^^^^^MBMH^HHBBMMBI ty of California ern Regional ary Facility I THE MAJOR SYMPTOMS OF HYSTERIA FIFTEEN LECTURES GIVEN IN THE MEDICAL SCHOOL OF HARVARD UNIVERSITY BY PIERRE JANET, PH.D., M.D. SECOND EDITION WITH NEW MATTER THE MACMILLAN COMPANY 1920 All rifhtt reserved, COPYRIGHT, 1907 AND 1920, BY THE MACMILLAN COMPANY. Set up and electrotyped. Published June, 1907. Second Edition Published, November, 1920. NortaooU J. 8. Cashing Co. Berwick & Smith Co. Norwood, Mass., U.S.A. PROFESSOR JAMES JACKSON PUTNAM OF HARVARD UNIVERSITY THESE LECTURES ARE AFFECTIONATELY DEDICATED PREFATORY NOTE ON the occasion of the inauguration of the new and magnificent buildings of the Medical School of Harvard University in Boston, President Eliot and Dr. J. J. Putnam, professor of the diseases of the nervous system, asked me to deliver before the stu- dents some lectures about pathological psychology. I greatly appreciated this honour, and tried to sum up before the American students some elementary psychological researches about a well-known disease, Hysteria, in order to show them how the study of the mental state of the patient can sometimes be useful to explain many disturbances and to give some unity to apparently discordant symptoms. So the follow- ing fifteen lectures were given in the Harvard Medi- cal School between the fifteenth of October and the end of November, 1906. Some of these lectures were also delivered in Johns Hopkins University at Baltimore, at the request of Professor J. M. Baldwin, and in the medical school of Columbia University in New York, at that of Professor Allen Starr. I avail myself of the opportunity of this publication to offer my best thanks to these professors and their col- leagues for their invitation and hearty welcome. Let me, too, thank here my friend M. Edouard Philippi, for the very useful help he gave me in drawing up these lectures in a foreign language. CONTENTS PAGE PREFATORY NOTE vii LECTURE I THE PROBLEM OF HYSTERIA . LECTURE II MONOIDEIC SOMNAMBULISMS 22 LECTURE III FUGUES AND POLYIDEIC SOMNAMBULISMS ... 44 LECTURE IV DOUBLE PERSONALITIES 66 LECTURE V CONVULSIVE ATTACKS, FITS OF SLEEP, ARTIFICIAL SOMNAMBULISMS 93 LECTURE VI MOTOR AGITATIONS CONTRACTURES . . . .117 i LECTURE VII PARALYSES DIAGNOSIS 138 ix x Contents LECTURE VIII PAGE THE PSYCHOLOGICAL CONCEPTION OF PARALYSES AND ANESTHESIAS . .159 LECTURE IX THE TROUBLES OF VISION . . . . . .182 LECTURE X THE TROUBLES OF SPEECH 208 LECTURE XI THE DISTURBANCES OF ALIMENTATION .... 227 LECTURE XII THE Tics OF RESPIRATION AND ALIMENTATION . . 245 LECTURE XIII THE HYSTERICAL STIGMATA SUGGESTIBILITY . . 270 LECTURE XIV THE HYSTERICAL STIGMATA THE CONTRACTION OF THE FIELD OF CONSCIOUSNESS THE COMMON STIG- MATA 293 LECTURE XV GENERAL DEFINITIONS 317 INDEX . 339 INTRODUCTION TO THE SECOND EDITION THE kind reception these lectures on hysteria have met with encourages us to publish a second edition of this work. It does not seem to us very useful to modify it profoundly, for the interest of a scientific work resides almost always in the date a't which it was drawn up, and one should not confusedly mix the ideas of one period with those of another. I only wish to show in a short preface that certain notions set forth in these lectures of 1906 have spread very much since that date and have played a great part in the interpretation of hysteria. I should also like to show in what direction I have been led myself, in my other works published since that time, to develop certain of my preceding interpretations. One of the chief conceptions that have directed my first researches on hysteria is that of the importance of fixed ideas in this disease : many of the most appar- ent symptoms recognized in the attacks, the somnam- bulisms, the disturbances of motility and sensibility, are but an outer manifestation, an expression of a conviction the patient keeps in his mind. In one of my first works on hysteria, published in I892, 1 I classed all these various accidents, the paralyses, con- tractures, dysaesthesias, etc., in the chapter on " fixed 1 L'ttat mental des hysUriques, 1892, II, p. 56; 2d ed., F. Alcan, 1911, p. 239. ri xii Introduction ideas." It is equally this interpretation that takes up the greatest place in these lectures on "The Major Symptoms of Hysteria." It is not without interest to remark that this con- ception has become the starting-point of the now most widespread theories which, under the name of "pithia- tism," sum up the whole hysterical disease by that disposition to auto-suggestion which, according to them, is capable of transforming the ideas of the sub- ject into real accidents. In these theories, the hyster- ical phenomena have the great character, common to all of them and existing only in them, that they are the result of the very idea the patient has of his accident: "the hysteric patient," M. Bernheim al- ready said, " realizes her accident as she conceives it." This view is really interesting and has surely some preciseness, for there is not any organic disease nor even any other mental disease in which matters go in this way. Nobody will maintain that in a maniacal fit the patient is agitated because he is thinking of agitation. This development of the accidents by a mechanism always identical to that of suggestion would therefore be something peculiar to hysteria and could evidently serve to define it. Far from contradicting the pithiatic interpretation of hysteria, which in my first writings I had already proposed to apply to many of the symptoms of the neurosis, I should now be inclined to believe that it ought to be still extended. One of the characters of the present conception of hysteria depends on the milieu in which it has been particularly studied, I Introduction xiii mean the Clinic of the Salpetriere. This Clinic was much more neurologic than psychiatric, and was chiefly devoted to the study of the somatic accidents, of the paralyses, the contractures depending on diseases of the nervous system. This is what has determined the direction of the studies on hysteria : what has been considered by preference in this disease is the paralyses, the contractures, the disturbances of the elementary sensibilities, as if these accidents constituted the essential of the neurosis. But if at the present time we agree that hysteria is before everything else a mental disease consisting chiefly in an exaggeration of suggestibility, we shall have to connect more and more with it accidents properly mental in which this exaggeration is also manifested, impairments of the memory, fixed ideas without somatic manifestations, and even deliriums in which auto-suggestion equally plays an evident role. The old hysteric deliriums are nearly forgotten now; it will perhaps be well to restore them, calling them, if one pleases, pithiatic deliriums : it will enable us better to understand a certain number of rather badly interpreted mental disturbances. It is none the less true that this conception of the hysterical neurosis is far from complete, and the re- strictions already laid on them in these lectures (p. 326) seem to me to have kept all their importance. I had occasion to insist upon this discussion in my little book on "Les nevroses" (Flammarion, 1909, P- 3 2 5)) which, I hope, will soon be translated into English. To be able to explain a symptom by auto- xiv Introduction suggestion, one must be able to demonstrate that the idea of this symptom has been predominant in the mind of the subject before the appearance of the symptom, that the idea has been automatically trans- formed into a belief, and that this belief has played a part in the development of the symptom. Now it is easy to show that such a demonstration has not been made and cannot be made in every case. The fundamental psychological characters of the neurosis, the disappearance of the activities of the higher order, the laziness of the mind, the disposition to absent- mindedness, the contraction of consciousness and the suggestibility itself cannot be considered as phenomena of pithiatism. No doubt a great share must be given to suggestion, but it should not be forgotten that in a normal mind suggestion does not give rise to serious accidents, and it is necessary to explain on what de- pends its power, abnormal in certain minds, for it is that which characterizes the hysterical malady. In my early writings and in these lectures on "The Major Symptoms of Hysteria," there was another notion to which I gave an important r61e to play, the notion of the contraction of the field of consciousness and that of subconscious psychological phenomena. I showed in these lectures that one of the chief characters of hysterical anesthesias, distractions, amnesias, paralyses was not the disappearance of a psychological phenomenon, but a particular trans- formation of this phenomenon in consciousness. It ceased to be a part of personal consciousness and no longer existed but in another grouping of psychological Introduction xv phenomena which constituted the sub-consciousness or sometimes the second consciousness of the somnam- bulisms or of the medianimic writings. These new notions have also had a remarkable development in the theories that have tried to ex- plain the hysteric neurosis through conversion, sym- bolism, "driving back." Certain ideas, certain recol- lections present themselves to the mind of the sub- ject in a painful manner, for they hurt his sensibility and are in opposition with his moral feelings. Dis- satisfied with having such thoughts in his mind, the subject makes great efforts to get rid of them: he struggles in every way with these ideas, and when they present themselves to his consciousness, he stops them, he does not allow them to develop, to realize themselves in acts and clear thoughts, and endeavours not to notice them, to forget them. "Driv- ing back," it was said, forms a part of the systems of defence of the organism. The ideas thus driven back became the subconscious phenomena and brought about in this manner various pathological disturb- ances. In my last work, "Les medications psychologiques" (F. Alcan, 1919, Vol. II, pp. 256-262), I had occasion to study these theories of driving back, to show their importance and their relations to the early writings on subconscious phenomena. In that work I ex- amined a remarkable case of left hysterical hemiplegy, in which, after a tragical event relative to his left side, the subject evinced singular horror for this side; the driving back, which seemed here obvious, could xvi Introduction be regarded as the determinative cause of the hemi- plegy itself. I tried to show likewise that phe- nomena analogous to driving back can play an in- teresting part in the formation of certain impulsions, of certain obsessions, particularly in the monstrous and sacrilegious obsessions. These new studies seemed therefore to continue the preceding ones in the same direction and sometimes to complete them in a useful manner. Nevertheless, as the theories of pithiatism seem to me insufficient, so, and wiih still stronger reason, I consider the theories of "driving back" as incapable of giving a complete explanation of the hysterical neurosis. The facts that are interpreted in this way can often be understood in another manner. With regard to the case of hemiplegy to which I have just referred, I have shown that the horror of the subject for his left side could very well be considered as the consequence of the incipient paralysis instead of being its starting-point. But the most important problem concerns driving back itself, as a moment ago it concerned suggestion. With normal individuals, the regret, the scorn for certain ideas, the driving back is far from bringing on analogous pathologic disturbances. To produce such results, the driving back must al- ready be exaggerated and transformed by the disease. Driving back, such as it is presented in these theories, seems to me to be a symptom of the malady, as sug- gestion did before, and it requires itself an explanation. To get beyond these first interpretations, to make new progress in these studies of psycho-pathology, it Introduction xvii would be useful to analyze more thoroughly these symptoms, which are too readily taken as starting- points, and with which one tries to link all the other phenomena without explaining them themselves. It would be necessary, if I mistake not, better to under- stand the nature of these phenomena of suggestion, of subconsciousness, of driving back, and the condi- tions that bring about their exaggerated develop- ment. This is why in my last writings, which at- tempt to complete these lectures on hysteria, I have begun again the analysis and the interpretation of the psychological phenomenon of impulsion, which seems to me to constitute the essential part of all the preceding facts. The question here is of the problem of voluntary action with individuals capable of conceiving the idea of an action before executing it, and capable of con- necting in various ways the idea of the action with the action itself, that is to say with the motion of their limbs; in a word, the question is of the problem of ideo-motor activity. Will and belief, which are the two forms of this activity, are analogous mental operations : in will, the execution of the act is im- mediate, as soon as the idea is accepted, the act is realized by the motion of our limbs; in belief, the question is also of the execution of an act, but the conditions of this act not being immediately present, the question is of a deferred and conditional act. To believe that it is raining outside is to make up one's mind to open one's umbrella if one goes out, but is not to open it immediately in the room. In xviii Introduction both these forms of action, the essential is the estab- lishment of a connection between the idea of the act and the act itself, either immediate or deferred, it is the operation of assent. With normally evolved and healthy individuals, this assent can be performed in a perfected manner, thanks to the mechanism of reflection. The ideas of different actions then present themselves to the mind, but they are stopped, suspended in their develop- ment, and are not immediately transformed into wills or beliefs. They are compared, opposed to one an- other ; in this comparison, one does not only take into account the present momentary force of the different ideas, each of which is more or less accompanied with desire. Reflection calls up moreover the still latent force of the tendencies that each idea represents. It is only after a longer or shorter deliberation, in which these deep forces are appreciated, that one of these ideas is adopted by assent and allowed to develop into will or belief. The wills or beliefs thus brought about by reflective assent represent the real forces of our tendencies, all of which have been called up and weighed ; they are exactly conformable to our whole personality, they are accompanied in the highest de- gree with the feelings of personality and reality. Such assents are difficult and require mental activity of a high order. In other circumstances, they may be replaced by assents that, while apparently analogous, are brought on in a simpler and easier way. Reflec- tion does not come in to stop the ideas, to investigate the latent force of the tendencies they represent. Introduction xix The assent is immediate, and is simply induced by the present and momentary force that each idea brings with it, whatever may be the accidental circumstance which gives it this force. Then it is that one wills and believes simply what one desires, what pleases one momentarily, what is strongly presented to one's mind by an outer influence. The question is still of wills and beliefs, but these phenomena are immedi- ate and irreflective. They still bring about acts, and even acts that are sometimes more violent, and more tenacious, but they do not in the same manner involve the whole personality and do not bear with them, like reflective beliefs, the feeling of reality. It is such wills and such beliefs that are often ac- companied with the feelings of automatism, deperson- alization and irreality. It is easy to observe that certain minds seem to be fixed in one or the other of these modes of assent. Selfish minds, capable of well understanding personal interest and of well calculating it, utilize almost ex- clusively the reflective mode ; weak minds, incapable of resisting their momentary desires, docile to every influence, hardly get beyond the second. But an- other psychological state is particularly interesting, namely that of the minds that, according to circum- stances, oscillate between these two modes of assent. Certain individuals are in reality capable of reflection, as they are capable of discussing with an adversary who contradicts their opinions. But they cannot sustain the discussion for a long while. If the ad- versary insists for some time, their resistance is very xx Introduction soon exhausted and they give up the struggle to adopt the strange opinion. Likewise they begin the re- flection, which is a sort of inner discussion, then they get tired, and, without concluding the deliberation they have begun, they allow themselves to be carried away by some desire or other. Impulsion appears to me to consist essentially in this insufficiency of reflection, which stops at a more or less advanced stage of its evolution and is transformed into immediate assent. Suggestion, obsession, exaggerated driving back are varieties of impulsion. These phenomena arise when different phenomena bring about the rapid exhaustion of reflection and the appearance of immediate and elementary assents. We find here once more the fundamental phenom- enon which plays an important part in all the disturb- ances of the mind, the decay, the lowering of the mind, which passes from a form of higher activity to a lower form. This phenomenon is met with in hysteria as well as in all the psychoses, and the study of hysteria should not be separated from the more general study of the psychological depressions. The defect of most of the preceding writings is that the early authors have too much considered hysteria in itself, because at the outset of psycho-pathology the study of psychological phenomena appeared particularly easy in this disease. At the present day we must extend the studies in psycho-pathology and replace hysteria in the ensemble of the mental diseases, and in particular put it in its place in the table of the psychological depressions, of which it presents us only a particular case. Introduction xxi If we attempted this study, which is very difficult nowadays, we might say that hysterical patients, by reason of their heredity, by the evolution of puberty, in consequence of various intoxications, various ex- haustions, under the influence of fatigues, of emotions, which are phenomena analogous to fatigues, have fallen into a very enduring but not very deep depres- sion, reaching the level of mental laziness. In my lectures at the College de France on these oscillations of the mind, I presented sadness as the first degree of depression, and laziness as the second. In that state of laziness, the patients are still capable of reflection, which disappears only in the third degree, that of aboulias, but they are incapable of the rational or "ergetic" acts in which the individual through his efforts adds energy to rational or experimental ideas, powerless by themselves. At the level of mental lazi- ness, the subject is passionate, selfish, lazy, and given to telling lies, for these are the essential features that psychological activity assumes in this form of de- pression, but he has not yet any characteristic acci- dents. Under different influences which bring on greater exhaustion, there is from time to time with these patients a period of deeper depression. The fall is often manifested by particular symptoms : the con- vulsive attacks, the crises of tears, the agitations, the megrims themselves are often phenomena of discharge and relaxation. The subject has gone down one de- gree, he remains at the level of aboulia. He has lost the mental syntheses that constitute reflective will xxii Introduction and belief, he simply transforms into automatic wills and beliefs the tendencies which are momentarily the strongest. It is at that moment that the sugges- tions, the fixed ideas, the deliriums arise which com- plicate the disease during longer or shorter periods, till the subject reascends to the preceding level, that of mental laziness. In all the mental diseases, oscillations of this kind are observed which bring about falls to more or less inferior levels and leave the subject for a longer or shorter time at the level to which he has fallen. The hierarchic table of the various activities will be es- i tablished one day, and such or such a psychosis will be determined by the level to which the depression falls in the various phases of this disease ; in a word, this disease will be determined by drawing the curve of the psychologic depression in the evolution of the disease, and by showing that this curve is characteris- tic. In many psychoses, in confusions, in toxic deliriums, in dementias, the curve descends very low, as far as the level of elementary intellectual activities or of reflex activities. But we may give the name of hysteria to a certain curve of mean depth which shows frequent oscillations between mental laziness and a more or less profound aboulia. It is these oscilla- tions, these depressions to a mean depth that account for the insufficiencies of the mental synthesis and the various impulsions which psychologic analyses had first shown us under the apparently physical symptoms of hystericals. Such are, briefly summed up, the researches that Introduction xxiii in my last works I have tried to add to the first investigations presented in these lectures. I have simply indicated them in this preface to encourage the readers to consider these lectures as a starting-point and to go beyond this old teaching through their own studies. PIERRE JANET Paris, April 10, 1920. THE MAJOR SYMPTOMS OF HYSTERIA LECTURE I THE PROBLEM OF HYSTERIA The interest and importance of studying hysteria The philosophical and the medical point of view Brief account of the evolution of the studies about this disease The necessity for the psychological study of the neuroses The psychological type of hysteria GENTLEMEN: President Eliot and the Professors of the great University of Harvard have determined to celebrate the opening of the new buildings of your Medical School by putting into practice a beautiful and great thought. They have determined to invite to come among them foreign professors, and have begged them to expose before you the ideas and teach- ings they give in other countries. It is a mode of teaching which is very often used in American uni- versities but, unfortunately, is rarely applied in France. It may have the most beautiful results for the teaching of youth, for the development of science, and for the union of the various nations, which is in our time the great aim of all true civilizations. Unhappily the application of this beautiful method is very difficult, for all depends on the choice of that foreign professor 2 The Major Symptoms of Hysteria called momentarily to teach among you. No doubt I congratulate myself very much upon the choice which has been made; it is for me a great honour, it gives me an opportunity to see again a town of which I am very fond, and to try to diffuse among you some ideas to which I hold. But I dare not congratulate you upon this choice, for I am afraid my ignorance of your methods of teaching, and above all my ignorance of your tongue, will make these lectures very hard to understand and very painful to hear. First, I make you my apologies; then, I wish you may overcome this bad luck and forget as much as possible the in- correctness and strangeness of my language. This done, let us all do our best you to understand me tolerably well and to draw from these lectures some notions of what interests French students; I, to speak nearly intelligible English and to give you as favourable an impression as possible of the psychological study of nervous diseases in the French universities. With the approval of President Eliot and of Pro- fessor James J. Putnam, I have chosen as the subject of these lectures the study of that nervous and mental disease called Hysteria. The reason of this choice is that from many points of view this study seems to me pretty well to answer the wish of the professors who called me. When a foreign professor is asked to express his ideas in another country, he is expected to expose one of the most characteristic studies of his The Problem of Hysteria 3 native land, just as, when we have landed in a new country, we seek to taste the dishes that characterize its cookery. Well, it seems to me that what has been most characteristic in France for a score of years in the study of nervous diseases is the development of pathological psychology. No doubt, the clinic and anatomic study of these same diseases is very honour- ably represented by French names, but this study has developed in the same way in other countries, and I think you have not much for which to envy us in this matter. Psychological studies, properly so called, especially the studies of psychological measures, have developed in Germany and in America more than in France, and it is not here, near Professor Miinster- berg's laboratory, that it would be well to come and deliver a lecture on this subject. But it seems to me that in France, under the influence of two of my masters, whose names I like to recall, Charcot and Professor Ribot, was realized an interesting union between two studies which were for the most part separated before. Beautiful natural experiences have been bor- rowed from mental pathology which strongly illumi- nate the problems of psychology; on the other hand, notions of experimental psychology have been made use of in order to understand and sometimes to treat patients' mental disturbances. I should be happy to make you feel how interesting is this new study, which seems to me to have very good prospects. Among these studies of pathological psychology, I determined on taking that of a particular nervous disease, Hysteria; I think it is by this one that one 4 The Major Symptoms of Hysteria should begin nowadays; for this we have historical and scientific reasons. Look back to the time of the first works of Charcot, Ribot, and their pupils. Cast a glance at the innumerable works which, twenty years ago, determined that current of researches. Remem- ber the names of Mesnet, Pitres, Paul Richer, Charles Richet, Binet, Fe're', Marie, Grasset, Gilles de la Tourette, Brissaud, and in foreign countries, of Del- boeuf, Moebius, Breuer, Freud, Morton Prince, etc. Remark what was, by a kind of singular common understanding, the subject of all their works. No doubt they seemed, like Professor Ribot, to speak of all possible mental diseases and to seek for mental dis- turbances in all the forms in which they present them- selves. Now and then, it is true, they devoted a few lines to idiocy or insanity ; but if you read their books again, you will see that, whatever the matter is, " Mala- dies de la Me"moire," "Maladies de la Volonte*," "Maladies de la Personnalite"," they always speak of localized amnesias, of alternating memory, which in reality are only to be met among hysterical som- nambulisms ; of irresistible suggestions, hypnotic cata- lepsias, which are, as I will try to prove to you, noth- ing but hysterical phenomena; of total modifications of the personality divided into two successive or simul- taneous persons, which is again the dissociation of consciousness in the hysteric. Besides all these works, pathologic psychology owes very much to the con- siderable movement concerning hypnotism, which took place during a few years. It is certain that the works of Charcot, Bernheim, Forel, and so many others The Problem of Hysteria 5 had the greatest influence on the development of this new science, but now that the quarrels of other times are somewhat appeased, everybody will probably recognize a fact which I hope also to be able to prove to you ; namely, that in reality it is only among hys- terical patients that this hypnotism is to be found in any marked degree. I will not raise now the difficult problem of deciding whether all the people who can be hypnotised must be called hystericals, but I believe almost every good observer will agree with me that the best studies about the clearest cases of artificially in- duced somnambulism and about its psychological proper- ties were made on hysterical subjects. Consider even the somewhat adventurous authors who have sought to draw attention to particularly strange phenomena and who, by the curiosity they have raised, have had a share in the development of the same researches; remember the studies on psychic polarization, on trans- fer, on marked points suggestions (suggestions a points de rep&re), on unconscious acts, etc. These studies have always had for their starting-point hysteric phe- nomena as equivalences and anesthesias. In a word, if any interest is given to the development of that patho- logical psychology which has been growing these twenty years, it ought to be recognized that this interest has for its object a special disease : Hysteria. No doubt, such exclusive fondness for this study was rather exaggerated, and all the psychologists who, for some time, in imitation of the masters, studied the hysteric, were somewhat like the sheep of our Panurge. It was an exaggeration to think that pathological psy- 6 The Major Symptoms of Hysteria chology could not be studied on other patients. Dr. Fe*r was somewhat mistaken when he called hystericals the frogs of experimental psychology. As in physiology the frog is not an absolutely necessary animal for our experiments, so the hysteric patient is not the only one worthy of psychological researches. We are even cer- tain to-day that the hysteric offer many drawbacks, and many studies have been made on other diseases. However, it is true that there were certain practical reasons justifying this choice at the beginning of this kind of studies; and these practical reasons are still the same for you. The psychology of the hysteric patient, though full of difficulties and obscurities, is surely simple. It is a question of measure ; all I want to say is that we are nowadays quite unable to under- stand, to express in formulas and in laws, what an in- sane person feels. We can hardly connect together by general laws the different facts observed in melancholic delirium or in the delirium of persecution. On the contrary, the various accidents of hysteria, though so different in appearance, are easily brought close to one another owing to common characters. We can dimly see some general laws, about the formula for which we hesitate, but of whose existence we have a suspicion. That is, after all, the reason that explains the character of the discussion about hysteria nowadays. While no- body endeavours to give or to discuss a general defi- nition comprising all the phenomena of epilepsy or melancholia, there are now a great number of authors who propose to explain in a few words, in a single definition, all the pathology of hysteria. In short, I The Problem of Hysteria 7 was right in saying to you that the psychology of this disease seems now to be simpler than the conception of other mental diseases. It is the reason why I told you that the psychology of this disease is simple. To this primordial reason are added practical reasons : the hysteric are patients who are easily managed, who talk willingly, who are not dangerous, on whom we can experiment without any great fear, and who, lastly, like to be observed, and readily lend themselves to examina- tion. Such are the reasons why the first studies were devoted to this kind of patients, and, in following the historical order, we also follow the practical order, which leads us to begin with the simplest and easiest disease. II Do not think, however, that this choice of the study of the hysteric is only justified by an historical chance and by reasons of convenience. The study of these patients, if happily it is a rather easy one, is at the same time very important, both from the philosophical and scientific and from the medical and practical point of view. I am convinced that in our times, every well- educated man wishing to have an opinion on moral and philosophical problems ought to know something of this singular mental disease, for it has played a considerable part in the history of all religions and superstitions, and it still plays a very important part in the most attractive moral questions. A great French alienist, Moreau de Tours, was in the habit of saying that all the great things accomplished in the world have been 8 The Major Symptoms of Hysteria accomplished by mad people. It is perhaps some- what exaggerated, but it is nevertheless true that most great creeds have spread by means of the emotion caused by surprising phenomena, which have always been due to hysteric people. In the development of every great religion, both in ancient and in modern times, there have always been strange persons who raised the admiration of the crowd because their nature seemed to be different from human nature. Their manner of thinking was not the same as that of others ; they also had extraordinary oblivions or remembrances, they had visions, they saw or heard what others could not see or hear. They were illumined by odd con- victions; not only did they think but they also felt in another way than the bulk of mankind; they had an extraordinary delicacy of certain senses joined to ex- travagant insensibilities which enabled them to bear the most dreadful tortures with indifference or even with delight. Not only did they feel but they also lived otherwise than other people; they could do without sleep, or sleep for months together; they lived without eating or drinking, without satisfying their natural needs. Is it not such persons who have always excited the religious admiration of peoples, whether sibyls, prophets, pythonesses of Delphi or Ephesus, or saints of the Middle Ages, or ecstatics, or illuminates ? Now they were considered as worthy of admiration and beatified, now they were called witches or demoniacs and burnt; but, at the bottom, they always caused astonishment and they played a great part in the development of dogmas and creeds. The Problem of Hysteria 9 Well, all these phenomena, as you know already, are the usual symptoms of hysteria, and there is not, from this point of view, a disease which has played so great a part in history. If I am not mistaken, it is still exactly the same now: we have changed only in ap- pearance. We beatify but few saints and we burn but few demoniacs, yet we have not forgotten them; they have become our somnambulists and mediums, and every time we want to throw some light on the mysteries of our destiny, to penetrate into the unknown faculties of the human mind, to whom do we appeal? Whom do we take as a subject of observation? Is it an ordinary person, a person in good health, whom we ask to foresee the future or to talk with the dead ? No ; it is a neuropathic patient, insensible to the things of this world, but whose sensibility is overexcited in a certain direction ; medically speaking, it is a hysteric person. Understand me well. I do not mean at all to tell you that these studies are warped by this, any more than I deny the sanctity of a personage of the Middle Ages whom I diagnosticate as hysteric. A hysterical person may be a saint ; a hysterical person may have a wonderful lucidity: that is undeniable. I only want you to be warned of what happens when you have to judge facts of this kind. When we have to appreciate facts which are out of our habitual observation and look wonderful, it is a material point to know well in what conditions they present themselves. Now in the ques- tion we are considering, one of these conditions, the most serious one, is the mental state of the persons in io The Major Symptoms of Hysteria whom such facts are observable. So you must know that such persons are hystericals, and be accustomed to the laws ruling the minds of hystericals. Perhaps there may be some cases in which this ascertainment does not diminish the interest taken in the phenomenon, but, believe me, it mostly takes away a great part of the wonderful. To judge these moral and philosophical problems, it is indispensable to study thoroughly this disease of the mind. This remark is truer still if you consider the subject from a medical and practical point of view. You who have chosen the medical career and will have to attend patients belonging to every class of society: bear in mind that you will constantly meet with neuropathic phenomena connected with this group of neuroses and that you will commit the most dangerous mistakes if you are not very well accustomed to the aspects and evolution of hysteria. It was the fashion for a certain time to say that hysteria was a very rare disease; you know that it had a bad reputation, that a kind of dis- honour was attached to this word, and that people tried to persuade themselves that this shameful disease was not of frequent occurrence. By a kind of international irony, people were willing to admit, after the innumer- able studies made by French physicians, that hysteria was frequent only among French women, which as- tonished nobody, on account of their bad reputation. Do not believe this nonsense. American women are terribly like French women. I was not astonished there- fore, when, two years ago, at the Chicago County Hospital and at the Boston City Hospital, some kind fellow- The Problem of Hysteria n physicians immediately showed me hysteric women, humorously adding that they were quite the same as those of La Salpetriere. The difference of races is also one of those silly things which the human mind has much difficulty in getting rid of. All civilized nations are now the same: we have the same mind and the same body, and, it must be recognized, the same miseries. If the hysterical seemed to be less numerous in other countries, it is first because physicians did not recognize them, then because they would not give them their real appellation. When medical instruction is more general in this matter, when prejudices have vanished, it will probably be acknowledged that in this matter, as in many others, the other nations have no reason for envying France. So you will often meet with hysterical people. You will call them neurasthenic for the family, if you like. I don't care. I only wish that you should at least know what is the matter. You must be able quickly to recognize this disease, in order to foresee its evolution, to provide against its dangers, and immediately to begin a rational treatment. This early diagnosis is much more important still from another point of view: it will keep you, allow me to tell you plainly, from making blunders. It is perhaps not very serious not to recognize a hysterical accident and not to treat it ; but what is always very serious is to mistake a hysterical accident for another one, and to treat it for what it is not. You cannot imagine the medical blunders, and too often also the medical crimes, committed in this way. One of the greatest difficulties in the medical art and one of 12 The Major Symptoms of Hysteria the greatest misfortunes of patients is that hysterical diseases are only well characterized from the moral point of view, which usually is not examined at all ; that they are very badly characterized from the physical point of view, and that they are uncommonly similar to all kinds of medical or surgical affections, for which they are easily mistaken. Contractures, paralyses, anesthesias, various pains, especially when they are seated in the viscera, may simulate anything ; and then you have the legion of false tuberculoses of the lungs, of false tumours of the stomach, of false intestinal ob- structions, and above all, of false uterine and ovarian tumours. What happens as to the viscera also exists as to the limbs and the organs of the senses. Some hysterical disturbances are mistaken for lesions of the bones, of the rachis, for muscular or tendinous lesions. Then the physician interposes, frightens the family, agitates the patient to the utmost, and prescribes ex- traordinary diets, perturbing the life and exhausting the strength of the sick person. Finally, the surgeon is called in. Do not try to count the number of arms cut off, 'of muscles of the neck incised for cricks, of bones broken for mere cramps, of bellies cut open for phantom tumours, and especially of women made barren for pre- tended ovarian tumours. Humanity ought indeed to do homage to Charcot for having prevented a greater depopulation. These things no doubt have decreased, but they are still done every day. Not long ago I saw a patient who had had an eye excised and the optic nerve cut out for mere neuropathic pains. If I could only, by calling your attention and interest to the knowl- The Problem of Hysteria 13 edge of this disease, contribute to diminish the number of these medical crimes, I should already have attained a very important result. Ill In order to be able to enter upon the study of hysteria in a profitable way, allow me, before I end the intro- duction, to summarize in a few words the history of the studies which have been made on this disease. We are not isolated in our studies : we come after generations of other students, and we always ought, before we begin our own researches, to try to see our way exactly. We ought to see at what point of medical history we are standing, what has been done and well done before us, what we have not to begin again. We ought to realize the difficulties that stopped our predecessors, in order to add our efforts to theirs, and to make some steps forward in the way they have laid down for us. The history of these studies would be a very long one, for they began in the remotest antiquity: Democritus already has his theory about hysteria. But I think that we can summarize this long history in a few words by establishing a few great divisions, and I pro- pose to you to adopt three great divisions. At first this history was anecdotical and descriptive : it is a period of curiosity and of somewhat uneasy and uncritical admiration. It is the period of sibyls, witches, con- vulsionists of all kinds, and of miscellanies of surprising facts about convulsions, somnambulisms, resurrections of lethargic people, extraordinary fastings, miraculous 14 The Major Symptoms of Hysteria wounds, etc. The second period, which, in reality, began very late, only in the nineteenth century, might be called the clinical period; then physicians sought, above all, to give a medical character to this disease, to distinguish it from other maladies, and to recognize the phenomena that appertain to it. It is a kind of clearing away and classification. The third period, which is quite contemporary, deserves to be called the psychological period; for, right or wrong, it is among mental phenomena that, for these thirty years, the interpretation has been sought of these innumerable phenomena which our first ancestors had only described and which their successors contented themselves with classifying. Later, perhaps, there will come an ana- tomical and physiological period, but, in my opinion, it does not yet exist. A word only about each of these great stages. In the first, it is sufficient to remind you of the names of Plato, Hippocrates, Celsus, Galienus, ^Etius, of the authors who, in the middle ages, described possessions, choreas, epidemics of tarentism. Among them are Ambroise Pare* and Fernel. A little later we have to cite Charles Lepois, who gave in the seventeenth century one of the best descriptions; Sydenham, who made known the hysterical nail, coughing, vomiting, and oedema ; Raulin (1758), who supported the opinion of Sydenham, and was one of the first to maintain that there were hysteric men; Witt (1767), Sauvage (1760), Astruc (1761), and Pomme (1760-1782), who discussed this strange problem. This descriptive period was, in fact, disturbed by a puerile and dangerous conception which vitiated all the The Problem of Hysteria 15 studies and made any attempt at an interpretation im- possible. You know the old revery of Plato in the Timaus: "The matrix is an animal which longs to generate children. When it remains barren for a long time after puberty, it finds it difficult to bear, it feels wroth, it goes about the whole body, closing the issues for the air, stopping the respiration, putting the body into extreme dangers, and occasioning various diseases, until desire and love, bringing man and woman together, make a fruit and gather it as from a tree." This pretty little story was for half a score of centuries the only interpretation of hysteria, and still originated all the foolish ideas expressed by Louyer de Villermay in 1860. You may guess the part played in this respect by the abdominal pains seated at the level of ovaries, by the movements of the hysterical nail, by the suffocations of the patients during their fits. As hysteria required an uterus (va-repov), its existence was not admitted in men, and the first serious discussions bore on the exist- ence of masculine hysteria. The recognition of this disease in men changed the old conception of hysteria and determined an ensemble of more precise clinical researches. Without pretend- ing to any chronological precision, we place at the beginning of the nineteenth century the inauguration of the second and truly clinical period. It is sufficient to remind you of the names of Georget (1821), of Hufe- land in Germany (1836), of Brachet and of Landouzy in France (1845), f Duchenne de Boulogne (1855), of Legrand du Saulle (1860). But I must insist on the beautiful book of the English physician Brodie (1837), \6 The Major Symptoms of Hysteria who described the sensitive and motor disturbances in the articulations, and who has given his name to an hysterical accident, the knee of Brodie. We must accord a good place to the work of Briquet (1859) ; it was the first general work of real value and it prepared the way for the contemporary studies. Lastly, you know that the most eminent representative of that period is Charcot, who in every way gave more precision to the clinical knowledge of hysteria. With these studies are connected the distinction be- tween the epileptic and the hysterical fit, which was for a long time considered impossible; the diagnosis of apoplexies, cerebral lesions, meningites, of hysterical mutisms, and fits of sleep; the separation between hysterical anorexics, gastralgias, and dyspnaeas, and the organic diseases which are apparently seated in the same viscera. It is chiefly to the patient studies of our predecessors that we owe the discovery and diagnosis of the different motor accidents of hysteria, of the articular disturbances analogous to the knee of Brodie, of the contractures, of the paralyses limited to one limb. Discussions relating to these motor accidents, their comparison with the diverse organic paralyses, re- searches on the traumatic neuroses, filled, as you know, the career of Charcot. In all these studies there was no room yet for an interpretation of the disease, and Charcot felt thoroughly the necessity of an interpretation of this kind. It was indispensable, not only in order to explain things ap- parently mysterious, but chiefly to give a unity capable of linking together those innumerable symptoms that The Problem of Hysteria 17 looked so heterogeneous. Lasegue had already said that "manifestations apparently the most disorderly have not the individual character one supposes, and they are not inexplicable exceptions." " Nothing is left to chance," said Charcot ; "on the contrary, all happens according to rules, always the same, common to private and hospital practice, applicable to all countries, to all times, to all races." He naturally sought to discover this determinism and these general laws of hysteria. Carried along by his habits as a clinician, he has, I think, sought these general laws too much in the physi- ological domain, which led him to a certain number of regrettable errors. In opposition to his school other studies, and in particular those of M. Bernheim in Nancy, have shown that this unity of hysteria, this in- terpretation of the symptoms it presents, would be much more surely found -in the domain of the moral phenomena. The contest of the two schools was the occasion of the development of psychological pathology, of which I have spoken to you, and brought on the beginning of the third period, the psychological period of the studies in hysteria. This period, which has already lasted for about twenty years, is still difficult to judge. It seems to me, however, that its first clear results, though interesting, are still very incomplete, and that I ought to warn you against their attractive simplicity. A certain num- ber of authors have been seduced by the psychological explanation. It seemed to them that the mere words "moral " and "thought" were enough to explain every- 1 8 The Major Symptoms of Hysteria thing, and, as people generally like simple explana- tions, physicians are too disposed nowadays to be con- tent with a vaguely mental explanation. Hysteria, they say, is a psychic disease ; it is the disease of suggestion, taken in a vague sense; it consists in disturbances which the patients persuade themselves that they have ; it is the disease of persuasion. Many physicians think that, when they have expressed a few formulas of this kind, nothing remains to be said. There is some truth in this view, for it brings into relief the psychic charac- ter of the affection; but it is quite insufficient. We should, in my opinion, retain something of the precise method of Charcot, of the search after the determina- tion and the laws of hysteria, and apply it only to the psychological fact, instead of always seeking for this determinism in physical facts. We must therefore use a certain preciseness in the description and study of the moral phenomena of hysteria. The description of such a disease is very difficult, first because the symptoms are exceedingly numerous. You know that formerly Sydenham called it a Proteus, an ever-changing malady. But the description is also difficult because the disease is not clearly defined, be- cause its limits, unfortunately, are very vague. It is easy to see that many contemporary authors do not quite agree about what they describe under the name of hysteria, and that some have a much broader concep- tion of the disease than others. This indecision generally surprises young people. You think that, in science, things are perfectly definite, and you are very much astonished to find indecision in your masters. In The Problem of Hysteria 19 reality definiteness does not exist in natural phenomena ; it exists but in our systematic descriptions. It is the men of science who cut separate pieces out of a whole that nature has made continuous. Do you believe that animal species are sharply distinguished from one an- other? Look at the quarrels of naturalists about the limits of the classes, about the animals of transition, which may at will be connected with one class or an- other. Remember the doctrine of evolution and the origin of species of Darwin. All this is still truer in regard to diseases, which, in reality, have not the dis- tinctness we invent. Physicians, it is true, may agree in certain cases, when there is a distinctly visible objective phenomenon characterizing such or such a lesion histologic analysis will serve to define a syphilitic lesion; in other cases, the presence of a microscopic organism will be a guiding mark, and the recognition of the bacillus of Koch will define a tuberculous lesion. But unfortunately we have nothing of the kind at our disposal to define the diseases of the mind. Save the case of general paralysis, there is no anatomical means to distinguish a patient labouring under the mania of persecution from the one who is affected with melan- cholia or neuropathy. When you have found the mi- crobe of hysteria, you will be able to transform all my descriptions and to make them much more accurate. Nowadays there is evidently a hypothetic, conven- tional part in the description and definition of a mental disease. Nobody, I think, felt so clearly the necessity of such hypotheses and conventions as Charcot when he exposed what he called the method of types. When 2O The Major Symptoms of Hysteria one wishes to describe a nervous disease, one must not fancy that one may comprise in its description all possible subjects. There are always some indistinct phenomena, some aberrant cases, some contradictory symptoms. In this case, if one tried to satisfy every- body, one would satisfy nobody; by seeking to be too true, one would be unintelligible. One must determine on making a necessary hypothesis, which characterizes the teaching and the opinion of a master; one must choose among the innumerable cases of the disease that which, in one's personal experience, appears to be the most important, that which presents the most definite phenomena, the most distinct from other maladies, the most frequent with patients of the same kind, the most intelligible. This patient becomes a type, which one describes by preference, though one knows very well that all the others are not absolutely like it, but because one supposes that they deserve the same name in the measure in which they resemble it. This is what I shall try to do before you in describing the major symptoms of hysteria. This word major in- dicates well that I do not pretend to describe all possible hystericals or all the shades these symptoms may present, but that I only wish to show you what, in my hypothesis, characterizes the typical symptoms of hysteria. Such symptomatic and hypothetic descrip- tions have the inconvenience of being transitory, of dis- appearing very soon after us, but it would be a singular illusion to seek to do something eternal. One has already obtained a great result when one has done something momentarily intelligible and useful. Charcot, The Problem of Hysteria 11 whose method I cited to you, applied it in a rather exaggerated degree in his description of hysteria; he described a type of hysterical which disappeared with him ; nobody nowadays any longer describes the attack of hysteria as Charcot did. I think, however, that his description did service to many a generation of students. It brought about an enormous scientific movement, which we continue by discussing it. No doubt, our types of hysterical phenomena are ephemeral like his. We wish they may have the same usefulness for some time. If I succeed in presenting to you a few simple types, intelligible for you, of the mental state that is called somnambulism, of the mental state that brings about the functional paralyses and insensibilities, I shall, I hope, have interested you in these studies of patho- logical psychology, indispensable nowadays to the under- standing of philosophical and moral problems ; I shall have helped you a little to play later on your part as physicians, for a physician should attend to the thought of his patient ; I shall thus have accomplished, partially at least, the wishes formed by your masters of Harvard school when they did me the great honour to call me among them. LECTURE II MONOIDEIC SOMNAMBULISMS Somnambulism as the typical form of hysterical accidents Description 0} some cases of monoideic somnambulisms Their essential psychological characters The emanci- pation, the dissociation of an idea, of a partial system of thoughts in somnambulism THE several conceptions of an illness are characterized by the choice of the symptoms described first and con- sidered as the most important ones. During a long time hysteria was considered as a chiefly physical dis- ease, and consequently convulsions, in all appearance deprived of intelligence, were put on the first line. Hysteria was, above all, a convulsive illness whose most important symptom was the fit. Charcot has still continued that tradition, and you know the pains he took to explain all that illness in taking as a starting- point the convulsive attack. His theory is nowadays considered very artificial, and his schematic conception of the attacks tends to fall into oblivion; that lack of success I easily explain through his error of the starting- point. The hysterical fit of convulsions, far from being a simple phenomenon, is, on the contrary, a very variable and complex symptom. The convulsions have all sorts of meaning ; sometimes they are in connection with sensations or ideas and very complicated states 22 Monoideic Somnambulisms 23 of consciousness ; sometimes they are nearly deprived of consciousness; in certain cases they are linked to habits and grimaces, or depend upon moving agitation in connection with certain voluntary paralyses. It may be said that for some rather aged patients, whose illness has lasted a long time, the convulsive attack sums up all the hysterical accidents they have had since/ the beginning of the disease. The attack I consider as a complex phenomenon that ought to be studied rather at the end of a course of lectures than at the beginning. To characterize at once the spirit of my teaching and to make you understand how to construe that nervous affection from the moral point of view, I ask you to put in the first line, as the most typical, the most character- istic symptom of hysteria, a moral symptom, that is somnambulism, the fit of somnambulism which appears spontaneously in hystericals. This is a new medical conception which I consider an important one. Somnambulism has been too long considered as a rare phenomenon, impossible to explain, that adds itself to the habitual troubles of neuropaths. To me som- nambulism is, on the contrary, extremely frequent under various forms, that may more or less conceal it. Som- nambulism does not add itself to all sorts of neuropathic troubles ; it constitutes the material point of a peculiar neurosis, hysteria. If one understands somnambulism well, one is, I believe, capable of understanding all hysterical phases that are more or less constructed on the same model. But among the various somnambulisms, a type must be chosen to be first studied. Here we will not choose 24 The Major Symptoms of Hysteria the form that occurs most frequently, but the necessity of teaching will induce us to choose the simplest form and the easiest to understand. This simple form of somnambulism deserves to be called monoideic, and that name will, I hope, be justified by this lecture. Thus we have to examine together the typical forms of monoideic somnambulism ; we shall then expose its essentially psychological character, and we shall end by trying to sum up in a simple and general conception the character of these somnambulisms, in order to com- pare gradually that first conception with those we shall draw from the study of other hysterical phenomena. What, then, exactly, is a somnambulist? Popular observation has answered long ago : it is an individual who thinks and acts while he is asleep. Without a doubt that answer is not very clear, for we don't know very well what sleep is. That answer means only that the person spoken of thinks and acts in an odd way, different from that of other people, and that at the same time that person is in some way like a person asleep. You will find nowhere a more beautiful description of this popular conception of somnambulism than in Shakespeare's tragedy, Macbeth: Doctor. I have two nights watched with you, but can perceive no truth in your report. When was it she last walked? Gentlewoman. Since his majesty went into the field, I have seen her rise from her bed, throw her nightgown upon her, unlock her closet, take forth paper, fold it, write upon 't, read it, Monoideic Somnambulisms 25 afterwards seal it, and again return to bed; yet all this while in a most fast sleep. Doctor. A great perturbation in nature, to receive at once the benefit of sleep and do the effects of watching ! In this slumbery agitation, besides her walking and other actual performances, what at any time have you heard her say? Gentlewoman. That, sir, which I will not report after her. Doctor. You may to me, and 't is most meet you should. Gentlewoman. Neither to you nor any one, having no witness to confirm my speech. Enter LADY MACBETH, with a taper Lo you, here she comes ! This is her very guise ; and, upon my life, fast asleep ! Observe her ; stand close. Doctor. How came she by that light? Gentlewoman. Why, it stood by her; she has light by her continually, 't is her command. Doctor. You see, her eyes are open. Gentlewoman. Ay, but their sense is shut. Doctor. What is it she does now? Look, how she rubs her hands. Gentlewoman. It is an accustomed action with her, to seem thus washing her hands; I have known her continue in this a quarter of an hour. Lady Macbeth. Yet here 's a spot. Doctor. Hark ! she speaks ; I will set down what comes from her, to satisfy my remembrance the more strongly. Lady Macbeth. Out, damned spot ! out, I say ! One, two ; why, then 't is time to do 't. Hell is murky ! Fie, my lord, fie ! a soldier, and afeard ? What need we fear who knows it, when none can call our power to account ? Yet who would have thought the old man to have had so much blood in him? Doctor. Do you mark that? Lady Macbeth. The thane of Fife had a wife; where is she now ? What, will these hands ne'er be clean ? No more o' that, my lord, no more o' that; you mar all with this starting. Doctor. Go to, go to; you have known what you should not 26 The Major Symptoms of Hysteria Gentlewoman. She has spoke what she should not, I am sure of that; heaven knows what she has known. Lady Macbeth. Here 's the smell of the blood still; all the perfumes of Arabia will not sweeten this little hand. Oh, oh, oh ! Doctor. What a sigh is there! The heart is sorely charged. Gentlewoman. I would not have such a heart in my bosom for the dignity of the whole body. Doctor. Well, well, well, Gentlewoman. Pray God it be, sir. Doctor. This disease is beyond my practice ; yet I have known those which have walked in their sleep who have died holily in their beds. Lady Macbeth. Wash your hands, put on your nightgown; look not so pale. I tell you yet again, Banquo 's buried ; he cannot come out on 's grave. Doctor. Even so? Lady Macbeth. To bed, to bed ! there 's knocking at the gate; come, come, come, come, give me your hand. What 's done cannot be undone. To bed, to bed, to bed ! [Exit. Doctor. Will she go now to bed? Gentlewoman. Directly. Doctor. Foul whisperings are abroad. Unnatural deeds Do breed unnatural troubles; infected minds To their deaf pillows will discharge their secrets. More needs she the divine than the physician. God, God forgive us all! Look after her; Remove from her the means of all annoyance, And still keep eyes upon her. So, good night; .My mind she has mated, and amaz'd my sight. I think, but dare not speak. Gentlewoman. Good night, good doctor. [Exeunt. Our modern examples are much less dramatic, but they may be compared as to their most striking features. Let me cite a certain number of cases to impress upon Monoideic Somnambulisms 27 your mind the idea of this phenomenon, which to me is a very important one. Here is a first instance: A young woman, twenty-nine years old, called Gib., intelligent, sensitive, hears one day abruptly some dis- astrous news. Her niece, who lives next door, has just died in dreadful circumstances. She rushes out, and comes, unhappily, in time to see the body of the young girl lying in the street. She had thrown herself out of the window in a fit of delirium. Gib., although very much moved, remains to all appearance calm, helping to make everything ready for the funeral. She goes to the funeral in a very natural way. But from that time she grows more and more gloomy, her health fails, and we may notice the beginning of the singular symp- toms we are going to speak of. Nearly every day, at night and during the day, she enters into a strange state; she looks as if she were in a dream, she speaks softly with an absent person, she calls Pauline (the name of her lately deceased niece), and tells her that she ad- mires her fate, her courage, that her death has been a beautiful one. She rises, goes to the windows and opens them, then shuts them again, tries them one after an- other, climbs on the window, and, if her friends did not stop her, she would, without any doubt, throw herself out of the window. She must be stopped, looked after incessantly, till she shakes herself, rubs her eyes, and resumes her ordinary business as if nothing had happened. A curious case I have lately observed is that of He., which I have related with more particulars in another of my works. That woman, a hysterical thirty-five 28 The Major Symptoms of Hysteria years old, was taking a walk in the zoological garden during her menstrual period, when she was frightened by a lioness that, as it was reported, seemed ready to rush upon her. When she came back to the hospital, she had a fit of delirium that lasted for eight days. After some interruption, she again had fits of the same odd delirium. In these crises she runs on all fours, roars, rushes on people, trying to bite them; and al- though she was anorexic before her attack and could eat very little, now she pounces on all sorts of food, picks it up with her teeth, and devours bits of paper and small objects she finds on the floor. In a word, she acts a comedy wherein she believes herself to be a lion- ess. I say that she acts a comedy, for it becomes certain that she studies her part, and that she often re- places real actors by metaphors. For instance, she looks in a drawer for photographs, generally children's portraits, and tries to eat them up. Without any doubt, as she is unable to devour real persons, she devours them in effigy. I won't insist on the form here borrowed by the idea rooted in her mind ; it is one of those changes in personality brought about by a suggestion or an invading idea which are already well known. At the same time we may observe in He., when she is awake, a very complete amnesia, that spreads not only upon the delirium, but also upon the walk at the zoological garden. Third observation: A man of thirty-two, Sm., pre- sents a still more singular case. He usually remains in bed, for both his legs are paralyzed. We won't occupy ourselves with that paralysis to-day, although it is a very odd one. In the middle of the night he rises Monoideic Somnambulisms 29 slowly, jumps lightly out of bed, for the paralysis we have just spoken of has quite vanished, takes his pillow and hugs it. We know by his countenance and by his words that he mistakes this pillow for his child, and that he believes he is saving his child from the hands of his mother-in-law. Then, bearing that weight, he tries to slip out of the room, opens the door, and runs out through the court-yard; climbing along the gutter, he gets to the housetop, carrying his pillow and running all about the buildings of the hospital with marvellous agility. One must take great care to catch him, and use all sorts of cautions to get him down, for he wakes with a stupefied air, and as soon as he is awake, both his legs are paralyzed again, and he must be carried to his bed. He does not understand what you are speaking about, and cannot comprehend how it hap- pens that people were obliged to go to the top of the house in order to look for a poor man who has been paralyzed in his bed for months. A fourth and last observation, for I insist upon relat- ing to you a great number of instructive examples. We come back to the common story of a young girl twenty years old, called Irene, whom despair, caused by her mother's death, has made ill. We must remember that this woman's death has been very moving and dramatic. The poor woman, who- had reached the last stage of consumption, lived alone with her daughter in a poor garret. Death came slowly, with suffocation, blood- vomiting, and all its frightful procession of symptoms. The girl struggled hopelessly against the impossible. She watched her mother during sixty nights, working at 3