
 StaartlEsafc*. CHRIS 
 A WOMAN OF FORTY 
 
 CHRIST ALLA, 
 
 DKkess oft. OXE HOUR 
 NEXT. 
 
 LOVE GROWN COLD. 
 SORDOX. 
 
 L M.). THE ROYAL 
 SPINNERS OF 
 [Mra.E.W.). SILENT 
 
 ATHELSTAXE FORD. 
 fmimrmmmjP**). A HEROIXE FROM 
 
 BY* A FINNISH LAKE. 
 
 Wmtaum (H. B. MarrMtH THE SKIRTS 
 
 ZMfc.' TALES OF DUXST ABLE WEIR.
 
 FICTION 
 
 39 
 
 THE GETTING WELL OF DOROTHY. By Mr*. 
 
 W. K. Clifford. .S:<7rf Edition. 
 ONLY A GUARD-ROOM Doc. By Edith E. 
 
 Cuthell. 
 THE DOCTOR or THE JULIET. By Harry 
 
 Collingwood. 
 LITTLE PETER. By Lucas Malet. Second 
 
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 MASTER ROCKAFELLAR'S VOYAGE. By W. 
 
 Clark Ru*seIL Third Edition. 
 THE SECRET OF MADAME DE MONLUC. By 
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 Second Edition. 
 
 HEPSY GIPSY. By L. T. Meade. a/. iC</. 
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 THF,RE WAS ONCE A PRINCE. By Mr*. M. E. 
 
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 CONSCIENCE. 
 THE CONVICT'S SON. 
 
 THE CORSICAN BROTHERS ; and OTHO THE 
 
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 CROP-EARED JACQCOT. 
 THE FENCING MASTER. 
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 GABRIEL LAMBERT. 
 GEORGES. 
 THE GREAT MASSACRE. Being the first part of 
 
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 HENRI DE NAVARRE. Being the second part 
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 PERE LA RCINE. 
 
 THE PRINCE OF THIEVES. 
 
 THE REMINISCENCES OF ANTONY. 
 
 ROBIN HOOD. 
 
 THE SNOWBALL and SULTANETTA. 
 
 SYLVAKDIRZ. 
 
 TALCS OF THE SUPERNATURAL. 
 
 THE THREE MUSKETEERS. With 
 
 Introduction by Andrew Lang. 
 
 volume. 
 
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 THE WILD DUCK S 
 THE WOLF-LEADER, 
 
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 Albanesi (E. ML). LOVE AND LOUISA. THE MUTABLE MANY. 
 Austen (Jan). PRIDE AND PRE Benson (E. F.). DODO. 
 
 [CE; _ Rronf P f Charlott*. L SHIRLEY. 
 
 BaWf Richard). A ROMAN MYSTERY. 
 Baffour (Andrew). BY STROKE OF 
 
 SWORD. 
 
 Barins-Gould (S.). FURZE BLOOM. 
 CHEAP JACK ZITA. 
 KITTY ALONE. 
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 THE BROOM SQUIRE. 
 IN THE ROAR OF THE SEA. 
 NO EM I. 
 
 A BOOK OF FAIRY TALES. Illustrated. 
 LITTLE TU'PENNY. 
 THE FROBISHERS. 
 WINEFRED. 
 Brr (Robert). JENNIE BAXTER, 
 
 JOURNALIST. 
 
 INTHE MIDST OF ALARMS. 
 THE COUNTESS TEKLA. 
 
 Bronte (Charlotte). 
 
 Browne 11 (C. L.J. THE HEART OF 
 
 JAPAN. 
 Burton (J. Bloundelle;. ACROSS THE 
 
 SALT SEAS. 
 C*yn(Mr).,('Iota'). ANNE MAULE- 
 
 VERER. 
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 Clifford (Mr.. W. K.). A FLASH OF 
 
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 MRS. KEITH'S CRIME. 
 Corbett (Julian). A BUSINESS IN 
 
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 Croker (Mr.. B. M-). PEGGY OF THE 
 
 BARTONS. 
 A STATE SECRET.
 
 40 
 
 MESSRS. METHUEN'S CATALOGUE 
 
 ANGEL. 
 
 Dante N (AUghieri). THE VISION OF 
 
 DANTE (Cary). 
 Doyle (A. Conan). ROUND THE RED 
 
 LAMP. 
 Duncan (Sara Jeannette). A VOYAGE 
 
 OF CONSOLATION. 
 T-TQSE DELIGHTFUL AMERICANS. 
 Euot (George). THE MILL ON THE 
 
 FLOSS. 
 Findlater (Jane H.). THE GREEN 
 
 GRAVES OF BALGOWRIE. 
 Gallon (Tom). RICKERBY'S FOLLY. 
 Oaskell(Mrs.). CRANFORD. 
 MARY BARTON. 
 VORTH AND SOUTH. 
 Gerard (Dorothea). HOLY MATRI- 
 MONY. 
 
 THE CONQUEST OF LONDON. 
 MADE OF MONEY. 
 Gissing (George). THE TOWN TRAVEL- 
 
 LER. 
 
 THE CROWN OF LIFE. 
 Glanville (Ernest). THE INCA'S 
 
 TREASURE. 
 THE KLOOF BRIDE. 
 Glelg (Charles). HUNTER'S CRUISE. 
 Grimm (The Brothers). GRIMM'S 
 
 FAIRY TALES. Illustrated. 
 Hope (Anthony). A MAN OF MARK. 
 A CHANGE OF AIR. 
 THE CHRONICLES OF COUNT 
 
 ANTONIO. 
 PHROSO. 
 
 THE DOLLY DIALOGUES. 
 Hornung (E. W.). DEAD MEN TELL 
 
 NO TALES. 
 Ingraham (J. H.). THE THRONE OF 
 
 Le Queux (W.). THE HUNCHBACK OF 
 
 WESTMINSTER. 
 Levett- Yeats (S. K.). THE TRAITOR'S 
 
 WAY. 
 Linton (E. Lynn). THE TRUE HIS- 
 
 TORY OF JOSHUA DAVIDSON. 
 Lyall (Edna). DERRICK VAUGHAN. 
 Malet (Lucas). THE CARISSIMA. 
 A COUNSEL OF PERFECTION. 
 Mann (Mrs. M. E.). MRS. PETER 
 
 HOWARD. 
 A LOST ESTATE. 
 THE CEDAR STAR. 
 ONE ANOTHER'S BURDENS. 
 Marchmont (A. W.). MISER HOAD- 
 
 LEY'S SECRET. 
 A MOMENT'S ERROR. 
 Marryat (Captain). PETER SIMPLE. 
 JACOB FAITHFUL. 
 Marsh (Richard). THE TWICKENHAM 
 
 PEERAGE. 
 THE GODDESS. 
 
 THE JOSS. 
 
 A METAMORPHOSIS. 
 Mason (A. E. W.). CLEMENTINA. 
 Mathers (Helen). HONEY. 
 GRIFF OF GRIFFITHSCOURT. 
 SAM'S SWEETHEART. 
 Meade (Mrs. L. T.). DRIFT. 
 Mitford (Bertram). THE SIGN OF THE 
 SPIDER. 
 
 Montresor (F. F.). THE ALIEN. 
 Morrison (Arthur). THE 
 
 IN 
 
 HOLE 
 
 THE WALL. 
 Nesbit(E-). THE RED HOUSE. 
 Norris(W. E.). HIS GRACE. 
 GILES INGILBY. 
 THE CREDIT OF THE COUNTY. 
 LORD LEONARD. 
 MATTHEW AUSTIN. 
 CLARISSA FURIOSA. 
 Oliphant (Mrs.). THE LADY'S WALK. 
 SIR ROBERT'S FORTUNE. 
 THE PRODIGALS. 
 Oppenheim (E. Phillips). MASTER OF 
 
 MEN. 
 Parker (Gilbert). THE POMP OF THE 
 
 LAVILETTES. 
 
 WHEN VALMOND CAME TO PONTI AC. 
 THE TRAIL OF THE SWORD. 
 Pemberton (Max). THE FOOTSTEPS 
 
 OF A THRONE. 
 I CROWN THEE KING. 
 Phillpotts (Eden). THE HUMAN BOY. 
 CHILDREN OF THE MIST. 
 Q.' THE WHITE WOLF. 
 Ridge(W. Pett). A SON OF THE STATE. 
 LOST PROPERTY. 
 GEORGE AND THE GENERAL. 
 Russell (W. Clark). A MARRIAGE AT 
 
 SEA. 
 
 ABANDONED. 
 
 MY DANISH SWEETHEART. 
 HIS ISLAND PRINCESS. 
 Sergeant (Adeline). THE MASTER OF 
 
 BEECHWOOD. 
 BARBARA'S MONEY. 
 THE YELLOW DIAMOND. 
 THE LOVE THAT OVERCAME. 
 Surtees (R. S.). HANDLEY CROSS. 
 
 Illustrated. 
 MR. SPONGE'S SPORTING TOUR. 
 
 Illustrated. 
 
 ASK MAMMA. Illustrated. 
 Walford (Mrs. L. B.). MR. SMITH. 
 COUSINS. 
 
 THE BABY'S GRANDMOTHER. 
 Wallace (General Lew). BEN-HUR. 
 
 Watson (H. B. Marriot). THE ADVEN- 
 
 . ft.). PRISONERS OF WAR. 
 White (Percy). A PASSIONATE 
 PILGRIM.
 
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