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The Major Symptoms of Hysteria · The Major Symptoms of Hysteria

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  Lecture one, The problem of hysteria, The interest and importance of studying hysteria,
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  the philosophical and the medical point of view. Brief account of the evolution
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  of the studies about this disease, the necessity for the psychological study of the
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  neuroses, the psychological type of hysteria. Gentlemen, President Eliot and the professors
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  of the Great University of Harvard have determined to celebrate the opening of the new
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  buildings of your medical school by putting into practice a beautiful and great thought.
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  They have determined to invite to come among them foreign professors, and have begged
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  them to expose before you the ideas and teachings they give in other countries.
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  It is a mode of teaching which is very often used in American universities,
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  but unfortunately, is rarely applied in France. It may have the most beautiful
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  results for the teaching of youth, for the development of science, and for
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  the union of the various nations, which is in our time the great aim
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  of all true civilizations. Unhappily, the application of this useful method is very
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  difficult. For all depends on the choice of that foreign professor called momentarily to
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  teach among you. No doubt I congratulate myself very much upon the choice which
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  has been made. It is for me a great honor. It gives me
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  an opportunity to see again a town of which I am very fond, and
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  to try to diffuse among you some ideas to which I hold. But I
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  dare not congratulate you upon this choice, for I am afraid my ignorance of
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  your methods of teaching, and above all my ignorance of your tongue, will
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  make these lectures very hard to understand and very painful to hear. First,
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  I make you my apologies. Then I wish you may overcome this bad luck
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  and forget as much as possible the incorrectness and strangeness of my language. This
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  done, let us all do our best. You to understand me tolerably well,
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  and to draw from these lectures some notions of what interests French students.
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  Aye to speak nearly intelligible English, and to give you as favorable an impression
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  as possible of the psychological study of nervous diseases in the French universities. One
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  with the approval of President Eliot and of Professor James J. Putnam, I
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  have chosen as the subject of these lectures the study of that nervous and mental
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  disease called hysteria. The reason of this choice is that, from many points
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  of view, this study seems to me pretty well to answer the wish of
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  the professors who called me. When a foreign professor is asked to express his
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  ideas in another country, he is expected to expose one of the most characteristic
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  studies of his native land, just as when we have landed in a new
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  country we seek to taste the dishes that characterize its cookery. Well, it
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  seems to me that what has been most characteristic in France for a score of
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  years in the study of nervous diseases is the development of pathological psychology. No
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  doubt, the clinic and anatomic study of these same diseases is very honorably represented
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  by French names. But this study has developed in the same way in other
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  countries, and I think you have not much for which to envy us in
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  this matter. Psychological studies, properly so called, especially the studies of psychological
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  measures, have developed in Germany and in America more than in France. And
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  it is not here near Professor Munsterberg's laboratory, that it would be well to
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  come and deliver a lecture on this subject. But it seems to me that
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  in France, under the influence of two of my masters, whose names I
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  like to recall, Chalcot and Professor Ribaut, was realized an interesting union between
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  two studies which were for the most part separated before. Beautiful natural experiences have
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  been borrowed from mental pathology, which strongly illuminate the problems of psychology. On
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  the other hand, notions of experimental psychology have been made use of in order
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  to understand and sometimes to treat patient's mental disturbances. I should be happy to
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  make you feel how interesting is this new study, which seems to me to
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  have very good prospects. Among these studies of pathological psychology, I determined on
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  taking that of a particular nervous disease, hysteria. I think it is by
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  this one that one should begin nowadays. For this we have historical and scientific
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  reasons. Look back to the time of the first works of Charcot, Ribau
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  and their pupils, cast a glance at innumerable works which twenty years ago determined
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  that current of researchers remember the names of Mene Petre Paul Richet, Charlerichet,
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  Binet Fire, Marie Garce, Gill de Latrouette, Brissau, and in foreign
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  countries of del Beuf, Mebius, Broyer, Freud, Morton, Prince,
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  et cetera. Remark what was by a kind of singular common understanding the subject
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  of all their works. No doubt, they seemed, like Professor Ribaut,
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  to speak of all possible mental diseases and to seek for mental disturbances in all
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  the forms in which they present themselves. Now and then, it is true
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  they devoted a few lines to idiocy or insanity. But if you read their
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  books again, you will see that whatever the matter is, maladid de la
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  memoir, maladide de la volonti, maladid la personneliti, they always speak of
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  localized amnesias of alternating memory, which in reality are only to be met among
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  hysterical somnambulisms, of irresistible suggestions, hypnotic catalepsias, which are as I will
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  try to prove to you, nothing but hysterical phenomena of total modifications of the
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  personality divided into two successive or simultaneous persons, which is again the dissociation of
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  consciousness in the hysteric. Besides all these works, pathological psychology owes very much
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  to the considerable movement concerning hypnotism which took place during a few years. It
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  is certain that the works of Charcrot, Bernheim, Phorrel, and so many
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  others had the greatest influence on the development of this new science. But now
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  that the quarrels of other times are somewhat appeased, everybody will probably recognize a
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  fact which I hope also to be able to prove to you, namely,
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  that in reality it is only among hysterical patients that this hypnotism is to be
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  found in any marked degree. I will not raise now the difficult problem of
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  deciding whether all the people who can be hypnotized must be called hystericals. But
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  I believe almost every good observer will agree with me that the best studies about
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  the clearest cases of artificially induced somnambulism and about its psychological properties were made on
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  hysterical subjects. Consider even the somewhat adventurous authors who have sought to draw attention
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  to particularly strange phenomena, and who, by the curiosity they have raised,
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  have had a share in the development of the same researches. Remember the studies
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  on psychic polarization, on transfer on marked points, suggestions, sigistur, poinder
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  roupell, on unconscious acts, et cetera. These studies have always had for
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  their starting point hysteric phenomena as equivalences and anesthesias. In a word, if
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  any interest is given to the development of that pathological psychology which has been growing
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  these twenty years, it ought to be recognized that this interest has for its
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  object a special disease, hysteria. No doubt, such exclusive fondness for this
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  study was rather exaggerated, and all the psychologists who, for some time,
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  in imitation of the masters, studied the hysteric were somewhat like the sheep of
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  our paniorge. It was an exaggeration to think that pathological psychology could not be
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  studied on other patients. Doctor Ferrey was somewhat mistaken when he called hystericals the
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  frogs of experimental psychology. As in physiology, the frog is not an absolutely
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  necessary animal for our experiments. So the hysteric patient is not the only one
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  worthy of psychological researches. We are even certain to day that the hysterics offer
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  many drawbacks, and many studies have been made on other diseases. However,
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  it is true that there were certain practical reasons justifying this choice at the beginning
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  of this kind of studies, and these practical reasons are still the same for
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  you. The psychology of the hysteric patient, though full of difficulties and obscurities,
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  is surely simple. It is a question of measure. All I want
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  to say is that we are now at day is quite unable to understand to
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  express in formulas and in laws what an insane person feels. We can hardly
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  connect together by general laws the different facts observed in melancholic delirium or in the
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  delirium of persecution. On the contrary, the various accidents of hysteria, though
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  so different in appearance, are easily brought close to one another. Owing to
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  common characters. We can dimly see some general laws about the formula for which
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  we hesitate, but of whose existence we have a suspicion. That is,
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  after all, the reason that explains the character of the discussion about hysteria nowadays,
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  while nobody endeavors to give or to discuss a general definition comprising all the
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  phenomena of epilepsy or melancholia. There are now a great number of authors who
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  propose to explain in a few words, in a single definition, all the
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  pathology of hysteria. In short, I was right in saying to you that
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  the psychology of this disease seems now to be simpler than the conception of other
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  mental diseases. It is the reason why I told you that the psychology of
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  this disease is simple. To this primordial reason are added practical reasons. The
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  hysteric are patients who are easily managed, who talk willingly, who are not
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  dangerous, on whom we can experiment without any great fear, and who lastly
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  like to be observed and readily lend themselves to examination. Such of the reasons
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  why the first studies were devoted to this kind of patients. And in following
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  the historical order, we also follow the practical order, which leads us to
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  begin with the simplest and easiest disease. SEC. Two. Do not think,
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  however, that this choice of the study of the hysteric is only justified
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  by an historical chance and by reasons of convenience. The study of these patients,
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  if happily it is a rather easy one is at the same time very
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  important, both from the philosophical and scientific and from the medical and practical point
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  of view. I am convinced that in our times, every well educated man
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  wishing to have an opinion on moral and philosophical problems ought to know something of
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  this singular mental disease, for it has played a considerable part in the history
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  of all religions and superstitions, and it still plays a very important part in
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  the most attractive moral questions. A great French alienist, Morau de Tours,
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  was in the habit of saying that all the great things accomplished in the world
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  have been accomplished by mad people. It is perhaps somewhat exaggerated, but it
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  is nevertheless true that most great creeds have spread by means of the emotion caused
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  by surprising phenomena, which have always been due to hysteric people. In the
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  development of every great religion, both in ancient and in modern times, there
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  have always been strange persons who raised the admiration of the crowd because their nature
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  seemed to be different from human nature. Their manner of thinking was not the
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  same as that of others. They also had extraordinary oblivions or remembrances. They
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  had visions, They saw or heard what others could not see or hear.
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  They were illumined by odd convictions. Not only did they think, but they
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  also felt in another way than the bulk of mankind. They had an extraordinary
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  delicacy of certain senses joined to extravagant insensibilities, which enabled them to bear the
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  most dreadful tortures with indifference or even with delight. Not only did they feel,
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  but they also lived otherwise than other people. They could do without sleep
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  or sleep for months together. They lived without eating or drinking, without satisfying
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  their natural needs. Is it not such persons who have always excited the religious
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  admiration of peoples. Where the sibyls, prophets, pythonesses of Delphi or Ephesus,
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  or saints of the Middle Ages, or ecstatics or illuminates, Now they
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  were considered as worthy of admiration and beatified. Now they were called witches or
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  demoniacs and burnt. But at the bottom they always caused astonishment, and they
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  played a great part in the development of dogmas and creeds. Well, all
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  these phenomena, as you know already, are the usual symptoms of hysteria.
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  And there is not, from this point of view, a disease which has
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  played so great a part in history. If I am not mistaken, it
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  is still exactly the same. Now we have changed only in appearance. We
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  beatify but few saints, and we burn but few demoniacs. Yet we have
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  not forgotten them. They have become our somnambulists and mediums. And every time
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  we want to throw some light on the mysteries of our destiny, to penetrate
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  into the unknown faculties of the human mind. To whom do we appeal?
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  Whom do we take as a subject of observation. Is it an ordinary person,
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  a person in good health, whom we ask to foresee the future or
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  to talk with the dead? No, it is a neuropathic patient, insensible
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  to the things of this world, but whose sensibility is over excited in a
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  certain direction. Medically speaking, it is a hysteric person. Understand me well,
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  I do not mean at all to tell you that these studies are warped
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  by this, any more than I deny the sanctity of a personage of the
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  Middle Ages, whom I diagnosticate as hysteric. A hysterical person may be a
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  saint. A hysterical person may have a wonderful lucidity that is undeniable. I
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  only want you to be warned of what happens when you have to judge facts
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  of this kind. When we have to appreciate facts which are out of our
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  habitual observation and look wonderful, it is a material point to know well in
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  what conditions they present themselves. Now in the question, we are considering one
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  of these conditions. The most serious one is the mental state of the persons
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  in whom such facts are observable. So you must know that such persons are
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  hystericals, and be accustomed to the laws ruling the minds of hystericals. Perhaps
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  there may be some cases in which this assertainment does not diminish the interest taken
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  in the phenomenon, but believe me, it mostly takes away a great part
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  of the wonderful. To judge these moral and philosophical problems, it is indispensable
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  to study thoroughly this disease of the mind. This remark is truer still if
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  you consider the subject from a medical and practical point of view. You who
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  have chosen the medical career and will have to attend patients belonging to every class
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  of society. Bear in mind that you will constantly meet with neuropathic phenomena connected
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  with this group of neuroses, and that you will commit the most dangerous mistakes
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  if you are not very well accustomed to the aspects and evolution of hysteria.
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  It was the fashion for a certain time to say that hysteria was a very
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  rare disease. You know that it had a bad reputation, that a kind
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  of dishonor was attached to this word, and that people tried to persuade themselves
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  that this shameful disease was not of frequent occurrence by a kind of international irony.
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  People were willing to admit, after the innumerable studies made by French physicians
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  that hysteria was frequent only among French women, which astonished nobody on account of
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  their bad reputation. Do not believe this nonsense. American women are terribly like
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  French women. I was not astonished therefore, when two years ago, at
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  the Chicago County Hospital and at the Boston City Hospital, some kind fellow physicians
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  immediately showed me hysteric women humorously, adding that they were quite the same as
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  those of La Salpetriere. The difference of races is also one of those silly
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  things which the human mind has much difficulty in getting rid of. All civilized
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  nations are now the same. We have the same mind and the same body,
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  and it must be recognized the same miseries. If the hysterical seemed to
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  be less numerous in other countries, it is first because physicians did not recognize
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  them, then because they would not give them their real appellation. When medical
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  instruction is more general in this matter, when prejudices have vanished, it will
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  probably be acknowledged that in this matter, as in many others, the other
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  nations have no reason for envying France. So you will often meet with hysterical
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  people. You will call them neurasthenic for the family if you like. I
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  don't care. I only wish that you should at least know what is the
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  matter. You must be able quickly to recognize this disease in order to foresee
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  its evolution, to provide against its dangers, and immediately to begin a rational
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  treatment. This early diagnosis is much more important. Still from another point of
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  view, it will keep you. Allow me to tell you plainly from making
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  blunders. It is perhaps not very serious not to recognize a hysterical accident and
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  not to treat it. But what is always very serious is to mistake a
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  hysterical accident for another one, and to treat it for what it is not.
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  You cannot imagine the medical blunders, and too often also the medical crimes
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  committed in this way. One of the greatest difficulties in the medical art,
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  and one of the greatest misfortunes of patients, is that hysterical diseases are only
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  well characterized from the moral point of view, which usually is not examined at
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  all, That they are very badly characterized from the physical point of view,
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  and that they are uncommonly similar to all kinds of medical or surgical affections for
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  which they are easily mistaken. Contractures, paralyses, anesthesias, various pains,
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  especially when they are seated in the viscera, may simulate anything. And then
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  you have the legion of false tuberculoses of the lungs, of false tumors of
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  the stomach, of false intestinal obstructions, and above all of false uterine and
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  ovarian tumors. What happens as to the viscera also exists as to the limbs
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  and the organs of the senses. Some hysterical disturbances are mistaken for lesions of
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  the bones of the rachis, for muscular or tenderness lesions. Then the physician
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  interposes frightens the family, agitates the patient to the utmost, and prescribes extraordinary
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  diets, perturbing the life and exhausting the strength of the sick person. Finally,
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  the surgeon is called in. Do not try to count the number of
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  arms cut off, of muscles of the neck incized for cricks, of bones
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  broken for mere cramps, of bellies cut open for phantom tumors, and especially
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  of women made barren for pretended ovarian tumors. Humanity ought, indeed, to
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  do homage to Charko for having prevented a greater depopulation. These things, no
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  doubt have decreased, but they are still done every day. Not long ago
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  I saw a patient who had had an eye excised and the optic nerve cut
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  out for mere neuropathic pains. If I could, only by calling your a
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  tension and interest to the knowledge of this disease contribute to diminish the number of
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  these medical crimes, I should already have attained a very important result. Three.
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  In order to be able to enter upon the study of hysteria in a
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  profitable way, allow me, before I end the introduction, to summarize in
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  a few words, the history of the studies which have been made on this
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  disease. We are not isolated in our studies. We come after generations of
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  other students, and we always ought before we begin our own researches to try
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  to see our way exactly. We ought to see at what point of medical
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  history we are standing, What has been done and well done before us,
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  what we have not to begin again. We ought to realize the difficulties that
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  stopped our predecessors, in order to add our efforts to theirs, and to
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  make some steps forward in the way they have laid down for us. The
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  history of these studies would be a very long one, for they began in
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  the remotest antiquity. Democritus already has his theory about hysteria. But I think
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  that we can summarize this long history in a few words by establishing a few
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  great divisions. And I proposed to you to adopt three great divisions. At
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  first, this history was anecdotical and descriptive. It is a period of curiosity
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  and of somewhat uneasy and uncritical admiration. It is the period of sybyls,
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  witches, convulsionists of all kinds, and of miscellanies, of surprising facts about
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  convulsions, somnambulisms, resurrections of lethargic people, extraordinary fastings, miraculous wounds,
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  et cetera. The second period, which in reality began very late, only
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  in the nineteenth century, might be called the clinical period. Then physicians sought
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  above all to give a medical character to this disease, to distinguish it from
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  other maladies, and to recognize the phenomena that appertained to it. It is
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  a kind of clearing away and classification. The third period, which is quite
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  contemporary, deserves to be called the psychological period. For right or wrong,
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  it is among mental for non that for these thirty years the interpretation has been
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  sought of these innumerable phenomena which our first ancestors had only described, and which
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  their successors contented themselves with classifying. Later, perhaps there will come an anatomical
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  and physiological period, but in my opinion it does not yet exist. A
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  word only about each of these great stages. In the first it is sufficient
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  to remind you of the names of Plato, Hippocrates, Celsus, Gallienus,
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  Aetius. Of the authors who in the Middle Ages described possessions, careers,
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  epidemics of tarrantism. Among them are Armvoros, Paris and Fernel. A little
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  later we have to cite Charles Lupois, who gave in the seventeenth century one
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  of the best descriptions Sidnam, who made known the hysterical nail, coughing,
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  vomiting, and edema. Rolin seventeen fifty eight, who supported the opinion of
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  Sidnam, and was one of the first to maintain that there were hysteric men
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  Witt seventeen six sixty seven, Sauvage seventeen sixty, Astruc seventeen sixty one,
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  and Pom seventeen sixty to seventeen eighty two, who discussed this strange problem.
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  This descriptive period was in fact disturbed by a puerile and dangerous conception, which
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  viciated all the studies and made any attempt at an interpretation impossible. You know
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  the old reverie of Plato in the Temius the Matrix is an animal which longs
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  to generate children. When it remains barren for a long time after puberty,
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  it finds it difficult to bear. It feels wroth. It goes about the
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  whole body, closing the issues for the air, stopping the respiration, putting
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  the body into extreme dangers and occasioning various diseases, until desire and love,
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  bringing man and woman together, make a fruit and gather it as from a
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  tree. This pretty little story was for half a score of centuries the only
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  interpretation of hysteria, and still originated all the foolish ideas expressed by Luille de
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  villeh May in eighteen sixty. You may guess the part played in this respect
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  by the abdominal pains seated at the level of ovaries, by the movements of
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  the hysterical nail, by the suffocations of the patients during their fits. As
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  hysteria required an uterus, its existence was not admitted in men, and the
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  first serious discussions bore on the existence of masculine hysteria. The recognition of this
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  disease in men changed the old conception of hysteria and determined an ensemble of more
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  precise clinical researches without pretending to any chronological precision, we place at the beginning
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  of the nineteenth century the inauguration of the second and truly clinical period. It
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  is sufficient to remind you of the names of George eighteen twenty one, of
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  Huffelant in Germany eighteen thirty six, of Brachet and of Landousie in France eighteen
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  forty five, of Duchend de Boulogneux eighteen fifty five, of Le Grand du
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  Saus eighteen sixty. But I must insist on the beautiful book of the English
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  physician Brodie eighteen thirty seven, who described the sensitive and motor disturbances in the
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  articulations, and who has given his name to an hysterical accident, the knee
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  of Brodie. We must accord a good place to the work of Briquet eighteen
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  fifty nine. It was the first general work of real value, and it
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  prepared the way for the contemporary studies. Lastly, you know that the most
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  eminent representative of that period is Charcourt, who in every way gave more precision
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  to the clinical knowledge of hysteria. With these studies are connected the distinction between
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  the epileptic and the hysterical fit, which was for a long time considered impossible,
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  the diagnosis of apoplexies, cerebral lesions, meningities, of hysterical mutisms and
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  fits of sleep. The separation between hysterical anorexies, gastralgas and dyspneas, and
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  the organic diseases which are apparently seated in the same viscera. It is chiefly
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  to the patient's studies of our predecessors that we owe the discovery and diagnosis of
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  the different motor accidents of histae exterior of the articular disturbances analogous to the knee
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  of Brody, of the contractures of the paralysies limited to one limb. Discussions
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  relating to these motor accidents, their comparison with the diverse organic paralysis. Researches
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  on the traumatic neuroses filled, as you know, the career of Charko.
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  In all these studies, there was no room yet for an interpretation of the
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  disease, and Chako felt thoroughly the necessity of an interpretation of this kind.
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  It was indispensable not only in order to explain things apparently mysterious, but chiefly
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  to give a unity capable of linking together those innumerable symptoms that looked so heterogeneous.
• 24:38
  Larseg had already said that manifestations, apparently the most disorderly, have not
• 24:44
  the individual character one supposes, and they are not inexplicable exceptions. Nothing is
• 24:51
  left to chance, said Chako. On the contrary, all happens according to
• 24:55
  rules, always the same, common to private and hospital practice, applicable to
• 24:59
  all entries, to all times, to all races. He naturally sought to
• 25:03
  discover this determinism and these general laws of hysteria, carried along by his habits
• 25:10
  as a clinician. He has, I think sought these general laws too much
• 25:14
  in the physiological domain, which led him to a certain number of regrettable errors.
• 25:18
  In opposition to his school, other studies, and in particular those of
• 25:22
  Monsieur Bernheim in Nanci, have shown that this unity of hysteria, this interpretation
• 25:27
  of the symptoms it presents, would be much more surely found in the domain
• 25:32
  of the moral phenomena. The contest of the two schools was the occasion of
• 25:37
  the development of psychological pathology, of which I have spoken to you, and
• 25:41
  brought on the beginning of the third period. The psychological period of the studies
• 25:45
  in hysteria. This period, which has already lasted for about twenty years,
• 25:51
  is still difficult to judge. It seems to me, however, that its
• 25:53
  first clear results, though interesting, are still very incomplete, and that I
• 25:59
  ought to warn you against their attractive simplicity. A certain number of authors have
• 26:03
  been seduced by the psychological explanation. It seemed to them that the mere words
• 26:07
  moral and thought were enough to explain everything. And as people generally like simple
• 26:12
  explanations, physicians are too disposed nowadays to be content with a vaguely mental explanation.
• 26:19
  Hysteria, they say, is a psychic disease. It is the disease
• 26:22
  of suggestion. Taken in a vague sense. It consists in disturbances which the
• 26:27
  patients persuade themselves that they have. It is the disease of persuasion. Many
• 26:33
  physicians think that when they have expressed a few formulas of this kind, nothing
• 26:37
  remains to be said. There is some truth in this view, for it
• 26:41
  brings into relief the psychic character of the affection, but it is quite insufficient.
• 26:45
  We should, in my opinion, retain something of the precise method of
• 26:48
  Shatkoor of the search after the determination and the laws of hysteria, and apply
• 26:53
  it only to the psychological fact, instead of always seeking for this determinism in
• 26:59
  physical facts. We must therefore use a certain preciseness in the description and study
• 27:03
  of the moral phenomena of hysteria. The description of such a disease is very
• 27:08
  difficult. First because the symptoms are exceedingly numerous. You know that formerly Sydonam
• 27:15
  called it a proteus, an ever changing malady. But the description is also
• 27:18
  difficult because the disease is not clearly defined. Because its limits, unfortunately are
• 27:23
  very vague. It is easy to see that many contemporary authors do not quite
• 27:29
  agree about what they describe under the name of hysteria, and that some have
• 27:32
  a much broader conception of the disease than others. This indecision generally surprises young
• 27:37
  people. You think that in science things are perfectly definite, and you are
• 27:41
  very much astonished to find indecision in your masters. In reality, definiteness does
• 27:47
  not exist in natural phenomena. It exists, but in our systematic descriptions.
• 27:52
  It is the men of science who cut separate pieces out of a whole that
• 27:56
  nature has made continuous. Do you believe that animal species are sharply distinguished from
• 28:00
  one another. Look at the quarrels of naturalists about the limits of the classes,
• 28:06
  about the animals of transition, which may it will be connected with one
• 28:08
  class or another. Remember the doctrine of evolution and the origin of species of
• 28:14
  Darwin. All this is still truer in regard to diseases, which in reality
• 28:18
  have not the distinctness we invent. Physicians, it is true, may agree
• 28:22
  in certain cases when there is a distinctly visible objective phenomenon characterizing such or such
• 28:27
  a lesion, histologic analysis will serve to define a syphilitic lesion. In other
• 28:33
  cases, the presence of a microscopic organism will be a guiding mark, and
• 28:37
  the recognition of the basilis of Koch will define a tuberculous lesion. But unfortunately,
• 28:42
  we have nothing of the kind at our disposal to define the diseases of
• 28:45
  the mind. Save the case of general paralysis. There is no anatomical means
• 28:51
  to distinguish a patient at laboring under the mania of persecution from the one who
• 28:55
  is affected with melancholia or neuropathy. When you have found the micro of hysteria,
• 29:00
  he will be able to transform all my descriptions, and to make them
• 29:03
  much more accurate nowadays. There is evidently a hypothetic, conventional part in the
• 29:10
  description and definition of a mental disease. Nobody, i think, felt so
• 29:14
  clearly the necessity of such hypotheses and conventions as Charcot when he exposed what he
• 29:18
  called the method of types. When one wishes to describe a nervous disease,
• 29:23
  one must not fancy that one may comprise in its description all possible subjects.
• 29:29
  There are always some indistinct phenomena, some arebarent cases, some contradictory symptoms.
• 29:34
  In this case, if one tried to satisfy everybody, one would satisfy nobody.
• 29:38
  By seeking to be too true, one would be unintelligible. One must
• 29:42
  determine on making a necessary hypothesis which characterizes the teaching and the opinion of a
• 29:48
  master. One must choose, among the innumerable cases of the disease, that
• 29:52
  which, in one's personal experience appears to be the most important, that which
• 29:57
  presents the most definite phenomena, the most distinct from other maladies, the most
• 30:02
  frequent with patients of the same kind, the most intelligible. This patient becomes
• 30:07
  a type which one describes by preference, though one knows very well that all
• 30:11
  the others are not absolutely like it, but because one supposes that they deserve
• 30:15
  the same name and the measure in which they resemble it. This is what
• 30:19
  I shall try to do before you, in describing the major symptoms of hysteria.
• 30:25
  This word major indicates well that I do not pretend to describe all possible
• 30:29
  hystericals or all the shades these symptoms may present, but that I only wish
• 30:33
  to show you what in my hypothesis characterizes the typical symptoms of hysteria. Such
• 30:40
  symptomatic and hypothetic descriptions have the inconvenience of being transitory, of disappearing very soon
• 30:45
  after us. But it would be a singular illusion to seek to do something
• 30:48
  eternal one has already obtained a great result when one has done something momentarily intelligible
• 30:55
  and useful. Charcot, whose method I cited to you, applied it in
• 31:00
  a rather exaggerated degree. In his description of hysteria. He described a type
• 31:03
  of hysterical which disappeared with him. Nobody nowadays any longer describes the attack of
• 31:08
  hysteria as Charcot did. I think, however, that his description did service
• 31:14
  to many a generation of students. It brought about an enormous scientific movement,
• 31:18
  which we continue by discussing it. No doubt, our types of hysterical phenomena
• 31:23
  are ephemeral like his. We wish they may have the same usefulness for some
• 31:27
  time. If I succeed in presenting to you a few simple types intelligible for
• 31:33
  you of the mental state that is called somnambulism, of the mental state that
• 31:37
  brings about the functional paralysis and insensibilities, I shall, I hope, have
• 31:42
  interested you in these studies of pathological psychology, indispensable nowadays to the understanding of
• 31:48
  philosophical and moral problems. I shall have helped you a little to play later
• 31:52
  on your part as physicians, for a physician should attend to the thought of
• 31:56
  his patient. I shall thus have accompanied partially at least the wishes formed by
• 32:01
  your masters of Harvard School, when they did me the great honor to call
• 32:06
  me among them. End of Section one. Lecture two. Monoidaics somnambulisms Somnambulism
• 32:15
  as the typical form of hysterical accidents. Description of some cases of monoidaics somnambulisms
• 32:21
  their essential psychological characters, the emancipation the dissociation of an idea of a partial
• 32:27
  system of thoughts. In somnambulism, the several conceptions of an illness are characterized
• 32:34
  by the choice of the symptoms described first and considered as the most important ones.
• 32:38
  During a long time, hysteria was considered as a chiefly physical disease,
• 32:43
  and consequently convulsions in all appearance deprived of intelligence, were put on the first
• 32:47
  line. Hysteria was above all a convulsive illness, whose most important symptom was
• 32:52
  the fit. Charcot has still continued that tradition, and you know the pains
• 32:57
  he took to explain all that illness in takes as a starting point the convulsive
• 33:00
  attack. His theory is nowadays considered very artificial, and his schematic conception of
• 33:07
  the attacks tends to fall into oblivion. That lack of success I easily explain
• 33:10
  through his error of the starting point. The hysterical fit of convulsions, far
• 33:15
  from being a simple phenomenon, is on the contrary, a very variable and
• 33:19
  complex symptom. The convulsions have all sorts of meaning. Sometimes they are in
• 33:23
  connection with sensations or ideas, and very complicated states of consciousness. Sometimes they
• 33:30
  are nearly deprived of consciousness. In certain cases they are linked to habits and
• 33:34
  grimaces, or depend upon moving agitation in connection with certain voluntary paralysies. It
• 33:38
  may be said that for some rather aged patients whose illness has lasted a long
• 33:43
  time, the convulsive attack sums up all the hysterical accidents they have had since
• 33:47
  the beginning of the disease. The attack I consider as a complex phenomenon that
• 33:52
  ought to be studied rather at the end of a course of lectures than at
• 33:55
  the beginning. To characterize at once the spirit of my teaching, and to
• 34:00
  make you understand how to construe that nervous affection from the moral point of view,
• 34:04
  I ask you to put in the first line as the most typical,
• 34:07
  the most characteristic symptom of hysteria, a moral symptom, that is somnambulism,
• 34:12
  the fit of somnambulism which appears spontaneously in hystericals. This is a new medical
• 34:17
  conception which I consider an important one. Somnambulism has been too long considered as
• 34:22
  a rare phenomenon, impossible to explain that adds itself to the habitual troubles of
• 34:28
  neuropaths. To me, somnambulism is, on the contrary, extremely frequent under
• 34:32
  various forms that may more or less conceal it. Somnambulism does not add itself
• 34:38
  to all sorts of neuropathic troubles. It constitutes the material point of a peculiar
• 34:43
  neurosis hysteria. If one understands somnambulism well, one is I believe, capable
• 34:49
  of understanding all hysterical phases that are more or less constructed on the same model.
• 34:54
  But among the various somnambulisms, a type must be chosen to be first
• 34:59
  studied. Here we will not choose the form that occurs most frequently, but
• 35:02
  the necessity of teaching will induce us to choose the simplest form and the easiest
• 35:07
  to understand. This simple form of somnambulism deserves to be called monoideic, and
• 35:13
  that name will I hope be justified by this lecture. Thus we have to
• 35:16
  examine together the typical forms of monoideic somnambulism. We shall then expose its essentially
• 35:22
  psychological character and we shall end by trying to sum up, in a simple
• 35:27
  and general conception the character of these somnambulisms. In order to compare gradually that
• 35:31
  first's conception with those we shall draw from the study of other hysterical phenomena.
• 35:37
  One, What, then, exactly is a somnambulist? Popular observation has answered
• 35:44
  long ago it is an individual who thinks and acts while he is asleep.
• 35:47
  Without a doubt, that answer is not very clear, for we don't know
• 35:51
  very well what sleep is. That answer means only that the person spoken of
• 35:54
  thinks and acts in an odd way different from that of other people, and
• 35:59
  that at the same time that person is in some way like a person asleep.
• 36:02
  You will find nowhere a more beautiful description of this popular conception of somnambulism
• 36:07
  than in Shakespeare's tragedy Macbeth. Doctor, I have two nights watched with you,
• 36:14
  but can perceive no truth in your report? When was it she last
• 36:16
  walked, gentlewoman? Since his majesty went into the field. I have seen
• 36:22
  her rise from her bed, throw her nightgown upon her, unlock her closet,
• 36:25
  take forth paper, fold it, write upon read it afterwards seal it,
• 36:30
  and again return to bed it, all this while in a most fast
• 36:35
  sleep. Doctor, a great perturbation in nature to receive at once the benefit
• 36:40
  of sleep and do the effects of watching in this slumbery agitation, besides her
• 36:45
  walking and other actual performances. What at any time have you heard her say,
• 36:51
  gentlewoman, that's sir, which I will not report after her. Doctor.
• 36:55
  You may to me, and tis most meet you should, gentlewoman.
• 37:00
  Neither to you nor any one having no witness to confirm my speech into Lady
• 37:06
  Macbeth with a taper. Lo you here she comes. This is her very
• 37:10
  guise, and upon my life fast asleep observer, stand close, doctor.
• 37:16
  How came she by that light? Gentlewoman? Why it stood by her?
• 37:22
  She has light by her continually? Tis her command? Doctor. You see
• 37:27
  her eyes are open, gentlewoman, Aye, but their sense is shut.
• 37:30
  Doctor, What is it she does? Now? Look how she rubs her
• 37:35
  hands, gentlewoman. It is an accustomed action with her to seem thus washing
• 37:40
  her hands. I have known her continue in this a quarter of an hour,
• 37:45
  Lady Macbeth. Yet he is a spot doctor, Hark she speaks.
• 37:51
  I will set down what comes from her to satisfy my remembrance the more strongly,
• 37:55
  Lady Macbeth, out damned spot what I say? One? Two?
• 38:00
  Why? Then tis time to do it? Hell is murky fie, my
• 38:05
  lord fi a soldier and a feared What need we fear? Who knows it?
• 38:09
  When none can call our power to account? Yet? Who would have
• 38:13
  thought the old man to have had so much blood in him? Doctor?
• 38:17
  Do you mark that Lady Macbeth, the thegne of Fife had a wife?
• 38:23
  Where is she now? What will these hands ne'er be clean? No more
• 38:29
  of that, my lord, no more of that. You are all with
• 38:31
  this starting, doctor, go too, go too. You have known what
• 38:37
  you should not, gentlewoman. She has spoke what she should not. I
• 38:42
  am sure of that. Heaven knows what she has known, Lady Macbeth.
• 38:47
  Here is the smell of the blood. Still all the perfumes of Arabia will
• 38:51
  not sweeten this little hand. Oh, oh, oh, doctor, what
• 38:55
  a sigh is there? The heart is sorely charged, gentlewoman. I would
• 39:00
  not have such a heart in my bosom for the dignity of the whole body.
• 39:05
  Doctor. Well, well, well, gentlewoman, pray God it be
• 39:09
  sir doctor. This disease is beyond my practice. Yet I have known those
• 39:15
  which have walked in their sleep, who have died holily in their beds.
• 39:20
  Lady Macbeth, wash your hands, put on your night gown. Look not
• 39:23
  so pale, I tell you yet again, banquets buried. He cannot come
• 39:28
  out on scrave doctor. Even so, Lady Macbeth, to bed to bed.
• 39:36
  There's knocking at the gate. Come, come, come, come,
• 39:38
  give me your hand. What's done cannot be undone to bed, to bed,
• 39:44
  to bed, exit doctor. Will she go now to bed? Gentlewoman?
• 39:50
  Directly, doctor. Foul whisperings are abroad. Unnatural deeds do breed,
• 39:57
  unnatural troubles, infected minds to the deaf pillows will discharge their secrets. More
• 40:01
  needs she the divine than the physician. God, God forgive us all look
• 40:07
  after her, remove from her the means of all annoyance, and still keep
• 40:10
  eyes upon her. So good night, my mind, she has made it
• 40:15
  and amazed my sight. I think, but dare not speak, gentlewoman,
• 40:20
  good night, Good doctor exuned. Our modern examples are much less dramatic,
• 40:25
  but they may be compared as to their most striking features. Let me cite
• 40:30
  a certain number of cases to impress upon your minds the idea of this phenomenon,
• 40:34
  which to me is a very important one. Here is a first instance,
• 40:37
  a young woman twenty nine years old called GiB, intelligent sensitive. Here
• 40:44
  is one day, abruptly some disastrous news her niece, who lives next door
• 40:47
  has just died in dreadful circumstances. She rushes out and comes unhappily in time
• 40:52
  to see the body of the young girl lying in the street. She had
• 40:57
  thrown herself out of the window in a fit of delirium. GiB, although
• 41:00
  very much moved, remains to all appearance calm, helping to make everything ready
• 41:05
  for the funeral. She goes to the funeral in a very natural way,
• 41:08
  but from that time she grows more and more gloomy. Her health fails,
• 41:13
  and we may notice the beginning of the singular symptoms we are going to speak
• 41:15
  of. Nearly every day, at night and during the day, she enters
• 41:20
  into a strange state. She looks as if she were in a dream.
• 41:23
  She speaks softly with an absent person. She calls Pauline, the name of
• 41:28
  her lately deceased niece, and tells her that she admires her fate, her
• 41:31
  courage that her death has been a beautiful one. She rises, goes to
• 41:36
  the windows and opens them, then shuts them again, tries them one after
• 41:39
  another, climbs on the window, and if her friends did not stop her,
• 41:43
  she would, without any doubt throw herself out of the window. She
• 41:46
  must be stopped, looked after incessantly till she shakes herself, rubs her eyes,
• 41:51
  and resumes her ordinary business as if nothing had happened. The curious case
• 41:55
  I have lately observed is that of Ay, which I have related with more
• 42:00
  particulars in another of my works. That woman, a hysterical thirty five years
• 42:04
  old, was taking a walk in the zoological garden during her menstrual period,
• 42:07
  when she was frightened by a lioness that, as it was reported, seemed
• 42:12
  ready to rush upon her. When she came back to the hospital, she
• 42:15
  had a fit of delirium that lasted for eight days. After some interruption,
• 42:20
  she again had fits of the same odd delirium. In these crises, she
• 42:23
  runs on all fours, roars, rushes on people, trying to bite them.
• 42:28
  And although she was anarexic before her attack and could eat very little,
• 42:31
  now she pounces on all sorts of food, picks it up with her teeth,
• 42:36
  and devours bits of paper and small objects she finds on the floor.
• 42:39
  In a word, she acts a comedy, wherein she believes herself to be
• 42:43
  a lioness. I say that she acts a comedy, for it becomes certain
• 42:46
  that she studies her part, and that she often replaces real actors by metaphors.
• 42:52
  For instance, she looks in a drawer for photographs, generally children's portraits,
• 42:55
  and tries to eat them up without any doubt. As she is unable
• 42:59
  to devour real persons, she devours them in effigy. I won't insist on
• 43:04
  the form here borrowed by the idea rooted in her mind. It is one
• 43:07
  of those changes in personality brought about by a suggestion or an invading idea,
• 43:12
  which are already well known. At the same time, we may observe in
• 43:15
  hair when she is awake, a very complete amnesia that spreads not only upon
• 43:21
  the delirium but also upon the walk at the zoological garden. Third observation,
• 43:27
  a man of thirty two some presents a still more singular case. He usually
• 43:32
  remains in bed, for both his legs are paralyzed. We won't occupy ourselves
• 43:37
  with that paralysis to day, although it is a very odd one. In
• 43:40
  the middle of the night, he rises slowly, jumps lightly out of bed
• 43:44
  for the paralysis we have just spoken of, as quite vanished, takes his
• 43:47
  pillow and hugs it. We know by his countenance and by his words,
• 43:52
  that he mistakes this pillow for his child, and that he believes he is
• 43:54
  saving his child from the hands of his mother in law. Then, bearing
• 43:59
  the weight, he tries to slip out of the room, opens the door,
• 44:02
  and runs out through the courtyard. Climbing along the gutter. He gets
• 44:06
  to the housetop, carrying his pillow and running all about the buildings of the
• 44:09
  hospital with marvelous agility. One must take great care to catch him and use
• 44:15
  all sorts of cautions to get him down, for he wakes with a stupefied
• 44:17
  air, and as soon as he is awake, both his legs are paralyzed
• 44:22
  again, and he must be carried to his bed. He does not understand
• 44:24
  what you are speaking about, and cannot comprehend how it happens that people were
• 44:29
  obliged to go to the top of the house in order to look for a
• 44:31
  poor man who has been paralyzed in his bed for months. A fourth and
• 44:37
  last observation, for I insist upon relating to you a great number of instructive
• 44:40
  examples. We come back to the common story of a young girl twenty years
• 44:45
  old called Irene, whom despair caused by her mother's death has made ill.
• 44:50
  We must remember that this woman's death has been very moving and dramatic. The
• 44:53
  poor woman, who had reached the last stage of consumption, lived alone with
• 44:58
  her daughter in a poor garret. Death came slowly, with suffocation, blood
• 45:02
  vomiting, and all its frightful procession of symptoms. The girl struggled hopelessly against
• 45:07
  the impossible. She watched her mother during sixty nights working at her sewing machine
• 45:13
  to earn a few pennies necessary to sustain their lives. After the mother's death,
• 45:17
  she tried to revive the corpse to call the breath back again. Then
• 45:22
  as she put the limbs upright, the body fell to the floor, and
• 45:24
  it took infinite exertion to lift it again into the bed. You may picture
• 45:29
  to yourself all that frightful scene some time after the funeral. Curious and impressive
• 45:34
  symptoms began. It was one of the most splendid cases of somnambulism I ever
• 45:38
  saw. The crises last for hours, and they show a splendid dramatic performance,
• 45:44
  for no actress could rehearse those lugubrious scenes with such perfection. The young
• 45:49
  girl has the singular habit of acting again all the events that took place at
• 45:52
  her mother's death without forgetting the least detail. Sometimes she only speaks relating all
• 45:58
  that happened with great volumes, putting questions and answers in turn, or asking
• 46:02
  questions only and seeming to listen for the answer. Sometimes she only sees the
• 46:07
  sight, looking with frightened face and staring on the various scenes and acting according
• 46:12
  to what she sees. At other times, she combines all hallucinations, words,
• 46:15
  and acts and seems to play a very singular drama. When in her
• 46:21
  drama death has taken place, she carries on the same idea and makes everything
• 46:24
  ready for her own suicide. She discusses it aloud, seems to speak with
• 46:29
  her mother to receive advice from her. She fancies she will try to be
• 46:32
  run over by a locomotive. That detail is also a recollection of a real
• 46:37
  event of her life. She fancies she is on the way and stretches herself
• 46:40
  out on the floor of the room, waiting for death. With mingled dread
• 46:44
  and impatience. She poses and wears on her face expressions really worthy of admiration,
• 46:50
  which remain fixed during several minutes. The train arrives before her staring eyes.
• 46:54
  She utters a terrible shriek and falls back motionless, as if she were
• 46:58
  dead. She soon gets up and begins acting over again one of the preceding
• 47:02
  scenes. In fact, one of the characteristics of these somnambulisms is that they
• 47:07
  repeat themselves indefinitely. Not only the different attacks are always exactly alike, repeating
• 47:13
  the same movements, expressions, and words, but in the course of the
• 47:15
  same attack, when it has lasted a certain time, the same scene may
• 47:20
  be repeated again exactly in the same way, five or ten times. At
• 47:23
  last, the agitation seems to wear out, the dream grows less clear,
• 47:28
  and gradually or suddenly, according to the cases, the patient comes back to
• 47:30
  her normal consciousness takes up her ordinary business quite undisturbed by what has happened.
• 47:37
  I could tell you many more of these examples, for all the events of
• 47:40
  life may be reflected in one of these scenes. This patient acts over again
• 47:45
  a scene wherein he has been bitten by a dog that one reproduces in his
• 47:50
  dream the emotion he had when he was wounded by the falling of the lift.
• 47:53
  This little girl fancies a scene of her school life in which she was
• 47:58
  severely punished. That young girl reflects a scene of ravishment. A young boy
• 48:02
  repeats a quarrel in the street. Another man lives through a chapter he has
• 48:07
  read in a novel where thieves get through a latticed window and bind him tightly
• 48:09
  to his bed. This kind of delirium may vary over and over again in
• 48:15
  a thousand different ways. It is, however, very characteristic, and in
• 48:19
  all mental pathology you will not find another delirium that may be compared with it.
• 48:23
  It is then necessary to study carefully the psychological character of which it is
• 48:28
  made up, for the precise analysis of this simple delirium will perhaps be the
• 48:31
  starting point whence we shall proceed to explain the other more complicated states. Two
• 48:39
  innumerable studies have been written to analyze the preceding state in every particular. I
• 48:45
  shall only sum up the very clear result of those studies, and I shall
• 48:47
  do it by following that state from its starting point to the return of normal
• 48:52
  life. There is a first, very important period, but on it we
• 48:57
  cannot yet dwell. It is the moment when some ambulism begins the change from
• 49:00
  the normal to the second state. When the change is sudden, there is,
• 49:05
  as it seems, a loss of consciousness half faint. When the change
• 49:08
  is slow, one may easily observe the abasement of mental activity. The patient
• 49:14
  pays no more attention to exterior events. He understands less and less what you
• 49:17
  tell him, and he answers with difficulty. As absent minded works more slowly
• 49:22
  or interrupts his work. In short, voluntary activity and close application seem to
• 49:28
  disappear to give place to the expansion of the dream. When the dream begins,
• 49:32
  you may note a very striking and important characteristic, namely the perfection and
• 49:37
  the intensity of its development. All the phenomena in connection with the dream seem
• 49:42
  enormously increased. Undoubtedly, we all take expressions and attitudes in connection with our
• 49:47
  thought, but our expressions look shabby and incomplete in comparison with the marvels of
• 49:52
  plasticity. We may sometimes observe. In somnambulism, some of the patients,
• 49:57
  as we have already remarked, neither speak nor move, but remain fixed in
• 50:00
  an expressive attitude. That form of monoideic somnambulism is called catalepsy. We have
• 50:07
  no time to dwell on all its various forms. We will only point out
• 50:10
  the perfect expression of those living statues that have often inspired superstitious wonder. We
• 50:16
  may learn by different means what images fill his consciousness, and we may see
• 50:21
  that he has not our dull memory of things, but that he sees the
• 50:23
  object he speaks of, and really hears, feels, touches them exactly as
• 50:28
  if they were real. The unfolding of hallucinations is incomparable, and except in
• 50:32
  some crises of alcoholic delirium that are a little like hysteria, we shall never
• 50:37
  find in lunacy such abundance and such copiousness in the hallucinations of all senses.
• 50:43
  When the patient speaks, he has a fluency of elocution, and even an
• 50:45
  eloquence that seems superior to his normal powers, because he gives himself entirely up
• 50:51
  to the idea he means to express. When he acts. He has a
• 50:54
  precision and quickness in his movements that makes a wonderful actor of him. And
• 50:59
  here here again he surpasses his usual powers. The patient we just spoke of,
• 51:04
  the one who believed he was rescuing his child by carrying his pillow,
• 51:07
  ran on the housetop with more agility than he would have shown in his normal
• 51:10
  state, even if he had not been palsy stricken. One of my patients
• 51:15
  who does not know how to write, writes during her somnambulism, it is
• 51:20
  no wonder and there is no mystery about the case. In the somnambulic state,
• 51:23
  that woman remembered the writing she had learnt at school as a child,
• 51:28
  and had to all appearance forgotten thirty years ago. The development of the somnambulic
• 51:32
  delirium is not only intense, it is also perfectly regular. The patient repeats
• 51:38
  the same words at the same moments, makes the same gestures at the same
• 51:42
  place, every time he begins his performance over again. He seems to have,
• 51:46
  on that point a marvelous memory. When he has appropriated his somnambulism to
• 51:51
  a given room, he remembers all that he did at each different spot.
• 51:54
  He knows from what drawer he took the photos he pretends to eat up in
• 51:58
  what table he found a bit of wood that he used as a pistol.
• 52:01
  He goes directly to that spot, unhesitating, knowing exactly what he expects to
• 52:06
  find there. Sometimes, in the course of various somnambulisms, the patient,
• 52:10
  instead of beginning his history over again, takes up his delirium at the exact
• 52:15
  point where he last stopped, and seems to remember perfectly at what point he
• 52:19
  broke off in his last delirium. You recollect one of Charco's somnambulists who believed
• 52:23
  himself a journalist and who wrote a novel. He waked after writing two or
• 52:28
  three pages, which were taken away from him. In the next crisis,
• 52:30
  he began his novel exactly at the point where he had broken off. You
• 52:35
  see what an important part regularity and memory play in these scenes. Inversely,
• 52:39
  the patient's liberty or power of will seem to have no share in these crises,
• 52:44
  for the scene is never altered in the way the patient could wish.
• 52:47
  This negative character will become even more striking if we study somnambulism from another point
• 52:52
  of view. In contrast with the brilliant unfolding of some phenomena, we discover
• 52:58
  with amazement, strange men blanks. The same patient who looks as if he
• 53:01
  had very precise sensations, since he can walk on the house's top, look
• 53:06
  for objects in a drawer, and see very clearly the bed wherein his fancy
• 53:09
  his mother lies dying. This same patient seems unable to grasp anything else.
• 53:15
  This is what first struck popular observation. Speak to them, and they do
• 53:19
  not answer. Try by all sorts of means to make your presence felt.
• 53:22
  They do not seem to feel it. The objects you thrust before their eyes
• 53:25
  do not in the least alter their dream, and do not in the least
• 53:29
  stop it. As the doctor remarks in the case of Lady Macbeth, their
• 53:32
  eyes seem open, but they are shut to all impressions that are not connected
• 53:36
  with their dream. To make yourself heard, you must dream with the patient
• 53:40
  and speak to him only words in accordance with his delirium. As the patient
• 53:45
  perceives nothing except the idea he is possessed of, he remembers nothing except that
• 53:50
  one idea. He knows not where he is, He has quite forgotten the
• 53:53
  changes that have taken place since the time he speaks of He often does not
• 53:58
  even know his name. His memory, as well as his sensations, is
• 54:01
  shut up in a narrow circle. The somnambulism is ended, the patient comes
• 54:07
  back to consciousness. We may then notice new characteristics and see how they add
• 54:12
  themselves to the preceding ones. The patient resumes his former sensations. The memory
• 54:17
  he has lost comes back. He knows his name, knows also where he
• 54:21
  is, and remembers all the events of his life. He has to all
• 54:24
  appearance his former character and personality. But the wonderful thing is that in this
• 54:30
  new personality, somnambulism has left a gap. He appears to have forgotten all
• 54:35
  that preceding period that amazed us to such a point by its dramatic character.
• 54:39
  He is not disturbed by it. He does not endeavor to apologize for the
• 54:43
  ridiculous acts he has just accomplished. He wonders sometimes at the untidiness of the
• 54:47
  room of which he is himself the cause, and cannot understand how it came
• 54:51
  about. If you question him, try to awaken his memory by direct questions,
• 54:55
  Either of two things may happen in describing with too much accuracy of what
• 55:00
  the patient has just done in his delirium. He will either revive his memory
• 55:05
  so vividly that he will fall back again into the preceding state, be wholly
• 55:07
  taken up by that recollection, forget that you are there and act the whole
• 55:12
  scene over again, or, as more frequently happens, you will be unable
• 55:15
  to recall to his mind the lost memory. He does not understand what you
• 55:19
  mean. All the preceding scene, which in reality is so lively and persistent
• 55:23
  in his memory, since it will begin over again or will enter in the
• 55:27
  next crisis, seems at that moment quite out of his consciousness. These are
• 55:32
  the chief psychological characteristics that come out in somnambulism. During the crisis itself,
• 55:37
  two opposite characteristics manifest themselves. First, a huge unfolding of all the phenomena
• 55:44
  connected with a certain delirium. Second, an absence of every sensation and every
• 55:47
  memory that is not connected with that delirium. After the crisis, during the
• 55:52
  state that appears as normal, two other characteristics appear opposite to all appearance,
• 55:58
  the return of consciousness of sensations and normal memory and the entire forgetfulness of all
• 56:02
  that is connected with the somnambulism. Let us remember all these notions that here
• 56:07
  seem very simple, and we shall afterwards see them unfolded in every hysterical phenomenon.
• 56:15
  Three. The facts and the laws of somnambulism we have just described have
• 56:19
  been well known for a long time, and usually they're made up all that
• 56:22
  was studied about this curious state. But I believe we must notice another interesting
• 56:27
  fact in order to understand better the whole of the monoideic somnambulism. This fact
• 56:32
  is usually more or less concealed, but it becomes very apparent and conspicuous in
• 56:37
  certain cases. Let us take up the case of that young girl Irene,
• 56:40
  who acts during her somnambulism the scene of her mother's death with such apparent precision.
• 56:45
  Let us watch her during the intervals of her fits, during the period
• 56:50
  in which she seems to be normal. We shall soon notice that even at
• 56:52
  that time she is different from what she was before. Her relatives, when
• 56:57
  she was conveyed to the hospital, said to us, she has grown callous
• 57:00
  and insensible. She has soon forgotten her mother's death and does not seem to
• 57:05
  remember her illness. That remark seems amazing. It is, however, true,
• 57:09
  that this young girl is unable to tell us what brought about her illness,
• 57:13
  for the good reason that she has quite forgotten the dramatic event that happened
• 57:16
  three months ago. I know very well my mother must be dead, she
• 57:21
  says, since I have been told so several times, since I see her
• 57:24
  no more, and since I am in mourning. But I really feel astonished
• 57:28
  at it. When did she die? What did she die from? Was
• 57:32
  I not by her to take care of her? There is something I do
• 57:36
  not understand why, loving her as I did, do I not feel more
• 57:39
  sorrow for her death. I can't grieve. I feel as if her absence
• 57:45
  was nothing to me, as if she were traveling and would soon come back.
• 57:50
  The same thing happens if you put to her questions about any of the
• 57:52
  events that happened during those three months before her mother's death. If you ask
• 57:57
  her about the illness, the mishaps, the nightly staying up, up,
• 58:00
  anxieties about money, the quarrels with her drunken father, all these things have
• 58:05
  quite vanished from her mind. If we had had time to dwell upon that
• 58:08
  case, we should have seen these many curious instances, the filial love,
• 58:14
  the feeling of affection she had felt for her mother, have quite vanished.
• 58:17
  It looks as if there was a gap as well in the feelings as in
• 58:20
  the memory. But I shall insist only on one point. The loss of
• 58:23
  memory bears not only, as is generally believed, on the period of somnambulism
• 58:29
  on the scene of delirium. The loss of memory bears also on the event
• 58:32
  that has given birth to that delirium, on all the facts that are connected
• 58:36
  with it, on the feelings that are related to it. This very important
• 58:40
  remark may be extended to all the other cases I have related. Hey,
• 58:45
  who has the delirium in which she fancies herself a lioness, has not only
• 58:49
  forgotten this period of somnambulism, but also the walk in the zoological garden that
• 58:53
  first cause of her delirium. Some who carries his pillow on the house top,
• 58:59
  believe ving that he is rescuing his child from the clutches of his mother
• 59:01
  in law, does not remember his quarrels with that woman, Although those quarrels
• 59:06
  were the starting point of the actual disease. I have noted down in this
• 59:10
  connection a very singular observation in which this retrograde amnesia accompanying somnambulism is well brought
• 59:16
  into evidence. A young girl nineteen years old Lee has fits of somnambulism in
• 59:22
  which she speaks about thieves, about a fire, and calls to her help
• 59:27
  a certain Lucienne. When awakened, she knows nothing about all this, and
• 59:30
  when you speak to her of what she said, she pretends that in her
• 59:35
  life there is no event in which any part was played by thieves, by
• 59:37
  a fire, or by Lucienne. As she had come alone to the hospital,
• 59:43
  we had no other information and were compelled to believe that she had an
• 59:45
  imaginary delirium. Six months afterwards, only some relatives of hers, who had
• 59:51
  come from the country to see her, told us of an event that happened
• 59:54
  three years before and was the starting point of her nervous crises. She was
• 59:59
  a service in a country seat which one night was robbed and set on fire
• 1:00:02
  by thieves, and she was rescued by a gardener called Lucienne. It is
• 1:00:07
  astonishing that this young girl could have utterly forgotten such an important event. And
• 1:00:12
  that she was never able to speak about it when she related to the physician
• 1:00:15
  the story of her life and the beginning of the disease. It is worthy
• 1:00:19
  of note that the forgetfulness of this fact coincides with the development of that extraordinary
• 1:00:23
  memory on the same subject that filled her somnambulism. Without any doubt, the
• 1:00:30
  forgetfulness of the idea which plays the greatest part in the monoideic somnambulism, is
• 1:00:34
  not always so clear, so perfect. But I believe this forgetfulness always exists,
• 1:00:38
  more or less concealed, and the profundity of the forgetfulness is in proportion
• 1:00:43
  to the depth the serious nature of the somnambulism itself. According to my belief,
• 1:00:47
  the somnambulism is followed by an amnesia which is retrograde, and which bears
• 1:00:52
  not only on the somnambulism itself, but also on all the facts the memories
• 1:00:57
  related to it. I beg the observers who can study such cases of somnambulism
• 1:01:00
  to notice with great care these troubles of memory added to the disease. How
• 1:01:07
  can we understand, how can we picture to ourselves the whole of these facts,
• 1:01:10
  What is the essential point which can sum up the observations? I propose
• 1:01:15
  to you the following psychological interpretation, an idea, the memory of an event,
• 1:01:20
  for instance, the thought of a ferocious animal, the thought of a
• 1:01:22
  mother's death. All these form groups of psychological facts closely connected with one another.
• 1:01:28
  They are certain kinds of systems, comprising all sorts of pictures and all
• 1:01:31
  sorts of tendencies to certain movements. But with a strong unity. These systems
• 1:01:37
  in our minds have their strength and their law of development that are peculiar to
• 1:01:40
  them. They have also a great tendency to development when they are not kept
• 1:01:45
  within bounds by another power. Allow me to represent to you this system of
• 1:01:50
  psychological facts, which constitutes an idea, by a system of points connected together
• 1:01:54
  by some lines, forming a sort of polygon figure. One. The point
• 1:01:59
  AS represents the sight of the face of the dead mother. The point V
• 1:02:02
  is the sound of her voice. Another point M is the feeling of the
• 1:02:07
  movements made to carry up the body, and so on. This polygon is
• 1:02:10
  like the system of thoughts which was developed in the mind and in the brain
• 1:02:14
  of our patient Irene. Each point is connected with the others. So one
• 1:02:17
  cannot excite the first without giving birth to the second, and the entire system
• 1:02:22
  has a tendency to develop itself to the utmost. But at the same time,
• 1:02:27
  in healthy minds, these systems pertaining to each idea are connected with an
• 1:02:30
  infinitely wider system of which they are only a part, the system of our
• 1:02:34
  entire consciousness, of our entire individuality. The remembrance of the mother's death,
• 1:02:39
  even the affection hern feels for her mother, with all the memories that are
• 1:02:44
  connected with it, forms only a part of the whole consciousness of the young
• 1:02:46
  girl, with all its memories and other tendencies. Let this large circle p
• 1:02:52
  near the little polygon represent the whole personality of the girl, the memory of
• 1:02:55
  all that happened in her previous life. Normally, in good health, the
• 1:03:00
  little system must be connected with the large one, and must in great part
• 1:03:04
  depend on it. Generally, the partial system remains subject to the laws of
• 1:03:07
  the total system. It is called up only when the whole consciousness is willing
• 1:03:12
  and within the limits in which this consciousness allows it now to picture to ourselves
• 1:03:17
  what has taken place during somnambulism. We may adopt a simple provisional resume.
• 1:03:22
  Things happen as if an idea, a partial system of thoughts emancipated itself,
• 1:03:28
  became independent, and developed itself on its own account. The result is,
• 1:03:31
  on one hand that it develops far too much, and on the other hand,
• 1:03:36
  that consciousness appears no longer to control it. That general remark may still
• 1:03:40
  seem to you very vague and very difficult to understand. Nevertheless, I wished
• 1:03:45
  to point it out to you in a few words, First because it emerges
• 1:03:49
  very clearly out of the study of the first phenomenon of hysteria. Secondly,
• 1:03:53
  because it will serve us as a clue to understand a thousand other cases of
• 1:03:57
  the neurosis. Don't trouble about the obscurity of that first remark. After you
• 1:04:01
  have repeated it exactly in the same way with a regard to a thousand different
• 1:04:05
  phenomena, it will not be long before you find yourself understanding it clearly.
• 1:04:12
  End of Section two. Lecture three. Fugues and polyidaic somnambulisms, Transformations and
• 1:04:19
  exaggerations of the first somnambulisms, Several cases of fugues, The laws of fugues,
• 1:04:26
  the diagnosis of hysterical fugues, differences between fugues and monoidaic somnambulisms, the
• 1:04:31
  characters of polyidaic somnambulisms, and their relations to the simpler forms the emancipation of
• 1:04:38
  feelings and emotions. A great many hysteric accidents are directly connected with the kind
• 1:04:44
  of somnambulism we have just studied. They are only slight transformations of the same
• 1:04:48
  phenomenon. Sometimes somnambulism increases, develops in a particular direction, sometimes it diminishes,
• 1:04:55
  keeps back only a few symptoms, and it is sometimes difficult to know
• 1:04:59
  it again. But the phenomena are still of the same kind. They must
• 1:05:02
  be explained in the same manner. And if we wish to understand hysteria well,
• 1:05:06
  it is very important we should know the possible transformations of that fundamental state
• 1:05:11
  of somnambulism. To day, and in our next lecture we shall study the
• 1:05:15
  exaggerations and developments that multiply to a very high degree our first monoidaic somnambulism.
• 1:05:21
  The first fact we meet with in this direction, is one of the most
• 1:05:25
  wonderful phenomena of hysteria. The study of which has already attracted many authors.
• 1:05:30
  This fact is the hysterical mania of running away that we call ambulatory automatism,
• 1:05:34
  flights, or better fugues. If we may keep the French word one.
• 1:05:41
  We shall begin as we are wont to, by showing you a certain number
• 1:05:44
  of clinical cases, as if the patients were here before your eyes. We
• 1:05:47
  shall thus more easily acquire the knowledge of the clinical characters and of the general
• 1:05:51
  idea that is to be derived from them. Here is a splendid case of
• 1:05:56
  hysterical fugue, remarkable for its simplicity. You can find the entire description of
• 1:06:00
  it in the Gazette's de ou Piteaux, where I published it with Professor Ramont
• 1:06:04
  on the second of July eighteen ninety five. The subject is a man p
• 1:06:10
  thirty years old, employed in a railway station in a town in the east
• 1:06:13
  of France. Although an active and clever fellow, he was a little eccentric,
• 1:06:17
  and had already led a somewhat adventurous life. In his youth. He
• 1:06:21
  had had frequent fits of somnambulism, sometimes in the day, but mostly at
• 1:06:26
  night. Moreover, the tendency to somnambulisms is to be found in his family,
• 1:06:30
  since his brother was also a nocturnal somnambulist, who got out of his
• 1:06:33
  bed while asleep to work at his exercises. One day, like a patient
• 1:06:38
  we have spoken of, he carried his pillow on the house top, mistaking
• 1:06:42
  it for a little baby. If I dwell upon these previous somnambulisms similar to
• 1:06:46
  those we have already described, it is because they form a link between the
• 1:06:49
  first phenomena we have spoken of and those we shall describe to day. This
• 1:06:54
  man p was also very easily affected, predisposed to fixed ideas. One day,
• 1:07:00
  in the notary's office where he worked, he was slightly suspected, though
• 1:07:02
  not accused, of stealing a trifle. He fell ill and was very distressed
• 1:07:08
  night and day. He discussed that suspicion, and although everybody tried to prove
• 1:07:12
  to him how trifling it was, he could not remain in that office.
• 1:07:15
  Moreover, he had a tendency to exaggerated fears. He had left Lorrain after
• 1:07:20
  its annexation to Germany, and during many years he was haunted by the fear
• 1:07:25
  of the German police, whom he always believed to be running after him.
• 1:07:29
  All those details have their importance. You must not forget, thus, to
• 1:07:31
  inquire into the previous character of your patients. Such an inquiry will often enable
• 1:07:36
  you to understand very well the neuropathic diseases that come on later. However,
• 1:07:42
  that may be. The man we are talking of had also an adventurous turn
• 1:07:45
  of mind. He started with the Crovaux mission on an expedition to South Africa
• 1:07:49
  and was sent back to France on account of his health. Then he enlisted
• 1:07:53
  under the orders of De Brazza, who was starting for Gabon. There.
• 1:07:57
  We must also notice he was very much debilitated by diseases peculiar to hot climates,
• 1:08:01
  and continued long after his return to have fits of the agu. This
• 1:08:05
  also is serious enough to prepare the way for the ensuing mental weakness. On
• 1:08:11
  his return to France at the age of twenty, he got a situation in
• 1:08:14
  a railway company and was soon in easy circumstances. He married and had a
• 1:08:18
  child he dearly loved. His wife was again pregnant when the following incident took
• 1:08:24
  place. Although he led a quiet and rather happy life, he was uneasy
• 1:08:28
  in his mind and gave himself up to intellectual labors too hard for a man
• 1:08:31
  who had no great acquirements. To his work in the railway office, he
• 1:08:35
  added book keeping, and what is more, he drew up a geographical account
• 1:08:40
  of Gabon from the notes he had taken, and this work gave him much
• 1:08:43
  trouble. He was made uneasy in his mind by family quarrels. His brother,
• 1:08:47
  who was jealous of him, had just quarreled with him and had charged
• 1:08:50
  him with shameful and dishonestacts. The charge was groundless, and nobody around him
• 1:08:56
  troubled about it. But we know how easily upset, how susceptible he was
• 1:09:00
  in that quarter, and how he lost his head at the mere idea of
• 1:09:02
  a charge of that kind. It is in these conditions that we come to
• 1:09:06
  the third of February eighteen ninety five. He was alone at Nancy, his
• 1:09:12
  wife having left him for a few days. He had just ended a chapter
• 1:09:15
  of his work on Gabon, and to take a little rest he went to
• 1:09:18
  a coffee house where he was well known. During the afternoon, a part
• 1:09:23
  of which he spent with some friends. At this coffee house, in playing
• 1:09:26
  billiards, he drank a cup of coffee, two glasses of beer, and
• 1:09:29
  a small glass of Vermouth, which the coffee house keeper wished him to taste.
• 1:09:33
  He told us himself all these circumstances, which he remembers quite well.
• 1:09:38
  He also knows that one of his neighbors came to the coffee house and invited
• 1:09:41
  him to dinner as he was alone at home. He accepted the invitation,
• 1:09:45
  so everything was as it should be, and he has a very exact memory
• 1:09:48
  of all that happened. Then he left that coffee house about five ready to
• 1:09:54
  go and dine with his friend. But a few yards off while crossing the
• 1:09:57
  Stunnish Last Bridge over the railway line, just as he got to the middle
• 1:10:00
  that also he perfectly remembers, he felt a violent pain in his head,
• 1:10:04
  as if he had been struck on the posterior part of his head. I
• 1:10:09
  point out these sensations to you without being able to dwell on them, for
• 1:10:13
  they have not as yet been sufficiently accounted for, but it is necessary you
• 1:10:16
  should know they often occur in the same conditions with neuropathic patients. The blow
• 1:10:21
  in the occiput is very often characteristic of great fits of great changes of personality.
• 1:10:28
  It is just what happened in this case, for immediately after that something
• 1:10:30
  must have changed in the mental state of our patient, as he has entirely
• 1:10:34
  lost the memory of all that happened afterwards on that Sunday, the third of
• 1:10:39
  February eighteen ninety five, and on the following days, when he comes back
• 1:10:43
  to consciousness, or rather when he resumes the thread of his recollections, the
• 1:10:46
  circumstances are changed to an extravagant degree. His first recollection is the following He
• 1:10:53
  was lying in a field covered with snow, half dead, and amazed to
• 1:10:57
  find himself in that place. He got up painfully, found a road with
• 1:11:00
  a tramway line, walked along that line, and finally got not without difficulty,
• 1:11:04
  to a town quite unknown to him, near a railway station. It
• 1:11:09
  was the South station at Brussels. It was eleven o'clock in the evening,
• 1:11:13
  and the date he read in a newspaper was the twelfth of February. In
• 1:11:16
  short, he had felt a shock on the head at Narcy on the third
• 1:11:18
  of February and awoke in the neighborhood of Brussels on the twelfth. All that
• 1:11:24
  had happened in the meantime, How he accomplished that singular journey he does not
• 1:11:28
  in the least know, he telegraphed to ask for assistance. He was taken
• 1:11:32
  care of and conveyed to Paris, to the Salpetrieal, where we studied his
• 1:11:36
  case. I will not now explain to you how we revived his recollections.
• 1:11:41
  It would imply notions on hysteria that you have not yet acquired. I shall
• 1:11:45
  only tell you that we contrived to know what happened during those nine days,
• 1:11:49
  and that we may now add it to the story of his fugue on the
• 1:11:55
  Stanislas Bridge. After he had felt the blow on the head, he felt
• 1:11:58
  himself overwhelmed with fear at the thought of the charge brought against him by his
• 1:12:01
  brother, so that he went home in great anxiety. A few slight occurrences
• 1:12:06
  too long to tell, increased the feeling of guilt, and in the evening,
• 1:12:11
  which he spent in wandering about the streets without going to his neighbors for
• 1:12:14
  dinner, he constantly pondered on the way to escape those accusations, and on
• 1:12:17
  the means of running away. He returned home, where he took some money
• 1:12:21
  and went to sleep in an hotel in the suburbs. Instead of remaining quietly
• 1:12:26
  at home. He rose early and avoiding the railway, went on foot through
• 1:12:30
  the fields to Champigneure. When he had arrived there, he went to the
• 1:12:34
  railway station, where he was not known, and took a ticket for Pannie
• 1:12:38
  on the Moselle. From Pangnie, he walked to Louis, still avoiding with
• 1:12:42
  the greatest care. The persons who he fancied were running after him, and
• 1:12:46
  in fact he did avoid them very well, for his disappearance had been noticed
• 1:12:49
  and he was sought after with great anxiety. At Lanois, he took the
• 1:12:54
  train to Luxembourg, and then to our Law and to Brussels, still with
• 1:12:58
  the rooted idea of taking refugee in a foreign country under a false name,
• 1:13:00
  in order to escape pursuit. At Brussels, he first went to a good
• 1:13:05
  hotel and spent his days in seeking the means of earning a few pence.
• 1:13:09
  But he did not succeed, and his small means dwindled away. He took
• 1:13:14
  lodgings in a very shabby room, then in one of those asylums where poor
• 1:13:16
  people are lodged at night. There a good man had pity on him and
• 1:13:20
  gave him a letter of introduction to a charitable foundation. That letter played afterwards
• 1:13:26
  an important part, for he found it again in his pocket after waking up,
• 1:13:30
  and it enabled him, at the time of his recovery to retrace the
• 1:13:32
  former events and to recollect what had happened. But on the day it was
• 1:13:38
  given to him, he did not use it, so that he fell into
• 1:13:40
  the most terrible poverty. He was on the point of enlisting for the Dutch
• 1:13:44
  Indies, but happily he was not accepted. Fancy that unhappy man, in
• 1:13:48
  the midst of a crisis of somnambulism, sailing for India, exhausted with fatigue
• 1:13:54
  and want of food, he stretched himself on the snow in the fields with
• 1:13:57
  the vague idea that he was about to die. Here something very extraordinary happened,
• 1:14:02
  something very interesting. As a psychological fact. As he thought he was
• 1:14:06
  at the point of death, he could not help changing the bent of his
• 1:14:09
  thoughts, and in spite of himself, he thought that he would like to
• 1:14:13
  see his family before he died. Stretched out in the snow, he must
• 1:14:16
  notice that the thought of his family had never entered his mind during the last
• 1:14:19
  days. The appearance of this idea had an unexpected result. He immediately said
• 1:14:25
  to himself, but after all, why am I dying here far from my
• 1:14:30
  family? He got up, he was awake. You know what happened afterwards.
• 1:14:34
  I want only to point out to you that enormous change in the mental
• 1:14:38
  state brought about by an idea. The fact is so interesting that we must
• 1:14:42
  observe it a second time. In another case I have studied, it is
• 1:14:45
  also a very strange one. I will only sum up the more important facts.
• 1:14:49
  If you care to read this entertaining observation, you will find it at
• 1:14:54
  full length in the second volume of my work on Neuroses and Fixed Ideas.
• 1:14:58
  Here I shall only state the facts that are interesting for us today. The
• 1:15:02
  subject is a boy of seventeen, oru son of a neuropathic mother, rather
• 1:15:06
  nervous himself, who already had when he was ten years old, ticks and
• 1:15:11
  contractures in the neck of which we shall speak in one of our following lectures.
• 1:15:15
  At thirteen, he often went to a small public house visited by old
• 1:15:18
  sailors. They would urge him to drink, and when he was somewhat flustered,
• 1:15:23
  they would fill his imagination with beautiful tales in which deserts, palm trees,
• 1:15:28
  lions, camels and negroes were pictured in a most wonderful and alluring way.
• 1:15:32
  The young boy was very much struck by those pictures, particularly as he
• 1:15:35
  was half tipsy. However, when his drunkenness was over, the story seemed
• 1:15:41
  to be quite forgotten. He never spoke of travels, and on the contrary,
• 1:15:45
  led a very sedentary life, for he had chosen the placid occupation of
• 1:15:48
  a grocer's boy, and he only sought to rise in that honorable career.
• 1:15:54
  Now there come on quite unforeseen accidents, almost always on the occasion of some
• 1:15:58
  fatigue or a fit of drunkennes. He then felt transformed, forgot to return
• 1:16:02
  home and thought no more of his family. He would leave Paris, walking
• 1:16:06
  straight ahead, and go to a more or less great distance through the forest
• 1:16:11
  of Saint Germain, or as far as the department of the Orne. Sometimes
• 1:16:15
  he walked alone, at other times he rambled with some tramps begging along the
• 1:16:18
  roads. He had but one idea left in his head, namely to get
• 1:16:23
  to the sea, enlist in a ship and sail away towards those enchanting countries
• 1:16:27
  of Africa. His journeys ended rather badly. He would awake suddenly drenched,
• 1:16:32
  half starving, either on the high road or in an asylum, without ever
• 1:16:35
  being able to understand what had happened, without any memory of his journey,
• 1:16:40
  and with the most ardent wish to go back to his family and his grocery.
• 1:16:44
  I will well on only one of his fugues, which is particularly amusing
• 1:16:47
  and was of extraordinary duration, for it lasted three months. He had left
• 1:16:51
  Paris about the fifteenth of May and had walked to the neighborhood of Milan.
• 1:16:57
  This time he was thinking about the means of succeeding in his scheme and of
• 1:17:00
  getting safely to the Mediterranean. Until then he had failed owing to fatigue and
• 1:17:04
  misery. The question was to find means of living. As he went along,
• 1:17:10
  a bright idea had occurred to him. Not far from Milan at more,
• 1:17:15
  there are canals that go more or less straight to the south of France,
• 1:17:17
  and in those canals there are ships laden with goods. He succeeded in
• 1:17:21
  being accepted as a servant on a ship laden with coal. His work was
• 1:17:26
  terrible. Now he had to shovel the coal, now to haul the rope
• 1:17:30
  in company with the donkey Calcadis his only friend. He was badly fed,
• 1:17:33
  often beaten, exhausted with fatigue, But though you would scarcely believe it,
• 1:17:39
  he was radiant with happiness. He thought only of one thing, of the
• 1:17:43
  joy of drawing nearer to the sea. Unhappily, Inauvergne, the boat stopped
• 1:17:47
  and he was forced to leave it and continue his journey on foot, which
• 1:17:51
  was more difficult. In order not to be resourceless, he hired himself as
• 1:17:56
  a helper to an old China mender. They went slowly along, working on
• 1:18:00
  the road. Then one evening an unlooked for event took place again. The
• 1:18:05
  day's work had been a success. The two companions had earned seven francs.
• 1:18:10
  The old china mender stopped and said, to our my boy, we deserve
• 1:18:14
  a good supper, and we will keep to day's feast. It is the
• 1:18:16
  fifteenth of August. On hearing this, the boy heedlessly said, the fifteenth
• 1:18:21
  of August? Why it is the feast of the Virgin Mary, the anniversary
• 1:18:25
  of my mother's name day He had scarcely uttered these words. When he appeared
• 1:18:30
  to be quite changed. He looked all around him with astonishment, and,
• 1:18:33
  turning to his companion, said, but who are you? And What am
• 1:18:38
  I doing here with you? The poor man was amazed and was quite unable
• 1:18:43
  to make the boy understand the situation. The latter still believed himself in Paris
• 1:18:47
  and had lost all memory of the preceding months. They had to go to
• 1:18:50
  the village mayors, where, with great difficulty the matter was made more or
• 1:18:55
  less clear. The mayor telegraphed to Paris, and the prodigal child was sid
• 1:19:00
  back home. Is not that name which suddenly evoked the memory of his mother
• 1:19:03
  and awakened him? Likewise a pretty conclusion of a fugue. The same particular
• 1:19:10
  is to be found in this final observation, which I will relate in a
• 1:19:13
  few words. A young man of twenty nine, a clerk at a notary's
• 1:19:16
  office, had made a fugue of the same kind as the preceding ones,
• 1:19:20
  and, impelled by a fixed idea, had gone as far as Algeria.
• 1:19:25
  He found himself at Drrent sitting on the terrace of a coffee house, quietly
• 1:19:29
  reading his newspaper, when his eyes fell on a singular piece of news.
• 1:19:32
  The newspaper related the story of the sudden disappearance of a young notary's clerk aged
• 1:19:38
  twenty nine of such a name, and wondered what had become of him?
• 1:19:42
  Why, thought the young man, quite amazed, I am that young man,
• 1:19:45
  what can have happened? And he awoke without remembering his freak. In
• 1:19:49
  the least, you see that the three observations are very much alike. It
• 1:19:54
  was formerly thought that such cases were very rare, and that they each had
• 1:19:58
  particular characters. In reality, it is not so, and we could easily
• 1:20:01
  collect twenty very typical instances quite similar to the three we have just described,
• 1:20:06
  and in which you would easily recognize the same features. Two. Let us
• 1:20:13
  then try and find the characteristic feature of the observations. We know you have
• 1:20:17
  noticed yourselves while listening to me. How obvious the analogy is between the phenomena
• 1:20:21
  called hysterical fugues and the monoidaic somnambulisms we lately studied In a general way.
• 1:20:28
  The essential characters are the same, and we could without difficulty apply to the
• 1:20:31
  former the four laws we applied to the latter. First. During the abnormal
• 1:20:36
  state, there is a certain idea, a certain system of thoughts that develops
• 1:20:41
  to an exaggerated degree. It is evident that P, for instance, constantly
• 1:20:45
  thinks during the eight days his few glasts of the charge brought against him by
• 1:20:49
  his brother, of the consequences it may have for him, and of the
• 1:20:53
  means of eluding capture. It is obvious that the young r ponders during three
• 1:20:58
  months over the means of getting to the Mediterranean and the hope of finding a
• 1:21:00
  ship there and sailing for Africa. Such thoughts are disproportionate to the situation of
• 1:21:05
  a railway officer, the father of a family, and to that of a
• 1:21:09
  grocer's boy. They bring about certain acts. They add to the endurance of
• 1:21:13
  those people who travel on foot work and bear hardships without difficulty. The second
• 1:21:18
  law applies equally well during the abnormal state. The other thoughts relating to the
• 1:21:24
  former life, the family, the social position, the personality, appear to
• 1:21:28
  be suppressed. It is very likely that during their fugues those people assume false
• 1:21:31
  names and create for themselves fictitious personalities. You will find with regard to this
• 1:21:38
  last detail an interesting observation in the paper of mister H. Coriat of Boston,
• 1:21:42
  published in the third number of the Journal of Abnormal Psychology, nineteen o
• 1:21:45
  six, page one oh nine. The important point is that these people have
• 1:21:49
  lost the memory of their real personality. This seems strongly confirmed by the phenomenon
• 1:21:55
  of the awakening. When some chance occurrence brings back to their mind a thought
• 1:21:59
  about their family, their real name, their former self, they fall into
• 1:22:02
  another system of ideas and wake up. This proves conclusively that during the abnormal
• 1:22:08
  state, chance had not roused that category of recollections. Outside of the time
• 1:22:14
  of the fit or of the abnormal state, and during the period considered as
• 1:22:17
  normal, you already guess it is not entirely so. The two inverse laws
• 1:22:21
  apply. The recollections of the fugue have vanished, and that to an extraordinary
• 1:22:27
  extent. But at the same time, the thoughts and feelings connected with an
• 1:22:30
  idea that predominated during the fugue have disappeared, more or less completely. I
• 1:22:35
  have already pointed out to you that young R was a model grocer's boy,
• 1:22:40
  taking much interest in the sugar and coffee trade, dreaming only of the pleasure
• 1:22:43
  of going on sundays with his mother to the Saint prou Fair, and having
• 1:22:46
  none of the tastes of an adventurous sailor. He does not continually feel this
• 1:22:51
  longing for travels, and even grieves very much. When you speak to him
• 1:22:55
  about his fugues. He is afraid they may begin again, since he comes
• 1:22:59
  of himself to the hospital in order to get advice and be rid of them.
• 1:23:02
  I insist on that point. If the boy really had all the time
• 1:23:05
  a taste for travels beyond the seas, a taste which, after all,
• 1:23:10
  he might have, he would not feel troubled about his fugues. He would
• 1:23:14
  resign himself in the idea that if they were successful, they might prove profitable
• 1:23:17
  to him. But he is far from doing so, for during his normal
• 1:23:21
  life his feelings are not the same as during the period of his fugue.
• 1:23:27
  You may observe the same fact in the railway clerk p. When he is
• 1:23:30
  awake, he does not speak at all in the same way of the charge
• 1:23:33
  his brother brought against him. Not only does he realize perfectly that there is
• 1:23:36
  no truth in it, but he also feels that it is of no importance.
• 1:23:42
  He feels it is not worth while to upset his home and spoil his
• 1:23:45
  situation. There is obviously something in this that recalls the amnesia of her mother's
• 1:23:49
  death we have noticed in Iran and the disappearance of her feelings of filial love.
• 1:23:56
  Lastly, during the state considered as normal, you find the development of
• 1:24:00
  the psychological phenomena that were suppressed during the period of the crisis, recollection of
• 1:24:04
  the entire existence, perception of all present occurrences, exact notion of personality.
• 1:24:11
  In short, you see that the four characteristic laws of somnambulisms apply to such
• 1:24:15
  cases. If to this you add that these fugues present themselves in individuals who
• 1:24:19
  have already had as I told you in the case of p fits of somnambulism,
• 1:24:25
  or if you remark that such individuals are apt to present somnambulic states later
• 1:24:29
  on, as happened with rule, it seems still more justifiable to bring the
• 1:24:32
  two phenomena together and say that upon the whole fugues are kinds of hysteric somnambulisms.
• 1:24:40
  We must insist a little while upon this summary and this diagnosis. In
• 1:24:45
  my opinion, these fugues must be ranked among hysterical somnambulisms for two reasons.
• 1:24:49
  First, because they represent to us all the major characteristics already known of hysterical
• 1:24:54
  somnambulism. In the next lecture, you will learn a new characteristic of this
• 1:24:58
  somnambulism, and it may be artificially reproduced, and that in this artificially induced
• 1:25:02
  somnambulism, the memory of the first abnormal stage of the fit of natural somnambulism
• 1:25:08
  reappears entirely. This new characteristic, which we shall study a little later,
• 1:25:14
  and which I simply allude to, can be still found exactly in the fugues
• 1:25:17
  we are now examining. Long after the awakening of his last fugue, when
• 1:25:21
  he seems to have no remembrance at all of what happened, the young rue
• 1:25:26
  can be put into artificial somnambulism, and can then relate to us with amusing
• 1:25:30
  preciseness all his adventures in the ship laden with coal, and his friendship with
• 1:25:33
  the donkey cade hauling the rope with him. When all these characteristics, and
• 1:25:40
  especially the last one, are to be found in a fugue, it seems
• 1:25:43
  to me difficult to class this phenomenon apart from hysterical somnambulism without complicating and confusing
• 1:25:48
  all the psychological classifications. It is only when the phenomenon, which seems to
• 1:25:53
  use similar to a fugue presents other characteristics which must be studied that you can
• 1:25:58
  frame for it another classification. The second reason we must insist upon is that
• 1:26:02
  fugues of this kind, exactly characterized, usually appear in the life of some
• 1:26:06
  subjects who have already or who will have later on other phenomena connected with the
• 1:26:12
  accidents we know as hysterical ones. In one word, this kind of fugues
• 1:26:16
  appears usually in hysterical people. This last point has called forth a number of
• 1:26:21
  interesting debates. You must read for these discussions a paper by doctor J.
• 1:26:26
  M. Courtney of Boston in the Journal of Abnormal Psychology in August nineteen o
• 1:26:30
  six, page one, two three. This author quotes a number of fugues
• 1:26:33
  which seem to have appeared in subjects who were formally affected by epileptic fits.
• 1:26:39
  In a word, in epileptic subjects, you must discuss with great care the
• 1:26:43
  observations. You must examine whether these fugues have exactly the same character as the
• 1:26:46
  preceding ones. It is necessary two to determine exactly the diagnosis of the fits
• 1:26:53
  which preceded the fugues. The diagnosis of epilepsy, as for me, I
• 1:26:57
  cannot help saying that I often doubt these diagnos, that I am not sure
• 1:27:00
  of the diagnosis of epilepsy in all the cases adduced by doctor Courtney in his
• 1:27:04
  interesting paper. But in the end, if you find a genuine case of
• 1:27:09
  fugue with all the preceding characteristics in a subject who is, on the other
• 1:27:13
  hand, an epileptic, what do you conclude? The neuroses are not definite
• 1:27:16
  entities which exclude one another. They are only certain classifications of facts. In
• 1:27:21
  my opinion, you must only conclude that this subject, usually severely ill,
• 1:27:26
  usually falling into serious epileptic fits, has once had a less severe attack which
• 1:27:30
  is connected with hysterical rather than with epileptical phenomena. This is rather frequent and
• 1:27:36
  is not inconsistent with the important comparison we made just now of the phenomena of
• 1:27:41
  a fugue and those of hysterical somnambulism. However, we must not delude ourselves.
• 1:27:46
  We must recognize differences. First. During the abnormal state, the idea
• 1:27:51
  that develops has certainly not the same power as during monoidaic somnambulism. True,
• 1:27:57
  it directs the conduct, but it does not bring on the hallucinations and deliriums
• 1:28:00
  that it produced. In the preceding case, when Irene had the idea of
• 1:28:05
  committing suicide and of getting herself crushed by a locomotive, she had not patience
• 1:28:10
  enough to go to the railway track and compass a real suicide. She immediately
• 1:28:14
  had the hallucination of the railway track and without more ado, lay down on
• 1:28:18
  the floor of the room. Remember that difference. There is no real hallucination
• 1:28:23
  in the fugue. The development of the idea is less intense. Secondly,
• 1:28:28
  the idea is not absolutely isolated, as in somnambulism. This is the most
• 1:28:31
  characteristic fact our great somnambulists, you remember, do not see or hear anything
• 1:28:36
  but what concerns the idea rooted in their mind. And it could not be
• 1:28:41
  otherwise. For if Heren saw the beds in the room, if she heard
• 1:28:44
  my voice, she would not believe herself alone on a railway track. On
• 1:28:47
  the contrary, the patients who make fugues need a great many perceptions and recollections
• 1:28:53
  to enable them to travel without any mishaps. What is most wonderful in fugues,
• 1:28:58
  Chacrous said, is that these as individuals contrive not to be stopped by
• 1:29:01
  the police at the very beginning of their journey. In fact, they are
• 1:29:05
  mad people in full delirium. Nevertheless, they take railway tickets, they dine
• 1:29:10
  and sleep in hotels, they speak to a great number of people. We
• 1:29:14
  are it is true, sometimes told that they were thought a little odd,
• 1:29:16
  that they looked preoccupied and dreamy. But after all they are not recognized as
• 1:29:20
  mad people. Whereas Irene could not take two steps in the street when she
• 1:29:26
  was dreaming of her mother's death without being immediately taken to the asylum. So
• 1:29:30
  you see that the range of consciousness is not at all the same, that
• 1:29:33
  the mind is not distinctly reduced to a single idea. We can make the
• 1:29:38
  same remark concerning the state called normal. The oblivion of the fugue is total,
• 1:29:43
  but the oblivion of the directive idea and of the feeling connected with it
• 1:29:45
  is by far less distinct, and the restoration of the normal self is much
• 1:29:49
  more complete. In short, the difference could I believe, be explained in
• 1:29:54
  the following remark. A few glasts much longer than a monoidaeic somnambulism, while
• 1:30:00
  the latter lasts a few hours at most, the former lasts for months.
• 1:30:03
  Together. It is necessary for a fugue to be able to last so long
• 1:30:08
  that the states should approach the normal state, and that the character of somnambulism
• 1:30:12
  should be attenuated. Three. In order to understand that degradation, that transformation
• 1:30:19
  of monoidaic somnambulism into the hysterical fugue, we must study states of mind which
• 1:30:25
  are in some manner intermediate, and they will prepare us to understand the transformations
• 1:30:29
  of typical somnambulism. I mean polydaic somnambulisms, which are opposed to the first,
• 1:30:34
  as their name shows, by the multiplicity of the ideas that fill them.
• 1:30:40
  One instance will be enough to make you understand how somnambulism can pass from
• 1:30:44
  one idea to several. Here is an hysterical woman lege who has led a
• 1:30:48
  very eventful life and has had several very dramatic adventures, capable of upsetting her
• 1:30:54
  mind and filling her head with those fixed ideas that lead to somnambulisms. One
• 1:30:59
  day, at the period of her menstrual discharge, she had searched her lover's
• 1:31:02
  desk and found a letter that confirmed her suspicions, showing her that he had
• 1:31:06
  deceived her. She fell into a great passion. Her menstrual discharge was stopped,
• 1:31:12
  of course, and she had a crisis of delirium in the form of
• 1:31:15
  monoey daeic somnambulism, during which she acted the scene over again. Another day,
• 1:31:20
  as she was taking a walk with her lover, she had been surprised
• 1:31:24
  by a violent storm and frightened by a very loud thunderclap. The lover,
• 1:31:28
  it appears, had not proved courageous and had not been equal to the task
• 1:31:30
  either of reassuring her or of finding a shelter for her. She got terribly
• 1:31:35
  angry with him, had a violent crisis of somnambulism, during which she heard
• 1:31:39
  the thunderclap, fainted, and then made a scene with her lover that again
• 1:31:44
  is quite simple and conformable to the rule. Now a third story. One
• 1:31:48
  day, again at the period of her menstrual discharge, she stole a revolver,
• 1:31:53
  placed herself in ambuscade on the road side, and saw a carriage pass
• 1:31:57
  by, in which was her lover with her rival. She shot at them
• 1:32:00
  and fell back in a crisis of delirium. Other adventures happened to her,
• 1:32:04
  the result of which was the same. After all these accidents, she was
• 1:32:10
  admitted into the hospital, and nearly every day, on the slightest occasion,
• 1:32:13
  she falls into crises of delirium. These crises begin at hazard by the recital
• 1:32:17
  or by the acting as you please, of one of her adventures. She
• 1:32:21
  has a haggard look, trembles and puts her hands before her face with an
• 1:32:25
  expression of violent terror. She shuts her eyes as if before flashes of lightning,
• 1:32:30
  and acts the scene of the storm. Then, suddenly, without awakening,
• 1:32:34
  her face takes on another expression. She seems to be looking for keys,
• 1:32:39
  breaks open drawers, reads letters, utter shrieks of fury. Lastly,
• 1:32:43
  her hands grasp an imaginary revolver. She looks out at the window with an
• 1:32:46
  infuriated air, pulls the trigger and falls back in a fainting fit. These
• 1:32:51
  three scenes, and others quite like them, begin over and over again,
• 1:32:55
  indefinitely succeeding one another, but not always in the same order. They may
• 1:33:00
  last four hours together. That is again a somnambulic state. The mind is
• 1:33:04
  likewise concentrated on one idea and remains closed to external things. But the ideas
• 1:33:10
  are manifold and bring on different comedies during which the perceptions and memories are not
• 1:33:14
  the same. The unity of the somnambulism is broken. There is something foreign
• 1:33:18
  to the idea itself that has unified those three or four ideas and has gathered
• 1:33:23
  them into one crisis. The same character may be observed, though with somewhat
• 1:33:27
  greater complication, in another form of polyidaic somnambulism. I take as a starting
• 1:33:32
  point the rather simple observation of a young girl twenty years old Orrah. This
• 1:33:38
  young girl, as it appears, found a situation at a tavern keeper's.
• 1:33:42
  The man was very brutal and beat and abused her in every way. She
• 1:33:45
  got to look upon him with the borns and fell into crises of delirium,
• 1:33:48
  during which she acted over again the scenes she had lived through in the tavern.
• 1:33:53
  The principal one was a scene of rape. She shrieked and resisted the
• 1:33:57
  brutal fellow. That is a monoidaic somnambulism. But as she runs about the
• 1:34:01
  room, she finds a broom. Immediately she takes it and keeping on her
• 1:34:05
  face the same look of terror. She begins to sweep the room, without
• 1:34:09
  seeming to think in the least of the scene of the rape. Another time
• 1:34:13
  it appears she found a wheelbarrow and rolled it about the yard for hours.
• 1:34:17
  It is clear that the act of rolling the wheelbarrow is not connected with the
• 1:34:20
  thought of the rape. This is, as you see, a second form
• 1:34:24
  of polyedaic somnambulism, in which the ideas are not modified by the memory of
• 1:34:29
  previous somnambulisms, but by the impression determined by outward objects which the subject still
• 1:34:33
  perceives. I could show you as a third form somnambulisms, in which the
• 1:34:39
  change of ideas seems to take place more easily, still simply through an association
• 1:34:43
  of ideas. Read again the amusing observation about the somnambulist of mine already described
• 1:34:48
  in eighteen seventy four, that man had a very varied somnambulism, during which,
• 1:34:54
  in turn he acted scenes of military life, then played music or fancied
• 1:34:58
  himself a servant. According to the impressions he received, one idea awakened by
• 1:35:02
  an association, develops into a comedy. It awakens another, then a third,
• 1:35:06
  and so on indefinitely. Somnambulisms are thus very complicated, sometimes and apparently
• 1:35:13
  filled with a great many different ideas. But we must then ask ourselves what
• 1:35:16
  makes the unity of these somnambulisms. Can we still apply here the general conception
• 1:35:21
  which was simple in the cases of monoidaic somnambulism. We summed up those states
• 1:35:27
  in a few words. There is a simple idea, a system of images
• 1:35:30
  which are separated from the totality of consciousness and has an independent development. It
• 1:35:35
  brings about two things, a blank in the general consciousness, which is represented
• 1:35:40
  by an amnesia, and an exaggerated and independent development of the emancipated idea.
• 1:35:46
  Now we find nothing of the kind here. We do not find one distinct
• 1:35:49
  idea, one precise system that has emancipated itself from consciousness. A great many
• 1:35:55
  different ideas seem to characterize the Somnambulisming for my part that the difficulty lies on
• 1:36:00
  the surface and that at the bottom the phenomena remain the same. The psychological
• 1:36:05
  systems that exist in our consciousness are very numerous, and they do not all
• 1:36:10
  present themselves in the same form. No doubt, one of the simplest systems
• 1:36:15
  is the idea relative to an event. The idea of one's mother's death is
• 1:36:18
  a well defined system, which can be suppressed clearly or can developed separately.
• 1:36:24
  But there are other vaguer systems, a great number of which we shall have
• 1:36:27
  to study. I only point out to you for the present the system of
• 1:36:30
  thoughts and of tendencies that is called a feeling or an emotion. It is
• 1:36:34
  not so clear as an idea, but nevertheless it exists with some unity.
• 1:36:40
  The feeling that arises from the fear of an ignominious charge, the feeling of
• 1:36:44
  curiosity for distant countries, the feeling of love and jealousy towards a lover,
• 1:36:48
  the feeling of bondage to a hated master. These are systems of thoughts that
• 1:36:53
  it is not always easy to express in words, that are not ideas properly
• 1:36:57
  so called, that may, on the contrary, enclose very many different ideas,
• 1:37:00
  but that nevertheless possess a mental unity well in polydaic somnambulisms and in fugues.
• 1:37:08
  It is upon this more serious feeling that the dissociation has borne. It
• 1:37:13
  is a feeling in its entirety, a more or less precise feeling that has
• 1:37:15
  separated from general consciousness and that develops in an independent way, giving birth to
• 1:37:20
  these odd deliriums. A certain complexity differentiates these phenomena from somnambulism, but we
• 1:37:27
  apply to them the same general law and the same interpretation. End of Section
• 1:37:33
  three. Lecture four Double personalities. The interest of the study of these rare
• 1:37:40
  cases. First type of double existence the lady of magniche the reciprocal somnambulisms,
• 1:37:46
  a graphic method for the representation of amnesias. Second type of double existence Felida
• 1:37:53
  X, the dominating somnambulisms, the group of complex cases, a case of
• 1:37:58
  artificial double existence, the true denomination of the different states, the oscillations of
• 1:38:02
  mental level and the dissociation of a state of mental activity. The somnambulisms,
• 1:38:09
  which we consider as the essential phenomenon of hysteria, are apt to present a
• 1:38:13
  new metamorphosis whose scientific interest is very great when they are so protracted and complicated
• 1:38:18
  as to give rise to what is called double existences. Double personalities. I
• 1:38:24
  said scientific interest rather than clinical and practical interest, because this phenomenon is,
• 1:38:29
  upon the whole rather rare, and it is unlikely you will have to occupy
• 1:38:32
  yourselves with it in practice. A celebrated neurologist of New York, Mdana,
• 1:38:39
  published in eighteen ninety four in the Psychological Review, page five hundred seventy a
• 1:38:44
  comprehensive study on the most definitive cases which have been observed, and he counted
• 1:38:47
  only sixteen in the last number of his Journal of Abnormal Psychology, page one
• 1:38:54
  hundred eighty six. Doctor Morton Prince gave a fine table of twenty cases,
• 1:38:58
  of which he explained the most interesting features. Let us suppose there are to
• 1:39:01
  day twenty five or thirty. It is certainly the total sum of the well
• 1:39:05
  known cases. Such cases are not often met with in usual practice. However,
• 1:39:11
  the importance of this fact is very great. Its very exaggeration allows us
• 1:39:15
  better to interpret the preceding states, and contributes very efficaciously to instruct us on
• 1:39:20
  the theory of hysteria. Moreover, the question presents for you, as it
• 1:39:25
  were a national interest for some reason why I don't know. It is in
• 1:39:29
  America that the greatest number of remarkable cases have appeared, and it is American
• 1:39:33
  doctors among them Macnish, Wood Weir, Mitchell, Dana and quite recently one
• 1:39:39
  of the greatest physicians of this town, doctor Morton Prince, who have devoted
• 1:39:43
  to it the most remarkable studies. We cannot in an elementary lesson discuss the
• 1:39:48
  different forms of this phenomenon and the various theories which have been presented. I
• 1:39:53
  refer you for this subject to the recent book of doctor Morton Prince, Dissociation
• 1:39:58
  of a Personality ninety zero six, and to that of M. M.
• 1:40:01
  B. Sidis and good Heart Multiple Personality nineteen o five. You will find
• 1:40:06
  in these works all kinds of psychological discussions in which I should not like to
• 1:40:11
  venture. So I shall confine myself to making three typical forms known to you,
• 1:40:15
  and to showing you, in a few words, in what manner these
• 1:40:17
  new states, which presents so many interesting features, are connected with the preceding
• 1:40:23
  somnambulisms. One the type of double existences, is given us by a celebrated
• 1:40:30
  case more legendary than historical, published in eighteen thirty one in a work of
• 1:40:34
  doctor Macnish entitled Philosophy of Sleep, whose observation it appears, dates still farther
• 1:40:41
  back. Since it is a question of a fact observed by Mitchell and Eliot
• 1:40:45
  in eighteen sixteen. It shows you that this observation is very old and very
• 1:40:49
  vaguely known. This is perhaps the reason why the fact is presented to us
• 1:40:54
  with a simplicity which astonishes us, and which we no longer find in our
• 1:40:58
  observations of to day. By much repetition, the fact must have become a
• 1:41:01
  great deal simplified, however it may be. The following is the abridged history
• 1:41:05
  of her, who is called the Lady of Macnish, A well informed,
• 1:41:11
  well bred, young lady of a good constitution, was suddenly seized without previous
• 1:41:15
  warning, with a profound sleep which lasted several hours longer than usual. On
• 1:41:19
  awaking, she had forgotten all she knew. Her memory was like a tabula
• 1:41:24
  raza, and had preserved no notion, either of words or of things.
• 1:41:28
  It was necessary to teach her everything anew. Thus she was obliged to learn
• 1:41:32
  again, reading, writing, ciphering. Little by little she became familiarized with
• 1:41:38
  the persons and things surrounding her, which were for her as if she saw
• 1:41:41
  them for the first time. Her progress was rapid. After a rather long
• 1:41:45
  time, she was, without any known cause, seized with a sleep similar
• 1:41:50
  to that which had preceded her new life. On awaking, she found herself
• 1:41:55
  exactly in the same state in which she was before her first sleep, but
• 1:41:59
  she had no remember of anything that had passed during the interval. In a
• 1:42:02
  word, in the old state, she was ignorant of the new state.
• 1:42:06
  It was thus that she called her two lives, which were continued separately and
• 1:42:10
  alternatively through remembrance during more than four years. This young lady presented these phenomena
• 1:42:15
  almost periodically in one state or in the other. She did not remember her
• 1:42:20
  double character any more than two distinct persons remember their respective natures. For instance,
• 1:42:26
  in the periods of her old state, she possessed all the knowledge she
• 1:42:29
  acquired in her childhood and youth. In her new state, she knew only
• 1:42:32
  what she had learned during her first sleep. If a person was presented to
• 1:42:36
  her in one of these states, she did not know this person in the
• 1:42:41
  other state, but was obliged to study and know him in both to have
• 1:42:45
  a thorough notion of him. And it was the same with everything. In
• 1:42:48
  her old state, she had a very fine handwriting, the one she had
• 1:42:51
  always had, while in her new state her handwriting was bad, awkward,
• 1:42:56
  as it were childish, because she had neither the time nor the means means
• 1:43:00
  to perfect it. As has been said above, this succession of phenomena lasted
• 1:43:04
  four years, and Missus X was accustomed to it, and had succeeded easily
• 1:43:09
  in maintaining an intercourse with her family. In connection with this case, I
• 1:43:13
  would like to avail myself of the opportunity to lay before you a graphic method
• 1:43:16
  which I once invented, and of which I make great use in my lectures
• 1:43:20
  before the French students. This schema, I believe, enables us to represent
• 1:43:25
  to ourselves the various disturbances of memory in a very simple manner, and makes
• 1:43:30
  their different varieties clearly perceptible to the eye. No doubt, you are already
• 1:43:33
  accustomed, in your courses of medicine to the little schemata which are made use
• 1:43:38
  of to represent the various lesions of the organs, and especially to represent the
• 1:43:42
  disturbances of sensibility. There existed no schemata of this kind for the disturbances of
• 1:43:47
  memory, For we have to deal with the considerable difficulty of representation. There
• 1:43:53
  are, indeed, in a remembrance or in an oblivion, two different things
• 1:43:57
  which must be represented simultaneously, we must first consider the time when the remembrance
• 1:44:01
  exists. For instance, it is today that I remember the studies on double
• 1:44:05
  consciousness. This is the date of the appearance of the remembrance. We must
• 1:44:10
  also consider in a remembrance the past period to which it refers. I remember
• 1:44:15
  today in nineteen o six, that I already came in Boston in nineteen o
• 1:44:18
  four. It is the period to which the remembrance refers. To represent these
• 1:44:23
  two things simultaneously, I propose to you the following schema, which is described
• 1:44:27
  in my book on Nevose de FIG's eighteen ninety eight, Volume one, page
• 1:44:30
  one hundred twenty four. The horizontal line O X in all these figures two
• 1:44:36
  three, four, five from the left to the right designates the different periods
• 1:44:41
  of the course of life in their order of appearance. It is on this
• 1:44:44
  line that we inscribe the remembrances at the moment of their appearance. The vertical
• 1:44:48
  line O Y from the bottom to the top represents the same periods, but
• 1:44:54
  as remembrance. As representation. At each point of the horizontal line, we
• 1:44:58
  draw a perpendicular parallel to the the vertical line, which represents the remembrances.
• 1:45:02
  Its height represents the number of remembrances one possesses at such or such a moment,
• 1:45:08
  as this height naturally increases as life passes away, and one can theoretically
• 1:45:12
  call up more remembrances. Normal memory will be represented by this triangle, whose
• 1:45:16
  base is the horizontal line ox, and which is formed by the diagonal drawn
• 1:45:20
  from the point O. If you have to represent Oblivion's amnesias, you will
• 1:45:26
  mark a black spot above the point, representing the date at which this accident
• 1:45:30
  took place, and the height of this black spot will be determined by the
• 1:45:33
  parallel line which meets on the vertical the forgotten remembrance. This figure, not
• 1:45:38
  very complicated upon the whole, allows us to represent the different amnesias in a
• 1:45:43
  very clear and striking manner. As examples, and in order to accustom your
• 1:45:47
  eyes to these schemata, which are very useful in clinical studies, I put
• 1:45:51
  before you various figures representing the more usual forms of amnesia which you will meet
• 1:45:57
  with in your practice. You have already studied within your masters of neurology and
• 1:46:00
  psychiatry the retrograde amnesia fig. Two, which, beginning after some physical or
• 1:46:05
  moral shock takes away all the memories of the preceding time, you know two,
• 1:46:10
  the continuous amnesia Fig. Three, wiping out the remembrances of events as
• 1:46:15
  life goes on continuously. You see that the general aspect of the schema is
• 1:46:18
  quite different, and that it puts into evidence the differences between the two diseases
• 1:46:24
  of the memory. We can now apply this method of representation to the double
• 1:46:29
  existence as we were studying. In Fig. Four, I have drawn a
• 1:46:32
  figure representing the case of the Lady of Macniche, and you see that it
• 1:46:36
  is very characteristic. It is a kind of draft board in which black and
• 1:46:41
  white squares alternate very exactly. You will remark, in fact, that in
• 1:46:45
  this singular history the oblivions and remembrances alternate in the same way, very regularly.
• 1:46:50
  In the state called state number one, the Lady of Macniche does not
• 1:46:55
  remember the state number two at all. In the state number two, she
• 1:46:58
  does not remember the state number one at all. When she comes back to
• 1:47:01
  the state number one, she remembers only this state and nothing more. It
• 1:47:05
  is the same when she comes back to the state number two. There is
• 1:47:10
  in the disease a perfect alternation which the Schemer illustrates very well by its draft
• 1:47:14
  board, and which is quite peculiar to this type of patience. I have
• 1:47:17
  proposed to call this form of somnambulisms reciprocal somnambulisms. Double existences of such a
• 1:47:25
  simple form are very rare. It very seldom occurs that the subject, in
• 1:47:29
  his abnormal existence has entirely forgotten his normal existence, and that in the latter
• 1:47:33
  he has likewise entirely forgotten the other period. This absolute division of life into
• 1:47:39
  two alternating periods which do not know each other at all, is quite exceptional.
• 1:47:43
  We can connect only a small number of cases with the type of the
• 1:47:45
  Lady of Macniche. The case of Dana is perhaps of this kind, but
• 1:47:50
  at all events the disease lasted a much shorter time. Two cases of Charcot,
• 1:47:56
  that of Marguerite d and that of Abillon, which you will find published
• 1:48:00
  in the last true volumes of his works, and which have been reported by
• 1:48:02
  Monsieur Guignant, approached this form. But certainly the finest modern case analogous to
• 1:48:09
  that of mac Niche appears to me to be the History of Mary Reynolds,
• 1:48:13
  published by doctor Weir Mitchell in eighteen eighty eight. Mary Reynolds was an intelligent,
• 1:48:17
  calm child, rather reserved and melancholy, but of apparent good health.
• 1:48:23
  The nervous disturbances began towards the age of eighteen with a rather protracted syncope,
• 1:48:28
  after which she remained for five or six weeks blind and deaf. The sense
• 1:48:31
  of hearing returned all at once. The sense of sight returned gradually and completely.
• 1:48:38
  We need not dwell now on these censorial disturbances, which we shall study
• 1:48:42
  later on. After a second syncope, which lasted from eighteen to twenty hours,
• 1:48:46
  she awoke, apparently with all her senses, but she had forgotten all
• 1:48:49
  her former life and all the knowledge previously acquired. Nothing was left her but
• 1:48:55
  the power of instinctively pronouncing like a child, a few words without understanding them.
• 1:49:00
  She was obliged to learn everything anew, but it must be acknowledged that
• 1:49:03
  her education was rapid, since after a few weeks she could again speak,
• 1:49:08
  read, and write. It was noticed that she learned again to write in
• 1:49:12
  an odd manner. She handled her pen awkwardly and began to copy from the
• 1:49:15
  right to the left, after the manner of the Orientals. She always kept
• 1:49:19
  in this second existence and inverted handwriting, very different from her ordinary handwriting.
• 1:49:25
  In this second existence, her character was quite transformed. She had become lively,
• 1:49:30
  cheerful, and was no longer afraid of anything, wandered about the woods,
• 1:49:33
  played with dangerous animals. She dealt shrewdly with and mocked at the persons
• 1:49:38
  who wanted to direct her, and in reality no longer obeyed anybody. After
• 1:49:42
  about ten weeks, she again had one of those strange sleeps and awoke of
• 1:49:45
  herself in the first state. She no longer had any remembrance of the period
• 1:49:50
  which had just elapsed, but she recovered her previous knowledge and character. She
• 1:49:55
  was slower and more melancholy than ever. After some time the same this accident
• 1:50:00
  caused her to return to the state which appeared to be the second These transitions
• 1:50:04
  often took place in the night, during her natural sleep, sometimes in the
• 1:50:08
  daytime, and they were often painful. The subject was, as it were,
• 1:50:12
  frightened by a kind of feeling of death, as if I were never
• 1:50:15
  to return into this world. When the second existence reappeared, Mary Reynolds was
• 1:50:19
  again exactly in the state in which she had been at the end of the
• 1:50:23
  corresponding period with the same acquired knowledge and the same remembrances. But she again
• 1:50:28
  forgot everything. When she returned to the state number one, about the age
• 1:50:32
  of thirty five or thirty six, the state called number two became definitively predominant.
• 1:50:38
  It was reproduced more often, lasted longer, and at length became in
• 1:50:41
  a manner definitive. Since she remained twenty five years in this state, the
• 1:50:45
  author remarks that at the end of her life there seemed to be a kind
• 1:50:48
  of confusion between the two states. At least the state number two, which
• 1:50:53
  had become preponderant, expanded and seemed vaguely to acquire remembrances belonging to the state
• 1:50:58
  number one. It seemed to her that she had, as it were,
• 1:51:01
  an obscure, dreamlike idea of a shadowy past which she could not quite grasp.
• 1:51:08
  You see that, in general, the observation of Mary Reynolds is the
• 1:51:10
  one which most approaches that of the Lady of mac Niche, and which best
• 1:51:14
  presents the two existences quite independent of each other. However, even in this
• 1:51:18
  case, you remark, at the end of life, a tendency of the
• 1:51:21
  state number two to encroach upon State number one this will be found to be
• 1:51:26
  the essential characteristic of another form of double existence, much more common than the
• 1:51:30
  first two. I have given to this new form the name of dominating somnambulism,
• 1:51:36
  because one of its essential features is that one of the states dominates the
• 1:51:40
  other. In this state, the subject is more active, more lively,
• 1:51:44
  more intelligent than in the other. And what is particularly important, the memory
• 1:51:47
  during this state is much more extended than in the other. If America can
• 1:51:53
  boast of having presented in the person of the Lady of mac Niche and in
• 1:51:56
  that of Mary Reynolds, the finest examples of the first form, the history
• 1:52:00
  of Felida X gives now to France an unquestionable superiority. Allow me to make
• 1:52:04
  you acquainted with Felida. She is a very remarkable personage who has played a
• 1:52:10
  rather important part in the history of ideas. Do not forget that this humble
• 1:52:14
  person was the educator of Taine and Ribaut. Her history was the great argument
• 1:52:18
  of which the positivist psychologists made use at the time of the heroic struggles against
• 1:52:23
  the spiritualistic dogmatism of Cusin's school. But for Felida, it is not certain
• 1:52:29
  that there would be a professorship of psychology at the College de France, and
• 1:52:32
  that I should be here speaking to you of the mental state of hystericals.
• 1:52:38
  It is a physician of Bordeaux who has attached his name to the history of
• 1:52:41
  Felida. Azan reported this astonishing history, first at the Society of Surgery,
• 1:52:46
  then at the Academy of Medicine. In January eighteen sixty he entitled his communication
• 1:52:51
  note on nervous sleep or Hypnotism, and spoke of this case in connection with
• 1:52:56
  the discussion of the existence of an abnormal sleep during which it would be possible
• 1:53:00
  to operate without pain. And this communication, thus incidentally made was to revolutionize
• 1:53:05
  psychology. In fifty years. Subsequent to that time, Azean understood better the
• 1:53:11
  interest and success of his observation. He published various memoirs and even books on
• 1:53:15
  this subject in eighteen sixty six, eighteen seventy six, eighteen seventy seven,
• 1:53:19
  eighteen eighty three, eighteen ninety as I told you first ten in his book
• 1:53:25
  on Intelligence. Then Ribaut, in his Diseases of Memory, took possession of
• 1:53:29
  this history, which has gone round the world, and today there is a
• 1:53:31
  whole library written about this poor woman. When Azan first knew Feir Leader in
• 1:53:36
  eighteen fifty eight, she was already fifteen years old and had already been ill
• 1:53:40
  for three years since the appearance of puberty. This frequently occurs in hysteria.
• 1:53:45
  As you will see later on, She had all kinds of hysteric accidents,
• 1:53:48
  attacks of motor agitation, disturbances of alimentation which we need not examine now,
• 1:53:55
  All kinds of sufferings had changed her character for the worse. She was a
• 1:53:58
  reserved, melancholy and timid person. She had a great number of disturbances of
• 1:54:02
  sensibility, consisting both of pains and diffuse insensibilities. Among all these miseries,
• 1:54:10
  there appeared from time to time, rather infrequently. At the beginning another very
• 1:54:14
  strange phenomenon. She seemed to faint away for a very few minutes. It
• 1:54:17
  is the transition we have already remarked in most somnambulisms. Then she would wake
• 1:54:23
  up, suddenly, become gay and active, and bustle about without any anxiety
• 1:54:27
  or pain. She no longer had those painful sensations or those insensibilities which troubled
• 1:54:31
  her before, and she was in much better health than in the preceding period.
• 1:54:36
  But let us immediately remark that in this apparently new state she by no
• 1:54:40
  means presented the characteristic disturbance of the lady of Magniche and of Mary Reynolds.
• 1:54:45
  She had nothing to learn again, because she had forgotten nothing. She preserved
• 1:54:48
  a very clear remembrance of all her former life, of all the sufferings she
• 1:54:53
  had undergone, and of all she had learned before. So everything went quite
• 1:54:57
  well. But this state of comfort lasted but a sh short time. After
• 1:55:00
  one to three hours, she had anu syncope and then awoke in the preceding
• 1:55:04
  state considered as normal, which we may call, according to Azan's convention,
• 1:55:10
  the prime state. On returning to this state, she resumed again all her
• 1:55:14
  infirmities and the slow, melancholy character which was her usual one. But there
• 1:55:19
  was now one phenomenon more. She had quite forgotten the few preceding hours filled
• 1:55:24
  by the state number two, or the lively state. All this period was
• 1:55:29
  for her as if it did not exist. This caused no great inconvenience at
• 1:55:32
  that time, since the state called number two occurred only from time to time
• 1:55:36
  and lasted an hour or two. But little by little this state developed singularly.
• 1:55:43
  It lasted for hours and days, and as the subject was now much
• 1:55:45
  more active, it was filled with all kinds of serious incidents. You will
• 1:55:50
  read in Azan the strange narrative of that consultation about the first pregnancy of Felida.
• 1:55:56
  The poor girl, during her period of excitation and gaiety, had give
• 1:56:00
  even herself up to a young man who was to be her husband. The
• 1:56:02
  awakening occurred shortly afterwards and did not leave her the least remembrance of this incident.
• 1:56:08
  As her health was impaired and her abdomen grew bigger, she naively went
• 1:56:12
  to consult Monsieur Arzan about the strange disturbances in her health. The pregnancy was
• 1:56:17
  evident, says Aarzent, but I dared not make it known to her.
• 1:56:20
  Some time after the state number two returned, and Phelida, addressing herself to
• 1:56:25
  the physician, laughingly apologized for her preceding consultation, for she now knew very
• 1:56:30
  well what was the matter. During the greater part of her life, these
• 1:56:34
  two periods alternated, and it was only in her old age that one of
• 1:56:38
  the two periods, the second, that is to say, the better one,
• 1:56:42
  during which the subject was more active and had a total memory encroached upon
• 1:56:45
  the first and filled almost the whole of her life. Henceforth, Phelida seldom
• 1:56:49
  remained three or four days in her former state called normal. But then her
• 1:56:54
  life was intolerable, for she had forgotten three quarters of her existence, and
• 1:56:58
  this gave rise to the most comical situations. She feared to pass for mad,
• 1:57:03
  and in her anguish hid herself till a new Syncopedius stored her to her
• 1:57:06
  better state, which was now her habitual one. Such are the chief features
• 1:57:12
  of this history, which has become celebrated. You may easily see wherein it
• 1:57:16
  differs from the preceding observations. The schematic figure Fig. Five, which you
• 1:57:21
  can now understand, gives you quite a characteristic image. It is no longer
• 1:57:26
  a draft board on which the periods of oblivion regularly alternate with the periods of
• 1:57:30
  remembrance. You see regularly entire light colored stripes which are broader and broader as
• 1:57:35
  life advances, in which there is no black spot. They are the periods
• 1:57:40
  of the state number two, during which the memory extends over the whole of
• 1:57:44
  life without any amnesia. On the contrary, in the intercaillery stripes representing the
• 1:57:48
  state number one. You see the series of black spots representing more and more
• 1:57:53
  extended amnesias affecting the periods of life which were filled by the state number two.
• 1:57:58
  This figure clearly shows you that the two somnambulisms are not equal, that
• 1:58:01
  one is superior to the other, especially as regards the memory. This is
• 1:58:05
  what justifies the name of dominating somnambulisms, which I have given to these cases.
• 1:58:12
  If the cases of the first kind, grouped around the lady of Magniche
• 1:58:15
  are rare, this is not true of those of the second group, which
• 1:58:18
  have Felida for type. The case of Ladame, that of Verieste eighteen eighty
• 1:58:24
  eight, of Bonameisson eighteen ninety, of Dufe eighteen ninety three, and many
• 1:58:29
  others could be described from the same model. It is of no use to
• 1:58:32
  dwell upon this. These cases do not present any really new psychological phenomena.
• 1:58:39
  But it would be well to form a third group, which might be called
• 1:58:42
  the group of complex cases, in which some celebrated observations ought to be placed.
• 1:58:47
  I allude to the complicated cases of patients who have not two forms of
• 1:58:50
  existence, but a very great number of forms of existence, as many as
• 1:58:55
  nine or ten. These different psychological states offer very various relations with one another.
• 1:59:00
  Sometimes they are quite independent of one another and present a simply reciprocal memory.
• 1:59:05
  The subject only finds again the remembrances of the state number one when he
• 1:59:09
  comes back to the state number one, but he by no means remembers this
• 1:59:13
  state when he is in the state number two or in the state number four.
• 1:59:16
  But such patients have besides and at the same time other states. Obeying
• 1:59:20
  another rule. For instance, they are apt to enter into a particular state,
• 1:59:25
  which we shall call number three, in which they not only remember the
• 1:59:28
  other periods of the state number three, but also remember the periods of the
• 1:59:31
  state number one and of the state number two. In a word, they
• 1:59:35
  have reciprocal somnambulisms and dominating somnambulisms. One of the most remarkable cases published in
• 1:59:42
  France is that of Louis Vives, studied from eighteen eighty two to eighteen eighty
• 1:59:45
  nine by many authors by le Gran, Dussaur, Mooisin, Mabille and Robadier,
• 1:59:51
  Bouru and Bureau. This boy has six different existences. Each of them
• 1:59:58
  is characterized first by more modifications of the memory affecting now one period, now
• 2:00:01
  another. Secondly, by modifications of character. In one state he is gentle
• 2:00:08
  and industrious, in another, he is lazy and irascible. Thirdly, by
• 2:00:12
  modifications of sensibility and of motion. In one state, he is insensible and
• 2:00:16
  paralyzed in his left side, In another, he is paralyzed in his right
• 2:00:20
  side. In a third he is paraplegic, et cetera. An English author,
• 2:00:25
  mister Arthur Myers, the brother of the well known psychologist, in an
• 2:00:29
  article in the Journal of Mental Science January eighteen eighty six, tried to group
• 2:00:32
  in a table these four modifications characterizing each state. The most curious fact of
• 2:00:39
  this state is that one can, by acting on this third character, bring
• 2:00:43
  about the corresponding modifications of the other two. If one cures the paralysis of
• 2:00:47
  his two legs, one causes him to enter into the state in which he
• 2:00:50
  has all his sensations and movements, and then one sees the character and the
• 2:00:55
  state of memory corresponding to this period reappear. But these facts so especially interesting
• 2:01:00
  from the point of view of the artificial reproduction of somnambulisms and even of second
• 2:01:03
  existences. We need not dwell on them. Today. After having reported this
• 2:01:10
  French case, let us consider some very remarkable American observations. One of the
• 2:01:15
  most astonishing observations, whose scientific value, unfortunately I can hardly appreciate, is
• 2:01:19
  that which was published in eighteen ninety four under the rather strange title of Molly
• 2:01:25
  Fancher The Brooklyn Enigma. An authentic statement of facts in the life of Mary
• 2:01:30
  J. Fancher, The psychological marvel of the nineteenth century. Unimpeachable testimony by
• 2:01:34
  many witnesses, by Abraham H. Daily, eighteen ninety four. The history
• 2:01:40
  is strangely related. You feel in it a kind of mystic admiration for the
• 2:01:44
  subject, an exaggerated seeking after surprising and supernormal phenomena, which of course inspires
• 2:01:49
  you with some fear as to the way in which the observation has been conducted.
• 2:01:54
  It nevertheless contains many very remarkable and interesting facts. Molly Fancher, who
• 2:02:00
  seems to have had all possible hysterical accidents, attacks, terrible contractures lasting for
• 2:02:03
  long years, more or less complete blindness, etc. Above all, presented
• 2:02:09
  all the forms of somnambulism, from the simplest to the most complicated ones.
• 2:02:13
  There are in her at least five persons who have very poetical pet names Sunbeam,
• 2:02:17
  Idol, Rosebud, Pearl Ruby, each one with her remembrances and her
• 2:02:23
  character. The complication of this case is very amusing. Lastly, we have
• 2:02:28
  to point out the last and most remarkable of the observations of this kind,
• 2:02:31
  the observation of Miss Beauchamp by doctor Morton Prince, one of the physicians of
• 2:02:36
  Boston, who have most interested themselves in the development of pathological psychology, and
• 2:02:41
  who devoted years of work to the observation of this complicated and interesting case.
• 2:02:46
  We cannot here enter into analysis of these complex cases, which moreover are but
• 2:02:50
  various combinations and forms of the two simple forms we have studied. In these
• 2:02:56
  complex cases, a new influence usually makes itself felt, which complicates men as
• 2:03:00
  a great deal. I mean the influence of the observer himself, who in
• 2:03:03
  the end knows his subject too well and is too well known to him.
• 2:03:08
  Whatever precautions one may take, the ideas of the observer in the end influence
• 2:03:13
  the development of the somnambulisms of the subject and give it an artificial complication.
• 2:03:17
  However it may be. I must add the study of these complex cases to
• 2:03:21
  the two simple forms I have pointed out, in order to make you understand
• 2:03:26
  all the developments which may be taken by this strange phenomenon of multiplex personality in
• 2:03:30
  hystericals. Three, we cannot enter into the psychological study of all the problems
• 2:03:36
  raised by the double existences of hystericals. Besides, I have pointed out to
• 2:03:42
  you some works published in this very city in which you would find these discussions
• 2:03:45
  very well conducted. I only wish, before concluding this lecture, to give
• 2:03:49
  you a few indications as to the direction which, in my opinion, these
• 2:03:53
  studies should take, and as to a general conception of these apparently mysterious phenomena.
• 2:04:00
  Take up one more observation of a double personality which differs from the preceding
• 2:04:02
  ones only by a singular, slight detail, namely that it was for a
• 2:04:06
  great part produced artificially long ago. In eighteen eighty seven, a young woman
• 2:04:12
  of twenty whose name was Marsline, entered the hospital in a lamentable state for
• 2:04:17
  several months past. She had not taken any food, first because she obstinately
• 2:04:21
  refused to eat, then because she immediately vomited any food or drink one forced
• 2:04:26
  her to swallow. Besides, she no longer had any function of evacuation.
• 2:04:30
  She was incapable of urinating spontaneously, and sounding alone could cause her to discharge
• 2:04:35
  a few drops of urine. In these conditions, this young woman, who
• 2:04:40
  had reached the last stage of emaciation, seemed to have but a breath of
• 2:04:44
  life left. She remained constantly lying in her bed, being incapable of standing.
• 2:04:48
  Her mental activity was as much reduced as her physical activity. She was
• 2:04:53
  completely insensible on the whole surface of her skin and on all her mucous membranes.
• 2:04:58
  She heard very badly, and saw but exceedingly little. Though she looked
• 2:05:01
  intelligent, she replied with great indifference to the questions put to her, and
• 2:05:05
  seemed to be in a serious state of stupefaction. As we did not succeed
• 2:05:11
  in nourishing her otherwise, we had to try the effect of hypnotic practice.
• 2:05:15
  After some attempts, we easily caused her to enter into a singular state,
• 2:05:18
  which appeared momentary and artificial, but differed altogether from the habitual state in which
• 2:05:23
  we had constantly seen her since her entrance into the hospital. She looked quite
• 2:05:28
  transformed, physically and morally. She was now capable of moving, She accepted
• 2:05:31
  any food, and had no longer any vomiting. Lastly, she urinated spontaneously
• 2:05:38
  without difficulty. On the other hand, she had become sensitive over her entire
• 2:05:42
  body and could hear and see perfectly. She expressed herself much better, with
• 2:05:46
  more vivacity, and showed a complete memory of all her anterior life. After
• 2:05:51
  having nourished her in this new state, we thought it necessary to awaken her.
• 2:05:56
  Since this state was considered artificial, she immediately fell back into her preceding
• 2:06:00
  state, inert, insensible, unable to eat or urinate. She simply presented
• 2:06:05
  one more disturbance, namely, according to the law of somnambulisms, which you
• 2:06:11
  know, she had quite forgotten what had happened during the preceding period. Nevertheless,
• 2:06:16
  thanks to these artificial somnambulisms, we were able to nourish her and cause
• 2:06:20
  her to recover her strength, but it was always impossible to make her eat
• 2:06:25
  in the period considered normal, which we always brought back by awakening her.
• 2:06:30
  So that tired of thus putting her to sleep at each meal, which was
• 2:06:33
  very long, we left her for whole days in the artificial state. The
• 2:06:38
  only result was apparently a great advantage, since all day she ate well,
• 2:06:43
  urinated completely, and presented more sensibility, memory, and activity. One day,
• 2:06:47
  her parents, finding her in this fine artificial state, considered her cured
• 2:06:51
  and took her out of the hospital. Everything went well during the first days,
• 2:06:57
  but after a few weeks, on the occasion of her menstrue period,
• 2:07:00
  she experienced a kind of upsetting and awoke spontaneously. That is to say,
• 2:07:04
  she suddenly returned to the state of depression and stupefaction from which we had drawn
• 2:07:09
  her. But she presented in addition a forgetfulness, bearing this time on whole
• 2:07:13
  weeks. She was very much bewildered at finding herself in her house without understanding
• 2:07:17
  how she had left the hospital, for she did not remember the events of
• 2:07:21
  the preceding days. Besides, she again refused to eat and could not urinate.
• 2:07:28
  Mausoleine was brought back to me, and in the presence of all these
• 2:07:30
  disturbances, which were well known to me, I could do nothing else but
• 2:07:33
  put her to sleep again, or rather bring her back to her artificial state.
• 2:07:39
  Well, gentlemen, things continued in this way for fifteen years. Marsolene
• 2:07:43
  would come to me in order to be put to sleep, enter into her
• 2:07:45
  alert state, and then go away very happy with complete activity, sensibility,
• 2:07:50
  and memory. She would remain thus for a few weeks, then, either
• 2:07:55
  slowly or suddenly, in consequence of some emotion, fall back into her numbness,
• 2:07:59
  returned, turned to the state we had considered primitive and natural, with
• 2:08:03
  the same visceral disturbances. The forgetfulness now extended over whole years and disturbed her
• 2:08:07
  existence completely. She would hasten to come to me to get herself transformed again.
• 2:08:13
  Things continued thus for years together till the death of the poor girl who
• 2:08:16
  succumbed to pulmonary tuberculosis. How are the two states of Mausolene to be explained?
• 2:08:24
  You see, they are quite like what we have just described in connection
• 2:08:26
  with the dominant somnambulisms of Felida. The latter also had two states, one
• 2:08:31
  melancholy and incomplete, in which she had great oblivions, the other alert,
• 2:08:35
  in which she found again all her sensibility and memory. Mausoleine resembles her so
• 2:08:41
  much that I have already proposed to call her an artificial Felider. We ought
• 2:08:46
  then to apply to her the conventions proposed by Monsieur Razon, as well as
• 2:08:50
  by all the authors. To designate these two states, we ought to say
• 2:08:54
  that the state number one is the state of depression in which we found her
• 2:08:56
  at the beginning, and which looked normal. That the state number two,
• 2:09:01
  a superadded or artificial state, is the alert state with complete memory. Well,
• 2:09:05
  these denominations seem to me quite incorrect when applied to this case, which
• 2:09:09
  I followed so long. It is absurd to call state number one a state
• 2:09:13
  of mental depression incompatible with life, a natural state. It is unlikely that
• 2:09:18
  this young woman has always been from the first in such a state. In
• 2:09:22
  reality, it is false. She began by having in her girlhood before puberty,
• 2:09:26
  all these sensibilities, all these functions at her disposal. She ate and
• 2:09:31
  digested very well, and urinated spontaneously. This is the real state number one.
• 2:09:37
  There is no doubt on this point. The state in which we saw
• 2:09:39
  her in the hospital, with all her disturbances and insensibilities, is an abnormal
• 2:09:43
  state brought on by illness by hysteria, which has evolved since her puberty.
• 2:09:48
  It is the state number two. But what shall we do then? With
• 2:09:52
  the state obtained through hypnotism, which was produced artificially, is it a state
• 2:09:58
  number three? By no means. In this state her functions were normal.
• 2:10:03
  She recovered the sensibility and memory she had formerly had. I see no reason
• 2:10:07
  why we should distinguish this state from the natural state of her childhood, which
• 2:10:11
  we called state number one. It is simply a momentary cure which we brought
• 2:10:16
  about through processes of artificial excitation. And when she falls back into the state
• 2:10:20
  number two, it is simply because the disease begins again. All this history
• 2:10:24
  may be represented by the following diagram. Slowly without its being perceived, this
• 2:10:30
  young girl grew worse every day. She had gradually lost sensibility and memory.
• 2:10:35
  We may represent this stage by a line which descends well below the line a
• 2:10:39
  B of normal activity Figure six. When she has been hypnotized in C,
• 2:10:43
  she rises again to a state of almost normal activity in D through the effect
• 2:10:48
  of illness, she gradually redescends. At first, she seems to awaken a
• 2:10:52
  little as soon as you leave her and forgets what you have just now told
• 2:10:56
  her. E. Then two days after she wakes again f that is to
• 2:11:00
  say, she experiences a fall into a state of hysterical anesthesia and amnesia,
• 2:11:05
  still deeper than before. G she forgets the two preceding days. Then she
• 2:11:09
  goes down very slowly. If you let her fall again by an emotion,
• 2:11:13
  for instance, there will be complete amnesia of the whole preceding period. If
• 2:11:18
  you excite her there will be, on the contrary, a psychological state far
• 2:11:22
  more complete, and a total remembrance of the preceding periods. It is these
• 2:11:26
  falls, these returns to anesthesia, which give to the normal periods the aspects
• 2:11:31
  of somnambulisms. I think it is absolutely the same with all such cases,
• 2:11:35
  that everything has been confused through false denominations. Phelida also had in her childhood
• 2:11:41
  a state number one, which now no longer exists except in her periods of
• 2:11:45
  alert state, improperly called state number two. It has been noticed with astonishment
• 2:11:50
  that at the end of her life this state exists almost alone. It is
• 2:11:54
  simply because the hysteria is cured and she returns to the normal state of her
• 2:11:58
  girlhood, which she ought always to have kept. There is nothing abnormal but
• 2:12:03
  the state of depression with amnesia, which settled gradually after her puberty, and
• 2:12:07
  which was mistaken for a state number one because it had lasted for a long
• 2:12:11
  time. When the subject was observed. In this view, things become somewhat
• 2:12:16
  clearer. The essential phenomenon that, in my opinion, is at the basis
• 2:12:20
  of these double existences is a kind of oscillation of mental activity, which falls
• 2:12:26
  and rises suddenly. These sudden changes, without sufficient transition, bring about two
• 2:12:31
  different states of activity, the one higher with a particular exercise of all the
• 2:12:35
  senses and functions, the other lower, with the great reduction of all the
• 2:12:39
  cerebral functions. These two states separate from each other. They cease to be
• 2:12:43
  connected together, as with normal individuals through gradations and remembrances. They become isolated
• 2:12:50
  from each other and form these two separate existences. Here again there is a
• 2:12:54
  mental dissociation more complicated than the preceding ones. There is dissociation not only of
• 2:13:00
  an idea, not only of a feeling, but of one mental state of
• 2:13:03
  activity. End of Section four. Lecture five. Convulsive attacks, fits of
• 2:13:11
  sleep artificial somnambulisms. A great number of convulsive attacks and of fits of sleep
• 2:13:16
  are nothing but imperfect somnambulisms. The association of ideas in the histerogenic points,
• 2:13:22
  the diagnosis of hysterical and epileptical fits, the crisis of emotional manifestation, the
• 2:13:28
  different fits of sleep, the lethargies, the perseverance of thought during this sleep,
• 2:13:33
  the crisis of reverie, the artificial reproduction of hysteric accidents of attacks of
• 2:13:39
  fits of sleep, artificial somnambulism or hypnotism, the hypnogenic points, the hypnotic
• 2:13:46
  state as a reproduction of hysteric somnambulism. All the preceding examples, the study
• 2:13:52
  of monoidaic and polyedaic somnambulisms, the study of fugues and of double existences,
• 2:13:58
  showed you the considerable importance assume by somnambulisms in hysteric neurosis. We should still
• 2:14:03
  have many forms of the same phenomenon to consider, But today I wish only
• 2:14:07
  to dwell on certain elementary and in some manner degraded forms of somnambulism, because
• 2:14:13
  they are common, because they are to be met with every day, and
• 2:14:15
  because it is necessary in order to understand them, to be able to connect
• 2:14:18
  them with the more typical somnambulism, of which they are only inferior forms.
• 2:14:24
  You will understand the interest of this study if you notice that it first applies
• 2:14:28
  to two phenomena very important in practice, convulsive attacks and fits of sleep.
• 2:14:35
  I hasten to tell you that I do not vaguely connect all hysteric attacks and
• 2:14:37
  all fits of sleep with phenomena of somnambulism. The words attack and sleep are
• 2:14:43
  vague words borrowed rather from the vulgar than from scientific language, and very varied
• 2:14:48
  phenomena arranged under them. You will soon see, on the occasion of motor
• 2:14:52
  agitations, that the hysteric attack is often constituted by an ensemble of ticks of
• 2:14:56
  choreic movements connected together in a certain manner. Sometimes fits of sleep are simply
• 2:15:03
  paralytic phenomena. The subject is incapable of moving, but hears and understands very
• 2:15:07
  well, and has no intellectual disturbance. So we shall meet later on with
• 2:15:11
  many other forms of attacks and fits of sleep. But today we are to
• 2:15:15
  study one of the most essential forms, in which these two accidents are nothing
• 2:15:18
  but particular aspects of certain imperfect somnambulisms. One convulsive attacks, which we have
• 2:15:26
  first to attend to, are exceedingly frequent phenomena. They were noted even by
• 2:15:31
  the philosophers and doctors of ancient Greece. It is this phenomenon that the Middle
• 2:15:35
  Ages and the Renaissance reproduced in the documents relating to exorcisms. Modern authors such
• 2:15:41
  as Briquet state in their statistics that three quarters of their patients have attacks at
• 2:15:46
  first sight. The patients who seem to have become unconscious and writhe in disorderly
• 2:15:50
  convulsions appear to be very different from the somnambulists we have just studied. Complete
• 2:15:56
  somnambulism was evidently characterized by a great number of intelligent manifestations. The subject expressed
• 2:16:03
  his idea, his dream by his adjusted movements, which usually are to our
• 2:16:07
  mind the expression of reasonable thoughts. The first and clearest of these expressions was
• 2:16:11
  speech, and we had no great merit in guessing the subject of such dreams,
• 2:16:16
  since the patient expressed it himself by language. When he did not speak,
• 2:16:20
  he had expressions of the physiognomy, attitudes and especially acts, the interpretation
• 2:16:24
  of which was very clear. He was seen to get up, to walk,
• 2:16:28
  to seek for objects in a drawer, to make the gesture of holding
• 2:16:31
  a revolver and pulling the trigger to struggle with phantoms, et cetera. In
• 2:16:35
  a word, the outer expression of the somnambulic idea was as clear as possible.
• 2:16:41
  There is nothing of the kind in convulsive attacks in which the subject seems
• 2:16:45
  to writhe in great, irregular, apparently meaningless movements. Yet it is easy
• 2:16:50
  to prove that from many points of view, these convulsive attacks approached somnambulisms.
• 2:16:56
  These accidents, though apparently constituted by uncoordinated mons movements, have the same moral
• 2:17:01
  causes as somnambulisms. They begin, like them on the occasion of particularly affecting
• 2:17:07
  events genital perturbations, sorrows, fears, et cetera. A man begins to
• 2:17:11
  have crisis of hysteria because he has seen his son fall from a scaffolding and
• 2:17:16
  die before him. Many girls or women begin to have a tax on the
• 2:17:20
  occasion of the death of a beloved person. In about ten observations, the
• 2:17:24
  cause of the first fit is a conflagration a petroleum lamp setting the subject's dress
• 2:17:28
  on fire. In others it is a fall from a tramcar or from a
• 2:17:31
  bicycle, a fight with comrades, heart grief, reverses of fortune, et
• 2:17:35
  cetera. I wish to dwell only on one story, that of the woman
• 2:17:39
  with the dog, which affords a fine example of attacks displaying the form of
• 2:17:43
  imperfect somnambulism joined with ticks, to which we shall allude later on. This
• 2:17:50
  lady, forty three years old, who had always been impressionable, of course,
• 2:17:54
  was already very much upset by the death of a very dear friend.
• 2:17:58
  She had kept only one souvenir from him, very precious souvenir, an old
• 2:18:01
  dog. Now, two years after his master's death, the dog died in
• 2:18:05
  his turn on a carpet. This lady, in despair, lay down on
• 2:18:09
  the carpet on which the dog had died, and remained there for sixty days,
• 2:18:13
  without consenting to accept any food or to take any care of herself.
• 2:18:18
  From that time she began to have terrible fits of hysteria, which assumed many
• 2:18:22
  forms. You see by this example that the starting point of convulsive attacks is
• 2:18:26
  the same as that of the preceding somnambulisms. Let us go one step farther
• 2:18:31
  and consider the occasional cause that determines the appearance of each new attack. It
• 2:18:35
  is easy to see that here again moral causes play an important part. It
• 2:18:39
  is true the patient maintains that the fit occurs irregularly without her knowing why,
• 2:18:45
  and that it is brought on solely by physical causes. There may be some
• 2:18:48
  truth in the remark that the time which has elapsed since the last attack plays
• 2:18:52
  a great part. When patients have just had their fit of somnambulism or convulsions,
• 2:18:58
  they cannot always begin a new attack immediately. They seem to be modified
• 2:19:01
  and to have become less sensitive to the various moral impressions. A certain time
• 2:19:07
  must elapse two days for one, a week, or a month for another
• 2:19:11
  before they become very impressionable and capable of recommencing the same phenomenon. This is
• 2:19:16
  true. We meet here with a very interesting periodical oscillation, which we shall
• 2:19:20
  have to take into account at the end of this course of lectures. But
• 2:19:24
  besides this general predisposition, it is none the less true that a thousand accidental
• 2:19:28
  circumstances bring about the appearance of the fit. First of all, slight exterior
• 2:19:33
  phenomena may produce this effect. The sight of a flame, sometimes of a
• 2:19:37
  match, only brings about the fit. With those subjects who have been affected
• 2:19:39
  by a conflagration. Any cry, or name or sentence will call it back
• 2:19:43
  with others. Our woman with the dog is admirable in this respect. It
• 2:19:48
  is enough that a dog barks in the street, she sees a cat pass
• 2:19:52
  by, the name of one of the animals is pronounced, or even certain
• 2:19:56
  words are pronounced, the use of which she absolutely forbids, as the words
• 2:20:00
  love, affection, happiness, et cetera. It is enough that a date
• 2:20:05
  on the calendar be mentioned before her, for the fear of remembering a certain
• 2:20:07
  date has caused her to forbid all possible debts. The least thing is enough
• 2:20:13
  to bring about an endless fit, in which convulsions and howlings mingle together for
• 2:20:16
  fifteen or twenty hours. Is it not obvious that in all such cases there
• 2:20:20
  is an association of ideas between the dreaded perception and the remembrances which bring on
• 2:20:26
  the fit, as well as the somnambulism. The different terms of these systems
• 2:20:31
  of ideas are connected together in such a manner that they mathematically call up one
• 2:20:35
  another. You would perhaps find it more difficult to recognize the same law if
• 2:20:39
  you considered a tax, the starting point of which seems to be the touch
• 2:20:43
  or excitation of a point on the subject's body. You know that formerly great
• 2:20:48
  importance was attributed to such points, which were called histogenic points. Chalcot and
• 2:20:52
  Petre wrote a long disquisition about them, which nowadays seems to contain many errors.
• 2:20:58
  It was admitted that the fit began with a pain or a strange sensation
• 2:21:01
  situated at such or such a point of the body. The most frequent points
• 2:21:05
  with women were the lower region of the abdomen, called the ovarian region.
• 2:21:09
  On either side pains at this point the moment of the fit were so frequent
• 2:21:13
  that they even determined the theories of the ancients on hysteria. He remember the
• 2:21:18
  absurd story invented by Plato, which spread all over the world, obnubilating the
• 2:21:24
  minds of physicians for centuries and casting a kind of shame on all such patients.
• 2:21:28
  It was, he said, the over excited matrix which required satisfaction,
• 2:21:33
  and as this satisfaction was not obtained, it ascended through the body as far
• 2:21:35
  as the throat of the patients and choked them. In fact, this sensation
• 2:21:41
  of uneasiness, which often begins in the lower part of the abdomen seems to
• 2:21:43
  ascend and to spread to other organs. For instance, it very often spreads
• 2:21:48
  to the epigastrium, to the breasts, then to the throat. There it
• 2:21:52
  assumes rather an interesting form which was for a very long time considered as quite
• 2:21:56
  characteristic of hysteria. The patient has the sensation of too big an object,
• 2:22:01
  as it were, a ball, rising in her throat and choking her.
• 2:22:05
  She makes an effort either to swallow or to expel this big object. Other
• 2:22:09
  points and sensations may intervene irregularly, situated in the breast, shoulders, eyes,
• 2:22:15
  or head, and they seem to depend on purely physical phenomena. Do
• 2:22:20
  not misunderstand the nature of such points. First, they never correspond to real
• 2:22:24
  organic lesions, or at least, if there are any lesions, they play
• 2:22:28
  no part in hysteria properly so called. Then, in spite of appearances,
• 2:22:33
  try to realize thoroughly that these sensations are moral, not physical, and that
• 2:22:37
  they also depend on the ideas and emotions of the subject. For you must
• 2:22:41
  not forget that the different regions of our body participate in all the events of
• 2:22:46
  our life and in all our sentiments. Let us consider two individuals, both
• 2:22:50
  of them wounded in the shoulder, one by an elevator, the other by
• 2:22:52
  an omnibus. These wounds have long been cured, but you can easily understand
• 2:22:58
  that the remembrance of a sensation inn in the shoulder, that even the idea
• 2:23:01
  of the shoulder is a part of the remembrance of the accident. It is
• 2:23:05
  enough that you touch one of these patients on the shoulder for this peculiar sensation
• 2:23:09
  to remind him of his accident and determine the crisis the idea of consumption.
• 2:23:13
  The fear of the thysis is accompanied by a certain painful sensation in the summit
• 2:23:18
  of the left lung on the occasion of which it began. The same sensation
• 2:23:22
  located in this spot will be the starting point of the fit. In amorous
• 2:23:26
  emotions, unless we have to deal with pure spirits, there are genital sensations
• 2:23:31
  with the swelling of the region. What difficulty is there in understanding that in
• 2:23:35
  all these emotions of regret, of love, of remorse, this image of
• 2:23:39
  a physical sensation intervenes and plays the part of a starting point. Add to
• 2:23:43
  this the innumerable associations of ideas determined by the habits of the patient or the
• 2:23:48
  questions of the physician, And do not forget that those pretended histerogenic points are
• 2:23:54
  merely spots in which certain peculiar sensations easily arise associated with the remembrance of an
• 2:23:58
  affecting event. Let us now pass on to the end of the fit,
• 2:24:03
  and you will meet with one more essential phenomenon of somnambulism. The subject,
• 2:24:07
  after more or less protracted struggling, seems to wake up all at once or
• 2:24:11
  gradually sets her dress to rights, and almost without any difficulty, gets up
• 2:24:16
  again and resumes her occupations. Here is to be noticed at a great medical
• 2:24:20
  fact, namely, that the hysteric fit does not seem to bring about a
• 2:24:24
  great physical disturbance as the epileptic fit does. The subject is not exhausted.
• 2:24:28
  She has not the stupefied haggard aspect of an awaking epileptic, nor the irresistible
• 2:24:33
  need of sleep which characterizes the commissial fit. Our hysteric patient, after howling
• 2:24:39
  for several hours, feels rather comfortable. She experiences, as it were,
• 2:24:43
  a relaxation, and declares she is much better than before the fit. Another
• 2:24:48
  characteristic phenomenon is that she attaches no importance to what has happened. She is
• 2:24:52
  not in the least ashamed of her cries, her indecent attitudes, the disorder
• 2:24:56
  of her acts. She seems to have forgotten everything. In truth, remembers
• 2:25:00
  only the facts previous to the fit. All that has occurred after the sensations
• 2:25:05
  of choking and the ascent of the ball no longer exists. For her.
• 2:25:09
  This oblivion is very important, no doubt, it is more or less profound,
• 2:25:13
  according as the hysteria is more or less characterized, but it is a
• 2:25:16
  part of the disease. Beware of crises of violent agitation, in which there
• 2:25:20
  is no loss of consciousness, and of which the subject keeps an accurate remembrance.
• 2:25:24
  Do not inconsiderately call that hysteria. It is nearly always something else.
• 2:25:30
  In the most favorable cases, you have to deal with the crisis of agitation
• 2:25:33
  of the psychosthenic. Unfortunately, you have often to deal with mental disturbances,
• 2:25:37
  the diagnosis of which is more or less easy. I would only insist on
• 2:25:43
  the fact that our fit of real hysteria ends with an oblivion, like somnambulism
• 2:25:46
  itself. Let us now return to the facts constituting the fit itself. They
• 2:25:52
  are first meaningless movements. The patience grow stiff, then seem to try still
• 2:25:58
  to exaggerate this extension by three throwing back the head, by raising the abdomen,
• 2:26:01
  by making a bridge according to the usual expression. The head is agitated
• 2:26:07
  in one direction or the other, the eyes closed or open with an expression
• 2:26:09
  of terror, the mouth distorted. Now the patients grind their teeth, but
• 2:26:15
  without biting their tongue. Now they open their mouth and utter piercing cries in
• 2:26:18
  every tone. The arms are agitated in every direction. They strike at haphazard
• 2:26:24
  on the surrounding objects or on the breast. The fists alternately close or open.
• 2:26:28
  The breathing is loud, irregular, The heart beats quickly. The face
• 2:26:33
  is congested, without however, being violet hued as in the epileptic fit.
• 2:26:37
  It all seems very disorderly and unintelligible. There is, however, a comparison
• 2:26:41
  which it once comes to our mind, and which is very clearly indicated in
• 2:26:46
  the old work of Priquet. A fit of simple hysteria, he said,
• 2:26:50
  is nothing but the exact repetition of the disturbances by which vivid and painful moral
• 2:26:54
  impressions are manifested. I choose as an example, what happens to a somewhat
• 2:27:00
  impressionable woman experiencing a sudden and vivid impression. This woman at once has constriction
• 2:27:05
  in the epigastrium, she feels some difficulty in breathing, something rises to her
• 2:27:11
  throat and chokes her. Lastly, she feels in all her limbs and uneasiness
• 2:27:15
  which causes them to fall. Or she feels an agitation a need of movement,
• 2:27:18
  which causes her to contract her muscles. This is the exact model of
• 2:27:22
  the most common hysteric accident, of the most usual hysteric spasm. This general
• 2:27:30
  conception applies very well to the greater part of convulsive fits. It is easy
• 2:27:33
  to verify the assertion that this crisis is in fact an ensemble of emotional manifestations.
• 2:27:39
  In many cases, it is even possible to distinguish and recognize the particular
• 2:27:43
  emotion thus expressed. Certain patients plainly manifest anger. They strike, scratch,
• 2:27:48
  bite, and their cries are menacing. Others evidently have crises of grief and
• 2:27:54
  despair. Their tears and moanings have quite another meaning than the cries of the
• 2:27:56
  former. It is not very difficult to recognize erotic crises with the latter,
• 2:28:01
  for they play certain scenes in a remarkable manner. With the former. On
• 2:28:07
  the contrary, much oftener, you have crises of fear. The bewildered expression
• 2:28:11
  of the eyes, the movements of defense of the arms stretched forward, the
• 2:28:15
  drawing back of the body are quite characteristic. Besides. Nearly all these patients,
• 2:28:20
  though they do not speak clearly, as in somnambulisms, mingle some words
• 2:28:24
  with their cries, and you easily distinguish the ones who call Gaston or Roscar
• 2:28:28
  with tender words and the one who howlds Mama help. In many cases,
• 2:28:33
  indeed, the phenomenon may be said to be intermediate. The subject speaks a
• 2:28:37
  little more, her movements are less incoordinate and somewhat more expressive. These phenomena
• 2:28:43
  are almost somnambulisms, analogous to the preceding ones, but less perfect. The
• 2:28:48
  crisis of the woman with the dog unquestionably belongs to this mixed type. For
• 2:28:52
  long hours together, the following phenomena mingle together and succeed one another. First
• 2:28:58
  sobs, tears streaming down her face, cries of despair, great movements of
• 2:29:03
  the arms to strike her breast and tear her hair. Then declamations about fate
• 2:29:07
  which strikes without a reason, which strikes even the best without their having deserved
• 2:29:11
  their lot. Then recitals of mournful passages borrowed from such poets as La martinoor
• 2:29:16
  mouseailles viveran jour tanseel massemble, la mare ma'ema. To live one day without
• 2:29:22
  her seemed to me death itself. L'r matnaproentis la du leore, sommertre man
• 2:29:28
  is an apprentice, grief is his master. To these phenomena quite peculiar to
• 2:29:33
  somnambulisms were added somewhat different symptoms, which we shall see later on when we
• 2:29:39
  study the ticks of respiration, namely certain moanings or certain monotonous howlings which were
• 2:29:45
  regularly repeated for hours together. This is decidedly a type of mixed crisis,
• 2:29:50
  in which somnambulisms, exaggerated emotional manifestations and ticks mingle together. From all these
• 2:29:58
  reasons, which show us the identity of the beg ginning and of the end
• 2:30:01
  the analogy of the essential manifestations, we can conclude that a great number of
• 2:30:05
  attacks are nothing but aborted somnambulisms. The idea which developed itself in somnambulisms through
• 2:30:11
  expressions of the physiognomy words and acts, now only appears in the inferior and
• 2:30:16
  merely emotional form. But these expressions of emotion are enlarged, disfigured. They
• 2:30:22
  seem to have become simpler, coarser than in the normal state. The emotions
• 2:30:26
  seem to have lost their intellectual aspect and to have increased in their visceral and
• 2:30:31
  motor expressions. They appear to have fallen and become inferior. Two. We
• 2:30:37
  shall reach an analogous conclusion by examining another equally frequent accident of hysteria, namely
• 2:30:43
  fits of sleep. You know what great curiosity this symptom has always roused For
• 2:30:48
  a long time. People have been amazed at seeing individuals remaining quietly asleep in
• 2:30:54
  spite of all efforts to awake them, sleeping on peacefully for hours and even
• 2:30:58
  days together. Such patients who sleep for ten, fifteen days, sometimes for
• 2:31:03
  months together do not all belong to the same variety. They differ in their
• 2:31:07
  physical aspect as well as in their moral state. Some seem to have a
• 2:31:11
  rather light sleep. The subject moves from time to time, changes his position,
• 2:31:16
  mutters a few words. Others have much deeper sleep, accompanied with complete
• 2:31:20
  immobility, or even with a certain degree of stiffness of the limbs. In
• 2:31:24
  the last stage, this sleep assumes that aspect of lethargy which has given rise
• 2:31:28
  to so many superstitious fears. As indicated by the words, the aspect of
• 2:31:33
  these patients approaches that of a dead body. The faces of wax and paleness,
• 2:31:37
  without any expression. The eyes are closed, and when one opens them,
• 2:31:41
  one finds that the pupils are dilated, and that the eyes remain motionless.
• 2:31:45
  The skin seems to have grown cold, the visceral functions appear to have
• 2:31:48
  much decreased. The breathing is superficial and rare. The beats of the heart
• 2:31:52
  are hollow and difficult to perceive. It appears that a certain number of patients
• 2:31:58
  in this state have been mistaken for corpse, and that this accident has given
• 2:32:01
  rise to untimely interments. For my part, I am always surprised when I
• 2:32:05
  hear of such mistakes. None of the lethargic people I have had the opportunity
• 2:32:09
  of seeing, could, in my opinion, be the object of any illusion,
• 2:32:13
  a little attention was sufficient to avoid this absurd mistake. First of all,
• 2:32:18
  it is not true, at least in the rather numerous cases I have
• 2:32:20
  seen that the functions stop. One cannot feel the pulse, but with some
• 2:32:24
  attention one can always hear the heart. If one seeks well, one always
• 2:32:28
  finds some manifestations of the breathing. Besides, the temperature is not very low,
• 2:32:35
  and the skin never gives by its contact the impression of a cadaveric skin.
• 2:32:39
  There are even some little peculiar phenomena that seldom fail. For instance,
• 2:32:43
  that slight tremulousness of the eyelids, which is typical the pupillary reflex either to
• 2:32:48
  light or often are still to pain, the change of attitude if the mouth
• 2:32:52
  and nose are closed and the breathing hindered. In a word, I do
• 2:32:56
  not very well understand how one can mistake a hysteric patient in lefts SGY for
• 2:33:00
  a dead woman, and in my opinion, such mistakes imply great ignorance.
• 2:33:05
  It is necessary, however, to warn you against this danger. As I
• 2:33:09
  told you at the beginning, I do not think that all hysteric fits of
• 2:33:11
  sleep are of the same kind. Any more indeed, than are all attacks.
• 2:33:16
  We shall resume this question when we have studied certain disturbances of the visceral
• 2:33:20
  functions of hystericals. To day. I wish only to make you understand one
• 2:33:24
  of the most frequent forms of these sleeps, the one which it must be
• 2:33:26
  acknowledged, usually seems to be the least profound and serious. It is to
• 2:33:31
  be found with those subjects who fall asleep for a few hours, and who
• 2:33:35
  nearly keep the aspect of normal sleep. I do not think that in these
• 2:33:39
  individuals the psychological phenomena have disappeared. I do not think that their sleep is
• 2:33:43
  a merely physical phenomenon. By many methods, one can prove the existence of
• 2:33:48
  thoughts that continue to develop in their minds. First of all, a protracted
• 2:33:52
  and attentive observation very often shows you slight signs connected with thoughts. There are
• 2:33:56
  a few little movements of the lips, as if the subject wanted to speak
• 2:34:01
  or sometimes smile, a few little transient expressions of the physiognomy, a few
• 2:34:05
  little movements of the hands. In certain cases, you have quite the impression
• 2:34:09
  that the patient chatters inwardly, and that but little is wanting for you to
• 2:34:13
  be able to understand him by means of certain processes which we cannot study in
• 2:34:18
  detail. One can sometimes put one's self in relation with such subjects. By
• 2:34:24
  merely touching them speaking to them, it is possible to attract their attention,
• 2:34:28
  and then one can question them and obtain certain answers. Sometimes, in the
• 2:34:31
  most favorable cases, the subject will answer by speaking. Sometimes he will answer
• 2:34:37
  by slight signs of the fingers or face. If you take his hand and
• 2:34:39
  ask him to press it in order to say yes, sometimes you obtain nothing
• 2:34:43
  but movements of the eyelids and eyebrows. A slight lowering of the eyebrows will
• 2:34:48
  mean yes, their rising will mean no, and you can thus penetrate a
• 2:34:52
  little into his thought. Lastly, in other and more frequent cases, you
• 2:34:56
  will be able, after the crisis of sleep, to find it again the
• 2:35:00
  recollection of it in states of artificially provoked somnambulism, about which I shall tell
• 2:35:05
  you a few words at the end of this lesson. By using these various
• 2:35:09
  means, you can ascertain that the immobility of such patience is much less physical
• 2:35:13
  than moral. Some have in their mind the fixed idea of sleep or death,
• 2:35:16
  and they realize outwardly the attitude they are thinking of. But many others
• 2:35:20
  have ideas that are not in the least connected with the sleep. They are
• 2:35:24
  seized with a profound reverie, in which they contemplate scenes that present themselves before
• 2:35:28
  them, or indulge in an endless inward chattering. A girl of sixteen,
• 2:35:33
  who has been terrified by a bull coming to attack her, has crises of
• 2:35:37
  sleep with perfect immobility, during which she is appalled by the hallucination of the
• 2:35:41
  bull. Another aged thirty two, in despair at the death of a friend,
• 2:35:46
  relates to herself dismal stories about her own death. They are going to
• 2:35:50
  put candles near my bed. They are putting me in a little deal coffin.
• 2:35:54
  My friends are bringing white flowers to put on my little coffin, which
• 2:35:56
  is there placed on two chairs. And she talks thus endlessly. A man
• 2:36:01
  of twenty five has been much upset by an accusation brought against him by a
• 2:36:05
  fellow workman. When he meets with this individual, he becomes motionless, like
• 2:36:09
  one petrified, and at last he slips to the ground and lies as if
• 2:36:13
  asleep for hours together, talking inwardly about the accusation brought against him. He
• 2:36:18
  fancies he is before his employer, and defends himself in every way, arguing
• 2:36:22
  in a complicated manner, as if he were before a court of justice.
• 2:36:28
  It is useless to remind you of the fact that we could make concerning these
• 2:36:31
  sleeps. All the remarks we have made about the beginning and the end of
• 2:36:33
  the fits. They are likewise originated by an affecting event, and the same
• 2:36:39
  part is played by the provocative circumstances, which, by an association of ideas,
• 2:36:43
  recall the initial event. You have just seen an example in which sleep
• 2:36:48
  is provoked by the sight of the person who brought the accusation. We could
• 2:36:52
  resume the same discussion about certain special points, which have been called hypnogenic points.
• 2:36:58
  In my opinion, these points do not act at all for physical but
• 2:37:01
  for moral reasons, because the sensations they bring about are associated with the affecting
• 2:37:05
  idea. At the end of these fits of sleep, there occurs the same
• 2:37:09
  awakening with indifference, and especially the same oblivion, exactly as in somnambulisms.
• 2:37:15
  You see, therefore, that these new phenomena do not differ very much from
• 2:37:18
  the preceding ones. However, you remember that in somnambulisms there were intelligible words,
• 2:37:24
  complex acts, and expressive movements. In attacks, the words and acts
• 2:37:28
  had disappeared. In the fits of sleep, which we are now considering,
• 2:37:33
  there remain not even movements or convulsions. It seems, therefore that all the
• 2:37:37
  phenomena of somnambulism have disappeared. But these missing phenomena are not, in my
• 2:37:43
  opinion, essential phenomena. What was most important in somnambulism was, as I
• 2:37:48
  told you, an idea persisting in consciousness and developing to an exaggerated degree.
• 2:37:54
  The development is complete if it manifests itself by emotional expressions, by words and
• 2:37:58
  acts. It is much less complete if nothing remains but the first term,
• 2:38:01
  namely the emotional agitation. Yet the idea may still persist and pervade immeasurably the
• 2:38:07
  consciousness of the patient without manifesting itself by anything outwardly. The subject is then
• 2:38:13
  invaded by a kind of meditation from which nothing can distract him. He perceives
• 2:38:16
  no phenomenon foreign to his dream, and this is the reason why he cannot
• 2:38:20
  be awakened by any means whatever, and takes on the appearance of being in
• 2:38:24
  a profound sleep. So we were right in saying that this form of hysteric
• 2:38:28
  accident was also connected with somnambulism, of which it was only the last to
• 2:38:31
  degree three. I should not like to conclude this study of hysteric somnambulisms without
• 2:38:37
  indicating to you in its proper place, if not a new form, at
• 2:38:41
  least an important characteristic of all the preceding forms. A very curious property of
• 2:38:46
  hysteric accidents, which no doubt is not absolutely peculiar to them, but which
• 2:38:50
  carried to this degree is rare, is that they can be artificially reproduced.
• 2:38:56
  In most diseases, the accidents are not at our disposal. To take only
• 2:39:00
  one striking example, we are not at all masters of an epileptic fit.
• 2:39:03
  We cannot stop it at will, nor can we reproduce it or make it
• 2:39:07
  reappear when we please. Let us take, for example, an individual who
• 2:39:11
  has been affected with epilepsy for ten or twenty years, and who very frequently
• 2:39:15
  has the most decided epileptic fits. Well, if we wished, for any
• 2:39:18
  reason in the interest of the patient himself, to study his epileptic fit,
• 2:39:22
  if we wished that a fit might take place in our presence, in the
• 2:39:26
  laboratory, where we have the time and the means to examine its details accurately.
• 2:39:30
  We could not, as you know, realize this wish. We can
• 2:39:33
  take the patient before us, try him in every way, but he will
• 2:39:35
  present no pathological phenomenon. He will not be impressionable at all. He will
• 2:39:41
  not have the shadow of an epileptic fit. An hour afterwards, when we
• 2:39:45
  are gone, and without our knowing why, he will suddenly fall and have
• 2:39:48
  a great epileptic fit. It is a disease on which experimentation has no hold.
• 2:39:54
  Formerly it was so with three fourths of the diseases. Nowadays, owing
• 2:39:58
  to the discoveries of physiology, of microbiology, and sometimes of psychology, we
• 2:40:03
  begin to be able to reproduce in the laboratory some of the diseases we want
• 2:40:05
  to study. You know that it was a revolution when Pasteor demonstrated that the
• 2:40:09
  cattle plague the carbuncle could be given to an animal when one pleased. It
• 2:40:15
  is the beginning of medical science, and sometimes of therapeutics, to be able
• 2:40:18
  thus to bring about the outbreak of a disease at will. Well. This
• 2:40:22
  character is developed to the highest degree in hysteric neuroses, and it applies especially
• 2:40:28
  to the somnambulisms of which I have just spoken. Notice first that it is
• 2:40:33
  a constant symptom of monoeedaic somnambulisms. We have only to awaken, in a
• 2:40:37
  more or less precise manner in the mind of the subject the idea whose development
• 2:40:41
  fills up the somnambulism, to cause the latter to reappear. Sometimes, to
• 2:40:46
  awaken such an idea, it is necessary to recall it completely, to describe
• 2:40:50
  it, to dwell on the images that constitute it. Sometimes it is sufficient
• 2:40:54
  to make a sign to call up a term associated with that idea, for
• 2:40:58
  the rest of the somnambulat to develop, owing to the automatic association which you
• 2:41:03
  know speak of Pauline, to that young woman who wanted to imitate her by
• 2:41:07
  throwing herself out of the window, she will think of the suicide of her
• 2:41:09
  niece, go towards the window, and begin all the scene over again.
• 2:41:13
  Question I nne on the death of her mother, You will see one of
• 2:41:18
  the following different phenomena. Either, as we have noted, she understands the
• 2:41:22
  question only partially answers us vaguely has no accurate remembrances relating to her mother's death,
• 2:41:28
  nor even to her illness. Or if you insist a great deal,
• 2:41:31
  if you'll remind her of facts characteristic of the agony, the subject will lose
• 2:41:35
  her composure, be agitated, and cease to hear us or see surrounding objects.
• 2:41:39
  She will soon be absorbed in her dream, and then will recite in
• 2:41:41
  a declamatory tone, the details of the agony we spoke of, and begin
• 2:41:46
  to play the scene of the death and of her own attempt at suicide under
• 2:41:48
  an engine. The somnambulism has begun again. What we have just said applies
• 2:41:54
  to all the other forms of somnambulism, to polyedaic somnambulism, in which the
• 2:42:00
  dam when once begun, is transformed by the appearance of new circumstances to fugues
• 2:42:03
  themselves, which we can make the patients recommence by dwelling on the dominant idea.
• 2:42:09
  Many of the fugues of young Aur were, in some manner experimental.
• 2:42:13
  His comrades provoked them by recalling through their chatter the stories of travels which had
• 2:42:16
  impressed the patient. Nay, more, the fact is but little known double
• 2:42:22
  existences can be experimentally reproduced. Allow me to recall this remarkable observation on which
• 2:42:28
  I have often insisted already, that of Mausoline, whom we have just studied
• 2:42:31
  in our preceding lecture. This patient, as you know, was transformed by
• 2:42:35
  hypnotism and kept during fifteen years two existences, the former with depression, anesthesias,
• 2:42:41
  amnesias, anorexy et cetera, brought about by the hysteria, and the
• 2:42:46
  latter with rather good health, normal sensations and memory determined by artificial excitation.
• 2:42:52
  She had really become a sort of artificial Felida, and she shows us that
• 2:42:56
  double existence itself can be reproduced by artificial means. What I have just told
• 2:43:01
  you of somnambulisms is still truer with respect to those incomplete forms of somnambulism which
• 2:43:07
  we have just studied under the name of emotional fits and fits of sleep with
• 2:43:09
  revery. Those who described the histerogenic and hypnogenic points had insisted on the following
• 2:43:16
  character, namely that at any moment you could, by the excitation of these
• 2:43:20
  points, caused the patient to fall back into the attack or sleep. One
• 2:43:24
  fell into convulsions as soon as her lower abdomen was pressed, the other into
• 2:43:28
  a fit of sleep when one of her breasts was touched. We know now
• 2:43:31
  what these phenomena mean. They belong to the same group with the preceding ones.
• 2:43:35
  The sensation provoked as again a signal associated with the group of psychological phenomena
• 2:43:41
  of the crisis. I shall only recall the essential fact, namely, that
• 2:43:45
  we can make these phenomena reappear artificially. The states thus artificially reproduced, the
• 2:43:52
  somnambulisms especially, are not long in being a little modified. After a certain
• 2:43:56
  time, they are no longer quite identical with the original natural phenomena. The
• 2:44:01
  reason of this is, as we saw when we studied polyedic somnambulisms, that
• 2:44:05
  new ideas may develop in this state without stopping it. An idea that plays
• 2:44:11
  a great part is the idea of the experimenter, who has artificially provoked the
• 2:44:13
  state. The latter is more and more capable of introducing himself into the somnambulism
• 2:44:18
  of the subject. At first, he can only be understood by the subject
• 2:44:22
  if he speaks to her of ideas related to the somnambulic dream, but he
• 2:44:26
  is soon himself a part of the dream, and is heard and understood if
• 2:44:30
  he speaks of anything. Whatever the greater and greater influence the experimenter requires over
• 2:44:35
  his subject is not long in transforming the somnambulism, in giving it a form
• 2:44:39
  and laws that are often strange and simply result from the habits of the experimenter.
• 2:44:45
  One teaches his subject always to say thee thou during the somnambulik state,
• 2:44:48
  whereas she says you in the normal state. Another accustoms her to fall profoundly
• 2:44:54
  asleep when her eyes are touched, and to wake up when her vertex is
• 2:44:56
  touched. Such phenomena were form he presented as laws of somnambulism, and gave
• 2:45:01
  rise at the time of Charcourt to many passionate discussions. Thus is formed in
• 2:45:07
  some subjects an artificial somnambulism, which has been given the name of hypnotism.
• 2:45:13
  This hypnotism raises one last serious question, which we cannot treat in detail,
• 2:45:16
  and on which I confine myself to giving you my personal opinion. Is this
• 2:45:22
  hypnotism something distinct from hysteric somnambulism, is it something peculiar, an abnormal state
• 2:45:26
  independent of hysteria. You remember what great battles have been fought on that point.
• 2:45:33
  For my part, I do not hesitate, and these are the principal
• 2:45:35
  reasons for my opinion. First considered, in itself, the hypnotic state has
• 2:45:39
  never any character which cannot be found in natural hysteric somnambulisms. The modifications it
• 2:45:45
  offers are very easily explained as the result of education. Secondly, if you
• 2:45:50
  examine the subjects with whom this state can be obtained, you will be convinced
• 2:45:54
  that they are mostly hysteric patients having already had somnambulism in some form or another,
• 2:45:58
  or for the remaining part, hysteric patients having presented other accidents but having
• 2:46:03
  the mental state characteristic of hysteria. Thirdly, you can verify, if you
• 2:46:07
  examine matters without preconceived ideas, the fact that subjects troubled with other diseases than
• 2:46:13
  hysteria epileptics, for instance, psychosthenics tormented by the mania of doubt, lunatics
• 2:46:18
  affected with systematic delirium are not at all hypnotizable, and that one will never
• 2:46:24
  be able to reproduce in them a real somnambulic state with complete consecutive amnesia.
• 2:46:30
  Fourthly, and I find this remark very important. This artificial somnambulism is healed
• 2:46:35
  and disappears in the same manner as natural somnambulisms. A subject whose hysteria decreases,
• 2:46:41
  who tends towards recovery, whose mental state changes, ceases to be hypnotizable.
• 2:46:46
  Fifthly, and lastly, these two states are so analogous to each other
• 2:46:50
  that you can pass from the one to the other by imperceptible transitions. You
• 2:46:54
  can enter into relation with an individual in natural somnambulism. First, speak to
• 2:46:58
  him of his dream, get him to listen to you, then direct his
• 2:47:01
  thoughts, and afterwards put him into the hypnotic state at will. Inversely,
• 2:47:05
  the hypnotic state, if you do not sufficiently direct the mind of the subject,
• 2:47:09
  can be transformed into a state of independent dream, into a state of
• 2:47:13
  hysterical somnambulism. In a word, it seems there is no reason for making
• 2:47:18
  a special place for the hypnotic state. It is a somnambulism analogous to the
• 2:47:22
  preceding one. And differs from it only in that it is obtained artificially instead
• 2:47:26
  of developing spontaneously. So we have passed in review the different forms of somnambulic
• 2:47:33
  accidents that characterize hysteria and constitute more than half of the accidents of this neurosis.
• 2:47:39
  End of section five. Lecture six. Motor agitations, contractures, disturbances
• 2:47:46
  in the motor functions of the limbs, apparent exaggeration of motion, the phenomenon
• 2:47:52
  of tics, rhythmical careers, the absence of will of consciousness, anesthesia,
• 2:47:58
  the diagnosis the tremors, the contractures, clinical importance of this accident, the
• 2:48:05
  part played by mental phenomena, the degradation of the movements in these hysterical accidents.
• 2:48:11
  Hysteric neuroses, the history of which we are pursuing, very often present
• 2:48:16
  accidents of quite another nature, which at first sight seem to be different from
• 2:48:20
  somnambulisms. These accidents do not affect the whole of the body and of the
• 2:48:24
  mind like the former. They seem only to disturb certain functions, and in
• 2:48:28
  particular, the accidents we consider to day appear only to disturb the motor functions
• 2:48:33
  of the limbs. In spite of the disturbances seated in the arm or leg,
• 2:48:39
  the mind may appear, at least in certain cases, absolutely intact,
• 2:48:41
  while in somnambulisms the delirium seemed to be general. In the second place,
• 2:48:48
  motor disturbances which we now consider are not momentary, but they are lasting.
• 2:48:52
  Instead of appearing like attacks and somnambulisms at determinate moments and disappearing in the interval,
• 2:48:58
  they they last for a long time, for days and months together,
• 2:49:03
  no matter what the state of the subject may be. They may exist during
• 2:49:07
  the fits and also exist in the interval. So you see that the phenomena
• 2:49:11
  are apparently pretty different. Yet most physicians, especially since the end of the
• 2:49:16
  last century, do not hesitate to connect this ensemble of motor disturbances with the
• 2:49:20
  same neurosis with hysteria. Perhaps we shall be able to justify this diagnosis later
• 2:49:26
  on by showing that the mental disturbance is at bottom about the same as in
• 2:49:30
  somnabulisms. For the present, we cannot ground our argumentation on this still unknown
• 2:49:35
  character, and we are obliged to justify the diagnosis of these disturbances of motion
• 2:49:39
  by mere clinical remarks. We observe only that they present themselves in the same
• 2:49:46
  subjects and in the same conditions as the preceding somnambulisms. The patients we shall
• 2:49:50
  describe to you today who have had these perversions of motion, these agitations or
• 2:49:54
  paralysies, are the same whom we already know they had a short time before
• 2:50:00
  monoidaic somnabulisms, FEUs or fits. They can still, if we choose,
• 2:50:05
  enter into those hypnotic states which we consider as the reproduction of spontaneous somnambulisms in
• 2:50:11
  them. These various accidents alternate with one another. After a fit, they
• 2:50:15
  may have spasms or paralysis. Inversely, these disturbances of motion may disappear in
• 2:50:20
  a new fit or a new somnambulism. No doubt, these are not absolutely
• 2:50:24
  irrefutable reasons, and it will be necessary to complete the diagnosis when we know
• 2:50:28
  better the nature of these motor phenomena. But after all, these reasons are
• 2:50:33
  sufficient to induce us, while pursuing the study of the hysteric, to enter
• 2:50:37
  into the examination of these phenomena which these patients often present. The motor disturbances
• 2:50:43
  that have the preceding characteristic are very various and irregular, we could range them
• 2:50:48
  into two large groups. First phenomena of at least apparent exaggeration of motion,
• 2:50:54
  which seem to exceed the will of the patient and to develop inopportunely and without
• 2:50:58
  his consent. And second and phenomena of deficiency, in which, on the
• 2:51:01
  contrary, motion seems to fail and not to obey the will and consciousness of
• 2:51:05
  the subject. In the first group, which we designate under the general name
• 2:51:09
  of motor agitations, are to be ranged ticks, careers, and contractures.
• 2:51:16
  In the second the strange functional paralysies or paralysies dependent on ideas. Today we
• 2:51:20
  shall study only the first group one. You all know the commonplace phenomenon of
• 2:51:28
  dicks, which is to be met under so many circumstances. I advise you
• 2:51:33
  to keep the French word, because I do not find in the English language
• 2:51:35
  a good translation. You must not fancy that all ticks are hysteric. There
• 2:51:39
  are some epileptic tics, and even often a psychosthenic tics. But to confine
• 2:51:46
  ourselves to our preceding diagnosis, there are some ticks that have been met with
• 2:51:50
  in patients who have already had all the preceding forms of somnambulism and that alternate
• 2:51:54
  with these somnambulisms. These ticks are essentially constant, tutored by little movements of
• 2:52:01
  the face, head, or limbs, which appear at random, without any
• 2:52:03
  relation either to the present circumstances or to the consciousness of the patients. This
• 2:52:09
  name is generally reserved for rather sudden little movements of short duration, and other
• 2:52:15
  terms are used when the same involuntary movements have a greater extent. These little
• 2:52:20
  muscular shakes may present themselves in all parts of the body. You may especially
• 2:52:24
  notice them in the face. They constitute grimaces of a thousand kinds, affecting
• 2:52:28
  the eyes, the nose, the mouth. The patient puckers his forehead in
• 2:52:31
  various ways, raises or lowers his eyebrows, winks, looks sideways, by
• 2:52:37
  starts. He makes his nostrils tremble, closes or opens them too much.
• 2:52:41
  A very interesting patient, whom we shall study with more detail today, blows
• 2:52:46
  violently through his left nostril. Others seem to wipe their noses or to sneeze
• 2:52:50
  their lips, suddenly draw to the one side or the other, stretch forward
• 2:52:54
  or shrink backward, or else are continually bitten. The upper lip as well
• 2:52:58
  as the lower one. The ticks of the neck have been brought into notice
• 2:53:01
  by being described under the name of psychic's stiff neck. Involuntarily and suddenly,
• 2:53:07
  the patient inclines his head towards one shoulder, or throws it back, or
• 2:53:11
  bends it forward, or turns it on its axis. He repeats these movements
• 2:53:15
  every two or three seconds, in a way which it is impossible to explain
• 2:53:18
  or justify by any present reason. I do not speak now of the ticks
• 2:53:22
  related to the visceral functions, such as the alimentation or breathing ticks. I
• 2:53:28
  at once pass on to the ticks of the limbs. In these the arms,
• 2:53:31
  the hands seem to have taken strange habits. They rise suddenly or move
• 2:53:35
  backwards. The shoulders are shaken convulsively. The legs, instead of regularly performing
• 2:53:41
  the act of walking, every moment interrupted by a strange little shake of the
• 2:53:45
  knee or foot or toes. These little movements, which have innumerable forms,
• 2:53:50
  of course, impede every action of the arms, and when they occur in
• 2:53:52
  the waking state, they often make walking almost impossible. Let us proceed at
• 2:53:58
  once, in order not to interrupt the description to the same kind of involuntary
• 2:54:01
  and useless movements that have a greater extent, and for that reason have been
• 2:54:05
  called careers. This distinction is not essential at the bottom, and must not
• 2:54:11
  prevent us from putting all the motor agitations in the same group. The first
• 2:54:15
  careers that physicians decidedly connected with hysteria were the rhythmical careers, thus called because
• 2:54:20
  the movements were repeated regularly at determinate intervals, like those of a pendulum.
• 2:54:26
  This kind of rhythmical movements occurs very often in the hysteric fit. It constitutes
• 2:54:31
  those complications of the simple fit which I have pointed out to you. Very
• 2:54:35
  often the patients without recovering consciousness cease their emotional manifestations to indulge in some odd
• 2:54:41
  and perfectly regular gymnastics. One of the most commonplace is the salute, which
• 2:54:46
  Sharkog described. The patient, lying on her bed, sits up, bends
• 2:54:50
  her head and body forward, sometimes low enough to touch her knees, as
• 2:54:54
  if she were making a salute, then suddenly throws herself back till her head
• 2:54:58
  falls on her bed. After a moment she begins again. She may thus
• 2:55:03
  make this salute twenty or forty times a minute for hours together. Others have
• 2:55:07
  maliatory movements of the arm or leg. You would think they strike regularly with
• 2:55:11
  a hammer. Others again, have saltatory movements, either when lying or when
• 2:55:18
  standing. They appear to jump or dance regularly. Besides these definite, classified
• 2:55:22
  movements, there are hundreds of others which have no definite name. This one
• 2:55:26
  clinches her fists and suddenly brings them together towards the middle of her body,
• 2:55:31
  then separates them and begins again indefinitely. Another turns her right wrist as if
• 2:55:35
  it were fixed to a wheel, and so forth indefinitely. In all such
• 2:55:39
  acts there is always the same rhythmical regularity. Shaluco quoted in reference to this
• 2:55:45
  the sentence in Hamlet. Though this be madness, yet there's method in it,
• 2:55:48
  and wish to bally master might observe and write down the strange and regular
• 2:55:52
  movements of the patients. These movements have their maximum of strength and rhythmical regularity
• 2:55:58
  during the fit. But it is characteristic of the motor agitations we speak of
• 2:56:03
  that they may very well persist in the interval of the fits. The patient
• 2:56:07
  speaks correctly, he is in possession of the whole of his consciousness, has
• 2:56:11
  all his recollections, can even execute movements with his unharmed limbs. But he
• 2:56:15
  continues to make the rotary movement with his right hand and bring his two hands
• 2:56:18
  into contact or separate them. Though the more distinct hysteric career is thus characterized
• 2:56:24
  by a rhythm, you must not fancy that every other career in which there
• 2:56:28
  is no rhythm is necessarily outside the great neurosis that was believed formerly. But
• 2:56:33
  this too simple diagnosis had to be reformed no doubt. A very irregular career
• 2:56:39
  consisting in characterless shakes of the arms and legs, occurring without any kind of
• 2:56:43
  regularity amidst voluntary movements is usually the common career called career of sydonym, with
• 2:56:48
  which we have not to deal. If, however, such a career appears
• 2:56:52
  in adults or young people after their puberty, you must be on your guard
• 2:56:56
  for such careers. Though a arrhythmic may very well depend on hysteria. A
• 2:57:01
  young woman thirty one years old, terrified by an explosion in a factory where
• 2:57:05
  she worked, presented for more than ten years deliriums, fits, somnambulisms of
• 2:57:11
  all kinds, which were unquestionably hysteric. Amidst these various accidents, taking their
• 2:57:16
  place or alternating with them, she had very long periods of career. This
• 2:57:20
  career, of all the limbs and of the head, presented no kind of
• 2:57:24
  rhythm, and yet we do not hesitate to maintain that it was a hysteric
• 2:57:26
  phenomenon like the other accidents of the patient. We have noted about twenty quite
• 2:57:31
  typical observations of this kind, which clearly show that the a rhythmic career must
• 2:57:35
  be counted among the possible forms of hysteric motor agitation. Its diagnosis then depends
• 2:57:41
  not only on the previous and simultaneous accidents, but also on the mental state
• 2:57:46
  which accompanies it, and on which we must now insist two. Whatever may
• 2:57:54
  be the tix or koreic movements that these patients present, you observe a certain
• 2:57:58
  number of psychological characteristics accus companying them. Which characteristics are the easier to discern,
• 2:58:03
  as these motor accidents continue during the waking state, and it is possible
• 2:58:07
  to question the subject about what he feels. When the movement thus exists during
• 2:58:11
  the waking state, one can better realize the mental state that accompanies it.
• 2:58:16
  First of all, the will of the subject has no influence on it.
• 2:58:20
  Of course, the subject asserts that he does not want at all to make
• 2:58:22
  this movement, and by all his conduct shows us that he would very much
• 2:58:26
  like to be rid of it. But he cannot stop it any more than
• 2:58:28
  he can produce it. The efforts of his will appear powerless. By making
• 2:58:33
  great efforts, he can at most disturb the rhythmical movement, make it less
• 2:58:37
  regular, complicated with shakes of the rest of his body. The movement is
• 2:58:41
  not stopped and begins again more regularly when the subject gives up his efforts of
• 2:58:46
  will. Consciousness does not seem to have a great hold on this phenomenon either.
• 2:58:52
  The subject seems to be scarcely aware of his stick or his career.
• 2:58:54
  Very often he performs it without knowing it. Even when he is attentive,
• 2:58:58
  he feels it but little, or even not at all. When he shuts
• 2:59:03
  his eyes, he may very well declare that now his arm no longer moves
• 2:59:05
  at all. While the movement continues with perfect regularity. We see those phenomena
• 2:59:11
  of insensibility appear here, which will play a greater and greater part in hysteric
• 2:59:16
  accidents. When treating of somnambulism, we spoke but little of insensibility in the
• 2:59:20
  first place. When the somnambulism is at an end, this disturbance may fail
• 2:59:26
  entirely. A somnambulist is not necessarily insensible in the waking state. He is
• 2:59:31
  merely amnesic. It is amnesia that is the stigma of somnambulism, and not
• 2:59:35
  anesthesia. Then during the somnambulism itself, there is, it is true,
• 2:59:39
  a certain anesthesia, but it is very peculiar and only affects the phenomena which
• 2:59:45
  are not connected with the subject's streams. When we come to motor disturbances,
• 2:59:50
  that insensibility, which is called hysteric anesthesia, begins to intervene. It may
• 2:59:54
  present itself in two ways. Sometimes it is systematic and bears only on the
• 2:59:58
  movement that constitutes the tick or the career. The subject does not feel that
• 3:00:03
  he moves his forehead or that he strikes his bed regularly with his hand,
• 3:00:07
  but he feels the other things, and in particular is able to tell you
• 3:00:11
  that somebody seizes his hand while he is performing the Koreic movement. Notice this
• 3:00:16
  systematic anesthesia, which will become more and more important. Sometimes the anesthesia is
• 3:00:20
  more important, and the whole of the limbs affected with a tick or a
• 3:00:24
  career is insensible. For instance, one of the subjects to whom I alluded
• 3:00:28
  used to turn his right hand in a circle and had a seesaw movement into
• 3:00:31
  his right foot. The whole of his right side was nearly insensible these anesthesias,
• 3:00:37
  this kind of unconsciousness must play a certain part in the diagnosis. He
• 3:00:43
  will not meet again with the same characteristics in the same degree in ticks of
• 3:00:46
  another nature, particularly in the ticks of the psychosthenic. With the latter,
• 3:00:50
  the tick, while appearing involuntary, is accompanied by a great deal of consciousness
• 3:00:54
  and attention. The subject performs his tick when he thinks of it, when
• 3:00:58
  he he directs his attention to the organ and tries to keep it motionless.
• 3:01:03
  It seems that with these patients attention increases the tick instead of diminishing it.
• 3:01:09
  Inversely, you may observe that distraction sometimes has a good effect. When the
• 3:01:13
  subject forgets his disease and his mind is absorbed by something else, he leaves
• 3:01:16
  off performing his tick. You see that with him the tick is conscious that
• 3:01:20
  it is in connection with thoughts the subject possesses. There is therefore no anesthesia
• 3:01:26
  in this case. The subject feels his movement very well, and all that
• 3:01:30
  passes in the diseased glimb. With the hysteric, the movement is impeded by
• 3:01:33
  attention, it develops, becomes more complete and regular. In a state of
• 3:01:37
  distraction, it is much oftener accompanied with anesthesia, These characteristics, which serve
• 3:01:43
  to make the diagnosis, also enable us better to understand the nature of the
• 3:01:48
  phenomenon. In fact, the tick and the koreic movement are much more intellectual
• 3:01:52
  phenomena than they appear to be. We notice many mental phenomena at their beginning,
• 3:01:56
  exactly as at the beginning of somnambulisms. Has had an accident to his
• 3:02:01
  face or eye, another a pain in his teeth. The man who constantly
• 3:02:05
  blew through one of his nostrils had had for a long time a scab in
• 3:02:07
  his nose, consequent upon a bleeding at the nose. All the patients who
• 3:02:11
  have had mental stiff necks have had some moral impression relating to a movement of
• 3:02:16
  the head. A girl I am attending now felt very dull. At home,
• 3:02:20
  she worked all day long by a window that looked out into the street.
• 3:02:24
  Her strongest desire was to leave her monotonous work and go out into the
• 3:02:28
  street, at which she constantly looked. At every moment she lifted her eyes
• 3:02:33
  from her work and turned her head to the left in order to see what
• 3:02:35
  was going on in the street. She gradually felt that her head constantly turned
• 3:02:41
  to the left, and even maintained that her hat was too heavy on that
• 3:02:43
  side, an absurd diagnosis. The application of a plaster bandage had singularly aggravated
• 3:02:50
  her state, and now she has a bad mental stiff neck on her right
• 3:02:54
  side. These ideas, these more or less definite mental phenomena, which existed
• 3:03:00
  the beginning, persists throughout the development of the teak or the career. Let
• 3:03:05
  us return to a singular story which I have often related. It tells how
• 3:03:09
  the rhythmic career of that girl of sixteen had begun, who kept on turning
• 3:03:11
  her right wrist and regularly raising and lowering her right foot. One evening,
• 3:03:16
  on the eve of the quarter day, she had heard her parents, who
• 3:03:20
  were poor work people, bewailing their poverty and the difficulty they had in paying
• 3:03:24
  their landlord. She was very much moved, and from that time she had
• 3:03:28
  at night a kind of somnambulism, during which she tumbled and tossed in her
• 3:03:31
  bed and repeated aloud, I must work, I must work. Now.
• 3:03:37
  What was the work of this girl? She had a singular trade, which
• 3:03:39
  was to make doll's eyes, and for this purpose she worked a lathe by
• 3:03:43
  treading a pedal with her foot and turning a flywheel with her right hand.
• 3:03:48
  During her nocturnal somnambulism, she made this movement of the hand and of the
• 3:03:52
  foot. But this movement was evidently accompanied with a corresponding state of consciousness,
• 3:03:56
  which she repeated aloud, I must work. It was a simple somnambulic action,
• 3:04:03
  like all those we have studied. On awaking. She no longer has
• 3:04:05
  any recollection or consciousness of her dream, but the movement continues exactly the same
• 3:04:11
  on her right side. Is it not likely that it is still accompanied with
• 3:04:15
  a state of consciousness of the same kind. We can make this state of
• 3:04:20
  consciousness evident by certain experiments which we know now how to effect. By hypnotizing
• 3:04:24
  the subjects, you find again dreams that account very well for the continuation of
• 3:04:28
  the tick. For instance, a young woman comes to complain of a pretended
• 3:04:33
  vertigo. It appears that in the street, every hundred steps she feels herself
• 3:04:37
  as it were precipitated forward, that she suddenly takes a leap, and has
• 3:04:41
  often fallen while taking it. What a strange vertigo in a state of induced
• 3:04:46
  somnambulism. She relates to us what follows. Once she went to her parents,
• 3:04:50
  who sharply reproached her for her irregular conduct. On going out of their
• 3:04:54
  house, she took a resolution that simplifies many things. She made up her
• 3:04:58
  mind to commit suicide, and in a dream, of course, for she
• 3:05:03
  was happily for her hysteric to a high degree. She fancied she had got
• 3:05:07
  upon the parapet on the bank of the Seine, took a leap, and
• 3:05:09
  was awakened by a fall to the ground. In all such cases, the
• 3:05:13
  existence of a system of images that works unknown to the subject is undeniable.
• 3:05:18
  The difficulty is greater in the case of great uncoordinated careers, in which all
• 3:05:24
  the motor functions seem to take a part. It is no longer merely a
• 3:05:28
  special thought. A system of images that seems to develop outside of consciousness.
• 3:05:33
  It is a function in its entirety, the function of moving the arm or
• 3:05:35
  leg that seems to emancipate itself. Let us notice for the present this phenomenon,
• 3:05:41
  which appears to us for the first time. It will become clearer and
• 3:05:45
  clearer through new studies. Three. Indeed, the problem raised by such dissociated
• 3:05:52
  motor activities working separately outside of consciousness becomes singularly complicated when we examine other forms
• 3:05:58
  they may assume, which u are. Among the most important phenomena of hysteria
• 3:06:03
  are referred to tremors and contractures. In a very great number of cases,
• 3:06:07
  hystericals have other disturbances of motility than ticks and careers. Their limbs are affected
• 3:06:13
  with a strange agitation differing from the preceding ones. For example, they are
• 3:06:18
  seized with tremors. The arm has regular little oscillations of an average rate of
• 3:06:22
  five to nine a second. These oscillations are nearly continual. There are some
• 3:06:28
  subjects with whom they never stop, either when their rest or when they move.
• 3:06:33
  There are some others with whom these tremors are intermittent, disappearing at the
• 3:06:37
  time of voluntary activity and increasing at the time of diversion and rest, but
• 3:06:41
  it is not possible to establish any rule for you. Often observe the reverse,
• 3:06:46
  in the form of intentional trembling, analogous to that of disseminated sclerosis.
• 3:06:50
  The subject, almost motionless when at rest, begins to tremble when he seeks
• 3:06:54
  to perform a movement Figure seven. These tremors occur under various conditions, sometimes
• 3:07:01
  gradually after paralytic phenomena, very often suddenly after an emotion. One of the
• 3:07:05
  finest cases I have observed is that of a workman who, in consequence of
• 3:07:09
  the breaking of a scaffolding, remained suspended at the height of a sixth floor.
• 3:07:15
  Others began to tremble after a fright after receiving bad news. In one
• 3:07:20
  of my observations, the tremor of which began in the right arm, was
• 3:07:22
  consequent on a dream the subject fancied he was pushing back an assassin with his
• 3:07:26
  right arm. In some rare cases, you can find behind the tremors as
• 3:07:31
  behind the ticks, the existence of a fixed idea separated from consciousness. A
• 3:07:37
  woman who presented an intense tremor of the right hand at last confessed that this
• 3:07:41
  tremor had appeared in consequence of her having long practiced automatic writing in order to
• 3:07:46
  question spirits. It was enough to put a pencil in her right hand for
• 3:07:50
  the tremor to cease and to be transformed into writing. So we had certainly
• 3:07:54
  to deal with a kind of tick, with an incomplete subconscious action which assumed
• 3:07:58
  the appear pearance of a tremor. But in most cases there is nothing behind
• 3:08:03
  the tremor but a vague emotive state and a kind of transformation of the motor
• 3:08:07
  function of the limb. It is what we observe in a higher degree in
• 3:08:11
  the exceedingly serious phenomenon of hysteric contractures. You know that the history of this
• 3:08:16
  phenomenon may be said to begin with the lessons of Brody eighteen thirty seven,
• 3:08:22
  lectures illustrative of certain local nervous affections. Then we have the works of Coulson
• 3:08:26
  eighteen fifty one, of Paget eighteen seventy seven, of Charcourt of La Seige
• 3:08:33
  of Pauliche. This history corresponds to the evolution of the greatest problems of medicine,
• 3:08:39
  For physicians have been led gradually to separate the hysteric contractors from all the
• 3:08:43
  osseous, articular, medullary, and nervous affections with which they were formally confounded.
• 3:08:50
  It amounts to saying that this problem is connected with everything in medicine.
• 3:08:54
  This contractor is a state of moderate contraction of an ensemble of muscles which maintains
• 3:08:58
  a limit, a determinate position, and that in an involuntary, unconscious and
• 3:09:03
  indefinite manner. Such contractors can be observed on absolutely all the muscles of the
• 3:09:09
  body, and in each region they raise medical problems which I can only point
• 3:09:13
  out to you. In the eyes, they determine the spasm of the orbicularis
• 3:09:16
  and the occlusion of the eyelids at the mouth, they are located very often
• 3:09:20
  on only one side, and they bring on the distortion of the face.
• 3:09:24
  In both cases they must be carefully distinguished from paralytic phenomena which they simulate,
• 3:09:30
  from the tosis of the eyelids which fall passively instead of contracting, and from
• 3:09:33
  the paralysis of one side of the face, which equally causes the face to
• 3:09:37
  deviate to the opposite side. You know the importance of the tosis of the
• 3:09:41
  eyelids and of the unilateral paralysis of the face. The diagnosis is of capital
• 3:09:46
  importance. The contractor may be seated in the neck, back, abdomen,
• 3:09:50
  or thorax, and in each place new problems arise. Here it simulates diseases
• 3:09:56
  of the vertebrae, deviations of the vertebral column, where it transforms the breathing
• 3:10:01
  and causes you to believe there is pulmonary disease. In other cases, it
• 3:10:05
  assumes the appearance of all possible tumors of the abdomen. It is these contractors
• 3:10:09
  which originate the great medical errors, of which hysteria is the occasion. As
• 3:10:15
  regards the limbs, we have the contractors of the legs of the hip,
• 3:10:18
  with the important problem of the white tumor of the knee and of tuberculous coxalgae.
• 3:10:24
  I think the most expert physician ought never to boast that he will make
• 3:10:26
  no mistake when he has to decide between hysteric coxalgae and tuberculous coxalgae. As
• 3:10:33
  regards the arms, the difficulty is not so serious in general, and yet
• 3:10:37
  you must beware of false luxations of the shoulder, of arthrites, and of
• 3:10:41
  cysts of the elbow or wrist. There is not a more important clinical problem
• 3:10:46
  than that of contractors. Curiously enough, we also meet here with an important
• 3:10:52
  psychological problem, with a question that is certainly one of the most obscure of
• 3:10:54
  pathological psychology. It is obvious that a certain number of the nomena connected with
• 3:11:00
  these contractors are very clear. First, we know that contractors are consequent,
• 3:11:05
  like all hysteric phenomena on thoughts and emotional phenomena. A shock has no action
• 3:11:09
  in this direction, except when it determines great phenomena of imagination. I will
• 3:11:13
  explain myself. An individual has his legs in a state of contracture because he
• 3:11:18
  says a carriage ran over them. After verification, it is found that the
• 3:11:22
  carriage passed beside him, and that he felt nothing at all. A real
• 3:11:26
  shock would do less than this imaginary shock. According to all the observations that
• 3:11:31
  have been made, the production of a contracture requires exactly as does that of
• 3:11:37
  a somnambulism, some emotion, some fear for the future, some terror,
• 3:11:41
  some dream, et cetera. It is the same with the cure of these
• 3:11:43
  contractors. In certain cases, they persist indefinitely. I have two cases which
• 3:11:50
  lasted for thirty years in other cases, they are suddenly cured through influences that
• 3:11:54
  are incomprehensible if one does not take into account imagination and emotion. These diseases
• 3:12:01
  are among those which make the fortune of religious relics and miraculous springs. When
• 3:12:05
  you hear a story about a cripple with hard, shriveled legs twisted under his
• 3:12:09
  body, who was rolled to the spring in a low carriage, and got
• 3:12:11
  up again, bearing away his carriage on his shoulders, you need not have
• 3:12:16
  the least hesitation in pronouncing the case one of hysteric contractors. If you are
• 3:12:20
  fond of erudition, I recommend you to read the admirable book of Caree de
• 3:12:24
  Morduran on the miracles wrought in the cemetery of Saint Madao on the tomb of
• 3:12:30
  Deacon Paris, seventeen thirty seven. It is also phenomena of this kind that
• 3:12:35
  physicians have cured in determinate conditions by all sorts of processes, by the electric
• 3:12:41
  current, by magnets, by the application of metallic plates, by merely speaking
• 3:12:46
  to the patients. So there are a great many psychological phenomena as well.
• 3:12:50
  At the end as at the beginning of contractors. You also meet with some
• 3:12:54
  during the time the phenomenon itself lasts. First of all, the contractor is
• 3:12:58
  more frequently systematic, at least at its beginning, than is generally believed.
• 3:13:03
  The limb is not stiff in every position, depending on the unequal strength of
• 3:13:07
  the different muscles. It keeps a particular attitude, requiring a certain harmony of
• 3:13:11
  permanent contractions. A woman has seen in the hospital an individual who has died
• 3:13:16
  of tetanus. She reproduces his attitude and keeps her head thrown back. Another
• 3:13:22
  of whom I have often spoken constantly keeps both her feet extended in the position
• 3:13:26
  of Christ on the cross. She has, moreover, a religious delirium in
• 3:13:30
  which she thinks herself crucified. She has crises of somnambulism and catalepsy, in
• 3:13:35
  which her trunk, arms and head remain for hours together, absolutely in the
• 3:13:39
  attitude they must have in a crucified person. During these crises, the entire
• 3:13:45
  attitude decidedly corresponds to a delirium and to thoughts. When in the interval of
• 3:13:50
  the crises the feet alone keep the contracture. It is very likely that something
• 3:13:54
  of the delirium persists. From another point of view, we may notice that
• 3:13:58
  the contrast varies with certain psychological facts. If the subject is very quiet,
• 3:14:03
  if nobody touches her contractured limb, and if she herself does not try to
• 3:14:07
  make a voluntary movement, we may see that the contractor decreases and that the
• 3:14:11
  limb unbends. Lastly, we may observe in contractuous many forms of insensibility.
• 3:14:18
  The subject does not feel the fatigue of this permanent contracture. Very often she
• 3:14:22
  does not feel anything at all in her contractured limb. In a word,
• 3:14:24
  you see that we may notice in contractors a great number of facts analogous to
• 3:14:28
  those we have observed in ticks and careers, showing us a kind of abnormal
• 3:14:33
  functioning of a psychological system which, in some way or other has become independent.
• 3:14:39
  I must, however, add, that we meet here with a new
• 3:14:41
  difficulty, the germ of which indeed was already to be found in careers and
• 3:14:45
  tremors. Let us try, with our sound limbs to copy the attitude of
• 3:14:48
  a rhythmic career and register our movements accurately. You will find that you are
• 3:14:54
  much more awkward than a hysteric person, and that unless you have practiced specially
• 3:14:58
  to this, you cannot obtain the same regularity. Try to keep your arm
• 3:15:03
  in the position of a hysteric contractor and describe the movement of the arm.
• 3:15:07
  You will remark that you have not the same perseverance or courage as the patient.
• 3:15:11
  After a short time, your arm trembles and is displaced, while the
• 3:15:16
  hysteric contracture has not changed. If therefore, we suppose there is a psychic
• 3:15:20
  action in these hysteric phenomena, it must be acknowledged that this action is not
• 3:15:24
  identical with ours, but that it is performed in other conditions. Here is
• 3:15:30
  my hypothesis. Think of it what you please. The actions that are manifested
• 3:15:33
  by muscular movements present different degrees of perfection, corresponding to the development and systematization
• 3:15:39
  of the consciousness that accompanies them. These degrees of perfection are manifested first of
• 3:15:45
  all by psychological characteristics of the action delicacy, harmony, usefulness of the act,
• 3:15:50
  but it is also manifested by properties of the movements themselves. The muscular
• 3:15:54
  movement of a draftsman's hand is not the same as the muscular movement of a
• 3:15:58
  dog's or a crocodiles pour. There are some particular physiological properties accompanying the perfection
• 3:16:03
  of the act. Some are known. The rapidity of the contraction is much
• 3:16:07
  greater, and in particular, the rapidity of the decontraction of the fall of
• 3:16:11
  the muscle is much more considerable. In the muscles of the lower animals,
• 3:16:16
  the contraction takes place slowly and disappears slowly. We see also the same modifications
• 3:16:22
  of the muscular contraction brought about by fatigue. By repetition, muscular contraction changes,
• 3:16:28
  becomes slower, has a long period of decontraction, as in the case
• 3:16:31
  of lower animals. I even think, excuse the temerity of these suppositions,
• 3:16:37
  that there must be in these different muscles, and in these different states of
• 3:16:39
  activity of the muscle, some anatomical differences. Great stress has been laid recently
• 3:16:45
  on the two organs that exist in the muscular fiber, the fibrils, which
• 3:16:48
  give short contractions, and the sarcoplasm, which gives long and permanent contractions.
• 3:16:54
  The latter predominates in the smooth fibers of the viscera, the former in the
• 3:16:58
  striated muscles of the voluntary movements. I suppose that it will be possible later
• 3:17:03
  on to observe some modifications in the proportion of these two substances in the muscles
• 3:17:07
  of different animals according to their state of evolution, and in the different states
• 3:17:11
  of the same muscles in rest or in fatigue, for instance. Now action
• 3:17:16
  by becoming unconscious in hysterics, by separating from consciousness, loses something of its
• 3:17:22
  dignity, retrogrades in a manner, and assumes an appearance that recalls the action
• 3:17:26
  of the visceral muscles, the action of the lower animals, and the movements
• 3:17:30
  of the fatigued muscles, as if the activity of the sarcoplasm prevailed over that
• 3:17:35
  of the fibrils. This is what, in my opinion, gives to the
• 3:17:39
  subconscious actions of the hysteric those abnormal characteristics we saw in tremors and contractures.
• 3:17:45
  It is this general idea that prepares us for the examination of the phenomenon of
• 3:17:48
  hysteric paralyzes. End of section six. Lecture seven paralyses diagnosis the clinical style
• 3:18:00
  body of hysteric paralysis. The beginning of these paralyses traumatic neuroses, the most
• 3:18:05
  frequent types of paralysis. The diagnosis of hysterical paralysis, the intrinsic characters,
• 3:18:13
  the localization and form of the paralysis, the examination of the reflexes, the
• 3:18:18
  value of the different signs, the extrinsic characters, the modification of sensibility,
• 3:18:24
  the description of hysteric anesthesia. Fashions prevail in medical studies as in costumes.
• 3:18:31
  At one time, one problem raises general enthusiasm, and everybody gives it his
• 3:18:35
  exclusive attention forgetting all the others. Twenty years ago it was hysteric somnambulism that
• 3:18:41
  was in fashion. Nowadays one seems very much behind the age when one speaks
• 3:18:46
  of somnambulism. The latest fashion is to apply one's self only to the study
• 3:18:50
  of hysteric paralysis. Let us follow the fashion and reflect for a time on
• 3:18:54
  this curious problem of physiology and psychology. This lecture will be d voted to
• 3:19:00
  the study of hysterical paralysis from the clinical point of view. The next lecture
• 3:19:05
  will analyze the psychological features of paralysis and anesthesias. The hysteric are capable of
• 3:19:11
  completely paralyzing a part of their body. You know what I mean by such
• 3:19:15
  an expression. I need only state that patients who have had the accidents we
• 3:19:20
  spoke of before, fits of all kinds simple or complicated somnambulism, careers of
• 3:19:24
  a special kind, mysterious contractures like those we have seen, may besides have
• 3:19:30
  paralytic accidents. It does not mean that a paralysis that presents itself in a
• 3:19:35
  woman who has had fits and somnambulism is necessarily a hysteric paralysis, obeying the
• 3:19:39
  psychological laws of this kind of disease. It even seems to be the clearest
• 3:19:45
  result of the present studies, which have spread everywhere nowadays to show us that
• 3:19:48
  it is not always so, that often, very often, even the paralysis
• 3:19:52
  that appears is a commonplace paralysis corresponding to a cerebral or medullary lesion. The
• 3:19:58
  diagnos to be made is exceedingly difficult and important, But it is nevertheless true
• 3:20:03
  that in a certain number of cases these subjects have paralyses analogous to their other
• 3:20:09
  accidents, whose evolution is the same, and whose diagnosis and nature we must
• 3:20:13
  study. One. These paralyzes appear in about the same circumstances as the other
• 3:20:20
  phenomena. They are always brought about by an accident, which, while very
• 3:20:24
  slight in itself, is accompanied by a violent moral emotion and by disturbances of
• 3:20:28
  the imagination. One of the oldest cases, and a very interesting one from
• 3:20:33
  a historical point of view, is quite typical. I allude to the observation
• 3:20:37
  of Estelle, which originated the remarkable book of an old magnetizer, Monsieur de
• 3:20:41
  Spinde's. In eighteen forty, a girl twelve years old had fallen into a
• 3:20:46
  passion, and, against her mother's will, had quarreled and fought with one
• 3:20:50
  of her little friends. In the heat of the fight, she had been
• 3:20:54
  knocked to the ground and had fallen rather violently on her posterior. This fall
• 3:20:58
  had been complicated by an aggravating circumstance, namely, her frock had been much
• 3:21:03
  dirted in a particularly significant part. The pain was slight and did not prevent
• 3:21:07
  the girl from getting up again and returning home. But what is essential is
• 3:21:11
  that she experienced a feeling of shame, of fright, and tried to hide
• 3:21:16
  her fault. The next day began a complete paralysis of both legs, a
• 3:21:20
  serious paraplegi which lasted eight years. Bear this in mind, eight years paralysis
• 3:21:26
  of the lower limbs for having fallen lightly on her backside. Such facts were
• 3:21:31
  hardly known at that time to any but to those strange magnetizers. The same
• 3:21:35
  authors of whom we spoke lately, Brodie, Todd, Duchen de Boulogne,
• 3:21:39
  Russell Reynolds, Schalco, Oppenheim, and all the modern authors were the ones
• 3:21:45
  who began to study what was first called traumatic neuroses. Indeed, traumatic accidents
• 3:21:50
  are among the most frequent causes. Railway catastrophes give rise to many of these
• 3:21:54
  accidents, and some physicians had even adopted the expression of railway spine. Falls
• 3:22:01
  from carriages, from horseback and shocks received in battles are their most common origin.
• 3:22:07
  For instance, a drunken carter falls from his box on his right arm
• 3:22:09
  and presents a paralysis of this arm. A man of eighteen falls in a
• 3:22:13
  staircase on his back. The consequence is a paralysis of the legs and a
• 3:22:18
  contractor of the lumber muscles. Often the shock is only imaginary. The celebrated
• 3:22:24
  patient who appears in the first Lessons of Chalcourt thinks he has been wounded by
• 3:22:28
  a carriage which did not run over him. One of the last observations I
• 3:22:31
  have noted is very strange. A man traveling by rail had done an imprudent
• 3:22:35
  thing. While the train was running, he had got down on the step
• 3:22:39
  in order to pass from one door to the other. When he became aware
• 3:22:43
  that the train was about to enter a tunnel, it occurred to him that
• 3:22:46
  his left side, which projected, was going to be knocked slantwise and crushed
• 3:22:50
  against the arch of the tunnel. This thought caused him to swoon away,
• 3:22:54
  but happily for him, he did not fall on the track, but was
• 3:22:56
  taken back inside the carriage, and his left side was not even grazed.
• 3:23:01
  In spite of this, he had a left hemiplegy. Other circumstances may act
• 3:23:07
  similarly, as for instance, fatigues, especially when located in a limb.
• 3:23:11
  A house painter felt his hand very tired while painting a ceiling and presented a
• 3:23:15
  severe paralysis of his right hand. I found it likewise in a girl who
• 3:23:20
  was learning the violin, in those who had tired their hands on the piano.
• 3:23:24
  But here again to the fatigue must be added an emotional state. As
• 3:23:28
  in this classical observation of Feiret, a girl who tires herself in learning a
• 3:23:33
  piece on the piano is seized with the paralysis of her right hand. At
• 3:23:35
  the moment when she is to play this piece at a ceremony. The part
• 3:23:39
  of emotion is so great that it may be sufficient when added to a purely
• 3:23:43
  imaginary fatigue. As in this other observation of Fairet, a girl dreams at
• 3:23:48
  night that she is pursued by a man, and that she runs very fast
• 3:23:52
  in the streets of Paris. She dreams that she is exhausted with fatigue,
• 3:23:56
  though she has not moved. The next day, is none the less paraplegic.
• 3:24:01
  Lastly, there are some paralyses that follow somnambulisms and crises, without our
• 3:24:05
  knowing very well for what reason. But as we shall see later on,
• 3:24:09
  they affect limbs formally paralyzed or having in them causes of decay, rakitic defamation,
• 3:24:15
  old scars, varices, et cetera. The paralyzes thus brought about may
• 3:24:20
  be very various. For the present I only point out to you those most
• 3:24:24
  common and most anciently studied. I reserve others for the end of this study
• 3:24:28
  because they are particularly interesting as regards the interpretation. The most common hysteric paralysies
• 3:24:33
  seem to be analogous to the great organic paralysis. The most frequent The most
• 3:24:39
  carefully studied nowadays is great hemiplegi, in which one half of the body is
• 3:24:43
  completely paralyzed. Usually, it is true hysteric paralysis strikes the limbs rather than
• 3:24:48
  the face, but the rule is not absolute. When the paralysis is in
• 3:24:52
  the right side, for instance, the face and speech may be paralyzed as
• 3:24:56
  well as the arm and leg. Here is a girl nineteen, already neuropathic
• 3:25:01
  and daughter of an epileptic mother, who lost her father a fortnight ago.
• 3:25:05
  The poor girl supported him with her right arm during his agony. On the
• 3:25:09
  very evening of the day on which she died, she felt exhausted with fatigue,
• 3:25:13
  especially in her right side, and her right leg trembled when she tried
• 3:25:16
  to support herself on it. She could not sleep, thinking every moment she
• 3:25:20
  saw and heard her father. The next morning, she had a pain in
• 3:25:24
  her abdomen. The menstrual discharge reappeared out of its period. The weakness in
• 3:25:28
  the right side had increased. On the third day, the right arm and
• 3:25:31
  leg could still move, but trembled continually. On the following day, the
• 3:25:35
  right hemiplegi was complete and speech was entirely lost. After a fortnight, the
• 3:25:41
  movements were little by little completely restored. I will observe to you here that
• 3:25:45
  this hemiplegie may appear in a more dramatic manner after a convulsive fit or a
• 3:25:50
  profound sleep, which then absolutely simulates the apoplectic stroke. In such cases,
• 3:25:56
  the diagnosis is very delicate. Though the hypothesis of her hemi plea and a
• 3:26:00
  hysteric sleep is difficult and rare. You must, however, think of it.
• 3:26:03
  Not long ago I recognized an accident of this kind in a man sixty
• 3:26:07
  years old, who at first sight looked quite as if he had had an
• 3:26:11
  apoplexy. The second severe and frequent form is paraplegy, in which both legs
• 3:26:16
  are completely paralyzed. This accident often appears when an individual is seized with an
• 3:26:22
  emotion while walking. It is about what English physicians call the giving way of
• 3:26:26
  the legs. A young woman of twenty five. What is strange is that
• 3:26:31
  she was a nurse who, as such ought to have known better. Was
• 3:26:33
  one evening, crossing a dormitory she saw a patient in a crisis of somnambulism,
• 3:26:39
  getting up and going about, wrapped up in a sheet. She took
• 3:26:41
  her for a phantom. Was terribly frightened, felt her legs shake under her,
• 3:26:46
  and fell down without being able to get up again. She remained paraplegic
• 3:26:50
  for several months. You must also beware of these paraplegies after childbirths and after
• 3:26:56
  somewhat long diseases in which the subjects have remained long in bed. The third
• 3:27:01
  form will be monopligy, which strikes a limb or a segment of a limb.
• 3:27:05
  For these paralyses may be very limited. With the painter I spoke of,
• 3:27:09
  it affected only the right wrist. In other cases it affects the articulation
• 3:27:13
  of the elbow or the shoulder, the foot, or the whole of the
• 3:27:16
  leg. A long discussion, which is not yet quite settled, bears upon
• 3:27:20
  the existence of hysteric facial paralysis. Shalcour denied them and maintained that what was
• 3:27:26
  called a paralysis of the right side of the face was nothing but a contractor
• 3:27:28
  of the left side. He only admitted in the face the existence of the
• 3:27:33
  glosso labi at spasm. This opinion has been much contradicted, and many cases
• 3:27:37
  of facial paralysies have been brought forward, which seem to be typical. For
• 3:27:41
  my part, I do not see why paralysis of the eyelids, mouth,
• 3:27:45
  and cheeks should not exist. And I have recognized some cases of this disease
• 3:27:48
  which seemed to be convincing. Lastly, there may be paralyses of the trunk,
• 3:27:54
  and I refer you to the most interesting, in my opinion, of
• 3:27:56
  the studies I have had the opportunity of making on this matter. The subject
• 3:28:01
  is a girl who had fallen into a well, and who, after this
• 3:28:03
  accident, presented a remarkable flacidity of all the muscles of the trunk. She
• 3:28:09
  was quite unable to stand or sit. Her head and body fell indifferently on
• 3:28:13
  every side. At the same time, she had a remarkable paralysis of the
• 3:28:16
  diaphragm, on which we cannot insist for the present. Such are the chief
• 3:28:20
  forms presented by hysteric paralysis. I must now somewhat insist on their diagnosis,
• 3:28:26
  which is of capital importance for you. Two. The diagnosis of hysteric paralysis
• 3:28:33
  can be made in two manners. First, in an extrinsic manner, which
• 3:28:37
  was formerly considered as the more important. In this case, you examine the
• 3:28:41
  symptoms that a foreign of the paralysis itself, the disturbances of the sensibility,
• 3:28:46
  the disturbances of the intelligence, the simultaneous phenomena, the circumstances of the appearance,
• 3:28:52
  et cetera. Secondly, you can make this diagnosis by an intrinsic examination,
• 3:28:58
  which chiefly takes into account the para analysis itself and its clinical characteristics.
• 3:29:03
  This second method appears nowadays to be more accurate and scientific, and is often
• 3:29:07
  preferred. As I told you, the fashion nowadays requires that you should discover
• 3:29:11
  the curious little modifications of the reflexes which may characterize a paralysis, without having
• 3:29:16
  to make any inquiry of the patient or those around him. Let us then
• 3:29:22
  first give our attention to those intrinsic characters, since at the present time they
• 3:29:26
  are considered as more serious. You may first, in certain cases take into
• 3:29:31
  account the localization and form of the paralysis. An Austrian author, Professor Freud,
• 3:29:35
  has insisted a great deal on this point. Hysteric paralysis never affects only
• 3:29:41
  one muscle. It is always a paralysis in a mass which strikes a group
• 3:29:43
  of muscles. Do not suppose that every group of muscles may be thus affected.
• 3:29:48
  The group that is affected is always one that is necessary to a function
• 3:29:52
  of a part of the body. Yet the paralysis does not extend beyond the
• 3:29:56
  limit of the muscles necessary for the functioning of this part of the body.
• 3:30:00
  It does not easily encroach upon other regions. It is otherwise in all organic
• 3:30:05
  paralyses. A lesion of a nerve may affect only certain muscles. A lesion
• 3:30:09
  of a nervous plexus affects several muscular groups. For instance, in the paralysis
• 3:30:15
  of the leg brought about by hysteria, the thigh and butter are affected,
• 3:30:18
  but the sacral region and the genital region are intact, which is not the
• 3:30:22
  case in spinal paralyses. The same author remarks further that hysteric paralysis is often
• 3:30:28
  seated in the extremities of the limbs only, which does not happen in organic
• 3:30:31
  paralyses, the latter more often affecting segments that are near the center. Notice
• 3:30:37
  also that hysteric paralysis is exaggerated, always carried to an extreme, which is
• 3:30:41
  very rare in organic paralyzes. A man whose hemiplegia is consequent on a cerebral
• 3:30:46
  hemorrhagy can still move a little and make some efforts to conceal his paralysis.
• 3:30:52
  One in whom hemiplegia is due to hysteria has no longer a shadow of a
• 3:30:56
  movement in his diseased side. Hence this difference in the gait which Todd and
• 3:31:01
  Charcour formally pointed out, and for which they invented rather barbarous Greek words.
• 3:31:07
  The subject affected with organic chemiplegie, they said, as a helicopod walk.
• 3:31:11
  He walks helically, throwing his paralyzed legs sideways by a movement of his loins.
• 3:31:18
  The subject affected with hystericchemiplegi has a helkopode walk. He drags his paralyzed
• 3:31:22
  leg in walking as if he did not trouble himself about it in the least,
• 3:31:26
  as if it no longer existed at all. To these positive characteristics are
• 3:31:31
  added negative characteristics. Hystericchemiplegia is not accompanied by any other serious disturbances in the
• 3:31:37
  diseased limb. In particular, there is no atrophy, or at least a
• 3:31:41
  very long time is required for it to appear after the period of immobility,
• 3:31:45
  so you must always carefully measure the two limbs of the patient. The existence
• 3:31:48
  of a notable atrophy will help you to recognize certain lesions of the medulla or
• 3:31:52
  brain. Nor are there any disturbances of the electric reactions. The reaction called
• 3:31:58
  reaction of degen eneration, which is so rapid in certain forms of medulla lesions,
• 3:32:03
  does not exist in hysteric paralysis. We come at last to the question
• 3:32:07
  of the reflexes, now considered as very important. Chiefly, it must be
• 3:32:13
  said, on account of the studies of a French physician, Monsieur Babinski,
• 3:32:16
  who has devoted himself to this subject. In a general way, all the
• 3:32:20
  reflexes of a limb must remain normal in a hysteric paralysis. This may easily
• 3:32:26
  be understood since these reflexes depend for the most part on lower madala or cerebral
• 3:32:31
  centers, which are supposed not to be affected with any disturbance. On the
• 3:32:35
  contrary, in an organic lesion, a certain number of reflexes must always be
• 3:32:39
  injured, because the lesion always bears more or less upon one of these centers.
• 3:32:43
  You have first to consider the tenderness reflexes in the elbow, wrist,
• 3:32:46
  knee, tendon of Achilles. They must not be suppressed as in tabes,
• 3:32:52
  nor exaggerated as in cerebral hemorrhagy, or in the lesions of the paramidal tract.
• 3:32:56
  You will seek, especially in the foot. For them, the epileptoid
• 3:33:00
  trepidation the clonus, determined by the sudden raising of the foot, which appertains
• 3:33:05
  exclusively to the lesions of this paramidal tract, does not exist in hysterical paralysis.
• 3:33:11
  You will also examine the cutaneous reflexes. For instance, Babinski has shown
• 3:33:16
  the very important sign given by the toes when the ball of the foot is
• 3:33:20
  slightly rubbed with a pin in normal adults, for there are some irregularities in
• 3:33:24
  children, the toes bend together towards the soul of the foot. In the
• 3:33:30
  lesions of the medulla, on the contrary, you observe a raising and extension
• 3:33:33
  of the toes, but nothing like this can be observed in hysteria. Excitation
• 3:33:39
  of the skin in different regions of the body, on the internal face of
• 3:33:41
  the thighs, on the abdomen, on the neck determine in a normal man
• 3:33:46
  contractions of the poissier muscles, that is to say, the muscles of the
• 3:33:50
  skin, which disappear in organic accidents and not at all in neuropathic phenomena.
• 3:33:56
  Don't forget to examine carefully the reflexes of the pupils to light to accommodation.
• 3:34:01
  The slightest disturbances of these reflexes must put you on your guard. You know
• 3:34:07
  that the least alteration of these reflexes strongly inclines you to admit organic lesions,
• 3:34:11
  either those of tabes or those of syphilitic meningitis. Lastly, Babinski has shown
• 3:34:18
  the importance of the preservation of the muscular tonus in hysterical paralysis. He insisted,
• 3:34:22
  too, with great accuracy, on the preservation of certain unconscious movements produced
• 3:34:26
  by association in these apparently paralyzed limbs. This fact is analogous to the observation
• 3:34:33
  of the preservation of certain subconscious sensations in spite of hysterical anesthesia that we have
• 3:34:37
  to study in the following lecture. According to these authors, this ensemble of
• 3:34:43
  signs is absolutely characteristic, and it is possible to recognize a hysteric hemiplegy solely
• 3:34:48
  through this objective examination, which requires nothing of the patient's psychological observation. The
• 3:34:54
  thing is perfect theoretically, but practically it is much more difficult than is supposed.
• 3:35:00
  Most of the signs we have spoken of when treating of the localization of
• 3:35:03
  paralysis either are indecisive or apply, but to quite particular cases. The signs
• 3:35:11
  of the reflexes are much more important, but can we absolutely trust them.
• 3:35:15
  First of all, we must eliminate the signs derived from the mere exaggeration of
• 3:35:18
  the tenderness reflexes. You cannot eliminate hysteria merely because a patient throws his leg
• 3:35:24
  upward too strongly after the shock of the rotul attendant. For this exaggeration of
• 3:35:28
  the reflex is exceedingly difficult to appreciate and very irregular. A very great number
• 3:35:33
  of subjects, when a little moved or nervous, throw their legs too strongly
• 3:35:37
  upward when their knee is struck. It may be said that one should distinguish
• 3:35:41
  the real reflex, which is quick and simple, from the semi voluntary,
• 3:35:46
  semi emotional movement which is added to it, and which is too tardy,
• 3:35:50
  too long, too much generalized. All this is true enough, but in
• 3:35:52
  practice I defy you to make the distinction. And moreover, I am inclined
• 3:35:56
  to believe that in hysteric and neurosthenic Paine there is often a real exaggeration of
• 3:36:01
  the reflexes, which is perhaps due to a diminution of cerebral inhibition, the
• 3:36:07
  sign of the clonus of the foot has more importance. The significance is much
• 3:36:11
  discussed at the present time, and several authors point out cases of unquestionably hysteric
• 3:36:16
  paralysis in which it has been met with. Some authors maintain that if they
• 3:36:20
  take the graphic of the shake with the registering apparatus, they recognize the regularity
• 3:36:26
  of the organic clonus in contradistinction to the irregularity of the hysteric clonus, but
• 3:36:31
  this is not quite certain. Babinski's sign of the toes is exceedingly interesting.
• 3:36:37
  In reality, you need not hesitate when it manifests itself clearly. I don't
• 3:36:41
  think it has yet been distinctly observed in a hysteric paralysis, but it is
• 3:36:46
  an irregular sign which often fails totally. Many subjects do not react at all,
• 3:36:50
  or react by a retraction in a mass of the leg. The pupillary
• 3:36:54
  reflexes are likewise of capital importance. Be always on your guard when you meet
• 3:36:58
  with the sign of Argyll Robertson. But this sign is not absolutely characteristic either.
• 3:37:05
  First of all, many neuropathic patients have pupillary dilatation. Then in some
• 3:37:09
  hystericals. There are contractors of the iris with dilatation or myosis, which prevent
• 3:37:13
  the reflexes from taking place easily, and may again be causes of error.
• 3:37:20
  In a word, it is certain that the intrinsic examination gives us exceedingly valuable
• 3:37:24
  indications. The invasion of the face, the disturbances of speech, the clonus,
• 3:37:28
  the signs of the toes, the pupillary disturbances are strongly in favor of
• 3:37:33
  an organic lesion. Unfortunately, they are not absolutely certain signs, and I
• 3:37:37
  think one is quite wrong in making things more difficult than they are, in
• 3:37:41
  refusing the unquestionable services rendered to diagnosis by much more characteristic extrinsic signs. Three,
• 3:37:50
  the most important extrinsic sign of all is derived from the examination of sensibility,
• 3:37:56
  the modifications of which are of the greatest importance in hysteria. We already
• 3:38:00
  met with them when studying careers and contractures. We observed that the hysteric patient
• 3:38:05
  often appears not to know what is going on in her arm or her leg,
• 3:38:09
  that she does not feel the fatigue of her protracted shakes or contractions,
• 3:38:13
  and that, what is more, she may not feel the movement of which
• 3:38:16
  her arm is the seat. This anesthesia is still more characteristic in paralysis.
• 3:38:20
  We must therefore insist now on its study. For a long time physicians had
• 3:38:26
  had some vague notions about the odd insensibilities of these patients. You know that
• 3:38:31
  in the Middle Ages people recognized witches and possessed persons by seeking on their bodies
• 3:38:35
  for what was called the claw of the devil. It was a more or
• 3:38:39
  less extensive part of the skin in which the subject was insensible to any touch
• 3:38:43
  or prick. The expert entrusted with this work would close the eyes of the
• 3:38:48
  subject, and armed with a sharp needle prick here and there the different parts
• 3:38:52
  of the body. The sufferer was to answer with the cry to each prick,
• 3:38:56
  and the claw of the devil on a certain spot was recognized from the
• 3:38:58
  face fact that he did not cry when this spot was examined. Later on
• 3:39:03
  Sidenum in sixteen eighty one, then Luis Villermey in eighteen sixteen, George in
• 3:39:09
  eighteen twenty four, l'aneouzie in eighteen forty six. Later still Briquet, Charcour,
• 3:39:13
  and all the modern authors have strongly insisted on all the varieties of this
• 3:39:16
  phenomenon. For the present we shall attend to the indications that anesthesia can give
• 3:39:22
  us as regards the diagnosis of hysteric paralysis, and especially to its seat and
• 3:39:28
  depth. This insensibility must be sought for this purpose in three organs, on
• 3:39:33
  the skin, on the mucous membranes, and in the muscles. It may
• 3:39:37
  indeed extend either over the cutaneous coat of the limb or over the accessible mucous
• 3:39:41
  membranes of the natural orifices. Or it may bear upon the sensations of motion
• 3:39:46
  and upon the notion of the position of the limbs. In the first case,
• 3:39:50
  we have to examine the skin and mucous membranes as regards contact by passing
• 3:39:54
  our finger or a blunt instrument over them. We may hope to obtain more
• 3:39:58
  accurate results by the use of the esthesiometer, which shows us how the subject
• 3:40:03
  recognizes the differences of sensation depending on the different spots of the skin. You
• 3:40:07
  will examine on these same regions the temperature sensations by alternately applying on the skin,
• 3:40:13
  unknown to the subject, a cold and a warm object. Lastly,
• 3:40:16
  you will examine the sense of pain by pinching, by sticking in a needle
• 3:40:20
  or by using one of the various alghesimeters. You will thus find that these
• 3:40:26
  various sensibilities may completely disappear, either simultaneously or separately. It is not rare
• 3:40:31
  to find absolute insensibility of the skin accompanying hysteric paralysis. You will then examine
• 3:40:37
  the so called muscular sensibility by displacing the limb in different ways and asking the
• 3:40:41
  subject to describe these positions and movements without looking at them, or better still,
• 3:40:46
  to reproduce them with his uninjured arm. Here again you will often find
• 3:40:50
  in hysteric paralysis complete in sensibility to position, the subject no longer possessing any
• 3:40:54
  information about his diseased limb. The existence of such an aim anesthesia's already gives
• 3:41:01
  you an important piece of information. No doubt, anesthesia exists in organic lesions,
• 3:41:05
  but it is much rarer and in general not nearly so deep as in
• 3:41:09
  hysteric affections. Further, it is easy to acknowledge that the anesthesia when it
• 3:41:15
  is connected with hysteria, presents certain characters that are not to be found when
• 3:41:18
  the insensibility depends on organic affections of the nervous system. One of the characteristics
• 3:41:24
  of this anesthesia, and one that plays a most important part in the diagnosis,
• 3:41:28
  has been well illustrated by Chalco, and nowadays still appears to us to
• 3:41:33
  be very significant the localization or the place of this insensibility. Chalco used to
• 3:41:39
  say that in hysteric paralysis, anesthesia takes the form of geometric segments, meaning
• 3:41:43
  that it is terminated by distinct regular lines, assuming definite forms, which can
• 3:41:48
  be foreseen, of course, when the hemiplegia is complete and the hemi anesthesia
• 3:41:54
  is also complete. The form is very clear, but has no great significance.
• 3:41:58
  It stops just as the median line of the body dividing into two equal
• 3:42:01
  parts the forehead, nose, mouth, breast and abdomen Figure eight. This
• 3:42:07
  section is curiously regular. On the one side, the skin is absolutely insensible,
• 3:42:11
  as well as the mucous membranes, and as we shall see later on
• 3:42:16
  the organs of the senses. On the other side, the sensibility is intact.
• 3:42:22
  You may barely observe some transitions, some degradation on the median line of
• 3:42:24
  the body. On one side, the subject feels nothing. On the other
• 3:42:30
  she feels quite normally. It is true even of the mouth and tongue.
• 3:42:33
  The separating line is found on the pallet and tongue. This hemianesthesia exists also
• 3:42:39
  in certain forms of organic lesions. In certain lesions of the internal capsule,
• 3:42:43
  one may at most say that it is rare, and that in general the
• 3:42:48
  separation is not so clear that there is a broader line of demarcation. With
• 3:42:52
  confused sensibility. One may say too that usually the troubles of sensibility are more
• 3:42:56
  severe in the extremities than at the root of the lie, instead of being
• 3:43:01
  regularly the same in all parts, as in hysteria. But of course in
• 3:43:05
  this case the form of the anesthesia will not give you much information. In
• 3:43:09
  the other paralyses, the form of the anesthesia is more instructive. It seems
• 3:43:15
  to terminate precisely enough above the paralyzed organ by a nearly circular line traced by
• 3:43:20
  the plain perpendicular to the axis of the limb. Thus, a paralysis of
• 3:43:24
  the hand brings about an anesthesia of the hand, extending up to the wrist
• 3:43:28
  and terminated by a line in the form of a bracelet. Figinine, an
• 3:43:31
  anesthesia of the whole of the arm is limited by a line including the shoulder
• 3:43:35
  passing a little under the armpit in the form of a jacket's sleeve. As
• 3:43:39
  Shako used to say, a paralysis of the foot brings about a sock or
• 3:43:43
  a stocking of anesthesia. A paralysis of the leg gives birth to an anesthesia
• 3:43:48
  in the form of a leg of mutton, which generally spares the anus and
• 3:43:52
  the genitals figinine. Now, these forms of anesthesia, which look so simple,
• 3:43:58
  are particularly extraor ordinary from a physiological point of view. They by no
• 3:44:03
  means correspond to the distribution of the nerves or even of the nervous plexuses.
• 3:44:07
  You know that the hand is innervated by three principal nerves, the radial,
• 3:44:11
  the median, and the cubital. A section of one of these nerves brings
• 3:44:15
  about a well known anesthesia of anatomic form corresponding to the distribution of the nerve.
• 3:44:20
  You know, for instance, the old anesthesia of the lesions of the
• 3:44:22
  cubital, which only affects the little finger and the longitudinal half of the fourth
• 3:44:26
  fig. Ten. It is not at all like our geometric segments. In
• 3:44:31
  the case of a paralysis of the hand, a lesion of the brachial plexus
• 3:44:35
  anesthetizes only a part of the arm, and the limit of the anesthesia affects
• 3:44:39
  a special form because it reserves the sensibility of a portion of the shoulder above
• 3:44:43
  the deltoid, which is innervated by the cervical plexus. Fig. Eleven.
• 3:44:48
  A lesion of the sacral plexus brings about. It is true the anesthesia of
• 3:44:52
  the thighs on their internal face, but affects the anus and the genitals.
• 3:44:58
  On this distribution of the incense abilities and on the places of the reserved regions
• 3:45:01
  is found at the anatomic diagnosis of the lesions of the nerves and of the
• 3:45:05
  tumors of the medulla. But it is not possible to connect the forms of
• 3:45:09
  anesthesias we just observed in the hysteric paralysis with these forms given by the organic
• 3:45:15
  lesions. This difficulty of localization was so great that Briquet tried to make other
• 3:45:20
  hypotheses and asked himself whether the distribution of hysteric anesthesias did not depend on the
• 3:45:26
  vascular circumscriptions, on the circulation of the blood more than on the nervous circumscriptions.
• 3:45:33
  Now we see that such is not the case. There is no arterial
• 3:45:35
  irrigation in the form of a wristband, a jacket sleeve, or a leg
• 3:45:39
  of mutton. This form of anesthesia is something quite peculiar. I have tried
• 3:45:46
  formally to sum up these localizations of hysteric anesthesia by a word that has had
• 3:45:50
  success. The hysteric patient, I said, seems to attend to the popular
• 3:45:54
  conception of the organ rather than to its anatomic conception. For the common people,
• 3:46:00
  what is an eye? It is the ensemble of the organs that feel
• 3:46:03
  the orbit eyelids included, and in fact the hysteric person who has anesthesia of
• 3:46:07
  the eyes has on her face, as it were, a pair of spectacles
• 3:46:11
  of anesthesia Fig. Nine, affecting the two eyelids in their central part.
• 3:46:16
  For the common people, the hand terminates of the wrist. They don't care
• 3:46:20
  if all the principal muscles that animate the hand and fingers are lodged beyond in
• 3:46:24
  the forearm. The hysteric person who paralyzes her hand seems not to know that
• 3:46:28
  the immobility of her fingers is due in reality to a muscular disturbance in her
• 3:46:33
  forearm. She stops her anesthesia at the wrist, as would the vulgar,
• 3:46:37
  who, in their ignorance, say that if the hand does not move,
• 3:46:41
  it is because the hand is diseased. Now, this popular conception of the
• 3:46:46
  limbs is formed by old ideas we have about our limbs, which we all
• 3:46:48
  keep in spite of our anatomic notions. So these hysteric anesthesias seem again to
• 3:46:54
  have something mental intellectual in them. This characteristic, though really very important,
• 3:47:01
  might still, however, give rise to some caveling. There are in intoxications
• 3:47:05
  in alcoholism, for instance, in sensibilities in the form of a sock or
• 3:47:09
  a boot in the medulla, segmental localizations have been studied that may lead one
• 3:47:15
  to conceive anesthesias of the same kind. Practically, you will be right nine
• 3:47:20
  times out of ten in basing a diagnosis of hysteric paralysis on this geometric form
• 3:47:24
  of anesthesia. But in order to avoid the least chances of error, we
• 3:47:28
  must insist on the last characteristic to which we have just come, namely the
• 3:47:31
  mental character of this anesthesia. It is moreover this character which will enable us
• 3:47:37
  to arrive at a more intelligible conception of the paralysis itself. Such will be
• 3:47:41
  the object of our next lesson. End of Section seven. Lecture eight.
• 3:47:48
  The psychological conception of paralyses and anesthesias, the problem of hysterical anesthesias, absence
• 3:47:56
  of any modification of the reflexes of any physiological disturbance, indifference of the patient,
• 3:48:03
  mobility of the anesthesia under various influences, attack, sleep, intoxication,
• 3:48:09
  somnambulism, suggestion, emotion, and above all attention contradictory character of this anesthesia,
• 3:48:16
  the part played by absent mindedness, the dissociation of certain groups of sensations
• 3:48:20
  in the anesthesia, the indifference, the lack of representation and memory in the
• 3:48:24
  paralysis, the aastasia, abasia, the systematic paralysis, the dissociation of a
• 3:48:31
  system of movements, the system of movements and sensations in a function, hemiplegia
• 3:48:37
  and paraplegias, dissociations of functions. The time has now come to give our
• 3:48:43
  attention to some psychological studies on hysteria that had a great development in France about
• 3:48:48
  twenty years ago, and have contributed much to the development of pathological psychology.
• 3:48:54
  They are perhaps rather special, having perhaps a less general importance than we then
• 3:48:58
  thought. Without them, we could not understand the particular nature of hysterical anesthesia,
• 3:49:03
  nor even perhaps form with sufficient clearness. A general idea of the hysterical
• 3:49:07
  disease itself, and especially of the paralyses that exist in this disease. We
• 3:49:13
  shall insist on the mental characters of anesthesia and try to derive from them a
• 3:49:18
  general conception, and then we shall see that it finds its application in the
• 3:49:22
  study of paralyses, which we shall take up again from a new point of
• 3:49:26
  view. One. We have already seen that hysterical anesthesia presents certain oddities which
• 3:49:33
  ought to attract the physician's attention. It is accompanied by a very deep and
• 3:49:37
  even exaggerated paralysis, and yet does not determine any serious objective disturbance. Is
• 3:49:45
  it not odd to see a limb remaining quite insensible, quite paralyzed, for
• 3:49:48
  months and sometimes years together, without any serious atrophy, without any modification of
• 3:49:54
  the electric reactions, and above all, without any change in the reflexes.
• 3:49:58
  Certain reflexes in in particular astonish us very much. The reflexes of the erectile
• 3:50:03
  organs, those of pain, remain intact. You know, for instance,
• 3:50:07
  that if you determine a strong pain by pinching the skin at any point whatever
• 3:50:11
  of the body, the pupils contract Suddenly. This fact persists with our hystericals
• 3:50:16
  who declare they feel nothing. The vascular reflexes in relation to the sensations of
• 3:50:22
  cold and heat are very delicate. Monsieur a Leon recently contrived to study them
• 3:50:26
  with great accuracy by means of a delicate little apparatus which he invented. The
• 3:50:31
  application of a little ice on the forearm immediately brings about the contraction of all
• 3:50:35
  the vessels of the hand. At my request, he was so kind as
• 3:50:39
  to study the fact with my patience, and found that the most anesthetic hystericals
• 3:50:45
  reacted quite correctly in this respect. Besides, we know quite well what the
• 3:50:50
  disappearance of the cutaneous sensations produces in practice. Physiologists have shown that when the
• 3:50:56
  limb of an animal is made insensible by the section of the sensitive root,
• 3:50:58
  this slimb, quite intact at first, cannot nevertheless be preserved. It is
• 3:51:03
  not long in becoming unclean and covered with sores, and it disappears little by
• 3:51:07
  little for the animal itself bites it off. Sensibility is a safeguard for our
• 3:51:13
  limbs. We may observe the fact in a well known disease. You know
• 3:51:18
  those patients who come to the consultation to complain that their hands are constantly burnt
• 3:51:22
  or wounded. They have scars of burns on their fingers and are not able
• 3:51:26
  to avoid this accident. They are syringo myelic patients, and the lesion of
• 3:51:30
  their spines makes them insensible to cold and heat. Why is there nothing of
• 3:51:35
  the kind to be found in our anesthetic hystericals. This absence of objective disturbances
• 3:51:41
  is mostly accompanied by a very curious subjective symptom, namely the indifference of the
• 3:51:46
  patient. When you watch a hysterical patient for the first time, or when
• 3:51:50
  you study patients coming from the country who have not yet been examined by specialists,
• 3:51:54
  you will find, like ourselves, that without suffering from it, and
• 3:51:58
  without suspecting it, they have the deepest and most extensive anesthesia. Larseg,
• 3:52:03
  who analyzed very carefully many of the subjective characteristics of hysteria, has often pointed
• 3:52:09
  out this ignorance among the patients. Chalco has often insisted on this point and
• 3:52:13
  shown that many patients are much surprised when you reveal to them their insensibility.
• 3:52:20
  Recent authors are also agreed on this point. It is far from being the
• 3:52:24
  case with anesthesias of organic origin. That particular symptom of tabes, which Charcur
• 3:52:30
  was one of the first to describe, and which he has called the tabetic
• 3:52:33
  mask, is well known. The patients lose the sensibility of a part of
• 3:52:37
  the face more or less extensive, but they account for it subjectively and declare
• 3:52:41
  that they experience a horrible feeling in regard to it. Ask hystericals who have
• 3:52:46
  facial anesthesia, and they are legion whether they experience a horrible feeling about it,
• 3:52:52
  and they will all tell you that they do not care to explain precisely
• 3:52:56
  this important difference between hysterical anesthesia and anae anesthesia of organic origin, It will
• 3:53:01
  not be out of place, we think to relate a little anecdote. We
• 3:53:05
  did not obtain it ourselves, but it was given to us by our brother,
• 3:53:09
  doctor Jeule Jeanne, when he was house surgeon at the Pitier with doctor
• 3:53:13
  Poulaignon. He had an opportunity to observe the following case. A young girl
• 3:53:18
  of about twenty had met with a rather serious accident. She fell through a
• 3:53:22
  glass door and a piece of glass cut into her right wrists just below the
• 3:53:26
  theena eminence. The hemorrhage was stopped, and the wound had united fairly well.
• 3:53:31
  When a few days after the accident, the young woman presented herself for
• 3:53:35
  treatment. She experienced a certain numbness in her right hand, but no paralysis
• 3:53:39
  was present. She complained, particularly of a persistent insensibility most inconvenient in the
• 3:53:45
  palm of the hand. This slight anesthesia about the fingers was in fact complete
• 3:53:50
  at the level of the theena eminence. The case was evidently one of a
• 3:53:54
  more or less complete severing of the median nerve, and especially of its superficial
• 3:53:58
  branches. But while accepting the observation of the patient, we made a singular
• 3:54:03
  discovery. She was a hysterical and on her entire left side she was completely
• 3:54:07
  anesthetic, of which she had not said a word. The physician joked her
• 3:54:11
  about it. How is it, miss, that you come here complaining about
• 3:54:15
  an insensibility that affects but a small portion of the palm of your right hand,
• 3:54:18
  while you do not even notice the much larger insensibility of the whole of
• 3:54:22
  your left side. The poor girl looked surprised and ashamed. To our minds,
• 3:54:28
  she might have replied to her doctor with much more assurance and said,
• 3:54:31
  be that as you think, sir, I came here to tell you what
• 3:54:33
  ails me. It is the insensibility of the palm of my right hand that
• 3:54:37
  troubles me, and that of my left side has never given me any trouble.
• 3:54:41
  You are the doctor, Explain it as you like to. These general
• 3:54:46
  remarks must be added all that we have said already on the form of these
• 3:54:50
  anesthesias, a form which has nothing anatomic or even scientific in it, and
• 3:54:54
  seems to correspond to false popular notions. These remarks compel us to enter more
• 3:55:00
  deeply into the scrutiny of the mental state corresponding to these strange insensibilities. This
• 3:55:05
  study leads us now to point out a new characteristic in the same order of
• 3:55:09
  ideas, namely, the remarkable mobility of these anesthesias. Unquestionably, some patients
• 3:55:16
  retain their stigmata all their lives, orrel is still hemi anesthetic. At seventy
• 3:55:20
  five, lere has kept a hemi anesthesia and a contraction of the visual field
• 3:55:26
  for forty years. We shall have to keep an account of these cases.
• 3:55:30
  But generally, and perhaps even among these very patients, without its having been
• 3:55:33
  observed, anesthesia becomes modified and disappears all at once, for longer or shorter
• 3:55:39
  periods. It varies from one moment to another, says Monsieur Ferrey, and
• 3:55:43
  under the influence of causes so slight that they may pass unnoticed. However rapid
• 3:55:50
  in their mobility. Some of these changes may nevertheless be studied, and one
• 3:55:54
  can note at least some of the circumstances in which they are oftenest affected.
• 3:56:00
  X modify considerably the localization of sensibility. Many authors have noted that anesthesias often
• 3:56:05
  increase at the time preceding the attacks. For example, Marguerite X, who
• 3:56:11
  ordinarily has right sided hemi anesthesia, becomes during the hours that precede the attack
• 3:56:16
  totally anesthetic. We point out a case much rareer. Still, it is
• 3:56:20
  an opposite phenomenon. Sell usually totally anesthetic recovers complete sensibility, sometimes during a
• 3:56:26
  form of excitement which lasts half an hour before the attack. During the attack
• 3:56:33
  itself, when we can obtain some intelligent sign we have seen that it is
• 3:56:37
  generally possible the sensibility becomes modified. Often, as happens with Belt, it
• 3:56:43
  is recovered entirely after the attack. Many patients, like maug return to their
• 3:56:48
  usual condition. Others have for some time anesthesias more extended than usual. Belt
• 3:56:54
  generally hemi anesthetic on the left side remains after the attack totally anesthetic and at
• 3:56:58
  times goes completely blind for some hours. It often happens during natural sleep at
• 3:57:05
  night, the tactile ansthesius disappear. It is very difficult to verify the fact.
• 3:57:11
  We have to take the patients by surprise at night, using all sorts
• 3:57:13
  of precautions not to wake them. We pinch them on the anesthetic side.
• 3:57:18
  They groan, turn over, complain in their dream, or wake suddenly,
• 3:57:22
  exactly as a normal person would. Monsieur Jeule Jeanne, when he was an
• 3:57:26
  assistant of du Montpellier, has repeatedly verified this fact on two patients, the
• 3:57:31
  observation of which he communicated to us. We had the fact established on various
• 3:57:35
  persons, particularly on Belt and Ease. Our friend Monsieur d'utille was kind enough
• 3:57:41
  to verify the fact for us. On a hysterical g Hemi anesthetic on the
• 3:57:46
  left side, pinched on that side during her natural sleep, she winced and
• 3:57:50
  spoke in her dream, you are pinching me, how stupid. During certain
• 3:57:56
  intoxications that bring with them, states analogous to sleep, insensibility vanishes more or
• 3:58:01
  less completely. Many patients totally anesthetic become entirely sensitive when drunk. Chloroform anesthesia
• 3:58:09
  in the period of excitation does away with all stigmata with the anesthesia as well
• 3:58:13
  as the contractures. Among the most paradoxical consequences of the hypodermic use of morphine,
• 3:58:20
  says mister Ball, we must cite the restoration of cutaneous sensibility with subjects
• 3:58:24
  who have lost it. A hysterical drugged with morphine a dose of eight centigrams
• 3:58:30
  a day felt all her pain disappear and her normal sensitiveness restored. Abstinence brought
• 3:58:35
  back her hysterical symptoms. The same fact has been described by Monsieur Jeulevoisin in
• 3:58:41
  the same manner. We see often a diminution of the anesthesia and a widening
• 3:58:46
  of the visual field in hystericals who are under the influence of morphine. And
• 3:58:50
  we could verify too the reappearance of the anesthesia after the cessation of the influence
• 3:58:54
  of the drug. Many other excitations must have analogous effects. The object of
• 3:59:01
  our first work was, above all the numerous modifications of sensitiveness during states of
• 3:59:05
  induced somnambulism. Certain subjects under rare conditions recover suddenly and completely all their sensitiveness
• 3:59:13
  as soon as they are in the second state. This fact has been sometimes
• 3:59:16
  pointed out in old descriptions of the magnetizers. We have very often established these
• 3:59:22
  same facts at the outset of our researchers before we had read the very interesting
• 3:59:26
  observations of these authors. Sometimes the subjects have during their somnambulism an anesthesia apparently
• 3:59:33
  general, but the slightest excitation that directs their attention somewhat upon tactile sensitiveness causes
• 3:59:39
  this anesthesia to disappear, even on parts that remained anesthetic when awake. Despite
• 3:59:46
  suggestions, this restoration to sensitiveness of some subjects proceeds somewhat slowly and becomes evident
• 3:59:52
  only when the hypnotic state has been considerably prolonged. Others, again, have
• 3:59:56
  a more complicated somnambulism. They pass through several states in which sensibility and above
• 4:00:01
  all memory undergo many modifications. It is only in one of these states,
• 4:00:07
  often a state that develops after all the others, that the subjects recover all
• 4:00:11
  their sensibilities sensibility may be modified even in waking time. Briquet has insisted on
• 4:00:18
  the action of electricity. Bulk and many others after him have shown that magnets,
• 4:00:22
  metal plates, and many other agents, which all vary according to the
• 4:00:26
  patients, have analogous effects. The sensibility increased by these agents persists for a
• 4:00:31
  longer or shorter time, and disappears with oscillations. The influence of suggestion,
• 4:00:37
  in general, very powerful with hystericals, may suffice momentarily to re establish the
• 4:00:43
  sensibility, but it should be borne in mind that this phenomenon is far from
• 4:00:46
  being general. That with a number of patients, sensibility changes very little when
• 4:00:52
  it is suggested, and on the contrary, undergoes great modifications under the influence
• 4:00:56
  of certain excitations such as drunkenness, or certain changes of psychological state as somnambulism.
• 4:01:05
  Many other psychological phenomena come in to produce, modify, or destroy anesthesia.
• 4:01:09
  For example, strong emotion, preoccupation, reveries increase it. The association
• 4:01:15
  of ideas may in some cases modify it. We say to one patient that
• 4:01:18
  she has a caterpillar on her left hand, and she cries out and pretends
• 4:01:22
  that she feels the tickling of it. At this moment, the whole of
• 4:01:26
  her left arm has become quite sensitive. But there is a psychological phenomenon which
• 4:01:31
  plays a far more important part than any other, and its study throws a
• 4:01:35
  great deal of light upon the problem. We mean attention. To verify this
• 4:01:41
  fact, we must remember, as we shall demonstrate later, that with hysterical's
• 4:01:45
  attention is altogether the most difficult thing to fix, and that only a few
• 4:01:48
  can succeed in directing it. As a general thing, we may, for
• 4:01:52
  a moment attract their attention upon their anesthetic hand by whatever means we please.
• 4:01:58
  A patient does not feel the electric current when he has his eyes shut,
• 4:02:01
  he acknowledges a tickling. On seeing the manipulation of the process, we fasten
• 4:02:05
  a red wafer on Belt's left hand. She looks astonished and stares at her
• 4:02:09
  hand. Let us leave her for a moment. Then, when her head
• 4:02:13
  is turned, let us lightly pinch that hand so insensible. But a moment
• 4:02:16
  ago, Belt now cries out when we pinch her, and feels it quite
• 4:02:20
  perfectly. It is true that this fine sensibility will not last long. We
• 4:02:26
  take that wayfer Off and a few minutes later she can no longer feel anything.
• 4:02:31
  All these phenomena, the last particularly, are the origin of many difficulties,
• 4:02:35
  for they very easily upset the sensibility that is the object of the study.
• 4:02:39
  They increase the anesthesia, they fix it or suppress it. They give
• 4:02:43
  it an extremely changeable aspect, which discourages the observer. Now, it will
• 4:02:50
  be asked, does the anesthesia, at least as long as it exists,
• 4:02:52
  present itself to the observer definitely? Is it always very certain? In whatever
• 4:02:58
  way you examine the subject? By no means? And we have to point
• 4:03:01
  out a second series of observations which complicate the problem of anesthesia still more,
• 4:03:07
  for they present it to us not only as changeable, but as contradictory.
• 4:03:11
  La Seg said in eighteen sixty four that hysterical anesthesia looked strange, and that
• 4:03:16
  it seemed to be a psychological perturbation, a sort of alienation. The studies
• 4:03:22
  which subsequently confirmed this theoretical conception were at first observations on an altogether special point,
• 4:03:28
  namely on unilateral amorrosis, that is, on certain very interesting disturbance of
• 4:03:33
  the vision about which we shall speak in our next lesson. If the unilateral
• 4:03:39
  amrosis presents embarrassing problems. It is the same with all anesthesias. Several years
• 4:03:43
  ago we made the following observation of a patient in Monsieur Pouillovitch's service at the
• 4:03:48
  Auvre Hospital. She was attacked with hysterical paraplegia and presented a state of total
• 4:03:54
  anesthesia. We used to treat her legs with electricity and noticed the strong muscular
• 4:03:58
  contractions she experienced at each contact of the negative electrode. When all at once
• 4:04:03
  we saw that the two wires which fastened the plugs to the apparatus had dropped
• 4:04:07
  for a long time. We had thus been applying electricity with mere pieces of
• 4:04:11
  wood. We continued without fastening the wires to the ends, and the contractions
• 4:04:16
  were all the greater by the simple contact of the plug. This, it
• 4:04:20
  will be said, is nothing very wonderful. There is a sort of habit
• 4:04:24
  in that a suggestion is taking place. We think so too. But how
• 4:04:28
  could this patient, whose skin all over her body was wholly insensible and with
• 4:04:31
  her head well turned away, feel the moment when the plug touched her legs,
• 4:04:37
  and make a movement just then, and only just then? We may
• 4:04:41
  every day experience a similar embarrassment. We propose to ease a little contrivance to
• 4:04:46
  verify her anesthesia quickly. She is to answer yes when she feels and know
• 4:04:50
  when she does not feel anything. As she is very simple minded, she
• 4:04:54
  accepts without demurring, and we discover then a curious contradiction. Although she has
• 4:05:01
  her eyes carefully concealed behind a screen, Although we avoid any kind of rhythm
• 4:05:05
  and pinch her several times irregularly on the same side before we pass over to
• 4:05:09
  the other, she is never mistaken and always says yes when we pinch her
• 4:05:13
  on the left, and know when we pinch her on the right. The
• 4:05:16
  same experiment, repeated on a man pasque gives exactly the same results until he
• 4:05:22
  perceives the queerness of his answers and tries to answer attentively. He then ceases,
• 4:05:26
  but only then to say no when we pinch his anesthetic side. Here
• 4:05:31
  now is another observation which bears no longer on the tactile but on the muscular
• 4:05:35
  sense. A young woman twenty two years old, whom we have often described
• 4:05:39
  by the name of Lucy, took during her attacks certain cataleptic poses. For
• 4:05:45
  an hour. She would keep her eyes fixed on the window, and her
• 4:05:48
  arms raised in an attitude of terror. For the present we must insist on
• 4:05:52
  only one detail of this attack. We observed that during the most normal of
• 4:05:56
  her waking states, it was enough to raise both of her oar and place
• 4:06:00
  them in the posture of terror, which they took during her crisis to induce
• 4:06:03
  at once an attack. Of course, you will say, the thing is
• 4:06:07
  quite simple and well known. By the position of the arms. You call
• 4:06:11
  forth the principal idea of attack, and the rest follows. True. But
• 4:06:15
  there is a little detail. Yet. Lucy was anesthetic over her entire body
• 4:06:20
  and presented nowhere any trace of muscular sense. As often happens in this case,
• 4:06:24
  she would fall down at once as soon as you closed her eyes.
• 4:06:28
  Now we have often taken the precaution to close her eyes before displacing her arms,
• 4:06:33
  and the crisis occurred all the same as soon as the members had the
• 4:06:35
  required position. How would you explain the notion of that position being appreciated by
• 4:06:39
  so insensible a subject. All these facts, and a great number of others
• 4:06:45
  which have been accumulated, are very likely to puzzle the observer. They show
• 4:06:48
  us that hysteric anesthesia not only changes from one moment to another, but indeed
• 4:06:52
  varies in the same instant and manifests itself by contradictory phenomena. According to the
• 4:06:58
  questions put to the subject two, we must rapidly lay aside a first interpretation
• 4:07:05
  of these facts. The anesthesia of hystericals is extremely changeable and contradictory. These
• 4:07:11
  patients pretend not to feel, and by very simple artifices we can prove to
• 4:07:16
  them that they feel perfectly well. Their insensibility is therefore simulated, and our
• 4:07:20
  processes are only means to deceive a deceiver and unmask a fraud. This resume
• 4:07:26
  have facts is to our mind altogether crude and insufficient to hystericals take any particular
• 4:07:31
  interest of pleasure in having their arms pierced through with needles. To these young
• 4:07:35
  girls pass through the Council of Revision to simulate unilateral amorrosis. How is it
• 4:07:41
  that in all civilized countries hystericals should have agreed to simulate the same thing ever
• 4:07:46
  since the Middle Ages to the present day. We must not be content with
• 4:07:50
  this crude explanation. And since anesthesia presents itself to us as a psychological fact,
• 4:07:56
  we must seek among the few notions. Psychology furnishes us that which best
• 4:08:01
  summarizes facts of this kind. We are happy to have La Seig confirm an
• 4:08:05
  opinion which we have maintained for several years. Hysterical anesthesia is a certain species
• 4:08:11
  of absent mindedness. A person, said La Sig in eighteen sixty four,
• 4:08:16
  absent minded through a great preoccupation, does not perceive sensations which, in another
• 4:08:20
  frame of mind he would scarcely have tolerated. It is probable that hystericals,
• 4:08:26
  whose moral state offers so many other singularities, acquire, likewise, through their
• 4:08:31
  very malady, a sort of laziness that renders them less apt to perceive certain
• 4:08:35
  psychic modalities. This explanation based on absent mindedness is, in reality but a
• 4:08:41
  first approximation. An aesthesia is surely not ordinary absent mindedness. It has much
• 4:08:46
  more clearness and duration, It is far from disappearing so easily as soon as
• 4:08:50
  the subject chooses, And above all, it appears without there being any fixed
• 4:08:54
  idea of any object which attracts the patient's attention to another point. There is
• 4:09:01
  in it a pathological incapacity to collect the elementary sensations in a general perception In
• 4:09:05
  reality, what has disappeared is not the elementary sensation, the preservation of which
• 4:09:09
  we have just seen. It is the faculty that enables the subject to realize
• 4:09:15
  this sensation, to connect it with his personality, to be able to say
• 4:09:18
  clearly it is I who feel, it is I who Here we shall often
• 4:09:22
  have the opportunity to reconsider this problem, But let us remark by the way,
• 4:09:26
  that this singular character of anesthesia is not unknown to us. After all,
• 4:09:31
  we have already seen something similar whilst studying the amnesias that follow somnambulisms.
• 4:09:37
  I have already told you that the subjects were unable to remember what had happened
• 4:09:41
  during the fit of somnambulism, and even to remember the principal idea which played
• 4:09:45
  a part in this state. Irene, whom I have repeatedly spoken of,
• 4:09:50
  had forgotten after the crisis, not only the comedy she played, but also
• 4:09:52
  her mother's death and illness, which were its starting point. We accepted at
• 4:09:58
  that moment without discussing it the description of this amnesia, for we did not
• 4:10:01
  want to complicate the matter. But in reality that oblivion was very strange.
• 4:10:07
  Was it real oblivion? The obliteration of the recollections, the destruction of the
• 4:10:11
  images by no means, Since the patient could be cured and is now able
• 4:10:15
  to relate clearly all those events, was it then the inability to reproduce them?
• 4:10:20
  Was it that the brain, while keeping their traces, was nevertheless not
• 4:10:22
  able consciously to cause them to reappear? By no means? Since the patient
• 4:10:28
  had dreadful fits every day during which she recited all the details of the events
• 4:10:33
  in a word, she had forgotten nothing, and she had the power to
• 4:10:35
  recite everything, then where was the oblivion? The oblivion consisted only in this
• 4:10:41
  that she could not recite. In a waking state, with full consciousness of
• 4:10:45
  the other events and of herself, she could relate, it is true,
• 4:10:48
  but in a dream, in a delirium, without having at the same time
• 4:10:52
  the notion of herself. As soon as she had the personal consciousness of her
• 4:10:56
  name, of her situation, she could no longer associate them remembrance in question.
• 4:11:01
  We try to sum this up by saying that somnambulism is not the destruction
• 4:11:05
  of an idea, but the dissociation of an idea that has emancipated itself from
• 4:11:09
  the ensemble of consciousness, and that the ensemble of consciousness can neither recover nor
• 4:11:15
  control well. Our anesthesias, which looked so strange, have just presented to
• 4:11:20
  us the very same characters with more clearness. Still, there are groups of
• 4:11:24
  sensations forming a kind of system, that is to say, the ensemble of
• 4:11:28
  sensations coming from the hand or the leg, which can no longer be connected
• 4:11:31
  with the totality of consciousness, although they still exist on their own account and
• 4:11:35
  even determine reflexes and usual movements. Let us apply the same notion to our
• 4:11:41
  paralyses. We shall see that the facts are absolutely of the same kind.
• 4:11:46
  Besides anesthesia, on which we dwelt for some time, there are other mental
• 4:11:50
  phenomena which accompany hysterical paralysies. The most curious are connected with a kind of
• 4:11:54
  indifference analogous to the one we remarked in anesthesia. If we we had a
• 4:12:00
  paralyzed arm, it would inconvenience us exceedingly. We should fret very much about
• 4:12:03
  this disease. We should perpetually regret our former state, and be forever making
• 4:12:07
  desperate efforts to recover the motion we had lost. We cannot help therefore,
• 4:12:13
  being somewhat surprised and ill humored when we attend a paralyzed hysterical. This kind
• 4:12:18
  of patients vexes us with their calm, indifference and inertia. One of their
• 4:12:22
  limbs, being out of use, does not appear to incommode them. They
• 4:12:26
  think it quite natural to walk with but one leg and do not make the
• 4:12:28
  least effort to use the other leg. It was just this that determined the
• 4:12:33
  famous distinction Shotco made between the helicopode and helcapode gates. While the person affected
• 4:12:39
  with organic hemiplegy labors hard to move his rest of limb forward, the hysterical
• 4:12:43
  drags hers after her like a cannonball. She almost despises it, and she
• 4:12:48
  wants to beat it, calling it an old stump like a patient. Professor
• 4:12:52
  James has described this conduct corresponds to a very special mental trouble. If you
• 4:12:58
  question such persons, you find and that they seem not to have kept the
• 4:13:01
  remembrance of their limb. They do not know any longer what this paralyzed limb
• 4:13:05
  used to do, and they can no longer make the efforts of imagination necessary
• 4:13:09
  to conceive it. Piret was one of the first who insisted on this point
• 4:13:13
  after having shut the patient's eyes, he says, I ask her to try
• 4:13:18
  to represent to herself her left hand executing movements of extension and flexion. She
• 4:13:22
  is not able to do it. She can represent to herself her right hand
• 4:13:26
  making very complicated movements on the piano, but on her left she has the
• 4:13:31
  sensation that her hand is lost in empty space. She cannot even represent to
• 4:13:35
  herself its form. I have verified this remark more than twenty times. This
• 4:13:41
  lack of representation and memory of the paralyzed limb is one of the most typical
• 4:13:45
  things many authors have remarked it. Here is the statement of an English author,
• 4:13:50
  doctor Bastian, who by the way, has quite another conception of hysteria
• 4:13:52
  than we. When I ask her if she can imagine that she touches the
• 4:13:56
  tip of her nose with her left finger, she immediately answers yes. If
• 4:14:01
  I ask her to imagine the same movements with the paralyzed hand, she remains
• 4:14:05
  hesitating and at last answers no. She can imagine herself playing on the piano
• 4:14:09
  with her left hand, but not with her right hand. The same remark
• 4:14:15
  applies to the old observations made at the outset on the will of these patients.
• 4:14:18
  The English author Brodie had already said in hysterical paralysis, it is not
• 4:14:24
  the muscles which do not obey the will, It is the will itself which
• 4:14:26
  does not enter into the action. W Page added when the patient says I
• 4:14:31
  cannot, it means I cannot will. And Monsieur Leuchaust said they cannot they
• 4:14:37
  will not will. What did these remarks applied to paralytics mean. They meant
• 4:14:43
  that the patient did not seem to make the initial effort to apply his consciousness
• 4:14:46
  to a certain act. He did not even seem to have the representation of
• 4:14:50
  this act. All these remarks are of about the same kind. And we
• 4:14:54
  find again in paralyses dissociations of psychological phenomena identical with those we have observed in
• 4:15:01
  somnambulic amnesias. There is but one difficulty left, What is the psychological phenomenon
• 4:15:07
  that dissociates itself? In somnambulism, it was the idea of an event and
• 4:15:13
  was relatively clear. But have we in our minds the idea of the motion
• 4:15:16
  of our two legs? Is it this idea that disappears in its entirety and
• 4:15:20
  makes us lose the motion? Of our legs. It seems very odd,
• 4:15:24
  and we are not accustomed to apply the word idea to the ensemble of the
• 4:15:28
  movements of our two legs. To make the thing clear, we must now
• 4:15:31
  recall certain forms of paralysies of which I have not yet spoken, and which
• 4:15:35
  will I think form the transition between the preceding phenomena of dissociation and the great
• 4:15:41
  paralysis which we do not understand. Three several authors, one of the first
• 4:15:46
  of whom was Jacques Coup, and among whom we find Charcourt, Block and
• 4:15:50
  Siglas, had pointed out a form of hysterical paralysis, still more extravagant and
• 4:15:56
  unintelligible than the others. The subjects are, as a rule young people.
• 4:16:02
  They seem not to have the least paralysis of the legs. When you examine
• 4:16:04
  them in their bed. Not only are the reflexes intact, but, and
• 4:16:08
  the fact is more surprising, the movements are intact. If you tell them
• 4:16:12
  to raise their legs, to bend, to turn them, they do exactly
• 4:16:17
  all that is required of them. What is more, they have kept a
• 4:16:19
  very great strength, quite the normal strength. They push back your hand with
• 4:16:23
  their feet. They lift you up if you bear down with all your strength
• 4:16:26
  on their knees. Then you will no doubt say there is nothing at all
• 4:16:30
  the matter with them. It is true, but they are absolutely incapable of
• 4:16:33
  walking. If you cause them to stand on the floor, they will bend,
• 4:16:37
  twist their legs, throw them to one side and the other, and
• 4:16:41
  fall down without having made one step. And this will last for weeks and
• 4:16:45
  months. They realize the paradox of having no paralysis of the legs and of
• 4:16:48
  being unable to walk. In a few described by Charcot, the comedy is
• 4:16:53
  still more complete. They are able to make with their legs certain movements which
• 4:16:59
  seem very complicated, as jumping, dancing, hopping on one leg, running,
• 4:17:03
  but they fall as soon as they try to walk. Can you conceive
• 4:17:06
  such an absurdity? For some time this disease, which was called astasia abasia,
• 4:17:11
  seems to be almost alone of its kind. But soon physicians were obliged
• 4:17:15
  to recognize that there were many other paralyzes belonging to the same type, and
• 4:17:19
  that they were even frequent. Some subjects are still able to walk but cannot
• 4:17:25
  stand. Others have lost some functions of the hands. They almost always forget
• 4:17:29
  their trade. A needlewoman can no longer sew an ironer can no longer handle
• 4:17:33
  an iron, though they have no paralysis of the hand. Frequently girls can
• 4:17:37
  no longer write at all or play on the piano. Monsieur Babinski has shown
• 4:17:41
  such cases for the functions of the mouth. The patient can no more blow
• 4:17:45
  or whistle, while he can make all the other movements of the lips.
• 4:17:48
  These examples are sufficient to prove to you that there are very often systematic paralysies
• 4:17:53
  in which a certain system of movements, grouped by education, separates from consciousness
• 4:17:59
  and takes existence of its own. These phenomena come much nearer to our somnambulic
• 4:18:04
  amnesia. The oblivion of her mother's death, which came upon one of our
• 4:18:08
  patients, and of all the care she had taken off her during her illness.
• 4:18:12
  Was the loss of a system of images and movements, which comes very
• 4:18:15
  near the oblivion of sewing or writing. You understand that in these two cases,
• 4:18:21
  the group and the more or less complex system are of the same kind.
• 4:18:25
  Well, if it is not too bold, I will propose to you
• 4:18:26
  not to consider a basia as an exceptional hysterical paralysis, but on the contrary,
• 4:18:32
  to make it the type of all the other hysterical paralysis. The ensemble
• 4:18:36
  of the movements of the right hand is a system of images and movements exactly
• 4:18:40
  as the ensemble of the movements necessary to play on the piano. Only it
• 4:18:44
  is a much more extended and above all, a much older system. It
• 4:18:48
  is the reason why it contains in itself and involves all the sensations of the
• 4:18:52
  hand, whereas playing on the piano involved only certain special sensations. And what
• 4:18:57
  about the paralysis of the two legs, you will ask me, It is,
• 4:19:00
  in my opinion, exactly the same. The two legs form a unity,
• 4:19:04
  not only anatomically, but especially psychologically speaking. Our ancestors, the animals,
• 4:19:11
  constructed in their mind the association of the limbs of the same level,
• 4:19:14
  of the same segment. These limbs have a common role to play. Such
• 4:19:18
  a segment enables us to stand, such another to seize objects. This system
• 4:19:22
  of images relative to the two legs is very vast. It contains subdivisions,
• 4:19:27
  as the system that concerns walking or jumping, but it can be dissociated in
• 4:19:32
  its sidentirety. Lastly, since we are making hypotheses, we must not stop
• 4:19:37
  halfway. Hysterical hemiplegia is a phenomenon of the same kind as the statia abesia.
• 4:19:42
  The movements of one side of the body also form a system. We
• 4:19:47
  have a very clear idea of the ensemble of the actions of the right side
• 4:19:49
  as opposed to the ensemble of the actions of the left side. No doubt
• 4:19:55
  you will tell me these great systems of sensations and images are at the same
• 4:19:59
  time comical systems which have a unity in the brain and in the spine.
• 4:20:03
  I do not deny it by any means. The fact that a system is
• 4:20:07
  psychological should not cause us to conclude that it is not, at the same
• 4:20:10
  time anatomical. On the contrary, the one involves the other. When I
• 4:20:14
  begin to learn to ride a bicycle, I voluntarily group together images depending on
• 4:20:18
  several centers and which have never been grouped. Consequently, I am very awkward.
• 4:20:23
  After some time I can maintain my equilibrium on a bicycle. It means
• 4:20:27
  that these different images have associated together and regularly call forth one another. It
• 4:20:33
  is very likely that this functional association corresponds to an anatomical association which has been
• 4:20:37
  effected among the different centers, and that a new little center has been formed
• 4:20:41
  in my brain the center concerning bicycle riding. It is even because this center
• 4:20:47
  persists and develops, that next year I shall be able to ride without learning
• 4:20:49
  again. With regard to new functions, we understand easily that the system is
• 4:20:55
  at once mental and physical. But you should impress your mind with the belief
• 4:20:59
  that your ancestor, as the monkeys, learned to walk on two legs,
• 4:21:02
  as you have learnt to ride a bicycle, and that before the monkeys,
• 4:21:06
  there were other beings who learned to systematize the movements of one side of their
• 4:21:08
  body and invent the right side and the left side. This very old function
• 4:21:14
  has well organized centers, but it is none the less a function, that
• 4:21:18
  is to say, a complete system of sensations and images. Well as the
• 4:21:22
  hysterical may lose while they have fits of somnambulism, a little system of thoughts
• 4:21:27
  that emancipates itself, which loss brings on two symptoms, somnambulic agitation and amnesia.
• 4:21:34
  So the same patient may in the same way lose through dissociation. A
• 4:21:37
  great and old system of thoughts and sensations, that of the right side,
• 4:21:41
  or that of the two legs, and this new dissociation will again manifest itself
• 4:21:47
  by two great symptoms, first by involuntary motor agitations, which we studied in
• 4:21:52
  our last lecture in the form of careers and of more or less extended ticks,
• 4:21:56
  and secondly by hysterical paralysies. I don't insist on the details of these
• 4:22:00
  phenomena, on the different degrees of these paralysies. It is enough to have
• 4:22:04
  presented to you this general conception end of section eight Lecture nine. The troubles
• 4:22:12
  of vision, the troubles of different perceptions touch, smell, taste, hearing,
• 4:22:18
  the total dissociation of the function of vision, hysterical blindness, the partial
• 4:22:23
  dissociation of vision, unilateral amorosis, the contradictory characters of this amorosis, the
• 4:22:30
  dissociation of the monocular and the binocular vision, the narrowing of the visual field,
• 4:22:37
  the dissociation of the peripheric and central vision. The problem of hysterical hemianopsia
• 4:22:44
  compared with hysterical hemiplega dischromatopsia, the troubles of the movements of the eyes.
• 4:22:52
  You have just seen from our remarks on hysterical anesthesia, that this neurosis may
• 4:22:56
  disturb the sensorial as well as the motor functions. This remark is extremely important,
• 4:23:02
  and the sensorial disturbances due to hysteria constitute a very considerable chapter of pathology.
• 4:23:07
  In this summary review of the great symptoms, we cannot follow this disease
• 4:23:11
  into the domain of each perception. Moreover, what will be said about a
• 4:23:15
  particular sense can easily enough be applied to all the others. On what sense
• 4:23:21
  must we particularly insist? What are the perceptions on which hysteria determines quite typical
• 4:23:26
  disturbances we have already spoken of the tactile sense. Besides, we may remark
• 4:23:32
  that disturbances of the tactile sense are not quite separate, that they are nearly
• 4:23:36
  always connected with disturbances of motion. Remember this old remark of a French doctor,
• 4:23:41
  to whom, in my opinion, justice has not been fully done.
• 4:23:44
  Doctor Burke. Anesthesia, he said, never exists without a myasthenia, that
• 4:23:49
  is to say, without muscular weakness. No doubt, in certain cases the
• 4:23:53
  tactile perception may be disturbed only as perception in subjects who need their tactile sense
• 4:23:59
  to recognize objects, but this occurs seldom. You may also observe disturbances of
• 4:24:03
  tactile localization, particularly the singular phenomenon called alokeria, in which the patient always
• 4:24:10
  localizes on his left side what is done to him on his right side,
• 4:24:14
  and vice versa. Lastly, you may connect with disturbances of the tactile sense
• 4:24:19
  certain abnormal pains and sensations, But deliriums always enter into these phenomena, or
• 4:24:25
  at least associations of fixed ideas. No more do I insist on the senses
• 4:24:30
  of smell and taste. They are very often disturbed in hysteria, but scarcely
• 4:24:33
  ever so in an independent way. Their disturbances are nearly always associated with those
• 4:24:38
  of the functions of alimentation and breathing. We shall find them again when we
• 4:24:44
  study the disturbances of the visceral functions. It would be more proper to devote
• 4:24:48
  a lecture to hysterical deafness to disturbances of hearing in these patients, which are
• 4:24:53
  often associated with disturbances of speech, but may also exist separately. A of
• 4:25:00
  hysterical deafness. It is frequent, and if I mistaked not occasions, very
• 4:25:04
  numerous errors of diagnosis to recognize it. With reference to these troubles of hearing.
• 4:25:10
  I am glad to indicate to you an interesting study of doctor G.
• 4:25:14
  L. Walton deafness in hysterical anesthesia published in the Brain eighteen eighty three.
• 4:25:19
  To recognize this affection, remember that it is a central and not a peripheric
• 4:25:23
  deafness. Rinnie's well known experiment will give you information concerning this first point.
• 4:25:30
  When the deafness is peripheric, when it is due, for instance, to
• 4:25:33
  obstruction of the canal, to a disease of the ossicles, or to a
• 4:25:37
  disturbance in the aeration of the drum, the patient keeps the central audition.
• 4:25:42
  You may verify it by making him hear a watch or a dire pasan applied
• 4:25:45
  to his teeth or to the bones of his skull. The vibrations propagated through
• 4:25:51
  the bones are still heard, whereas they can no longer be transmitted by the
• 4:25:55
  air. In central deafness. It is just the reverse, and the hysterical
• 4:26:00
  disease is connected with this last group. This being once established, you will
• 4:26:03
  be able to make the diagnosis by studying the motile and contradictory character of this
• 4:26:07
  anesthesia and by examining the evolution. I regret not being able to insist any
• 4:26:14
  further on this curious symptom, the study of which is now beginning to be
• 4:26:17
  in fashion. But there is a sense so interesting from the point of view
• 4:26:21
  of hysteria, and the alterations of which are so characteristic for the comprehension of
• 4:26:25
  this neurosis, that I want to devote to it as much time as possible.
• 4:26:30
  And it is the reason why our study on the hysterical disturbances of the
• 4:26:33
  perceptions must be above all a study on the diseases of vision. One you
• 4:26:41
  know now the general idea that directs us in the examination of the innumerable phenomena
• 4:26:45
  of hysteria. It is the idea of dissociation. This disease seems to have
• 4:26:49
  an analytic power. It decomposes the enormous psychophysiological system, it separates its functions.
• 4:26:56
  Nowhere is this dissociation more precise and curious than in the case of vision.
• 4:27:02
  The reason is that vision is a very complicated function, which is subdivided
• 4:27:04
  into numerous operations, and which plays a great part in the mind. Hysteria
• 4:27:10
  can effect on it every possible dissociation. First, it may separate at once
• 4:27:15
  the whole of the visual function from the ensemble of the mind. This is
• 4:27:18
  the most radical and the rarest dissociation. Then it may cause the visual function
• 4:27:22
  to crumble, so to speak, dividing and subdividing it into its elementary functions,
• 4:27:27
  doing away with one and sparing another, with a cleverness that the greatest
• 4:27:30
  physiologist might envy. You even see here an example of the services that hysteria
• 4:27:37
  may render to the physiologist by teaching him in what way composite functions are decomposed,
• 4:27:41
  which he would be unable to analyze himself. The first great disturbance we
• 4:27:47
  have just said is the dissociation of the ensemble of vision. In other terms,
• 4:27:51
  it is hysterical blindness. This phenomenon is rare, for it seems that
• 4:27:56
  the subject always keeps as much as possible the essential functions and loose is only
• 4:28:00
  a part of the vision. However, the fact has been very often established.
• 4:28:04
  As long ago as sixteen eighteen, Lepois pointed out this blindness. Since
• 4:28:10
  then it has been studied by many authors, and in this respect I especially
• 4:28:14
  draw your attention to the works of the French oculists such as Landault, Borell
• 4:28:18
  and Parinaut. This total blindness comes on usually in consequence of accidents, and
• 4:28:25
  it belongs to the phenomena of traumatic hysteria. The following of the two latest
• 4:28:30
  cases I have observed. A man thirty eight years old was busy cleaning a
• 4:28:34
  machine. A rag full of grease and petroleum caught in a gear and lashed
• 4:28:38
  him on the face. The face was only dirted, and he did not
• 4:28:42
  trouble about the accident. He washed himself, but he had much difficulty in
• 4:28:47
  clearing his skin and eyelids of these fatty substances. Remark that nothing penetrated into
• 4:28:52
  his eyes, and that he felt no pain in them. However, after
• 4:28:56
  an hour he seemed to see as it were, a mist before him.
• 4:29:00
  His mist grew thicker, and two hours later he could no longer see it
• 4:29:03
  all. His vision fluctuated a little on the morrow, and the following days.
• 4:29:07
  From time to time he could see a little, chiefly with his right
• 4:29:10
  eye. These fluctuations lasted for a month, then they disappeared absolutely, and
• 4:29:15
  for four years he remained quite blind. Here is a woman thirty one years
• 4:29:19
  old whose story is similar. In a laundry where she worked, she received
• 4:29:23
  in the face some water mixed with soap and lime. In consequence of the
• 4:29:26
  explosion of a boiler. Her skin was lightly burnt and her eyelids swelled.
• 4:29:32
  She was in her menstrual period when the accident happened. She felt very much
• 4:29:36
  agitated and very giddy. During the first days she hardly dared open her eyes.
• 4:29:41
  It was soon noticed that she could see no more. The amorosis was
• 4:29:45
  complete for two years. When I examined this patient, there was already a
• 4:29:48
  slight restoration of the vision, which was easily and rapidly completed. In other
• 4:29:53
  cases, the blindness is less serious. It lasts a few days and disappears
• 4:29:57
  suddenly. A woman of twenty seven has the following singular habit. While reading,
• 4:30:03
  she sees, as it were, a red flash of lightning which illuminates
• 4:30:07
  the room. She shuts her eyes, and when she opens them again,
• 4:30:10
  she sees no more. Once this accident lasted twelve days, another time seven,
• 4:30:15
  another eight. Her sight comes back suddenly just as it disappears. It
• 4:30:19
  is needless to tell you that when the blindness is thus complete, the diagnosis
• 4:30:23
  is very difficult, and that you cannot take too many precautions. Of course,
• 4:30:27
  you must first ask for a thorough examination of the vision made by a
• 4:30:32
  competent oculist, you should beware of lesions of the funders of the eye and
• 4:30:36
  of the optic nerve, of hemorrhages of the vitreous body, et cetera.
• 4:30:40
  Inquire into the state of the pupillary reflexes. Theoretically they must be quite normal
• 4:30:45
  in hysterical blindness. It is a rule we have already seen. It was
• 4:30:49
  so in the three cases of which I just spoke to you. It is
• 4:30:53
  true you may have complications connected with the contractors of the iris. But then
• 4:30:57
  do not be in too great a hurry to make make a diagnosis. Of
• 4:31:02
  course, you will find a great help in the study of the mobility of
• 4:31:03
  the phenomenon if you can provoke it. Sometimes this kind of blindness disappears absolutely
• 4:31:10
  in abnormal states, in crises, or in somnambulisms, then it is all
• 4:31:14
  right. Lastly, you will sometimes succeed in making the contradictory character evident,
• 4:31:18
  and in showing that in reality the hysterical can see, though she maintains the
• 4:31:23
  contrary. Professor Jolly of Berlin said, in this respect, those children who
• 4:31:29
  seem not to perceive any light, nevertheless, are void. Obstacles unexpectedly put
• 4:31:33
  before them they do not behave like people really blind. They must have a
• 4:31:37
  kind of perception you recognize in this our subconscious perception, the establishment of which
• 4:31:42
  assumes great importance here. It is, however, true that complete hysterical blindness,
• 4:31:48
  which happily is rare, is always very perplexing to physicians. Happily,
• 4:31:53
  it is no longer so when we consider the incomplete and more frequent forms into
• 4:31:57
  which hysteria decomp the visual function, doing away with only one part of it.
• 4:32:03
  The simplest, and if I may say so, the most amusing of
• 4:32:07
  these decompositions is unilateral, a morosis, which is simply grounded on the fact
• 4:32:11
  that man has two eyes, and that total vision is a system composed of
• 4:32:15
  two visions. Very often you hear young people complaining that they see only with
• 4:32:18
  one eye. They do not trouble very much, however, about this accident.
• 4:32:23
  Usually they do not know its origin, and have noticed it by chance,
• 4:32:26
  being one day obliged for some reason to keep their right eyes shut.
• 4:32:30
  They are quite surprised to find themselves in darkness. You repeat the experiment,
• 4:32:34
  and you recognize that they see quite well when they have both their eyes open,
• 4:32:38
  but see absolutely nothing when one of their eyes is shut. These observations
• 4:32:42
  are innumerable, and they have given rise to many studies and discussions about hysteria.
• 4:32:48
  It is perhaps one of the facts which served as introduction to the studies
• 4:32:51
  of experimental psychology. The reason is that this amrosis presented itself in rather odd
• 4:32:57
  conditions and was for oculists and here riating problem. Why there is nothing extraordinary
• 4:33:03
  in the fact that an eye is affected separately, it is because we find
• 4:33:07
  here carried to the highest degree the character of hysterical anesthesia. First, this
• 4:33:11
  blindness occurs without any appreciable organic disturbance, and without any impairment of the elementary
• 4:33:18
  function of the organ. The eye is absolutely uninjured outwardly and inwardly. Its
• 4:33:22
  important reflexes are quite unimpaired. However, you may not infrequently recognize a suppression
• 4:33:29
  of the reflexes of peripheric origin, I mean the corneal and conjunctival reflexes.
• 4:33:33
  The touching of the conjunctiva or of the cornea with a bit of paper,
• 4:33:37
  for instance, will not bring on the spasmodic shutting of the eyelids. We
• 4:33:41
  have there a reflex of superficial sensibility, which may be disturbed, but the
• 4:33:47
  pupillary reflexes to light and to accommodation are mostly perfect, with a reservation of
• 4:33:51
  contractures of the iris of which I told you to beware. In these conditions,
• 4:33:56
  physicians are astonished that the subject cannot see. In certain particular cases,
• 4:34:02
  their distrust is still more justifiable, as when, for instance, before the
• 4:34:04
  Board of Examination for recruits, young men wishing to avoid military service maintain that
• 4:34:10
  they are blind of the right eye and that they are unable to take aim.
• 4:34:15
  The army surgeon charged with the inspection has certainly a right to express some
• 4:34:18
  doubt. When he does not recognize any objective disturbance in this eye, and
• 4:34:22
  sees the pupil react to light as if the retin are perceived quite well,
• 4:34:26
  he invents subtle processes to find out what he thinks is a fraud. The
• 4:34:32
  two prettiest of those processes are the letters of Snellen and the box of Fleece.
• 4:34:36
  On an absolutely dark ground are pasted letters cut out of paper, some
• 4:34:40
  blue, others red. To the eyes of the subject is applied a pair
• 4:34:44
  of eye glasses, one of the glasses of which is quite of the same
• 4:34:47
  blue tint as the letters and the other of the same red tint. Through
• 4:34:52
  the red glass, which lets only the red rays pass through. The red
• 4:34:55
  letters on the black ground can be seen, but the blue ones become as
• 4:34:57
  black as the ground and cannot be distinguished from it, while the reverse is
• 4:35:02
  true for the blue glass. The result is that in these conditions, the
• 4:35:06
  right eye can read only one half of the letters, and the left eye
• 4:35:08
  the other half. A person who sees with both eyes instinctively completes one eye
• 4:35:14
  with the other and reads the whole word without difficulty. In these conditions,
• 4:35:18
  a one eyed person can only read a part of the letters. Now what
• 4:35:22
  does our recruit do with the eye glasses on his eyes? He quietly reads
• 4:35:26
  all the letters on the black board. The box of Fless is still more
• 4:35:30
  ingenious. Here Fig. Twelve is its schema. The subject looks into a
• 4:35:36
  little box through two holes corresponding to his two eyes, D and G.
• 4:35:41
  At each end of the box are two colored spots two wafers, one red
• 4:35:45
  R and the other white B, for instance, But the subject cannot see
• 4:35:48
  them directly. He only sees their images in two little mirrors M M hidden
• 4:35:52
  in the bottom of the box in black paper and making an angle of forty
• 4:35:56
  five degrees with the bottom. These mirrors cast the images of the wafer's sideways
• 4:36:00
  in a strange way. The object, which in reality is seen by the
• 4:36:04
  right eyed D, appears on the left side in B, and the object,
• 4:36:08
  which in reality is seen by the left eye G appears on the right
• 4:36:11
  side in R. Neither, however, of those wafers can be seen simultaneously
• 4:36:17
  by the two eyes. How would a one eyed man who has really lost
• 4:36:21
  his left eye conduct himself when asked to look into this box? He would
• 4:36:25
  say, I see only one wafer, the white one B, for instance.
• 4:36:27
  But what astonishes me is that it appears on my left side. Now,
• 4:36:32
  usually I am not able to see on this side. What will a
• 4:36:36
  malingerer do who sees with his left eye but pretends to be blind of this
• 4:36:38
  eye. In reality, he will see the two wafers, but as he
• 4:36:42
  will think it necessary to suppress one, he will of course suppress the one
• 4:36:45
  which appears on the left side, the supposed blind side. He suppresses the
• 4:36:49
  white wafer B, and he declares that he sees only one wafer, the
• 4:36:53
  red one, on his right side. Now, as this wafer R can
• 4:36:57
  only be seen by the left eye, which he pretends is blind. The
• 4:37:00
  fraud is discovered. How do our hysterical patients conduct themselves in presence of this
• 4:37:07
  box? We must admit that they look very absurd. Oftenest they naively say
• 4:37:12
  that they see both wafers. You will understand that formerly, in these conditions
• 4:37:17
  they were generally accused of fraud. It is strange to remark that our hystericals
• 4:37:22
  are not lucky. Their accidents are such that they are nearly always mistaken for
• 4:37:26
  crimes or tricks. Some were burnt on account of their fits or devil's clause.
• 4:37:30
  Others were sent to prison in order to be cured of their amurosis.
• 4:37:34
  However it may be these singular facts discovered by army surgeons had excited curiosity.
• 4:37:41
  There was a time, especially in France, when the apparently insignificant little phenomenon
• 4:37:45
  of unilateral amrosis was intensely studied. With the researches of that period are connected
• 4:37:51
  the names of Ronard pariinau Bernheim, and perhaps also mine, if you will
• 4:37:56
  allow me to recall it to the preceding experiments, men, any others of
• 4:38:00
  much the same kind have been added. You know, the old experiment of
• 4:38:03
  the physicist Brewster. If the subject looks at an object with both eyes open,
• 4:38:07
  and if you press slightly on one of his eyes, he sees two
• 4:38:11
  objects instead of one, simply because the object is no longer painted on the
• 4:38:15
  concording points of the two retinas. If in the same conditions, without touching
• 4:38:19
  the eyes, you put a prism before one eye, the same phenomenon takes
• 4:38:22
  place. The object is doubled. Of course, this doubling implies the existence
• 4:38:27
  of two eyes and two visions. Nothing of the kind takes place. If
• 4:38:30
  the experiment is repeated with the one eyed person, you can verify it yourself
• 4:38:36
  by shutting one eye and slightly pressing on the other. The object moves,
• 4:38:40
  but is not doubled. Well in the unilateral amorrosis of hystericals. All these
• 4:38:45
  experiments, and many others of the same kind, give the same results as
• 4:38:48
  with normal subjects who see with both eyes. The explanation based on fraud is
• 4:38:53
  very simple, perhaps too simple, in the case of persons who are not
• 4:38:56
  recruits and have not the least interest in giving them themselves out to be one
• 4:39:00
  eyed, and must even pay the oculist when they take advice with a more
• 4:39:06
  attentive observation. This first interpretation of things was given up. We have all
• 4:39:10
  recorded our word on this question. Of course, Monsieur Belheim spoke of suggestion.
• 4:39:15
  I have myself insisted on the subconscious sensations, which continue to exist in
• 4:39:19
  certain cases though the subject has no personal perception of them. But now I
• 4:39:25
  acknowledge that Monsieur Pariinaut has given the best formula of this special fact. In
• 4:39:29
  a pretty disquisition on vision, he showed that the existence of the two eyes
• 4:39:33
  and their position gave birth to two different visions. First, there is the
• 4:39:37
  monocular vision, either separate or alternating, which is the only one with many
• 4:39:41
  animals, as horses, whose eyes are on either side of the head,
• 4:39:45
  they can look to the right or to the left they can alternate. But
• 4:39:48
  that is all. With animals such as man, monkeys, and some dogs,
• 4:39:52
  whose two eyes are nearly on the same plane, things are more complicated.
• 4:39:56
  These beings may have not only the preceding monocular and alternating vision, but
• 4:40:00
  also another vision called the binocular vision. This vision consists in the synthesis of
• 4:40:06
  the two preceding ones, which enables us to see only one object with two
• 4:40:10
  eyes. This vision is an improvement on the preceding one, in that it
• 4:40:14
  allows us to see the same object more clearly, permits fixity, and gives
• 4:40:18
  the appearance of relief. It is the starting point of the experiment with the
• 4:40:22
  stereoscope. Generally we make use of this vision, but we retain the possibility
• 4:40:27
  of using the inferior vision, which we utilize in many cases, sometimes involuntarily
• 4:40:33
  to see sideways or when one eye is tired, sometimes voluntarily by shutting one
• 4:40:37
  eye when taking aim with a pistol, or looking in a microscope. Now,
• 4:40:42
  it is very curious to see that hystericals are able to effect the dissociation
• 4:40:47
  of these two visions, the existence of which we scarcely suspected. They mostly
• 4:40:52
  lose, and this is an accident that was not known. They lose the
• 4:40:55
  binocular vision, that is to say, the higher, truly human vision,
• 4:41:00
  only they do not complain of it. It is the medical examination that will
• 4:41:03
  reveal to you this unexpected thing that an hysterical cannot look with a stereoscope and
• 4:41:08
  is unable to perceive the relief in Ducoudo or Ron's anaglyphs. But sometimes also
• 4:41:14
  they lose the monocular vision of one eye while keeping the binocular vision. The
• 4:41:18
  preceding experiments by appealing to the binocular vision, by making it necessary placed hystericals
• 4:41:23
  in conditions in which their disturbances did not appear. You see that this singular
• 4:41:29
  amorosis has already dissociated the visual function in an amusing manner. Setting apart now
• 4:41:33
  the binocular now the monocular function. Two. Let us continue the examination of
• 4:41:41
  the hysterical disturbances of vision, and we shall see that dissociation will still gain
• 4:41:45
  ground and enter into more delicate functions. The most important symptom to be known
• 4:41:49
  now is the famous narrowing of the visual field on which we ought to be
• 4:41:52
  able to dwell for a long time. You know that human sight, owing
• 4:41:57
  to the dimensions of the retina, extend over a certain surface. The extent
• 4:42:02
  of the surface and eye can see simultaneously without moving is called the visual field.
• 4:42:07
  No doubt, all the points of this definition should be discussed. It
• 4:42:11
  is not quite certain, in particular that all the points of the visual field
• 4:42:14
  are seen simultaneously in a single act of attention. But this definition is practically
• 4:42:18
  sufficient if you measure the visual field of a normal subject with those instruments which
• 4:42:22
  are called campimeters and perimeters, the description of which would be too long.
• 4:42:27
  You obtain the following figure which I have presented to you. In this picture
• 4:42:30
  of the visual field of the right eye are in Fig. Thirteen. The
• 4:42:36
  field has the form of an irregular circle, more extended on the external and
• 4:42:40
  on the inferior sides, where it measures almost ninety degrees, which means that
• 4:42:44
  the angles formed by the fixation point the eye for vertex and the limit of
• 4:42:48
  the visual field is of ninety degrees. The circle is narrowed on the internal
• 4:42:52
  and superior sides, where it is barely sixty degrees. This very natural diminution
• 4:42:57
  is due, as you may guess, to the obstacle formed by the nose
• 4:43:00
  and the eyebrows. Well, if you examine the visual field of hystericals,
• 4:43:06
  you will recognize a very remarkable fact which very likely exists only in this neurosis.
• 4:43:11
  The visual field is narrowed concentrically. The extent of the simultaneous vision becomes
• 4:43:15
  smaller. The field is almost circular at thirty degrees or twenty degrees, as
• 4:43:21
  you see in the left eye of the figure thirteen. Sometimes the field has
• 4:43:25
  only ten degrees or five degrees, and nothing is left but the fixation point.
• 4:43:29
  It is true that a disease of the retina pigmentary retinitis, and perhaps
• 4:43:33
  also certain forms of chronic glaucoma, give rise to an analogous phenomenon. But
• 4:43:37
  then, in the first place, the visual field has an irregular form,
• 4:43:41
  and in the second place there are visible lesions of the funders of the eye.
• 4:43:45
  As regards the diseases of the nervous system, it has been said that
• 4:43:49
  this concentric contraction of the visual field is found in epilepsy and in disseminated sclerosis.
• 4:43:56
  This has been recognized to be false. So this symptom becomes one of
• 4:43:59
  the most important of hysteria, not for the patient, of course, but
• 4:44:03
  for the physician, who makes use of it as a characteristic sign. This
• 4:44:07
  contraction of the visual field has interesting psychological properties. It is quite a matter
• 4:44:11
  of indifference to the subject. And this is a curious fact on which I
• 4:44:15
  have elsewhere insisted. As a matter of fact, nothing is so inconvenient as
• 4:44:19
  a real contraction of the visual field. You know how the unfortunate people who
• 4:44:23
  are affected with chronic glaucoma complain of being no longer able to glance over the
• 4:44:27
  newspaper because they see only one word or one syllable at a time. These
• 4:44:33
  patients, who however, see very well in the center, can no longer
• 4:44:36
  find their way in the street. Hystericals who have an exceedingly small visual field
• 4:44:41
  run without in the least troubling themselves about it. This is a curious fact
• 4:44:45
  to which I remember, having attracted the attention of Chalcourt, who had not
• 4:44:48
  remarked it, and was very much surprised at it. I showed him two
• 4:44:52
  of our young patients playing very cleverly at ball in the courtyard of La Salpetriere.
• 4:44:57
  Then, having brought them before him, I remarked to him that their
• 4:45:00
  visual field was reduced to a point, and I asked him whether he would
• 4:45:03
  be capable of playing at ball if he had before each eire card merely pierced
• 4:45:07
  with a small hole. It is one of the finest examples that can be
• 4:45:12
  shown of the persistence of subconscious sensations in hysteria. Besides, I had shortly
• 4:45:18
  afterwards the opportunity of making a still more precise experiment on the same point.
• 4:45:23
  A young boy had violent crises of terror caused by a fire, and it
• 4:45:27
  was enough to show him a small flame for the fit to begin again.
• 4:45:30
  Now his visual field was reduced to five degrees, and he seemed to see
• 4:45:34
  absolutely nothing outside of it. I showed that I could provoke his fit by
• 4:45:38
  merely making him fix his eyes on the central point of the perimeter, and
• 4:45:42
  then approaching a lighted match to the eightieth degree. The same experiment can be
• 4:45:47
  more simply realized by using suggestions, of which we shall speak later. A
• 4:45:52
  subject has received the order, which he obeys unconsciously, to raise his arm
• 4:45:56
  as soon as he sees a paper before his eyes. Suggestion is executed,
• 4:46:00
  even if the paper is put at the eightieth degree, far out of the
• 4:46:03
  limits of his conscious visual field. You see that this hysterical disturbance has not
• 4:46:08
  quite done away with the ocular perception in the lateral parts of the retina.
• 4:46:12
  It is again a dissociation, like the preceding ones. We have two visions,
• 4:46:17
  the central vision, which is accurate and attentive, and the peripheric vision,
• 4:46:21
  which is vacant and of secondary importance. You see that the hysterical keeps
• 4:46:26
  only the first consciously, the second persisting quite subconsciously. I cannot end this
• 4:46:33
  examination of the visual field without saying a few words on a very curious problem
• 4:46:36
  in which I took a particular interest. Can the visual field be modified only
• 4:46:41
  in this way? In other words, is the contraction always concentric? We
• 4:46:45
  have not the time to examine the different faces of this problem. I shall
• 4:46:49
  only insist on one. Can we meet in hysteria with the hemiopical visual field
• 4:46:53
  or with the phenomenon of hemionopsia. The question is more important than it looks.
• 4:47:00
  Heminopsia. That is to say, the vision of only one half of
• 4:47:03
  the visual field is a frequent phenomenon, often succeeding cerebral lesions, the section
• 4:47:08
  of the optical nerves, gratiolaise radiations, the lesions of the occipital lobes of
• 4:47:14
  the cuneus do away with the vision in one of the vertical halves of the
• 4:47:17
  retina, and you know that the lesion is distinguished by the place and form
• 4:47:21
  of this hemiinopsia. After some fluctuations, physicians had come, especially after Jild
• 4:47:26
  de Latorette's work, to deny absolutely the existence of hysterical hemianopsia and to reserve
• 4:47:32
  this symptom for organic lesions. This decision is not tenable a priori. I
• 4:47:37
  do not see any reason why the functional disturbance of hysteria should not realize the
• 4:47:41
  same symptoms as the organic destruction of the center of the function. Every function,
• 4:47:47
  as we said when treating of paralysies, finally has when it is old,
• 4:47:51
  its organic center, and in certain cases the functional and organic disturbances may
• 4:47:56
  be alike. Besides, did we not, unquestionably as lablished this fact when
• 4:48:00
  we studied hemiplegi. There is no disturbance more symptomatic of a great lesion than
• 4:48:04
  motor hemiplegie, and nobody denies that it takes place in hysteria. It is
• 4:48:11
  the same with hemianopsia, and in despite of theories, we must recognize a
• 4:48:15
  fact if it exists. After the preceding period of negation, Monsieur Dejerine in
• 4:48:19
  eighteen ninety four and I myself in eighteen ninety five presented the first authentic observations
• 4:48:26
  of functional heminopsia. I think I gave the demonstration of the hysterical character of
• 4:48:30
  this syndrome by showing the existence of subconscious sensations in the apparently suppressed part of
• 4:48:36
  the visual field fig. Fourteen. Since then I have had the opportunity to
• 4:48:40
  show other equally distinct cases, a schema of which you see here Fig.
• 4:48:44
  Fifteen. In a paper which appeared in the Brain in eighteen ninety seven,
• 4:48:48
  W. Harris presented analogous cases. He pointed out, in particular, as
• 4:48:53
  I had done myself, some cases in which hysterical hemianopsia begins with amorrosis.
• 4:49:00
  It is at the time of the recovery from an hysterical amorrosis that the visual
• 4:49:03
  field takes in many cases the hemianopsic form for some time. I refer you
• 4:49:08
  the respect to this to my paper on transitory hemianopsia ankhars demillanupsi Esterich transitois la
• 4:49:15
  Presse medical, October twenty five, eighteen ninety nine, Page two four One.
• 4:49:22
  These phenomena of hemianopsia should not, I think, astonish us beyond all
• 4:49:26
  measure and induce us to transform our general conception of the neurosis. The study
• 4:49:30
  of the anatomical localization of the vision leads us to conceive a particular distribution of
• 4:49:36
  vision on the retina. Suppose a man having only one eye in the middle
• 4:49:38
  of his forehead like the cyclops or, if you prefer it, two eyes
• 4:49:42
  placed one under the other in the middle of his head. Each of these
• 4:49:45
  eyes will have a right half and a left half, like the rest of
• 4:49:48
  the body, and a distinct function of the vision to the right and of
• 4:49:52
  the vision to the left will form, comprising the two right halves and the
• 4:49:56
  two left halves of the two eyes. Later the two eyes separated and disposed
• 4:50:00
  themselves otherwise, but the function has remained the same, and there is still
• 4:50:04
  now a function of the vision to the right and another of the vision to
• 4:50:07
  the left. These functions may become dissociated in hysteria, just as all the
• 4:50:11
  others, only as these functions are very old, the dissociation seldom goes so
• 4:50:17
  far. It exists sometimes, however, and hysterical hemianopsia is a profound accident
• 4:50:22
  which can be compared to motor hemiplegi. Three. You can now apply the
• 4:50:29
  same method yourselves to the interpretation of all the other visual disturbances, which are
• 4:50:33
  still very numerous. I will only point out to you dyschromatopsia, that is
• 4:50:37
  to say, the loss of the vision of colours. It frequently happens that
• 4:50:41
  hystericals, whilst still having a good visual acuity, cease to perceive colors or
• 4:50:45
  at least certain colors violet, blue, and green seem to vanish first.
• 4:50:51
  Red appears to be the most persistent color. This fact was formally considered as
• 4:50:56
  accounting for the fondness of hystericals for red. They are fond of rising in
• 4:51:00
  showy colors, of putting red ribbons in their hair. The reason is it
• 4:51:03
  was said that these colours are the only ones they continue to see. There
• 4:51:07
  is some exaggeration in this, and it is more likely that moral reasons,
• 4:51:11
  such as the very curious need they feel to be noticed, play a more
• 4:51:15
  considerable part in this phenomenon. I think also that this loss of colours has
• 4:51:21
  been examined with exaggerated accuracy. A visual field of colours has been drawn,
• 4:51:26
  and efforts have been made to prove that in hysteria this visual field is modified
• 4:51:30
  in a regular manner, the visual field of blue, for instance, becoming
• 4:51:33
  in this disease smaller than that of red. It may be so, but
• 4:51:37
  I advise you to be cautious in this study. First of all, the
• 4:51:41
  perception of colours at the periphery of the visual field changes very much, even
• 4:51:45
  in a normal person, according to all kinds of conditions, and in particular
• 4:51:49
  according to the lighting Besides in hystericals, the influence of the association of ideas
• 4:51:56
  plays an enormous part in the perception of colours. A young woman saw red
• 4:52:00
  flowers put on her father's coffin. It made her very angry, because these
• 4:52:03
  flowers constituted a political emblem. She now holds red in abhorrence, and has,
• 4:52:08
  on that account a very fine perception of red, and a visual field
• 4:52:11
  for red more extended than for white. Special account should be taken of the
• 4:52:15
  part played by perceptions and ideas in the dissociation of the small details of vision,
• 4:52:21
  particularly in the accidents of painful vision, of fears of certain colors,
• 4:52:25
  of photophobia, which I merely point out to you. I wish to insist
• 4:52:30
  before ending this lesson on some other accidents, the types of which I must
• 4:52:33
  at least indicate to you. These accidents are the disturbances in the motion of
• 4:52:37
  the eyes, about which you will notice as many complications as about vision itself.
• 4:52:44
  Let us not speak of the movements of the eyelids. You will again
• 4:52:47
  find here the phenomena of paralysis, ticks, contractures, which we have already
• 4:52:51
  studied. But let us dwell a little on othalma pleigi such as was pointed
• 4:52:56
  out by le Breton Ballets Bristow and a special by Kernig in eighteen ninety one.
• 4:53:02
  Because it is again an interesting phenomenon as regards interpretation, certain subjects seem
• 4:53:07
  to become unable to move their eyes. They have an absolutely fixed look,
• 4:53:11
  which seems strange. Such fixity of the look is often connected with an automatic
• 4:53:15
  fixation of certain objects or with certain hallucinations. This is the most frequent case,
• 4:53:21
  and when one can divert the subject from his fixed idea, he looks
• 4:53:23
  in every direction. But in certain cases, which have as yet been rather
• 4:53:27
  seldom described, it is not so. The subject looks at nothing fixedly.
• 4:53:33
  He can look at different objects, but only by turning his head. It
• 4:53:37
  is his eyes that do not move. Earlier authors, among them Moras and
• 4:53:41
  Parinous, showed that this immobility is purely in connection with the will. If
• 4:53:45
  the subject wants to look sideways, if he is asked to do so,
• 4:53:49
  if he thinks of it, he cannot manage it. But do not think
• 4:53:52
  it is an absolute immobility. It is sufficient to let an object fall noisily
• 4:53:56
  near him without warning him, and his eyes will immediately and rapidly turn in
• 4:54:00
  this direction. In a word, here, as always, the subconscious and
• 4:54:03
  automatic motion is retained, whereas the voluntary motion is lost. These disturbances of
• 4:54:11
  the movements of the ocular muscles may be less simple and consistent spasms in irregular
• 4:54:15
  contractures. Then, of course the eyes will deviate in one direction or the
• 4:54:18
  other, and you will have all possible forms of strabismus, the diagnosis of
• 4:54:22
  which is also important. Lastly, the disturbance of the ocular motion may affect
• 4:54:27
  the internal muscles, and particularly the muscles of the crystalline lens. Here again
• 4:54:33
  we have a function that becomes dissociated, that of accommodation. Instead of being
• 4:54:37
  able to accommodate their eyes to very various distances from thirty centimeters to the horizon,
• 4:54:44
  these patients have only a very limited accommodation. Their eyes are an optical
• 4:54:48
  instrument in crystal adjusted to a given and immutable distance. When you find the
• 4:54:52
  exact distance to which they are accommodated fifty centimeters, for instance, or one
• 4:54:56
  meter, an object placed at this dist stance is seen quite clearly, but
• 4:55:02
  it is no longer seen at all if you put it nearer or farther.
• 4:55:06
  This spasm of accommodation is connected with a great many hysterical disturbances on which I
• 4:55:10
  am very sorry not to be able to dwell. Monocular diplope, polyopy,
• 4:55:15
  macropsia, micropsia, et cetera. Now objects are seen double or triple,
• 4:55:21
  and that by a single eye, which from the point of view of optics
• 4:55:23
  seems quite paradoxical. Now they are seen too large or too small, or
• 4:55:27
  deformed in a thousand ways. I have described in this connection some very odd
• 4:55:33
  phenomena, objects appearing to the subject too big or too small in one of
• 4:55:37
  their halves only, and quite normal in the other, a kind of hemimcropsia.
• 4:55:42
  I shall only point out to you, if not two theses, at
• 4:55:45
  least two tendencies in the interpretation of these odd phenomena. Monsieur Pariinou and his
• 4:55:51
  school sought a physical interpretation of the accidents in the contracture of the crystalline lens.
• 4:55:56
  Others attribute a more important part to psychological phenomena. You have here a
• 4:56:00
  fine field open to your personal researches. You see what would be the richness
• 4:56:04
  of a study that bears upon the hysterical disturbances of visual perceptions. Let us
• 4:56:11
  only retain the two following general notions. First, the disturbance is never very
• 4:56:15
  profound and always bears solely on attentive and voluntary perceptions. It always spares the
• 4:56:21
  elementary sensations, reflexes, anatomical movements. Second, the disturbance seems to consist
• 4:56:27
  in a very curious separation of the different functions united in the vision, which
• 4:56:32
  all at the same time or each in its turn, separate from personal consciousness
• 4:56:36
  and seem to proceed henceforward on their own account. End of Section nine.
• 4:56:41
  Lecture ten. The troubles of speech, importance of the psychological study of the
• 4:56:48
  disturbances of speech, description of some cases of hysterical mutism, the part played
• 4:56:52
  by emotion by shocks on the right side, the characters of hysterical dumbness,
• 4:56:59
  the forgetfulness of speech, the absence of paralytic phenomena, the alleged differences between
• 4:57:03
  hysterical mutisms and organic aphasas, the different forms of hysterical dumbness aphonia, stammering,
• 4:57:11
  aphemia, agraphia, a case of hysterical word deafness. Automatic speech during
• 4:57:17
  hysterical mutism or alternating with periods of dumbness, ticks, or agitations of speech
• 4:57:22
  the emancipation of the function of speech. As we now know the disturbances of
• 4:57:29
  motion and those of perceptions, we can enter upon the study of a complex
• 4:57:32
  phenomenon which, in reality is nothing but a mixture of the preceding symptoms.
• 4:57:37
  I mean, the disturbances of speech. The function of speech plays a considerable
• 4:57:41
  part in every impairment of thought. It is always more or less modified in
• 4:57:45
  all intellectual disturbances. However, most mental derangements bear upon a somewhat higher level
• 4:57:51
  upon the formation of ideas, properly so called On the contrary, hysteria,
• 4:57:56
  which bears essentially upon the voluntary functions of motion, upon the conscious perceptions,
• 4:58:00
  which is precisely this mental level to which speech corresponds and must determine very frequent
• 4:58:06
  disturbances in the expression of thoughts. These disturbances have long been known, but
• 4:58:11
  physicians have generally been inclined to consider them as being of quite a particular nature.
• 4:58:17
  They thought that hysterical phenomena could not be like others, and it seems
• 4:58:21
  to me that they separated far too much the disturbances of speech in hystericals from
• 4:58:25
  the pathology of speech in general. I should like to show you that all
• 4:58:29
  the disturbances of speech, whatever they may be, are to be found in
• 4:58:33
  these patients, and that you can study the pathology of aphasia in them as
• 4:58:37
  well as in organic patients. And even better, now, when in the
• 4:58:41
  papers of doctor Pierre Marie of Paris, the troubles of aphasia are brought nearer
• 4:58:45
  the disturbances of thought, it is interesting to study the hysterical troubles of speech,
• 4:58:49
  in which the alteration of the whole consciousness is more evident one. In
• 4:58:56
  antiquity, certain impairments of speech had already been noticed, but evolution and the
• 4:59:00
  surprising cure of which seemed unaccountable. The following observation made by Hippocrates appears to
• 4:59:06
  relate to a hysterical accident. The wife of Polemarchus, having an arthritical affection,
• 4:59:11
  felt a sudden pain in her hip, as her mensis had not come.
• 4:59:15
  Having drunk some beetroot water. She remained voiceless for the whole night until
• 4:59:18
  midday she could hear and understand. She showed with her hand that the pain
• 4:59:23
  was in her hip. This description seems to contain everything the stopping of the
• 4:59:29
  mensis, the arthritic disturbances which are probably disturbances of motion, the preservation of
• 4:59:33
  the perceptions of speech, and the dumbness. It is not necessary to remind
• 4:59:38
  you of the story of Creesus's son, the dumb young man who suddenly recovers
• 4:59:42
  his speech to cry, soldier, do not kill Creesus. We may pass
• 4:59:48
  on to modern times and remind you of all the stories of dumbness in possessed
• 4:59:51
  people and ecstatics. I have already alluded to carried de mor Duran's work on
• 4:59:56
  the miracles of Deacon Paris, in which you can read the case of Margaret
• 5:00:00
  maerat Francois Duchenes. After a fit of lethargy, which lasted seven or eight
• 5:00:03
  days, there appeared a nearly total loss of voice. She was deprived of
• 5:00:07
  everything, even of the power of complaining. A month afterwards she recovered her
• 5:00:12
  hearing and sight, but it was not the same with her voice, which
• 5:00:15
  was never restored to her. In the nineteenth century, such cases became more
• 5:00:19
  numerous. The English surgeon Watson boastood of having, through an electric treatment,
• 5:00:25
  restored the power of speech to a young lady who had been voiceless and dumb
• 5:00:29
  for twelve years. Briquet gusmau Rivilloule, Charcot and Cartase insisted very strongly on
• 5:00:36
  these phenomena, which are now well known in their ensemble. This accident may
• 5:00:41
  happen to confirmed hysterics who have already had many accidents of the neurosis after a
• 5:00:45
  somnambulism or a fit, but they may also happen to people who have hitherto
• 5:00:49
  seemed nearly normal. It is almost always brought on by a great and somewhat
• 5:00:53
  sudden emotion. It was so, for instance, in the classical case studied
• 5:00:57
  by Charcot, a man of about forty living in a little town had saved
• 5:01:02
  some money. His wife persuaded him to come and spend it in Paris.
• 5:01:07
  He settled with her in an hotel in the metropolis. One day, after
• 5:01:11
  a short absence, he came back to the hotel and found that his wife
• 5:01:14
  had disappeared, taking the little hoarde with her. The poor man was so
• 5:01:18
  upset that he was deprived of utterance and remained speechless for eighteen months. Now,
• 5:01:22
  though seemingly cured, he is still liable to the same accident. At
• 5:01:26
  the least emotion or fatigue, he loses again. The use of speech for
• 5:01:30
  a fortnight or for two months. Notice, by the way this character of
• 5:01:33
  hysteria. When an accident has once happened in a particular and serious form,
• 5:01:37
  it is always the same accident that reappears on every occasion. The same remark
• 5:01:44
  applies to the following observation, which I have noted down. A man who
• 5:01:48
  is now forty six has been ill since he was twenty one day. At
• 5:01:52
  that period, he was in a garden near a glass verandah. A heavy
• 5:01:55
  object thrown from one of the upper floors, fell on the verandah and broke
• 5:01:57
  some of the glass with a noise like the report of a gun. Our
• 5:02:02
  man was very much frightened and remained dumb for two months. Though twenty six
• 5:02:07
  years have elapsed since the accident, he never recovered from it. The slightest
• 5:02:11
  noise he hears suddenly near him, a word spoken somewhat too loud, is
• 5:02:15
  enough to make him dumb again for thirty or fifty days. In other observations,
• 5:02:18
  the dumbness begins in young women of twenty on occasion of a fire,
• 5:02:22
  of the break off, of a betrothal, or of a quarrel with their
• 5:02:26
  parents. In one case it is caused by the sudden appearance of a man
• 5:02:30
  disguised as a specter. The accident happened when she was eighteen and is not
• 5:02:33
  yet cured at forty one. Sometimes the emotion bears particularly on the organs of
• 5:02:40
  speech or respiration. It comes on after a sore throat or a disease of
• 5:02:44
  the chest. In certain cases, one must not forget that the accidents bore
• 5:02:48
  on the right side of the body. A young man of eighteen fell from
• 5:02:52
  horseback on his right knee. The consequence was a really hysterical hemiplegia of his
• 5:02:56
  right side and a dumbness. A young woman working in a tavern hurt her
• 5:03:00
  right hand with a broken bottle. She was first paralyzed in her right side,
• 5:03:04
  and this paralysis seemed to extend to the throat, for she lost the
• 5:03:07
  use of speech. These last cases are important in regard to the association of
• 5:03:12
  paralyses of the right side with aphasias. In another curious case, I will
• 5:03:18
  remind you of the story of a woman, a great spiritualistic medium, who,
• 5:03:22
  after having too often made use of automatic writing, was affected with hysterical
• 5:03:25
  dumbness. This again is interesting as regards the interpretation. However, it may
• 5:03:32
  be. When this dumbness is constituted, it appears nearly always in the same
• 5:03:36
  manner of which Chalcour gave a very famous and vivid picture. The patient,
• 5:03:40
  save in exceptional cases, looks healthy and is not paralyzed. He has not
• 5:03:44
  that weak and sickly appearance of persons struck with an organic hemiplegi consequent on a
• 5:03:48
  cerebral hemorrhage. Nor does he offer a very visible intellectual weakness the dazed look
• 5:03:53
  of the latter patients. On the contrary, he seems intelligent and lively.
• 5:03:59
  He comes forward with an expressive face, understands all you tell him, but
• 5:04:02
  takes a singular attitude when he has to answer. The characteristic fact is that
• 5:04:07
  he does not try to answer. He does not make those efforts of speech
• 5:04:10
  that an aphasic person makes, or that a foreigner makes when trying to express
• 5:04:14
  himself in a language he knows imperfectly. He does not look as if he
• 5:04:18
  thought it possible to answer with words. He does not open his mouth,
• 5:04:21
  he makes no sound. He answers with signs, or else takes up a
• 5:04:25
  pencil and answers in writing in a word. There is no imperfect speech.
• 5:04:29
  There is no speech at all, and there does not even seem to be
• 5:04:32
  any idea or remembrance or wish of speech. The subject seems to have forgotten
• 5:04:36
  that use which men right or wrong, have made of their mouths. I
• 5:04:40
  insist on this character because all the authors, with much exaggeration, in my
• 5:04:42
  opinion, make it a sign of distinction between organic aphasia and hysterical dumbness.
• 5:04:48
  When you try to realize the reason of this silence, which has often lasted
• 5:04:52
  for months together, you examine the different peripheric organs and then notice the second
• 5:04:57
  character of our affection, namely the total absence of paralytic phenomena. The lips,
• 5:05:03
  cheeks, tongue, and soft pallet move easily in the most correct way.
• 5:05:07
  The patient, who understands everything, does all he is asked, moves
• 5:05:11
  his lips, bears his teeth, smiles, draws his lips one way or
• 5:05:15
  the other, makes all the movements of his tongue, and that without difficulty,
• 5:05:18
  no doubt. I think in certain cases some reservation should be made about
• 5:05:22
  this somewhat too theoretical description of Charkle's. You will very often find in these
• 5:05:26
  mutes certain small, localized disturbances of such or such an organ, for instance,
• 5:05:32
  slight contractures of some muscle of the tongue. You must seek for them
• 5:05:36
  carefully, for it is important to do away with them before trying to bring
• 5:05:38
  back speech. You will also remark that the movements of the lips are not
• 5:05:42
  so perfect. As Charcros said. There is no paralysis properly so called,
• 5:05:47
  but there is often awkwardness, clumsiness, and ugliness, yes, ugliness.
• 5:05:52
  These subjects, whose mind retrogrades, in my opinion, lose the delicacy,
• 5:05:56
  the perfection of certain functions, and you can very we will notice their return
• 5:06:00
  to animality from the vulgarity of certain delicate movements. However, I readily recognize
• 5:06:06
  that these motor impairments are slight and quite inadequate to account for the enormous paralysies
• 5:06:10
  of speech which are to be observed if we go farther we try to study
• 5:06:15
  the condition of the vocal cords. This study, begun in Chalcour's time,
• 5:06:18
  is summarized in the thesis of Cartas he recognizes that in reality, there is
• 5:06:23
  no great disturbance in the vocal cords. Certain authors have tried to establish a
• 5:06:29
  certain degree of parisis in the adduction, but I fear they have deluded themselves.
• 5:06:33
  The only means we know to establish the drawing nearer of the vocal cords
• 5:06:37
  is to ask the subject to speak or utter a sound. Now, as
• 5:06:40
  he cannot speak or cry, he does not produce this movement before us.
• 5:06:44
  There is nothing to prove that the vocal cords are not able to accomplish it
• 5:06:48
  if it were asked of them. So we are again obliged to appeal to
• 5:06:52
  moral phenomena in order to explain the hysterical syndrome, and all the authors are
• 5:06:56
  obliged to acknowledge that the disturbance is purely mental. Two. One of the
• 5:07:02
  things that, in my opinion, obscured this study at the outset and brought
• 5:07:06
  on many difficulties is the difference that physicians at once wished to establish between these
• 5:07:11
  hysterical mutisms and the aphasias accompanied with right sided paralysies, which were observed to
• 5:07:15
  succeed hemorrhages and softenings of the brain, and whose cerebral localizations were so eagerly
• 5:07:21
  studied in imitation of broker aphasias with destruction of the third frontal convolution, were,
• 5:07:27
  it was said, the true impairments of the psychophysiological function of speech,
• 5:07:32
  and these aphasias do not present the same symptoms as hysterical dumbness. In aphasias,
• 5:07:37
  the subject feels that he has lost the use of speech, and he
• 5:07:41
  makes desperate efforts to express himself. These efforts have some success, for he
• 5:07:45
  has never lost all power to utter a sound. He can give cries,
• 5:07:48
  make varied noises with his larynx oftenest he has even retained a few words which
• 5:07:53
  have more or less meaning, as Papa, come, come, macassi,
• 5:07:59
  makassa, which he repeats at random, sometimes oddly varying the intonation. On
• 5:08:04
  the other hand, the disturbance spreads farther. A patient who cannot speak at
• 5:08:08
  all very seldom keeps all the other functions of speech intact. He has nearly
• 5:08:12
  always considerable disturbances of writing. He can no more read, or he reads
• 5:08:18
  with difficulty without understanding the meaning of what he spells. Lastly, he does
• 5:08:22
  not thoroughly understand the words spoken before him. These different disturbances, which nearly
• 5:08:27
  always exist in German a phasia properly so called, may develop separately. You
• 5:08:33
  know, the classification of the disturbances of speech made in this connection according to
• 5:08:37
  the predominance of such or such a symptom. Motor aphasias, agraphias, sensorial
• 5:08:41
  aphasas with word blindness and word deafness, have been described. Nothing of the
• 5:08:47
  kind, it has been said, is to be found in hysterical dumbness,
• 5:08:49
  which seems to be at once more extended and more restricted. It is more
• 5:08:53
  extended, for in this case motor speech is more distinctly done away with,
• 5:08:57
  and the subject does not see me and to make efforts to speak as aphasere
• 5:09:02
  patients do. It is more restricted, for the disease seems to be limited
• 5:09:06
  to the expression of words, and not to impair kindred phenomena such as writing,
• 5:09:10
  reading, and the understanding of words perceived by the ear. So the
• 5:09:14
  two things are different. And as a phasa was considered as the impairment of
• 5:09:18
  the function and of the center of speech, hysterical dumbness was necessarily quite another
• 5:09:22
  thing to these remarks, which I think quite wrong. We must first answer
• 5:09:26
  clinically. Hysterical dumbness, which I have described to you after charcot is a
• 5:09:32
  type this word being taken in the sense given to it by this author.
• 5:09:36
  It is a particular and striking case which is very remarkable from many points of
• 5:09:40
  view, but was somewhat arbitrarily chosen. You must not fancy that all the
• 5:09:44
  disturbances of speech brought on by hysteria are always conformable to this theoretical model.
• 5:09:51
  We have first to put beside it many attenuated, imperfect, or rather incomplete
• 5:09:55
  forms in which the function of language is analyzed as the visual function was before.
• 5:10:00
  One of the most frequent forms distinguishes the two degrees of vocal power we
• 5:10:03
  have at our disposal. We have the loud voice with intense sounds, which
• 5:10:07
  enables us to be heard in public, and we have the whispering voice,
• 5:10:11
  in which the movement of the lips and tongue is complete, but in which
• 5:10:15
  there is very little emission of air. Very often in hysteria the first voice
• 5:10:19
  is lost and the second is kept. It is what is called aphonia.
• 5:10:23
  In certain cases, the dissociation is still nicer. Certain subjects can sing aloud
• 5:10:29
  and cannot speak except in whispers. These distinctions will remind you of astasia abasia.
• 5:10:34
  In still other cases, there are only slighter disturbances of speech. The
• 5:10:38
  subject can speak, but stammers or stutters, or has a special voice more
• 5:10:42
  or less different from his normal voice. I do not insist on these varieties,
• 5:10:48
  because it is more important to study the varieties approaching the table of aphasia
• 5:10:52
  properly so called. In my opinion, many hystericals have disturbances of speech quite
• 5:10:57
  identical with those described as six eating an apopleptic ictus. Here is an observation
• 5:11:03
  I borrow from the second volume of my nevoszeid Fichs, page four fifty two.
• 5:11:08
  A young woman of twenty, in consequence of various emotions, shows for
• 5:11:11
  a few hours or days a very singular disturbance of speech that little resembles typical
• 5:11:17
  hysterical dumbness. First of all, she is not voiceless and can make a
• 5:11:21
  noise with her larynx. She even utters cries, either spontaneously or when she
• 5:11:26
  is asked. Nor is she quite dumb, for she tries to speak,
• 5:11:29
  which the preceding patients did not do. She makes with her tongue and lips
• 5:11:33
  movements that produce articulate sounds. But these sounds have no meaning, and they
• 5:11:37
  nearly always consist in the repetition of a few incomprehensible syllables. If I say
• 5:11:42
  to her, miss X, you walk much better to day she answers,
• 5:11:45
  smiling, petty be dable. Petty be dable. Chat cha, petty be
• 5:11:49
  dable. To the question what happened to you to day? She replies,
• 5:11:52
  very quickly, petty be dabla chopeti petty be dable. We can draw nothing
• 5:11:57
  more from her. She will go on with this jargonage, as she says
• 5:12:02
  for a few hours. Notice that we have here a real oblivion of the
• 5:12:06
  movements necessary for the pronunciation of words. She is impatient at not being understood,
• 5:12:11
  and seeks to answer by giving different intonations to her word, pretty be
• 5:12:14
  dable. It seemed to us that the intonations were often right, as well
• 5:12:18
  as the expressions of the face, But the words never changed. Our other
• 5:12:22
  functions of speech disturbed. The audition of words is not disturbed. In the
• 5:12:26
  least. She can understand very correctly all that is said to her. She
• 5:12:30
  reads very well. I mean that she does all you ask her in writing,
• 5:12:34
  but she is unable to read aloud. As for writing, it is
• 5:12:37
  not totally lost. But there is a phenomenon that appears to us worthy of
• 5:12:41
  a remark. The writing has quite changed. It has become very bad.
• 5:12:47
  It is curious to compare her writing during this state. With her normal writing,
• 5:12:51
  you see that the faculty of writing is markedly diminished, if not entirely
• 5:12:53
  lost. How can we designate these symptoms if not by the usual words of
• 5:12:59
  motory, a, phasa or aphemia. With a certain degree of agraphia,
• 5:13:04
  it is needless to demonstrate here that these symptoms are hysterical. With such a
• 5:13:07
  patient, the demonstration would be superfluous. Besides, these phenomena will disappear in
• 5:13:12
  a few hours. We could, if we chose, cause them to disappear
• 5:13:17
  immediately during the hypnotic sleep, which is easily induced, the patient will at
• 5:13:22
  once assume a normal manner of speaking. What is more, as we shall
• 5:13:25
  see presently, the subject presents, even during her periods of disturbance, automatic
• 5:13:30
  words which she utters during a state of delirium, and which are quite normal.
• 5:13:34
  It is then an altogether hysterical phenomenon. And yet, as you see,
• 5:13:38
  it differs in no way from an organic aphasure. Such cases might easily
• 5:13:42
  be multiplied. Besides these cases, you can observe as many phenomena of agraphia
• 5:13:48
  as you please. I have already indicated to you the loss of writing as
• 5:13:52
  one of the possible forms of systematic paralysis. Charco already pointed out some such
• 5:13:57
  cases in his Luscu Marti Lepine Ballets. Soulier published some. I observed several.
• 5:14:06
  You may even observe some curious forms in which the writing becomes again childish
• 5:14:10
  and is quite like old writing books of the patient. Can we go further?
• 5:14:15
  Do there exist in hysteria word blindness and word deafness? For my part,
• 5:14:21
  I am convinced of it, and I do not see why this dissociation
• 5:14:23
  should not take place when all the others do. It must be acknowledged,
• 5:14:27
  however, that cases of this kind have seldom been published. I therefore recommend
• 5:14:32
  to you to study an observation that, in my opinion, is important,
• 5:14:36
  the one which concerns a young girl called Rachel, and which I published in
• 5:14:40
  the second volume of my book on Neuroses and Fixed Ideas. The observation and
• 5:14:45
  the discussion are too long to reproduce here. I only point out the principle
• 5:14:48
  points. A girl of nineteen has a strange bearing. As soon as we
• 5:14:53
  speak to her, she looks embarrassed, She does not answer, moves on
• 5:14:56
  her chair, moans, and at last says, I do not understand.
• 5:15:00
  I cannot understand. At first sight, it looks as if she were deaf.
• 5:15:04
  That is, moreover, the dominant opinion entertained about her in her surroundings.
• 5:15:10
  Yet this opinion is not right. If you make a noise behind her,
• 5:15:12
  she almost always turns around curiously enough. If you put a watch near
• 5:15:18
  her ear, she declares that she hears. You may thus recognize that she
• 5:15:21
  hears the ticking of the watch at sixty centimeters on the right and at forty
• 5:15:25
  on the left. The hearing of this girl was very carefully examined by Monsieur
• 5:15:29
  Geleis two different times. His conclusions were always the same and quite definite.
• 5:15:34
  This patient is not deaf by any means. All we can say is that
• 5:15:38
  there is a slight diminution of the auditory acuity, especially on the left.
• 5:15:42
  There is no appreciable lesion of the external auditory apparatus. But then, why
• 5:15:48
  does not this patient answer us? Because, as she says herself, she
• 5:15:52
  does not understand. Though she hears our words, they have no meaning for
• 5:15:55
  her. It is the same with musical airs. She hears them very well,
• 5:15:59
  but she does not recognize, does not understand them. In a word.
• 5:16:03
  It is the syndrome well known under the name of word deafness. In
• 5:16:07
  the present case, this word deafness is quite complete. The patient has also
• 5:16:11
  completely lost the functions that appear to depend on word audition. She is quite
• 5:16:17
  incapable of writing from dictation and of repeating, even without understanding them, the
• 5:16:21
  words spoken before her. They are noises, she says, and she does
• 5:16:25
  not know how she could manage to repeat them. The disappearance of that connection
• 5:16:29
  between sounds and movements has often been noticed in word deafness. If the word
• 5:16:33
  deafness is complete, it is nonetheless very isolated. That is to say,
• 5:16:37
  all the functions of speech, save the audition of words, seem to have
• 5:16:40
  remained quite intact. Now what are the diagnosis and origin of this clinically and
• 5:16:47
  contestable word deafness. They are most strange. A few years ago, this
• 5:16:52
  already impressionable and nervous girl was being educated in a convent at the age of
• 5:16:56
  twelve. She had a typhoid fever and remained weak and nervous, though still
• 5:17:02
  intelligent and free from any disturbance of speech were hearing. A short time afterwards,
• 5:17:06
  she began to present odd symptoms about which, unfortunately we have quite insufficient
• 5:17:10
  information, for they were only observed by the nuns of the convent. The
• 5:17:15
  child had a disposition to fall asleep in the middle of the day, especially
• 5:17:18
  between one and four in the afternoon. These sleeps were sometimes complete and very
• 5:17:22
  deep, Nor could anything awaken the sleeper, who did not even feel prickings
• 5:17:26
  made in her arm. On other days, the sleep seemed less profound,
• 5:17:30
  since the child kept her eyes open and went on with her sewing. But
• 5:17:33
  she did not answer, could not be disturbed, and on awaking, would
• 5:17:37
  say that she had done nothing and was surprised to see her work getting on.
• 5:17:41
  This is all we know about those sleeps, which lasted for nearly two
• 5:17:45
  years with the same characteristics. One day the nuns became incensed at these continual
• 5:17:49
  sleeps and punished the child, but it was of no use. The chaplain
• 5:17:53
  was sent for, and it was demonstrated to her in a fine exhortation that
• 5:17:57
  if she slept again, she should first be shut up in a dark room
• 5:18:02
  and later on go to hell. The little girl was frightened and swore that
• 5:18:06
  she would sleep no more. When the hour of her usual sleep came,
• 5:18:10
  she contrived, through desperate efforts to remain awake. It is impossible for us
• 5:18:14
  to know exactly what happened. Rachel asserts she had no convulsions, went on
• 5:18:18
  with her sewing, but felt her mind confused and her head as it were
• 5:18:22
  clogged. Moreover, her recollection in this respect is very vague. However,
• 5:18:29
  it may be after a few hours discomfort, she realized that she was no
• 5:18:32
  longer sleepy at all. When she was spoken to, she did not answer,
• 5:18:34
  and her features assumed a dazed expression. Every endeavor was used to rouse
• 5:18:40
  her, but it was soon noticed that she understood nothing and answered very badly.
• 5:18:45
  What was exactly the extent of the disturbance at the outset? Our information
• 5:18:48
  is insufficient. It seems certain that there was no paralysis, but it seems
• 5:18:52
  that speech was disturbed as well as hearing. However, it may be the
• 5:18:56
  disturbance of speech did not persist. After a few weeks she spoke correctly,
• 5:19:00
  as now she had only a somewhat odd accent, but the hearing of words
• 5:19:04
  made no progress. She remained, as at the outset, incapable of understanding
• 5:19:10
  anything. No doubt all this is not very definite, and we may wish
• 5:19:15
  to find later on more distinct observations of hysterical word blindness and word deafness.
• 5:19:19
  However, these sleeps, these somnambulisms, the neuropathic disturbances which still persist,
• 5:19:25
  the total absence of any symptom of cerebral lesion or lesion of the ear seem
• 5:19:29
  to prove that the disease approaches the great neurosis. These observations, which could
• 5:19:34
  easily be multiplied, show you distinctly enough. I think that besides the classical
• 5:19:38
  and typical hysterical dumbness, there are all kinds and forms of this affection,
• 5:19:44
  and that some of these forms are quite identical with what is understood under the
• 5:19:47
  name of aphasia. So there is no opposition between those two groups of symptoms.
• 5:19:52
  The hysterical dumbness of Charcourt is nothing but a more sharply differentiated, more
• 5:19:56
  isolated form of the disturbances of speech. The the subject loses absolutely the power
• 5:20:00
  of speaking, and loses only that he loses the power so entirely that he
• 5:20:06
  forgets it and does not regret it, so that he has no longer even
• 5:20:08
  the idea of the efforts to be made. This we already saw when studying
• 5:20:12
  hysterical paralysies and anesthesias. It is therefore very likely that the function of speech
• 5:20:18
  is also disturbed in the same manner in all those organic and neuropathic accidents.
• 5:20:25
  Three. To understand the impairment of this function of speech, we must rapidly
• 5:20:30
  make some remarks which you already know. Let us take up again the observation
• 5:20:33
  of the hysterical who, to all the questions put to her, could only
• 5:20:37
  reply with the words cha, cha peti bedable. Often in the midst of
• 5:20:41
  this state of aphasia, the patient had kinds of reveries or deliriums, in
• 5:20:45
  which she experienced aloud, either fixed ideas which preoccupied her, or conversations she
• 5:20:51
  had just had, in which she put the questions and made the answers herself.
• 5:20:55
  In all those slight deliriums, she spoke very correctly, either in French
• 5:20:59
  or in English, and there was no trace of aphasure left. Observe that
• 5:21:03
  in all those chatterings she said things she regretted later on expressing her secrets aloud.
• 5:21:07
  They were quite involuntary words. If you interrupted her, if you attracted
• 5:21:11
  her attention to ask her to reply to a question you put her, she
• 5:21:15
  listened, tried to speak, and no longer said anything but pretty bedubbed in
• 5:21:21
  a word, there was a phasure in conscious and voluntary speech, and the
• 5:21:23
  normal expression of ideas reappeared only in the deliriums at automatic speech. This fact
• 5:21:30
  is more general than is commonly believed. In patients affected with dumbness, you
• 5:21:33
  may often recognize in the period of dumbness itself that normal speech reappears during the
• 5:21:38
  crises, the somnambulisms the dreams. Hoppenheim indicated some facts of this kind.
• 5:21:45
  Gield de LaTourette describes a dumb patient who speaks during her dreams. More often
• 5:21:51
  still, those automatic and irrepressible words do not coincide exactly with the period of
• 5:21:55
  dumbness, but present themselves in the same patients before or after this period.
• 5:22:00
  We then find in these subjects crises of irresistible chattering to which we already alluded
• 5:22:04
  in connection with somnambulisms. Sometimes these crises come on during a sleep or an
• 5:22:10
  abnormal state, but often they take place while the patient is awake, and
• 5:22:14
  then he listens in astonishment to the words he speaks. Read again in the
• 5:22:18
  history of the Camisals in the seventeenth century, the anecdotes relating to the lesser
• 5:22:22
  prophets of the Cevennes, and to the most celebrated among them, all Eli
• 5:22:26
  Marion. He felt himself as it were seized by the Lord. He could
• 5:22:30
  no longer dispose of his voice or speak voluntarily. He did not know what
• 5:22:34
  his mouth was about to utter, and was quite surprised at hearing the fine
• 5:22:37
  discourses with which the Holy Ghost inspired him. This verbal automatism should be placed
• 5:22:44
  beside the automatism of writing in the spiritualistic medium. He also feels that his
• 5:22:48
  hand escapes his control and is no longer ruled by his will. He is
• 5:22:52
  quite surprised at seeing what his hand has written. It is a phenomenon of
• 5:22:56
  the same kind. With the same group also to be connected the ticks of
• 5:23:00
  speech, which are numberless in the form of coprolalia, echolalia, et cetera.
• 5:23:06
  You will find a very good description of them in the Little Book of
• 5:23:07
  Monsieur Segla on the Disturbances of Speech. I should be inclined to go even
• 5:23:12
  further and to say that many verbal hallucinations of inner words are phenomena of the
• 5:23:17
  same kind, though somewhat less marked. In all these facts, the function
• 5:23:22
  of speech, which is by no means destroyed, seems to escape the conscious
• 5:23:25
  will of the subject inwardly or outwardly. He speaks in spite of himself,
• 5:23:30
  and without any participation of his self. It is a mechanism which has emancipated
• 5:23:33
  itself. Well, I believe that for this fact, as for the preceding
• 5:23:38
  ones, this symptom of agitation of automatic functioning of the function should be placed
• 5:23:44
  beside the paralysis bearing on the same function. They are too parallel and concomitant
• 5:23:48
  phenomena. One more example occurs to me. Bez had very varied crises in
• 5:23:53
  the hospital. After her ordinary crises in which she had cried to exhaustion,
• 5:23:59
  she retained perfec the power of speaking. But she had special crises in which
• 5:24:03
  her speech seemed as it were to be thrown out of gear, in which
• 5:24:06
  she chattered in a low voice with extreme volubility. After these crises, she
• 5:24:11
  always awoke dumb. The emancipation of speech brought on dumbness. This we have
• 5:24:15
  already seen in the somnambulism that brings about amnesia in Korea, and in the
• 5:24:19
  tick that brings about paralysis. Here again, everything happens as if the system
• 5:24:26
  of the movements and images that constitute speech, separated from the personality and functioned
• 5:24:30
  a part in an automatic and at the same time inferior and as it were,
• 5:24:33
  degraded manner. End of Section ten. Lecture eleven. The disturbances of
• 5:24:41
  alimentation, visceral troubles, hysterical anorexy, the description of its three periods,
• 5:24:48
  the gastric period, the moral period, the period of inanition, the frequent
• 5:24:53
  termination by death, The theory of the fixed idea, the diagnosis with the
• 5:24:59
  psychosthenic refuge usal of food. The theory of anorexy through the anesthesia of the
• 5:25:03
  stomach. The part played by anesthesia in the modifications of the feeling of hunger,
• 5:25:08
  the motor agitation of the patient, The different explanations of this fondness for
• 5:25:12
  physical exercises, the suppression of the feeling of fatigue and the motor excitation.
• 5:25:18
  The psychological function of alimentation, the hysterical dissociation of this function, the dissociation
• 5:25:26
  of the elements of this function, The paralysis of the lips, tongue,
• 5:25:29
  pharynx, esophagus, abdomen, The troubles of the function of the bladder after
• 5:25:36
  passing in review the mental disturbances of hystericals. Their sensory and motor disturbances,
• 5:25:41
  we shall now enter upon a rapid survey of their visceral disturbances. These patients,
• 5:25:45
  in fact, seem to present great impairments of the visceral functions, especially
• 5:25:49
  of the functions of digestion and respiration. These visceral phenomena have always greatly puzzled
• 5:25:56
  physicians, and nowadays they are still often opposed to those who want to give
• 5:26:00
  a mental explanation of this disease. We must therefore insist on their interpretation.
• 5:26:07
  To penetrate into the study of the mental disturbances of hysteria, we shall begin
• 5:26:11
  by studying a very important phenomenon, that of anorexi, which, by its
• 5:26:15
  character at once physiological and mental, will furnish a transition between these new studies
• 5:26:21
  and the preceding ones. One the words hysterical anorexy designate a disease both mental
• 5:26:29
  and physiological, very long and very complicated, which consists chiefly in the systematic
• 5:26:33
  refusal of food in certain digestive disturbances, and in a consequent inanition. This
• 5:26:40
  odd phenomenon was for a long time very ill known. It was confusedly ranged
• 5:26:45
  among the other manias of those patients, and their strange way of living without
• 5:26:49
  eating was often ascribed to the action of the damon or to that of God.
• 5:26:53
  Its accurate description is recent. It was made almost simultaneously by Wall in
• 5:27:00
  eighteen sixty eight and by Laseg in eighteen seventy three. The article of La
• 5:27:04
  Segu was the only one that had success and contributed to spread this new medical
• 5:27:08
  notion. It led Gull to observe in eighteen seventy three that he had already
• 5:27:12
  indicated these facts. In eighteen sixty eight. The English physician called this disease
• 5:27:18
  apepsia hysterica. Laseg named it hysterical anorexi. Neither of these two appellations is
• 5:27:25
  perfect. The absence of pepsin which moreover is doubtful, has nothing interesting in
• 5:27:30
  it. Here, the loss of appetite is more important, but it is
• 5:27:33
  not certain that it is the essential characteristic. Therefore, some subsequent authors,
• 5:27:37
  wishing to emphasize the capital fact, which is systematic refusal of food, made
• 5:27:42
  use of the words city or phobia, that is to say, aversion to
• 5:27:45
  food, and citi ae eugia food repelling, that is to say, rejection
• 5:27:52
  of food, or even of the words hysterical, inanition which Laseg had also
• 5:27:56
  proposed. The last words are evidently bad, but usage, which is a
• 5:28:00
  great master, has not accepted them, and has even employed them differently.
• 5:28:06
  It has retained the term hysterical anorexy. It is enough if we understand one
• 5:28:10
  another. This accident may happen in the course of hysteria after many characteristic phenomena
• 5:28:17
  which will serve for its recognition. Oftenest it forms the outset of hysteria,
• 5:28:21
  and its real nature is only recognized late. Many cases have been cited in
• 5:28:26
  adult and young men, but it cannot be denied that it is infinitely more
• 5:28:30
  frequent in women. A case has been cited at the age of eleven Kissel.
• 5:28:34
  I have observed one in a little girl of nine. It has also
• 5:28:37
  been recognized in a woman of thirty eight. Lately, I studied a very
• 5:28:41
  distinct case in a woman of forty, but it was an old accident which
• 5:28:45
  reappeared. It must be acknowledged that these ages are quite exceptional. The greatest
• 5:28:51
  number of cases, by far nine out of ten, are to be met
• 5:28:55
  with in girls of sixteen to twenty three or twenty five at most. It
• 5:28:59
  is one of the facts of the special pathology of the girl of eighteen.
• 5:29:03
  You should never forget it when in presence of a patient of this age.
• 5:29:07
  That affection which seizes the girl of eighteen is a chronic one. It is
• 5:29:11
  a disease that never lasts less than eighteen months to two years, and often
• 5:29:15
  continues for ten years. The result is that it goes through different periods,
• 5:29:18
  which La Seig reduced rightly enough to three principal ones. The first period might
• 5:29:25
  be called the gastric period. For everybody fancies that the disease consists simply in
• 5:29:30
  an affection of the stomach and behaves accordingly. The beginning, which is not
• 5:29:33
  always easy to know, often coincides with a slight, more or less real
• 5:29:37
  affection of the stomach. More often it is again the consequence of an emotion
• 5:29:42
  mew. For instance, a girl of nineteen, of whom I often think
• 5:29:45
  when speaking to you of Anorexi, presented her first gastric disturbances after the death
• 5:29:51
  of her brother, who succumbed rapidly to pulmonary thesis. The patients complain of
• 5:29:56
  various and vague sufferings which they connect with the DA then come consultations on consultations,
• 5:30:03
  and of course a lot of absurd diagnoses and ridiculous medicines. It is
• 5:30:07
  thought quite natural that the girl whose stomach is diseased should be careful of what
• 5:30:11
  she eats. Her medical attendance would even be inclined to prescribe to her a
• 5:30:17
  still stricter diet. She resigns herself to everything and shows herself a patient of
• 5:30:21
  exemplary docility. Moreover, save for vaguer and vaguer pains in her stomach,
• 5:30:26
  she seems to enjoy perfect health. Her tongue is clean, her stomach and
• 5:30:30
  abdomen normal. The only thing she may suffer from is obstinate constipation. Usually,
• 5:30:37
  after a long time begins the second period, the moral period or period
• 5:30:40
  of struggling. The family at length become disquiet at the indefinite prolongation of these
• 5:30:45
  treatments and ultra strict diets, which do not seem very well justified. They
• 5:30:51
  suspect hypochondriac ideas and obstinacy, and their attitude becomes quite modified. Now they
• 5:30:56
  try to allure the patient by all possible delicate cases of the table. They
• 5:31:00
  scold her severely. They alternately spoil, beseech, threaten her. The excess
• 5:31:06
  of the insistence causes an exaggeration of the resistance. The girl seems to understand
• 5:31:11
  that the least concession on her part would cause her to pass from the condition
• 5:31:15
  of a patient to that of a capricious child, and to this she will
• 5:31:18
  never consent. All the relatives and friends interfear by turns to try what their
• 5:31:23
  authority and influence may do. Larseg has well described those distressed families who all
• 5:31:29
  day and to the first comer speak mournfully of the girl's food. It's all
• 5:31:33
  of no use. The disease develops more and more under the influence of these
• 5:31:37
  surroundings. Now the girl scarcely ever speaks of her pains in the stomach,
• 5:31:41
  but she repeats that she will eat when she is hungry, and that she
• 5:31:45
  is never hungry, that she does not need more food, that she can
• 5:31:48
  very well live indefinitely in that way, that moreover, she has never felt
• 5:31:52
  better. In fact, she seems to be in very good health and shows
• 5:31:56
  much strength and activity. She has even a greatly exact, gaggerated physical and
• 5:32:00
  moral activity to which we shall have to revert, for the fact is very
• 5:32:03
  important. Supported by this conviction, our strange patient struggles with all those around
• 5:32:10
  her by every possible means. She seeks a support in one of her parents
• 5:32:14
  against the other. She promises to do wonders if her family is not too
• 5:32:17
  exacting. She has recourse to every artifice and to every untruth. It is
• 5:32:22
  the period when such patients hide victuals in their pockets, fill their cheeks and
• 5:32:26
  throat with them to go and spit them out in the lavatory, when they
• 5:32:29
  learn to vomit immediately what they have just swallowed, et cetera. Lastly comes
• 5:32:33
  on sooner or later, but sometimes only after years. The third period called
• 5:32:37
  period of inanition. Organic disturbances begin to appear. The breath is foul,
• 5:32:44
  the stomach and abdomen are retracted. There is an insuperable constipation. The urine
• 5:32:48
  is scarce and contains little urea, only three grams instead of thirty grams with
• 5:32:52
  one of my patients. The skin becomes dry, pulverulent, and in certain
• 5:32:57
  places, as on the wrist and forehead, cracked and covered with pimples.
• 5:33:02
  The pulse becomes very quick, between one hundred and one hundred and twenty.
• 5:33:06
  The breathing is short and hurried. You hear cardiac and arterial breaths. Lastly,
• 5:33:11
  the extenuation, which the parents best observe, makes surprising progress. It
• 5:33:15
  is a clinical fact which one must well remember that weight is not a reliable
• 5:33:19
  sign of the progress of the disease, for after a rather great decrease at
• 5:33:23
  the outset, it is only at the end, and often too late,
• 5:33:26
  that it falls Suddenly matters have changed. Then, the patients who no longer
• 5:33:33
  leave their beds remain in a semi delirious semichomatose condition. At this stage they
• 5:33:37
  behave in two different ways. Some continue to be delirious, and, as
• 5:33:41
  Charcours said, have but one idea left, namely to refuse to eat.
• 5:33:45
  Others fortunately begin to be frightened. This was what Larseeg expected, because of
• 5:33:52
  a singular therapeutic dignity. He judged that the physician was not justified in doing
• 5:33:56
  anything before. At that moment he resumed his author and according as the patient
• 5:34:00
  yielded completely or partially, which latter case was the more frequent, he cured
• 5:34:06
  her more or less completely. In fact, the hysterical is privileged in this
• 5:34:11
  respect. You know that the dog cannot be called back to life when it
• 5:34:14
  has lost forty percent of its weight. The hysterical can still be saved.
• 5:34:18
  At fifty and above. There is a limit. However, out of his
• 5:34:22
  eight cases, La Sig had not one death. The number of deaths since
• 5:34:26
  then cannot be numbered. I know three. For my part. It is
• 5:34:30
  the melancholy period when those poor girls ask to eat and it is too late.
• 5:34:34
  It is true that things generally take another turn, and an intercurrent disease
• 5:34:38
  comes on broncho pneumonia or almost thysis, which simplifies the situation. Such is
• 5:34:45
  the general history of this strange mental disease. Its gravity, its frequency,
• 5:34:49
  the regularity of its evolution, whatever may be the intelligence of the subject,
• 5:34:53
  show that it is due to a deep psychological disturbance, of which the refusal
• 5:34:57
  of food is but the outer ex expression. Two. This disturbance of thought
• 5:35:04
  is fairly well known in its details and evolution, but it is certainly very
• 5:35:07
  difficult to interpret, and various theories of anorexy give the pre eminence to one
• 5:35:12
  or the other of the essential phenomena. La Seige and later on Charcourt gave
• 5:35:18
  the pre eminence to a delirious disturbance, to a fixed idea. The disease
• 5:35:22
  consists essentially in an idea of which the patient is perfectly conscious, though she
• 5:35:26
  often conceals it, and which has for consequence the voluntary and calculated refusal of
• 5:35:32
  food. Some are over anxious about their stomach, apprehend the pains provoked by
• 5:35:37
  digestion, or simply fear the sensation of a ball in their esophagus. Others
• 5:35:41
  have scruples, regret to eat the flesh of living animals, are ashamed to
• 5:35:45
  eat when too many poor people have not sufficient food. I knew a girl
• 5:35:49
  of eighteen who died in consequence of her abhorrence of turnips, which she had
• 5:35:52
  contracted when at school. To the end she refused to eat anything, saying
• 5:35:57
  that everything smelt of turnips. Very often they simply have the commonplace idea of
• 5:36:02
  suicide. For some reason or other, these girls make up their minds to
• 5:36:07
  die because of a thwarted marriage, a reproach for having quarreled with a friend,
• 5:36:10
  et cetera, and in their innocence, they adopt starvation for their mode
• 5:36:14
  of death, chudging it to be a simple, clean, not very painful
• 5:36:18
  process which will arouse nobody's suspicion. The following observation of chalcur is famous.
• 5:36:23
  While undressing a patient of this kind, he found that she wore on her
• 5:36:26
  skin, fastened very tight around her waist, a rose colored ribbon. He
• 5:36:30
  obtained the following confidence the ribbon was a measure of which the waste was not
• 5:36:36
  to exceed. I prefer dying of hunger to becoming big as Mamma. Coquetries
• 5:36:41
  of this kind are very frequent. One of my patients refused to eat for
• 5:36:45
  fear that during her digestion her face should grow red and appear less pleasant in
• 5:36:48
  the eyes of a professor whose lectures she attended after her meals. The authors
• 5:36:53
  who have observed such ideas seem to me to be inclined to exaggerate their importance.
• 5:37:00
  This is what certainly happened to Charcour, who used to seek everywhere for
• 5:37:03
  his rose colored ribbon and the idea of obesity. I believe there is on
• 5:37:07
  this point a diagnosis to be made, on which I have much insisted in
• 5:37:11
  the first volume of my work on obsessions. Refusals of food are not always
• 5:37:15
  a phenomenon of the hysterical neurosis. They belong at least as often to the
• 5:37:19
  psychosthenic neurosis. It is in the Latin neurosis that fixed ideas remain alone and
• 5:37:25
  play a predominant role. To the end. These patients will be recognized by
• 5:37:30
  the absence of other psychological disturbances associated with the fixed idea. In particular,
• 5:37:36
  they have no real anorexy, they have retained the feeling of hunger, and
• 5:37:40
  they often submit to veritable tortures in order not to yield to their need of
• 5:37:44
  food. These patients make it a point of honor not to yield, at
• 5:37:48
  least before others, and this accounts for an odd fact often indicated in their
• 5:37:51
  history. After having all day refused the food offered to them, they get
• 5:37:56
  up at nights secretly and steel dirty victuals, so that one must always be
• 5:38:00
  careful to leave food within their reach. As they have no real loss of
• 5:38:03
  the feeling of hunger, so they have no real anesthesia, either in their
• 5:38:07
  mouth or in their epigastrium. Lastly, they do not present that excessive need
• 5:38:11
  of movement, the importance of which I have already indicated in real hysterical anorexies.
• 5:38:18
  In the latter, in fact, the fixed idea which existed at the
• 5:38:21
  outset it is true and played a certain role for a while becomes complicated with
• 5:38:26
  very serious phenomena as the loss of appetite, the anesthesia of various organs,
• 5:38:30
  certain phenomena of systematic paralysis of the acts relating to alimentation, and the great
• 5:38:36
  motor agitation. I believe, therefore, that one should distinguish real hysterical anorexy
• 5:38:41
  from those refusals to eat brought on by various obsessions, and in particular by
• 5:38:45
  obsessions of scruples in various psychosthenics. Therefore, other theories tried to take these
• 5:38:52
  new phenomena into account, and this is done in particular by a theory which
• 5:38:55
  is nowadays pretty widespread, the theory of anorexy through the anesthesia the stomach.
• 5:39:00
  Besides the anorexies due to delirious ideas relating to illness, to pudicity, to
• 5:39:06
  obesity, it has been asked whether there do not exist anorexes brought about by
• 5:39:10
  disturbances of the organic sensibility. They would then justify their name and be above
• 5:39:15
  all losses of the sensation of hunger. This already old thesis, which was
• 5:39:19
  indicated by magnetisers such as Deppine in eighteen forty, has been chiefly developed through
• 5:39:26
  studies on metallotherapy carried on especially by Bulk eighteen seventy five to eighteen eighty two.
• 5:39:30
  Since then it has been systematised and exaggerated by solier anesthesia. Bulk once
• 5:39:37
  said, exercises a preponderant influence on all the other symptoms, in particular on
• 5:39:41
  the disturbances of alimentation and on the secretions. His great argument was that he
• 5:39:47
  could cause these anesthesias to vanish through the use of the metallic plates and armatures
• 5:39:51
  he had contrived, and that he then saw the hysterical phenomena anorexi in particular
• 5:39:56
  disappear. There is much truth in these remarks. First of all, we
• 5:40:00
  must recognize in anarexy, when already well settled and of decidedly hysterical nature,
• 5:40:06
  the existence of numerous anesthesias. They are observed in the mouth, on the
• 5:40:11
  tongue, on the internal face of the cheeks, in the esophagus. At
• 5:40:15
  the same time may be noted the absolute anesthesia of the special senses of taste
• 5:40:18
  and smell. You know that the patients, especially at the outset of their
• 5:40:22
  disease, want to have raw aliments and ask for salt and vinegar in order
• 5:40:26
  to give some taste to their food, and that later on they complain that
• 5:40:30
  they are given sand or earth to eat. You also know that some of
• 5:40:33
  them do not feel the food in their mouths. It is not rare to
• 5:40:37
  observe at the same time the anesthesia of the lower part of the digestive tube,
• 5:40:41
  of the anus, and of the rectum. The anesthesia of the stomach
• 5:40:45
  itself and of the small intestine is the more difficult to establish, as the
• 5:40:48
  sensibility of these organs is commonly very obtuse. But it is highly probable many
• 5:40:55
  subjects do not feel too hot or too cold food descend into their stomachs.
• 5:41:00
  Moreover, you have already seen a very curious law indicated by Monsieur Gill de
• 5:41:03
  Latorette, namely that often in hysteria, superficial anesthesia of the skin accompanies the
• 5:41:08
  anesthesia of the organs placed under it. Now, in hysterical anesthesia, a
• 5:41:14
  patch of cutaneous insensibility is often recognized seated just in the epigastric region. It
• 5:41:19
  is probable, therefore, that the mucous membrane of the stomach is as anesthetic
• 5:41:22
  as that of the mouth. Do these various anesthesias seated in all the parts
• 5:41:29
  of the digestive tube play a role in the disturbances of the functions of alimentation.
• 5:41:33
  The thing seems to me very likely. The fine studies of physiologists,
• 5:41:38
  in particular those of Monsieur Pavlov, have shown that the saliva secreted by a
• 5:41:42
  dog varies with the object presented to him, with the taste and smell of
• 5:41:47
  that object. They have shown that the secretions of the stomach and of the
• 5:41:51
  intestine were in connection with the sensation of the food in the various parts of
• 5:41:55
  the digestive tube. Since these patients feel neither taste, nor smell, nor
• 5:42:00
  any excitation of the mucous membrane of their stomachs, it is very likely that
• 5:42:03
  their digestion will be disturbed. A physician even tried to go still further.
• 5:42:08
  You know that the anesthesias of hystericals are mobile, that it is possible,
• 5:42:12
  through various processes, to cause them to disappear and reappear. This physician thought
• 5:42:18
  he recognized at least in one case, that the secretion of the gastric juice
• 5:42:22
  was very different, according as the subject felt or did not feel in his
• 5:42:26
  esophagus and in his stomach. From these remarks results a new conception of the
• 5:42:30
  disease. It is the gastric anesthesia which is here the great culprit. While
• 5:42:34
  the sensation of the movements and of the secretions of the stomach is the starting
• 5:42:38
  point of the feeling of appetite. The immobility and insensibility of the stomach bring
• 5:42:44
  on complete anerexy, and all the delirious ideas which are considered here as secondary.
• 5:42:48
  There is some truth in this conception, but it does not seem to
• 5:42:52
  me to be complete. First of all, the anesthesia of hystericals is never
• 5:42:56
  complete and does not do away with the reflexes. We have already studied this
• 5:43:00
  point. If food is introduced by force with the sound into the stomach of
• 5:43:04
  the most anorexic hysterical, if you prevent immediate vomiting, you will recognize that
• 5:43:10
  the digestion, perhaps somewhat slow at the beginning, comes to be completely effected
• 5:43:15
  and in the most normal way. This Monsieur Henry Francais has just shown again
• 5:43:19
  in his thesis on apepsy, which he maintained this year. So psychic insensibility
• 5:43:25
  does not play here a considerable material part. Supposing the anesthesia of the stomach
• 5:43:30
  should do away with the appetite, it would not make the patience incapable either
• 5:43:33
  of eating or of digesting. In my opinion, an exaggerated importance is ascribed
• 5:43:40
  to the role played by these local phenomena of the mouth and stomach in the
• 5:43:44
  general feeling of hunger and in the function of alimentation. Animals that have been
• 5:43:48
  deprived of their stomach still try to feed. We do not always need a
• 5:43:52
  perfectly marked appetite to eat. We often accept food out of politeness, in
• 5:43:56
  mere imitation of others, or because we think it reasonable, when we do
• 5:44:00
  not really wish for it. In a word, these authors are right in
• 5:44:04
  adding more elementary and more general disturbances to the fixed ideas of hystericals. They
• 5:44:10
  are wrong in stopping in this matter at the sensibilities of the mouth and stomach.
• 5:44:15
  I wish a more thorough investigation might be made in this connection of a
• 5:44:18
  phenomenon that is as yet very imperfectly elucidated, namely, the excessive fondness for
• 5:44:25
  physical exercise that characterizes a whole group of anorexic patients. This character was already
• 5:44:30
  noted by La Seige. It is well indicated in a short and unfortunately very
• 5:44:34
  incomplete article of doctor Rooilais. The patient, he says, is exceedingly fond
• 5:44:40
  of long walks. As she is growing thinner with enormous rapidity, they are
• 5:44:44
  forbidden to her. She then begins to walk from morning to night, up
• 5:44:48
  and down the little garden of the house, which was likewise forbidden to her.
• 5:44:52
  Then she plays all day at Shuttlecock. It is prescribed that she stay
• 5:44:56
  in her room. There she gives herself up to violent g symnastic exercises.
• 5:45:02
  Even in bed she goes on with her gambols and somersaults. For my part,
• 5:45:07
  I was much struck with this odd phenomenon, which most authors merely indicate
• 5:45:10
  without dwelling upon it. One of my patients, Meu, has had for
• 5:45:15
  years a mania of walking, of at least as great gravity as her mania
• 5:45:18
  of refusing to eat. She must needs go every day on foot as far
• 5:45:22
  as the Torcadero and the Bois de Boulogne. The carriage has only the right
• 5:45:26
  to follow her. She tires the persons who accompany her. If a limit
• 5:45:30
  is fixed of two hours fast walking a day, she makes scenes about the
• 5:45:33
  calculation of the minutes. No supplications or menaces can stop her walking any more
• 5:45:38
  than they can stop her. In anition with a very singular woman who has
• 5:45:42
  periodical anorexies consequent on the least emotion, the need of walking begins immediately with
• 5:45:48
  the refusal to eat. It happens suddenly after the emotion she refuses to return
• 5:45:52
  home as well as to dine. This character is at least as strange as
• 5:45:56
  the first. The first explanation of this fact was presented by La Sig and
• 5:46:02
  by Charcour, and since then it has always been repeated without hesitation. These
• 5:46:07
  patients walk too much and take too much exercise. By virtue of a piece
• 5:46:10
  of reasoning, they want to make those around them believe that they are still
• 5:46:14
  strong and robust, in order not to be compelled to eat more. I
• 5:46:18
  confess this explanation does not satisfy me. Many patients who spoke to me sincerely
• 5:46:23
  during or after their disease have assured me that they thought nothing of the kind.
• 5:46:27
  Moreover, this exaggerated motion is to be found in aged patients who are
• 5:46:32
  left at liberty and whose alimentation nobody watches over. Another curious explanation is that
• 5:46:38
  which was given by Monsieur Lais in eighteen ninety two. The patient walks in
• 5:46:42
  order to grow thin. In order to compensate with the exercise, he takes
• 5:46:47
  the alimentation that is imposed upon him. With this explanation, we return to
• 5:46:52
  the initial idea of Charcour, namely that all these patients want to grow thin.
• 5:46:56
  You know that it is not true, and that if in some particular
• 5:47:00
  cases this exaggeration of motion can be explained by such reasoning, it would be
• 5:47:04
  absurd to generalize the explanation. I believe that the phenomenon in question is much
• 5:47:10
  more important and serious than these authors thought. It is not the result of
• 5:47:14
  a little particular imposition. It is connected with a very general disturbance. This
• 5:47:19
  disturbance first comprises the suppression of the feeling of fatigue, which is here much
• 5:47:23
  more important, in my opinion, than the anesthesia of the stomach. It
• 5:47:29
  comprises, besides something that is very little known, namely, a general excitation
• 5:47:33
  to physical and moral activity, a strange feeling of happiness and euphoria. According
• 5:47:38
  to the medical term which are certain but very little studied facts. The need
• 5:47:44
  of food goes with the feeling of weakness and depression. Persons depressed by neurasthenia
• 5:47:48
  are great eaters. The exaltation of the strength, the feeling of euphoria,
• 5:47:52
  as it is known in the ecstatic Saints, for instance, does away with
• 5:47:56
  the need of eating. Our hysterical anorexi is to be traced to much deeper
• 5:48:00
  sources than what was supposed. This is how I propose to you to represent
• 5:48:06
  it to ourselves, without however, pretending to explain it. The function of
• 5:48:10
  alimentation, if we consider it on its psychological side, is one of the
• 5:48:14
  most considerable systems of thoughts that exist in the brain of an animal. It
• 5:48:18
  comprises fundamental phenomena such as the feeling of weakness, of depression, and the
• 5:48:22
  fear of death. Besides, it comprises numberless secondary phenomena, such as the
• 5:48:27
  sensations and motions connected with all the parts of the organism that play a role
• 5:48:32
  in alimentation, from the hands, lips, and tongue to the rectumananus.
• 5:48:37
  Lastly, it also comprises phenomena of improvement, as the images of pleasant elements,
• 5:48:41
  the habits of eating cleanly, and the mixture of certain social phenomena that
• 5:48:45
  usually complicate our alimentation. There is in the hysterical a dissociation of this system,
• 5:48:51
  which may totally or partially withdraw from consciousness. In complete anorexy, you
• 5:48:56
  will find the loss of all the elements I have just described, the loss
• 5:48:59
  of the sense sation of weakness replaced by a pathological euphoria, the loss of
• 5:49:03
  the sensations of the organs, but also, more than is generally believed,
• 5:49:07
  the loss of the movements. These patients can no longer cleanly convey their food
• 5:49:12
  to their mouths, they can no longer masticate, and above all, they
• 5:49:15
  can no longer swallow, nor can they go to stool. There is besides
• 5:49:19
  a phenomenon which has not been much noticed, and which consists in losses of
• 5:49:22
  the social ideas of alimentation. Mausoline was very amusing when she explained to me
• 5:49:29
  how ridiculous she thought the act of eating, and how much she wondered to
• 5:49:33
  see people gather for this dirty operation. Hysterical anorexy is at bottom a great
• 5:49:37
  amnesia and a great paralysis. Alimentation has become, as it were, a
• 5:49:41
  somnambulistic phenomenon which can only be effected in the second or somnambulistic state, as
• 5:49:48
  happened with the last patient, this phenomenon is lost to the normal and waking
• 5:49:52
  consciousness. Three. Before concluding this lecture, I should like rapidly to add
• 5:49:59
  a few detail, which it is necessary that you should know, but to
• 5:50:02
  dwell on which would take too long. The dissociation of which I have just
• 5:50:06
  spoken to you may bear on all the elements of which the function is composed,
• 5:50:10
  and suppress them separately. You have then kinds of paralyses or amnesias as
• 5:50:15
  you choose, which may be connected with all sorts of organs. It is
• 5:50:18
  needless to enumerate them. You have only to follow the organs themselves. The
• 5:50:22
  hysterical patient may lose the functions of the lips in alimentation, as she lost
• 5:50:26
  them in speech. She may lose the functions of the tongue or those of
• 5:50:30
  the teeth. Grant a little more attention to the functions of diglutician of the
• 5:50:34
  pharynx. Many of these patients can no longer swallow, and they should not
• 5:50:40
  be confounded with psychosthenics who have the phobia of deglutician. Some of these subjects
• 5:50:45
  cannot make their food pass from their esophagus into their stomach. I am attending
• 5:50:48
  an old hysterical lady. And you know what my first care must be when
• 5:50:52
  I see her after her lunch. It is to make her swallow her lunch,
• 5:50:56
  which she still has in her esophagus. I am sure sure that the
• 5:51:00
  amnesia of defecation plays a role in many obstinate constipations. What happens for the
• 5:51:06
  intestine is still more important and frequent for the bladder. You know that hystericals
• 5:51:11
  may lose all the functions of the bladder, or only some part or other
• 5:51:14
  of them. Nothing is more important for a physician than to know thoroughly the
• 5:51:18
  neuropathic disturbances of micturition. He can render many services to unfortunate people and avoid
• 5:51:23
  many guilty mistakes. How many operations are performed on young women under pretends that
• 5:51:29
  their urethray is either too big or too narrow. When their urethra has nothing
• 5:51:33
  to do with their urinary awkwardness. They can no longer either begin the micturian
• 5:51:37
  or stop it or control it, and you have varieties of incontinence or retention
• 5:51:42
  that may become exceedingly complicated. This rapid review of the dissociation of the functions
• 5:51:48
  of alimentation confirms my general studies on hysterical paralysis and amnesias, and gives us
• 5:51:53
  the plan of our next lecture on respiratory disturbances into section eleven. Lecture twelve.
• 5:52:03
  The ticks of respiration and alimentation, Respiratory paralysis, the problem of hysterical
• 5:52:08
  asphyxia, respiratory anesthesia, respiratory disorders, the rhythm of chain stokes, the
• 5:52:15
  paralysis of the diaphragm with alternating seesaw respiration, respiratory agitations, polypnia, inspiration
• 5:52:23
  ticks, the sigh yawn, hiccop aerophagia, expiratory tis, hysterical cough,
• 5:52:32
  laughter, hysterical bark, complex ticks, the meteorism of the abdomen, the
• 5:52:37
  tix of alimentation, bolimia, polydipsia and polyuria, the spasms of the jaws,
• 5:52:45
  cheeks, pharynx, the tick of vextation, the tick of regurgitation,
• 5:52:51
  the ticks of aspiration, hysterical vomiting, the vomiting of blood. We have
• 5:52:57
  to repeat, in regard to respiration, a study analogous to that which we
• 5:53:00
  devoted to the functions of alimentation. The phenomena are about of the same kind,
• 5:53:07
  though they are of less gravity. On the other hand, they are
• 5:53:10
  of infinite variety, and we might dwell indefinitely on the apneas, dystneers,
• 5:53:15
  suffocations, respiratory disturbances, on the varied respiratory paralysis, on the innumerable ticks
• 5:53:22
  polypnia, yawn, sigh, sob hiccop cough, sneeze, bark, shakes
• 5:53:27
  of the abdomen, meteirism, without counting the ticks of the organs of alimentation,
• 5:53:33
  which I should like to place by the side of the latter, namely
• 5:53:36
  erectation, regurgitation, boberigums, vomitings, et cetera. Do not be too
• 5:53:41
  frightened. We shall be brief on all this, for the general rules once
• 5:53:45
  known, these various phenomena are always similar to one another. One. Let
• 5:53:52
  us first speak of the respiratory paralyses, and to illustrate our teaching, let
• 5:53:56
  us at once place a very curious example before your eyes. The case was
• 5:54:00
  published a few years ago by Monsieur Leloyer, a distinguished specialist in diseases of
• 5:54:04
  the nose and larynx, being very interesting as regards the theory of hysteria,
• 5:54:10
  and being described simply without any preconceived idea by a physician who has not made
• 5:54:15
  a specialty of the diseases of the nervous system, and who was not engaged
• 5:54:18
  in the quarrels of our schools. This case should have attracted the attention of
• 5:54:22
  scientists much more than it did. A girl of about twenty was taken to
• 5:54:27
  Monsieur lel Mooieer because a nose was obstructed by adenoid vegetations, which disturbed her
• 5:54:33
  respiration and attention. The vegetations were not very big, and the operation was
• 5:54:37
  effected without any difficulty, but it was noticed that the girl did not breathe
• 5:54:41
  better than before that in particular, she was obliged to keep her mouth open,
• 5:54:45
  which dried her tongue and lips. Monsieur le Mooiller thought that the nose
• 5:54:51
  was still obstructed, so he examined it minutely, but he discovered nothing,
• 5:54:55
  for the respiratory channels were wide open. Wishing to prove to the girl that
• 5:54:59
  she breathed very well through her nose, that she kept her mouth open needlessly
• 5:55:03
  and out of habit, he applied his hand on her mouth with the idea
• 5:55:07
  that she would simply breathe through her nose. To his great surprise, it
• 5:55:11
  was not so. There was no breath through the nostrils. The patient writhed
• 5:55:14
  as if she were choking, and as he insisted on her trying again while
• 5:55:18
  she was being held fast, her face and ears turned blue. In a
• 5:55:22
  word, this girl suffocated when you shut her mouth while leaving her nose open.
• 5:55:26
  There was, however, no obstacle at any point. There was only
• 5:55:30
  a singular disturbance of the nervous system, an incapacity of effecting the respiratory motion,
• 5:55:36
  of moving her chest in the least as soon as the mouth was shut.
• 5:55:40
  As Monsieur Leromier very rightly said, this girl had forgotten how one manages
• 5:55:44
  to breathe through one's nose. Can a finer confirmation be found of our teaching
• 5:55:48
  on functional paralysies and amnesias? Have we not there a pretty dissociation of the
• 5:55:53
  respiratory function, or at least of one of the parts of the respiratory function.
• 5:55:59
  This example at one time shows you that we shall find the same problems
• 5:56:02
  in the study of respiration. Yet it is incontestable that we cannot begin with
• 5:56:07
  so important and so definite a disturbance as anorexy. The latter was, as
• 5:56:11
  we saw, the suppression the dissociation of the whole of alimentation, going as
• 5:56:15
  far as inanition and death. It was the great functional paralysis. Is there
• 5:56:21
  a corresponding absence of respiration, a corresponding asphyxia, suppressing all respiration, and
• 5:56:26
  going as far as death? The point is moot. You may see the
• 5:56:30
  opinions for and against it in the book of Monsieur Gille de LaTourette. For
• 5:56:33
  my point, I hesitate to admit that it can be true. I have
• 5:56:37
  seen several persons die of hunger. I have not yet seen any one die
• 5:56:41
  of suffocation. Hysterical asphyxia resulting from various disturbances in the respiratory mechanism does not
• 5:56:47
  seem to us to be capable in general of bringing about death. A moment
• 5:56:51
  comes when asphyxia brings on fainting. That is the arrest of the higher functions
• 5:56:55
  of the brain, and the respiration, being no longer impeded by these higher
• 5:56:59
  functions, is restored owing to the automatism of the bulb. Therein lies,
• 5:57:03
  in fact, the difference I indicate to you between the alimentary and respiratory disturbances
• 5:57:10
  alimentation, or at least the mechanical part of it consisting in the prehension of
• 5:57:14
  elements is entirely a conscious, voluntary function. Even if we die of hunger,
• 5:57:18
  if we are in a swoon brought on by inanition, no bulber mechanism
• 5:57:22
  will cause us to eat. Whereas respiration is not entirely a conscious and voluntary
• 5:57:27
  function, consciousness may disturb it greatly, no doubt, we shall see how
• 5:57:32
  many foolish things it may do. But happily for us there is outside our
• 5:57:36
  consciousness a fundamental mechanism which is the safeguard of our hystericals. This difference between
• 5:57:41
  hysterical anorexy and hysterical asphyxia as regards danger is still another fact to be pointed
• 5:57:48
  out in order to justify our mental interpretation of the disease. However, it
• 5:57:53
  may be there exist hysterical disturbances of respiration, which fact we understand very well.
• 5:57:59
  Now we know the inf of the brain on this function. Florence in
• 5:58:03
  eighteen forty two connected respiration entirely with the bulb. But since the works of
• 5:58:07
  cost in eighteen sixty one, of Danilowski in eighteen seventy five, of Leppin,
• 5:58:12
  of Richet, of France, of Paschon, and especially of Mosso,
• 5:58:17
  we know very well that there is a cerebral respiration. When the brain is
• 5:58:22
  benumbed, the respiration decreases and is reduced. It seems that in total respiration
• 5:58:26
  there is a part of superfluous respiration or respiration of luxury as mosso called it,
• 5:58:32
  which depends on cerebral activity. It is this respiration of luxury that hystericals
• 5:58:37
  can modify in a thousand ways. We first find disturbances of the respiratory sensibility,
• 5:58:42
  which of course play a fairly important part in the evolution of the accidents.
• 5:58:47
  For you know that every loss of a function, or every paralysis,
• 5:58:49
  is accompanied by an unconsciousness relative to the special sensations that play a part in
• 5:58:55
  the function. That is to say, with the systematic anesthesia. You will
• 5:59:00
  often find more or less diffuse anesthesias distributed over the organs of respiration. The
• 5:59:04
  nose is very often insensible, and the absence of the perception of odors and
• 5:59:10
  nosmia accompanies the respiratory disturbances as well as the disturbances of alimentation. The pharynx
• 5:59:15
  is very often insensible. You know that formerly Cheron wanted to make this insensibility
• 5:59:22
  and the loss of the pharyngeal reflex to tickling, a symptom characteristic of every
• 5:59:26
  hysteria. This is very exaggerated, though the fact is frequent. Since it
• 5:59:30
  accompanies the disturbances of alimentation and those of respiration. You will find disturbances of
• 5:59:37
  sensibility distributed over the thorax and abdomen. What is more interesting, you will
• 5:59:41
  be able, in certain cases to recognize a very special anesthesia relative to respiration
• 5:59:47
  itself. We feel our respiration, and above all, we feel the need
• 5:59:51
  of breathing. Monsieur Block in eighteen ninety seven invented a curious apparatus for measuring
• 5:59:56
  this respiratory sensibility. The subject is obliged to breathe through a tube, the
• 6:00:02
  end of which is closed by a window of calculated dimensions. A screw allows
• 6:00:06
  you to gradually reduce the dimensions of the window, and the subject, whose
• 6:00:08
  eyes are shut must indicate at what moment he feels a difficulty in breathing.
• 6:00:15
  The figures obtained very pretty much with the subject, the hour of the day,
• 6:00:18
  and the movements the subject has just made. But I have been able
• 6:00:22
  to observe that in hystericals the figures are often very different and infinitely smaller.
• 6:00:26
  The patient indicates only very late the need to breathe, much later than a
• 6:00:30
  normal individual would do when she is already half suffocated. This phenomenon shows a
• 6:00:36
  special unconsciousness of the respiratory need, which is to a certain extent comparable to
• 6:00:41
  anorexy, that is to say, to the unconsciousness of hunger. These disturbances
• 6:00:47
  of the sensibility are accompanied with motor disturbances of which the subjects are more or
• 6:00:51
  less conscious. They can no longer breathe voluntarily, though they do not arrive
• 6:00:55
  at total asphixia, for the physiological reasons I have pointed out. They can
• 6:01:00
  no longer add to their respiration that luxury to which we are accustomed. The
• 6:01:03
  subject complains of feeling oppressed, are feeling contracted in her neck, in her
• 6:01:07
  chest, of suffocating, of not being able to make air enter her chest.
• 6:01:12
  Sometimes these phenomena are consequent on accidents bearing on the respiratory organs. We
• 6:01:18
  have just seen this in the case of Les Moyll, and the least cold
• 6:01:21
  in the head may cause similar phenomena in the patient in question. Sometimes they
• 6:01:26
  are consequent on any emotion whatever, disturbing the respiration, which the subject cannot
• 6:01:30
  restore. In many cases, the respiration abnormal during the waking state very quickly
• 6:01:36
  becomes normal again during the somnambulistic state or the periods of absent mindedness. The
• 6:01:41
  accident is quite conformable to the rules that apply to paralyzes. You should not
• 6:01:45
  believe, however, that these facts are connected with real paralyses of such or
• 6:01:49
  such an organ of respiration. The paralysis is less definite here than in alimentary
• 6:01:55
  disturbances. Again for the same reason. A most interesting phenomenon, which sha
• 6:02:00
  I have very often recognized in this connection is the respiratory disorder, an absence
• 6:02:03
  of regularity and harmony. Respiration depends on complex organs the nose, the pharynx,
• 6:02:10
  the glottis, the thoracic cavity, the diaphragm. It cannot be effected
• 6:02:15
  correctly if everything does not work at the same time and in the same direction.
• 6:02:18
  It is useless to dilate your thorax, if you shut your glottis or
• 6:02:22
  swell your diaphragm. This is what our patients do. The efforts they make
• 6:02:26
  in their various organs are contradictory, and that is the reason why they make
• 6:02:30
  only very little air into their chest in spite of apparently considerable efforts. Bear
• 6:02:36
  this detail in mind. You must not think that people breathe very much when
• 6:02:40
  they agitate their chest very much. Spirometric measures show us that hystericals breathe very
• 6:02:45
  little in reality, in spite of great apparent heavings of their thorax and abdomen.
• 6:02:49
  Their respiratory disturbance is less a paralysis proper than a want of synergy.
• 6:02:55
  This is also interesting for the comprehension of their paralyses, which are, as
• 6:02:59
  I have told you, paralysies of a system. One may no longer be
• 6:03:03
  able to ride a bicycle without having any apparent paralysis of the legs. In
• 6:03:07
  certain cases, however, the respiratory disturbance may assume more determinate forms, which
• 6:03:12
  have greater resemblance with known paralyses. But these facts are rare and still discussed.
• 6:03:18
  I merely indicate to you the problem I myself communicated to the Congress of
• 6:03:22
  Psychology held in Paris in nineteen hundred, a fact which is very important in
• 6:03:26
  my opinion, namely, the appearance of the rhythm of Chain Stokes in hysteria.
• 6:03:33
  You know that about eighteen sixteen, Chain of Dublin and Stokes described a
• 6:03:37
  certain quite special irregularity of respiration, which, to their mind was characteristic of
• 6:03:41
  the most serious states. As you see on this table Figure sixteen, this
• 6:03:47
  rhythm is characterized by respiratory pauses. There is a series of ten to fifteen
• 6:03:52
  quick breaths, then an arrest of the respiration, which may last long half
• 6:03:56
  a minute in some cases. Then the active respiratory series begins again at the
• 6:04:02
  outset. This phenomenon was only established in cerebral apoplexy, in most forms of
• 6:04:06
  agony, in certain varieties of cerebral tumors. Later on, it was also
• 6:04:11
  found in typhoid fever, in eureemia, in various intoxications. Monsieur Mosso was
• 6:04:17
  the first to generalize this respiratory rhythm singularly. He showed that it existed in
• 6:04:22
  simple natural sleep when profound, and in general in all states of general numbness.
• 6:04:27
  At a time when I used to take systematically, and with some exaggeration,
• 6:04:30
  the graphic of the respiration of all the hystericals I attended, I was
• 6:04:34
  very much astonished to find with one of them a graphic which exactly presented the
• 6:04:38
  rhythm of Chain Stokes. I refer you to my article if you wish to
• 6:04:42
  see studies which are not without interest in the modifications of this rhythm. This
• 6:04:48
  patient was always in a state of absent mindedness and revery. When her attention
• 6:04:52
  was attracted through any process, her respiration changed and it became again nearly normal.
• 6:04:57
  It is the same in the other cases of chain stokes that I found
• 6:05:00
  in hystericals. This respiration exists in subjects who are in a condition of half
• 6:05:06
  sleep and who are incapable of any attention. It vanishes when the subject is
• 6:05:10
  more awake and more active. These observations are interesting in that they show the
• 6:05:15
  role of respiration and attention. They are also important for the theory of hysteria,
• 6:05:19
  for they show us here the disturbance of a function, that of attentive
• 6:05:22
  respiration, which is not a function known to the subject, and which consequently
• 6:05:26
  cannot be disturbed through preconceived ideas. In the same order of ideas I wish
• 6:05:33
  to indicate to you rather as a curiosity, for this time, I have
• 6:05:36
  seen only one case of the phenomenon, a paralysis of the diaphragm with alternating
• 6:05:41
  seesaw respiration. You know that in normal respiration, the diaphragm falls. When
• 6:05:47
  the thorax rises, actively forces down the intestines and consequently swells the abdomen during
• 6:05:52
  each inspiration. If the diaphragm is paralyzed, it cannot perform this active movement.
• 6:05:57
  It floats like an inert veil and allows itself to be drawn up.
• 6:06:02
  During each thoracic inspiration. The abdomen hollows inwards instead of swelling when the thorax
• 6:06:07
  dilates. That is what is called seesaw respiration. It was formerly considered as
• 6:06:12
  very dangerous and incompatible with life. Briquet already vaguely indicated an instance of it
• 6:06:18
  in a case of hysteria. I have very accurately described an observation of this
• 6:06:23
  phenomenon relating to the girl whose whole trunk was paralyzed in consequence of a fall
• 6:06:27
  into a well. You see in this graphic Figures seventeen and eighteen that the
• 6:06:33
  respiration is very quick eighty respirations in a minute, and that the graphic of
• 6:06:37
  the thoracic respiration T and of the abdominal respiration A are not parallel but discordant.
• 6:06:44
  The abdomen hollows inward instead of swelling when the thorax dilates, which I
• 6:06:48
  have pointed out as the sign of the paralysis of the diaphragm. The young
• 6:06:52
  patient of this case had undoubtedly a number of hysterical accidents, and this phenomenon
• 6:06:56
  was I think of the same kind. But when it is, I own
• 6:07:00
  a phenomenon whose presence in hysterics is still open to discussion. If this presence
• 6:07:06
  is confirmed, we shall be obliged to admit more profound older functions relative to
• 6:07:11
  the movement of the diaphragm, which may be troubled in certain serious forms of
• 6:07:15
  hysteria. As old functions are disturbed in hemiplegae and hemianopsia, two to those
• 6:07:22
  paralysies of the respiratory function are added, as is always the case, and
• 6:07:26
  according to the rule we know automatic agitations. The functions are never entirely lost
• 6:07:33
  in hysteria. They are emancipated. In this state. They are performed in
• 6:07:37
  a more or less absurd manner without the will of the subject. As there
• 6:07:41
  are in the respiratory function a quantity of small, distinct functions, each of
• 6:07:45
  them may emancipate itself separately and give rise to very varied sticks. Let us
• 6:07:52
  put in the first rank the exaggeration of total respiration polyp near Here is a
• 6:07:56
  fine case. A is a man of thirty a foreman in a seaport.
• 6:08:02
  One day he was commanding some workmen who were working a capstin in order to
• 6:08:04
  raise a tall mast. He saw a rope break and the mast incline,
• 6:08:10
  and fancied that it was falling on his workmen, which caused him to utter
• 6:08:12
  large cries. No accident occurred, but he was so fatigued with this emotion
• 6:08:18
  that he was obliged to return home. The next day, it was noticed
• 6:08:22
  that he breathed in an odd way. The respiratory disturbance grew little by little
• 6:08:26
  and turned to a great polypnear, which lasted several months. He kept on
• 6:08:30
  breathing with unheard of quickness and force. His chest heaved very strongly and very
• 6:08:36
  quickly, without any interruption. He had eighty eight, then ninety seven respirations
• 6:08:41
  a minute, instead of the normal eighteen pig nineteen. This formidable respiration exhausted
• 6:08:47
  him, threw him into a perspiration, and above all did not leave him
• 6:08:49
  the least freedom of mind. He sat motionless on his chair, thinking of
• 6:08:53
  nothing, doing nothing but Breathe notice also that continual parallel of the disturbance of
• 6:09:00
  respiration and those of attention. As soon as he was hypnotized, the respiration
• 6:09:03
  became calm, and he was very quickly cured through this process. But note
• 6:09:10
  in passing a fact to which we shall revert later on. Our patient remained
• 6:09:14
  cured for two years. Then he lost a little daughter. And you know
• 6:09:17
  what disturbance he was affected with in consequence of this grief. Was it a
• 6:09:21
  somnambulism or a crisis, as was the case in so many of the patients
• 6:09:23
  we passed in review. No, it was the same polypnia which began again
• 6:09:29
  and had to be cured through the same process. By the side of this
• 6:09:33
  case might be put that of a girl who breathed seventy times a minute after
• 6:09:36
  suffering an attempt at rape, and many of the same kind. After those
• 6:09:41
  exaggerations of the total respiration, let us rapidly enumerate the exaggerations of details the
• 6:09:45
  ticks bearing on such or such a particular function. Let us first consider inspiration
• 6:09:51
  tis exaggerated inspiration, which is connected with a certain degree of dysnea, and
• 6:09:56
  will assume the form of continual size. When a little stronger it will be
• 6:10:00
  a sob than a yawn. You know what importance was formally attributed to the
• 6:10:04
  hysterical yawn, which was thought very amusing. Nothing, in fact, is
• 6:10:10
  more singular than those poor girls who all day long and two or three times
• 6:10:14
  a minute yawn till they almost disjoint their jaws. It is one of the
• 6:10:18
  phenomena in which the imitative contagion is best exhibited. It is also a phenomenon
• 6:10:22
  in relation with the disturbances of alimentation. It is the same with the last
• 6:10:29
  inspiratory tick, the hiccup, which is also very frequent. The hiccup is
• 6:10:33
  nothing but a very rapid inspiration with a certain degree of spasma of the glottis.
• 6:10:37
  The air cannot re enter quickly enough because the inspiration is too rapid,
• 6:10:41
  and also because the glottis is a little closed. This results first in a
• 6:10:45
  certain characteristic noise and also in a certain thoracic vacuum, which causes an aspiration
• 6:10:49
  in all the organs. You can see this fact in the graphic of hiccup
• 6:10:53
  Fig. Twenty. When the hiccup appears at the beginning of each inspiration,
• 6:10:57
  the abdomen is aspirate, and the graphics of both respirations thoracic t and abdominal
• 6:11:03
  a are momentarily discordant. This will presently play a great part in the phenomenon
• 6:11:08
  of air of phagure with patients whose swallow air and in vomission. Let us
• 6:11:14
  only remark that the hiccup is one of the most frequent phenomena. When looking
• 6:11:18
  over my notes to prepare this course of lectures, I counted twenty nine great
• 6:11:22
  observations of hysterical hiccup that had lasted for months. Together. Among the expiratory
• 6:11:27
  tics, we shall first range the hysterical cough, that little phenomenon so frequent
• 6:11:33
  at the outset of the disease. There are in this connection clinical observations on
• 6:11:37
  the evolution, which are facts of experience and cannot very well be accounted for.
• 6:11:41
  Thus, the hysterical hiccup is to my mind a rather serious phenomenon of
• 6:11:45
  bad prognosis. It points to a great hysteria. The hysterical cough, which
• 6:11:51
  is almost like it, is, a more commonplace and less serious phenomenon.
• 6:11:55
  Almost every girl has had an irrepressible cough in consequence of a certain cough of
• 6:12:00
  efforts in singing, or of fits of bashfulness. When the phenomenon is isolated,
• 6:12:04
  it is very difficult, in my opinion, to say whether we have
• 6:12:07
  to deal with incipient hysteria or with a mere psychosenic tick. As always pay
• 6:12:12
  attention to the state of the sensibility, to the degree of the unconsciousness,
• 6:12:17
  and to the effects of distraction. One degree further, you have hysterical laughter,
• 6:12:23
  those interminable crises of laughter which develop for hours together like real fits of
• 6:12:27
  hysterics. You know the psychological problem of laughter, and are aware that this
• 6:12:32
  phenomenon, apparently so amusing, is a torturing problem for the unfortunate scientists.
• 6:12:37
  You should not fancy that laughter is always the expression of joy. Certain hysterical
• 6:12:42
  laughters are of this kind. Thus, a girl of bad morals had undergone
• 6:12:47
  a little surgical operation for which she had been half chloroformed. But during this
• 6:12:51
  trifling operation, young students of the hospital who surrounded her had kept joking her
• 6:12:56
  and making her laugh. Probably under the influence of the chlorophy this laughter was
• 6:13:00
  transformed into an independent, automatic phenomenon and persisted as a tick. But in
• 6:13:06
  other cases, laughter accompanies pain, It accompanies nervous exhaustion, and is to
• 6:13:11
  be observed in great delirious attacks. It is probably a phenomenon of derivation of
• 6:13:15
  the nervous strength, very difficult to account for. One degree further, and
• 6:13:21
  the expiration more violent and accompanied with spasms of the glottis, will bring about
• 6:13:26
  the most varied cries, the famous hysterical barks. You know that they occurred
• 6:13:30
  epidemically in the Middle Ages, and that in the Convents nuns began by hundreds
• 6:13:34
  to howl, bark or mew. It was necessary to threaten them with a
• 6:13:38
  hot iron to silence them. It is by far less widespread nowadays, and
• 6:13:44
  is not so epidemic, but nevertheless it exists very often under various forms.
• 6:13:48
  In many cases this tick is mixed with some phenomena of disturbances of speech of
• 6:13:52
  which we have already spoken. Little by little, the bark becomes a particular
• 6:13:56
  word, the name of a person, or some absessity or other. You
• 6:14:02
  understand in fact that all these various ticks we have analyzed may be mixed with
• 6:14:06
  one another and give rise to complex phenomena. One of the most interesting is
• 6:14:11
  that to which I alluded just now when speaking of the hiccup. The hiccup
• 6:14:15
  through the vacuum. It determines in the thorax, produces a draft in the
• 6:14:18
  esophagus and causes the subjects to swallow air. After three or four hiccups,
• 6:14:22
  the stomach is full of air, which brings about another fact, namely,
• 6:14:26
  the expulsion of those gases from the stomach through an erectation. Therefore, as
• 6:14:32
  you may easily notice, great hiccups are always interrupted now and then by erectations
• 6:14:36
  of different tones. I used to note down in the following manner the noises
• 6:14:40
  that one of my patients regularly made nupe nupe, nupe czar, and thus
• 6:14:45
  indefinitely this same patient complicated her respiratory disturbances a little by adding to them disturbances
• 6:14:52
  of speech. Thus the noises of her hiccup were often transformed into veritable words.
• 6:14:57
  Now and then she would repeat all right and all rock, which sounded
• 6:15:03
  about like the name of a medical attendant. It even appears that the noise
• 6:15:07
  nupe nupe had been consequent on the reading of a novel in which some savages
• 6:15:11
  sang you you with those same complex ticks of respiration. I should like to
• 6:15:18
  connect an exceedingly curious phenomenon, the swelling of the abdomen or materrorism. It
• 6:15:23
  is necessary that you should know this phenomenon well, because it is the one
• 6:15:26
  which gives rise to the most common and grotesque medical errors. You know of
• 6:15:32
  those newly married young women who long to have a child. The menses are
• 6:15:34
  suppressed, the abdomen becomes big and hard, the breasts hard and colored.
• 6:15:40
  There are nauseas and vomitings. A midwife has called in. She feels the
• 6:15:45
  arm of the child and fixes the date of the delivery. This date comes,
• 6:15:48
  and nothing ceases. The expectation continues. One fine day, everything disappears,
• 6:15:53
  without its being possible to know what has become of the child. It
• 6:15:57
  is the famous nervous pregnancy, of which I have noted down about ten cases,
• 6:16:03
  and of which one should beware. The error is less serious here than
• 6:16:07
  when these swellings of the body are attributed to various tumors, and operations are
• 6:16:11
  counseled. However that may be, this abdominal swelling is not very easy to
• 6:16:15
  account for. The Old theories of the time of Chalcourt connected it with a
• 6:16:19
  paralysis of the intestinal walls. Admitting of the dilatation of the gases, I
• 6:16:25
  am much more inclined at the present day to believe that it is due to
• 6:16:27
  respiratory phenomena. One of those phenomena is a spasm of the diaphragm, which
• 6:16:33
  remains lowered and compresses the visceraa forward, but it only brings about the smaller
• 6:16:37
  swellings. The other is in relation with that same aerophagure which I have just
• 6:16:42
  mentioned. Certain patients eject the air they have inhaled by means of erectations.
• 6:16:48
  Others do not succeed in emptying their stomach through the upper end. They force
• 6:16:52
  their pylorus open and send this air into their intestine, which determines varied disturbances
• 6:16:56
  of the digestion and in particular diode, But at the same time are sometimes
• 6:17:02
  enormous swelling of the whole abdomen. You may imagine many other combinations of these
• 6:17:07
  respiratory disturbances. Three. But before leaving the subject of visceral disturbances, I
• 6:17:15
  should like to tell you briefly of some other very important ticks which depend on
• 6:17:18
  the function of alimentation of which we have spoken. Most of these ticks of
• 6:17:22
  alimentation, besides, are at the same time complicated with a respiratory phenomenon.
• 6:17:29
  In the first place, the function of alimentation, emancipated from the personal consciousness,
• 6:17:33
  may become exaggerated and give brise to various forms of bolimia. Patients affected
• 6:17:38
  with bolima cannot stop eating. They constantly ask for food. The fact of
• 6:17:44
  bolimia, it is true, exists in hysteria, but be on your guard.
• 6:17:48
  It mostly belongs to psychosthenic impulsions. It is to be met with among
• 6:17:52
  those patients who feel weakened, depressed, and have taken the mania to revive
• 6:17:56
  themselves by some stimulant or other adopted moral at haphazard. Some have the mania
• 6:18:03
  of always eating others, and they are the most numerous, have the mania
• 6:18:07
  of drinking alcohol. Yet there is one form of those manias which is in
• 6:18:11
  relation with a hysterical phenomenon, and which it is right that you should know.
• 6:18:15
  It is polydipsia, which is not to be confounded with dipsomania. The
• 6:18:19
  dipsomaniac seeks after exciting drinks, and it is alcohol he wants to swallow.
• 6:18:23
  The polydipsical is not so hard to please. He is content with pure water,
• 6:18:29
  but he swallows twenty liters of it a day. This excess of drink
• 6:18:33
  has an inevitable consequence, namely an excess of urine polyuria. Some of these
• 6:18:37
  patients discharge eighteen liters a day. Curiously enough, more stress has generally been
• 6:18:42
  laid on this consequence of the phenomenon than on the phenomenon itself. Polyuria was
• 6:18:48
  studied among the disturbances of the renal secretion to be met with in neuropathic patients.
• 6:18:53
  I think it should rather be connected with deliriums, or with the disturbances
• 6:18:56
  of the functions of alimentation, which bring about the impulsion to drink indefinitely.
• 6:19:03
  But after those great automatisms of the function of alimentation, we have to point
• 6:19:07
  out a host of partial disturbances. Spasms of the jaws and cheeks, spasms
• 6:19:11
  of the pharynx, ticks of perpetual spitting and salivation. Tialism, which is
• 6:19:17
  frequent in certain melancholy deliriums, exists also in hysteria. I do not insist
• 6:19:22
  on the spasms of the esophagus to which we alluded in our last lecture.
• 6:19:26
  You also know that ticks of erectation and the belches of which I have just
• 6:19:30
  spoken to you in connection with the hiccup. But I must point out to
• 6:19:34
  you a complication of the phenomenon, which is called regurgitation meriicism. Some of
• 6:19:40
  these patients learn to ruminate like cows. They know how to bring back into
• 6:19:45
  their mouths the food they have swallowed. It has been said that this constituted
• 6:19:48
  an odd physiological phenomenon in which the movement of the esophagus was reversed. I
• 6:19:53
  think rather that it is one of those curious phenomena of aspiration induced by abnormal
• 6:19:59
  respiration. By making a movement of aspiration very quickly while shutting the glottis and
• 6:20:03
  preventing the air from entering into the lungs, one induces a vacuum in the
• 6:20:07
  thorax which can react on all sides. A certain individual who was formerly celebrated
• 6:20:12
  in Paris thus drew up air through his anus and knew how to eject it
• 6:20:15
  in a melodious way. We know that many thus draw air into their esophagus,
• 6:20:22
  But the aspiration into the esophagus may be effected in the opposite direction and
• 6:20:26
  throw up the contents of the stomach. We shall see this mechanism assume a
• 6:20:30
  greater importance still in the following phenomenon, The only one that is really important,
• 6:20:34
  namely hysterical vomiting. Hysterical vomiting is almost as serious as anorexi itself.
• 6:20:41
  It is certainly responsible for several deaths. It almost always complicates all the preceding
• 6:20:45
  disturbances. This vomiting is rarely pure, that is to say, it rarely
• 6:20:51
  depends on hysteria alone. Nowadays, as I told you at the outset,
• 6:20:56
  the attention of physicians is much more directed to associated hysteria, to the organic
• 6:21:00
  affections that are at the starting point of hysteria or its localizations. Lately,
• 6:21:06
  Monsieur Mathieu and Rue, in a paper in the Gazette de Opitaux, again
• 6:21:10
  insisted on this point in connection with hysterical vomitings. Almost always, they said,
• 6:21:15
  there is at the starting point some organic affection which induces the beginning of
• 6:21:18
  the phenomenon. This primum mobilae may be either the vomitings in pregnancy, or
• 6:21:23
  alcoholic gastrites or gastrites of any kind, or above all ulces of the stomach,
• 6:21:29
  of which we shall have to speak again. But however it may be,
• 6:21:33
  what characterizes the phenomenon is the exaggeration and regular and indefinite reproduction of the
• 6:21:37
  vomiting long after the action of its cause. This vomiting, in fact,
• 6:21:42
  is exceedingly rapid and easy. It immediately follows the meal. It is accompanied
• 6:21:47
  with very little nausea and no effort. It is repeated with any kind of
• 6:21:51
  food, and produces the most dangerous inanition. It is also in cases of
• 6:21:56
  this kind that the tuberculous complications supervene, which almost always terminate hysterical inanitions.
• 6:22:03
  A rather characteristic phenomenon is that the patients cannot seem to endure the arrest of
• 6:22:07
  the vomiting. When through any process they are prevented from vomiting, they exhibit
• 6:22:11
  anguish, are agitated, writhe in every way, complain of a thousand sufferings,
• 6:22:15
  and finally become unconscious in a great hysterical attack. Many patients have thus
• 6:22:21
  to choose between delirious attacks and perpetual vomiting. This is quite the character of
• 6:22:25
  an automatic agitation which they can no longer control. Formerly, an apparently very
• 6:22:30
  serious accident was always brought close to hysterical vomiting, namely the vomiting of blood,
• 6:22:36
  and these hema temeses were unhesitatingly connected with hysteria. It had been noticed,
• 6:22:41
  and that very rightly too, that these hema temeses almost always coincided with
• 6:22:45
  the beginning of the mensis, and it was usually said that these women have
• 6:22:49
  their mensis through their stomachs. At the present time, this notion of these
• 6:22:53
  neuropathic gastric hemorrhages tends to become obliterated, and physicians are inclined to say that
• 6:23:00
  they are due to an unrecognized ulcer of the stomach. The symptoms that were
• 6:23:03
  formally indicated as conducing to the diagnosis seem to have lost something of their value.
• 6:23:08
  The pain occurring long after the meal, the irregular paroxystic crises, the
• 6:23:12
  relation with the menses, even the relation with moral emotions. All that was
• 6:23:18
  found again in the ulcer. Kutner in eighteen ninety five pointed out a patient
• 6:23:22
  whose first vomiting of blood came on after the death of a relative. He
• 6:23:26
  was led to cut open her stomach and found a real ulcer. Another woman,
• 6:23:30
  after a scene in which her daughter left home forever, had a vomiting
• 6:23:33
  of blood, which formerly would have been unhesitatingly connected with emotional neuropathic disturbances.
• 6:23:41
  Her stomach was also cut open and an ulcer was found. It is in
• 6:23:44
  the work of Messieur Mathieu and Rue that you will find a very well conducted
• 6:23:48
  discussion of this fact. The authors, however, hesitate to make a complete
• 6:23:52
  denial of purely hysterical hemaateemysies. They admitted in hemorrhagic petuities, in petuitous vomitings
• 6:23:57
  tinted with blood, in hemotemices coinciding with multiple hemorrhages of the skin of the
• 6:24:03
  ear. Then why should it not be admitted that in certain cases this disposition
• 6:24:07
  to hemorrhage may be localized in the stomach. Be very prudent, however,
• 6:24:12
  in this diagnosis, which at the present time must be less readily accepted than
• 6:24:17
  formally the same prudence. Even still, greater prudence is of course necessary when
• 6:24:22
  you have to deal with fecaloid or still stranger vomitings, which some of those
• 6:24:25
  subjects may exhibit. They are almost always due to simulations or deliriums, which
• 6:24:30
  you must know how to recognize the real ticks of alimentation and respiration. We
• 6:24:36
  have just described a numerous enough for us not to complicate their list with doubtful
• 6:24:38
  phenomena. One of the characteristics of the present study of hysteria is that efforts
• 6:24:44
  are made to limit the disease more clearly than formally, and to leave out
• 6:24:48
  mysterious phenomena or phenomena depending on another malady. Our enumeration of the symptoms of
• 6:24:53
  hysteria is already complete enough, and we can now enter upon more general studies
• 6:24:59
  on the common ca characteristics of these diseases. End of Section twelve. Lecture
• 6:25:06
  thirteen. Hysterical stigmata, suggestibility, the need of unity in presence of the
• 6:25:11
  diversity of hysterical phenomena. The problem of the stigmata, the stigma of anesthesia,
• 6:25:18
  the historical importance of this stigma its exaggeration. The two meanings of the
• 6:25:22
  word stigma, the psychological stigmata, the character of hystericals instinctive falsehood, the
• 6:25:30
  mental stigma of suggestibility. The distinct meaning of the word suggestion. Description of
• 6:25:36
  the principal facts of suggestion, the complete development of the elements contained in an
• 6:25:41
  idea without any participation of the will or of the personal consciousness. The distinction
• 6:25:45
  between real suggestion and normal phenomena, the conditions of suggestion, the systematization of
• 6:25:51
  images, the absence of suggestion properly so called with normal people, the weakening
• 6:25:56
  of consciousness, the lack of synthesis as a sign of hysteria, the disappearance
• 6:26:02
  of suggestibility after recovery from hysteria. The examination, even rapid of the numerous
• 6:26:08
  accidents of hysteria raises inevitable problems in our minds. The most important one,
• 6:26:14
  the one that always torments the human mind in all possible studies, is the
• 6:26:18
  problem of unity, of the conception of the whole, of the essential and
• 6:26:21
  fundamental character. The first authors who described hystericals were always struck with the diversity
• 6:26:26
  and complexity of their symptoms. It is not a disease, said one of
• 6:26:30
  them. It is a host of ailments, and you know that. To
• 6:26:33
  express the changeableness of hysteria, Sydenham called it that proteus that cannot be laid
• 6:26:38
  hold of. Sometimes it takes the form of delirium, such as we have
• 6:26:42
  seen in somnambulisms, and we are in the domain of mental diseases. Sometimes
• 6:26:48
  it presents accidents of the arms and legs, which make us think of articular
• 6:26:51
  and muscular lesions. Now we meet with disturbances of the stomach or lungs,
• 6:26:56
  and we have to deal with visceral diseases, gastrities, and ammonias. You
• 6:27:00
  may understand the perplexity of the first clinicians, the best of whom came to
• 6:27:04
  abhor and loathe such a malady. They did not seek to take away from
• 6:27:08
  it its bad renown, for their scientific dissatisfaction discomposed them and made them impatient
• 6:27:15
  with the subject, and inclined them to call him a simulator under deborchi slow
• 6:27:19
  was the reaction against this tendency, brought about by a very natural perplexity.
• 6:27:26
  The best answer has been to make hysteria intelligible, and above all, to
• 6:27:30
  seek to give it some unity, by linking together those scattered accidents, by
• 6:27:33
  finding in all of them some fundamental features which serve at once to explain them,
• 6:27:38
  to connect them with one another, to diagnosticate, and to identify them.
• 6:27:44
  This need of unity under diversity, which has never been so serious as
• 6:27:47
  in the study of hysteria, has enlarged with regard to this study. A
• 6:27:51
  problem that upon the whole exists in every medical research, the problem of the
• 6:27:55
  stigmata. If one admits that somnambulism, paralysis, vomiting are all three of
• 6:28:00
  them hysterical phenomena in spite of their enormous differences, there must be something common
• 6:28:06
  among them. In the three patients, a common character must be found,
• 6:28:10
  which is, with all of them, the starting point of the observed symptom,
• 6:28:14
  and serves to diagnosticate the hysterical character of this accident. That common character
• 6:28:18
  is the stigma. And one may say that since the beginning of the scientific
• 6:28:22
  study of hysteria, all the attention of clinicians of any merit has been directed
• 6:28:26
  to the study and search of the stigma. One. Of course, this
• 6:28:33
  stigma has varied very much, for it reflects the theories of each period on
• 6:28:37
  the diseases. One considers. Now this essential stigma of hysteria was the convulsive
• 6:28:41
  attack, now the hysterical ball. You will read with astonishment the books of
• 6:28:47
  the beginning of the nineteenth century, in which you will find that hysteria is
• 6:28:51
  recognized from the ball of nervous women. For about fifty years past, other
• 6:28:55
  more important characters have become predominant. And you are aware that, especially under
• 6:29:00
  the influence of the school of charco, one symptom has become the pre eminent
• 6:29:03
  stigma, namely anesthesia. The singling out of this symptom was in some degree
• 6:29:10
  an unconscious return to the past. In the Middle Ages, people had also
• 6:29:14
  a kind of diagnosis to make in order to recognize witches and those possessed as
• 6:29:18
  well as possible before burning them. And you know the singular method they made
• 6:29:22
  use of a surgeon or an expert woman examined the body of the sufferer on
• 6:29:26
  all sides, testing the sensibility with a sharp needle in order to discover the
• 6:29:30
  devil's claw, that insensitive patch, which was a certain sign of witchcraft.
• 6:29:36
  They examined every nook and corner, for the devil is in the habit of
• 6:29:38
  concealing himself in the most hidden places. And they actually tested the sensibility of
• 6:29:44
  the mucous membranes as well as that of the skin. The fact is really
• 6:29:48
  very curious and shows an instinctive medical perspicacity that has not been sufficiently celebrated.
• 6:29:53
  Well. Charco nearly brought us back to the time of the celebrated inquisitor Bourdain.
• 6:29:59
  And in our clinics we are somewhat like the woman who sought for witches.
• 6:30:03
  We blindfold the subject, we turn his head away, rub his skin
• 6:30:06
  with our nail, prick it suddenly with a hidden pin watch his answers or
• 6:30:10
  starts of pain. The picture has not changed. This research has allowed clinicians
• 6:30:17
  to establish that in many cases, various anesthesias accompany most hysterical symptoms. In
• 6:30:22
  the case of paralyses or contractures of the limbs, the phenomenon is very clear
• 6:30:26
  and regular, whether in regard to cutaneous sensitiveness or better still, for it
• 6:30:30
  is very important to muscular sensitiveness. In the case of sensorial accidents. The
• 6:30:37
  anesthesia is very often quite distinct at the periphery. Sometimes it conceals itself by
• 6:30:41
  taking extremely interesting forms which the inquisitors did not know how to seek for,
• 6:30:47
  such as the contraction of the visual field in the case of visceral accidents,
• 6:30:51
  and of certain motor disturbances, which are rather agitations than paralyses. The question
• 6:30:56
  becomes more delicate. Often the superficial anesthesia of the region indicates the diseased organ,
• 6:31:02
  but to be sincere, this is not always true when we have to
• 6:31:04
  deal with the great mental accidents, with all the innumerable forms of somnambulism,
• 6:31:10
  the anesthesia sought for by Chalco is often to be met with, but it
• 6:31:14
  does not constitute the absolute rule. That method which consisted in characterizing hysteria by
• 6:31:19
  anesthesia and by the contraction of the visual field, has enabled medicine to make
• 6:31:23
  great progress. It has successively brought about the discovery of a crowd of unknown
• 6:31:29
  hysterical symptoms of special spasms, tremors, localized pains, et cetera. Must
• 6:31:33
  it continue to dominate in medicine, and must anesthesia be made an essential symptom.
• 6:31:38
  The discussion on this point began at the very outset of the teaching of
• 6:31:41
  Charko. His adversaries, and they were numerous, always opposed his interpretation of
• 6:31:47
  this symptom. The great and interminable quarrel about traumatic neuroses which began, especially
• 6:31:52
  in Germany in connection with railway accidents, rests on this question. This criticism
• 6:31:56
  is in great part justified, for hysteric anesthesia certainly does not play in practice
• 6:32:02
  the absolutely preponderant role that Chalcour maintained it did. First of all, it
• 6:32:07
  is only too certain that this anesthesia is not so easy to recognize as was
• 6:32:11
  believed it has, as we have seen very delicate psychological characteristics which make the
• 6:32:15
  answers of the subject very often difficult to interpret. But above all, it
• 6:32:21
  is very mobile very impressionable. Now your examination alone will suffice to cause a
• 6:32:26
  real anesthesia to disappear. Now, and this is more serious, your manner
• 6:32:30
  of interrogating will create outright an anesthesia that did not exist. The study of
• 6:32:36
  the stigmata is made on no patients so well as on old ones, the
• 6:32:38
  real pillars of the hospital, who have already been examined thousands of times.
• 6:32:44
  When you have to deal with new patients who have not yet been touched,
• 6:32:47
  you recognize with astonishment that anesthesia is rarer less important than Charcos said. On
• 6:32:52
  this point, I apologize myself and acknowledge that, under the influence of La
• 6:32:56
  salpetriere, I formerly atributed more importance to anesthesia than I would do now.
• 6:33:04
  What then must be our conclusion as to the role of anesthesia as a stigma?
• 6:33:08
  We should understand one another and not ask the sciences of observation, which
• 6:33:12
  are so difficult to furnish us with absolute theorems. In my opinion, the
• 6:33:17
  two meanings of the word stigma should be separated. In the first place,
• 6:33:21
  it has the theoretical meaning. It indicates the fundamental character, the causal character
• 6:33:26
  from which the rest of the disease springs. For instance, if you consider
• 6:33:30
  a tuberculous lesion, the real stigma will be the basillis of Koch, because
• 6:33:34
  we consider it, at least at the present day, as the cause of
• 6:33:37
  all the innumerable lesions, however varied they are. It will be the same
• 6:33:41
  with the existence of the pale spirokeet of Chaoudin in syphilis. If the hypothesis
• 6:33:45
  is corroborated. Now we must own that anesthesia does not play this role in
• 6:33:52
  hysteria, that we do not know the microbe of that malady, that there
• 6:33:55
  is probably none, and that we know no better its histological lesion. From
• 6:34:00
  this standpoint, Chalco's stigma has failed. But the stigma has another meaning,
• 6:34:04
  which is practical. It is a mere means of diagnosis. Now anesthesia accompanies
• 6:34:11
  two thirds of the hysterical accidents. It has, besides the character of persisting
• 6:34:15
  long after the disappearance of the accident. The result is that almost all the
• 6:34:19
  hystericals who at present show a serious phenomenon have had in the past one of
• 6:34:25
  those accidents that leave behind them as a trace some persisting anesthesia. I examine
• 6:34:30
  in a subject of perplexing mental or sensorial disturbance and find traces of a hemi
• 6:34:34
  anesthesia. It means that in the course of his life he has already had,
• 6:34:40
  in a greater or smaller degree a hysterical hemiplegi. I establish with him
• 6:34:45
  a contraction of the visual field which he did not even know. It proves
• 6:34:48
  to me that he has had, in a greater or smaller degree a hysterical
• 6:34:52
  amorrosis. Is not this recognition extremely important for the interpretation of the present accident,
• 6:34:57
  even if I do not believe at all that this anesthesia accounts for his
• 6:35:00
  accident. Very often in medicine the stigmata are not so serious as the basilis
• 6:35:06
  of Koch. You examine a patient who has serious intestinal disturbances and fever,
• 6:35:11
  You seek on his breast for the little rosy lenticular spots, and if you
• 6:35:15
  find them, you say it is typhoid fever. Yet you do not know
• 6:35:18
  the role of those spots in the evolution of typhoid fever. I think,
• 6:35:23
  therefore, that the anesthesia of Charakol must remain in practice a very important stigma,
• 6:35:27
  the search for which is in the first rank of the methods of diagnosis,
• 6:35:32
  but that it is not the only or fundamental symptom of hysteria. There
• 6:35:37
  are some troubles and symptoms which we connect with hysteria. Though we do not
• 6:35:40
  recognize any anesthesia. We must look more deeply for other phenomena playing the role
• 6:35:45
  of stigmata two. Anesthesia pleased the physicians because this symptom is, in some
• 6:35:52
  manner intermediate between physical and moral phenomena. They could not make up their minds
• 6:35:57
  to make hysteria a purely mental malle They always declared that such was the case,
• 6:36:03
  but in reality they quickly forgot that declaration to consider by preference physical symptoms
• 6:36:07
  and measure them through physical methods. Since hysteria has become a more distinctly mental
• 6:36:12
  malady, it is in the mind that we must seek for the sigmata,
• 6:36:15
  and that we have a chance to find more general stigmata coexisting with all the
• 6:36:19
  accidents. Scientists had long felt that there was a hysterical mental state. You
• 6:36:26
  know that it was the fashion to write thesis on the character of hystericals.
• 6:36:30
  They were first brought into relief in the works of Le Grand du Saules Ballier
• 6:36:34
  Mebeus toldieux riche et cetera certain curious and striking But of course somewhat exceptional features.
• 6:36:42
  Our poor patients were not lucky. Formerly they were burnt as witches.
• 6:36:48
  Then they were accused of all possible debaucheries. Then, when the manners had
• 6:36:52
  become gentler, one was content with saying that they were versatile to excess remarkable
• 6:36:56
  for their spirit of duplicity, of falsehood, of perpetual similar A common feature
• 6:37:00
  characterizes them, says Taldieux, namely instinctive simulation, the inveterate and incessant need
• 6:37:07
  of unceasingly lying without reason, solely for the sake of lying. And this
• 6:37:11
  not only in words, but also in action, by a kind of parade
• 6:37:15
  in which the imagination plays the principal part, gives birth to the most inconceivable
• 6:37:19
  incidents and sometimes proceeds to the most disastrous extremities. So falsehood becomes the stigma
• 6:37:26
  of hysteria. Do not smile. There are still many physicians who take that
• 6:37:32
  seriously. No doubt, falsehood exists in hysteria, and often it is even
• 6:37:37
  very amusing. I regretted very much when we studied mental disturbances, not having
• 6:37:41
  the time to devote a lecture to the accidents of falsehood. I have known
• 6:37:45
  two or three subjects, one especially who were really magnificent. This poor woman
• 6:37:49
  has had all her life, that is, for thirty years, an extravagant
• 6:37:53
  need of falsehood, above all of falsehood by letters. Her greatest happiness consists
• 6:37:59
  in devising amorous correspondence. She sends to an individual man or woman marvelous letters
• 6:38:03
  in which she states that he or she has inspired her with a sudden love
• 6:38:07
  when passing on the promenade. What is most wonderful is that it always takes
• 6:38:12
  the gentleman answers post restante, and she goes on with the correspondence for months
• 6:38:18
  or years. What is sad is that it ended before the assizes, but
• 6:38:22
  the observation deserves to be published. Falsehood is, in my opinion, one
• 6:38:27
  of the mental accidents of the neurosis, one of the deliriums that the hysterical
• 6:38:32
  may have in a very serious or in an attenuated degree, just as she
• 6:38:36
  may have somnambulisms or fugues, that is to say, ambulatory fits. But
• 6:38:41
  it is very well known that all hystericals have not necessarily made fugues. Likewise,
• 6:38:45
  they have not necessarily all of them. The mental accident of falsehood,
• 6:38:49
  its frequency has been much exaggerated. It has been so often described that in
• 6:38:53
  the end patients were trained to present it. Formerly, Le Grand du Souls
• 6:38:59
  was convinced that all hystericals had red flowers in their hair and red ribbons tied
• 6:39:03
  to their bedsteads. At length he made them believe it. We cannot dwell
• 6:39:07
  on these first mental stigmata, which only show the importance that must be attached
• 6:39:11
  to psychological disturbances. In reality, the great mental stigma that modern studies have
• 6:39:18
  brought into evidence is the mental phenomenon of suggestion. No doubt, I begin
• 6:39:22
  to think that the importance given to it, in particular in the last works
• 6:39:26
  of Babinski, is somewhat exaggerated. But it is certain that this exaggeration is
• 6:39:30
  as yet very slight, and that suggestion is indeed one of the most fundamental
• 6:39:33
  stigma of the hysterical state. But it is necessary to define this phenomenon exactly
• 6:39:38
  to give a distinct meaning to the word, because physicians are in the habit
• 6:39:42
  of using it in an extremely vague manner, of comprising under this word all
• 6:39:47
  possible mental phenomena. It is needless to recall the fundamental phenomena of suggestion.
• 6:39:53
  You know them very well. You cause any idea whatever to penetrate into the
• 6:39:57
  mind of the subject through any means you please, through sensations, signs,
• 6:40:00
  and especially speech. Note this fact, there must be an idea. The
• 6:40:06
  subject must have the thought the conception of something precise. This idea does not
• 6:40:11
  seem to conduct itself in him, as it usually does in normal minds.
• 6:40:15
  When somebody puts an idea into our head, this idea brings in its train.
• 6:40:19
  It is true, other thoughts which revolve around it, some more or
• 6:40:22
  less vague images, some gestures, or some incipient movement. If you speak
• 6:40:27
  to me of the faults of the Niagara, I cannot help seeing dimly in
• 6:40:32
  a kind of p number a few fragments of that fine scenery. If I
• 6:40:36
  am surrounded with calm, I shall be able to dwell a little on that
• 6:40:38
  remembrance, and to call to mind a few particulars of my journey. The
• 6:40:42
  images I see are always dim, and the words I speak I speak to
• 6:40:45
  myself. I always know very well that I am not actually before the falls,
• 6:40:49
  and in reality I do not see them. If you speak to me
• 6:40:53
  of dancing, of balls, of rhythmical music, the idea awakens in me
• 6:40:57
  even to this day, an incline to move my legs feelings of rhythms.
• 6:41:03
  I may even go so far as to move my feet in cadence. But
• 6:41:06
  don't be afraid nobody in a drawing room will be aware of it, for
• 6:41:08
  the movement is very slight and is perceptible only to myself. It is thus
• 6:41:12
  that things happen when ideas are called up in our minds. It is quite
• 6:41:18
  different with really suggestible individuals. The idea seems to be transformed and should become
• 6:41:22
  at once another psychological phenomenon, an act or a perception. In fact,
• 6:41:26
  they almost immediately move their limbs in a manner quite visible outwardly. They really
• 6:41:32
  get up and dance. They walk, run, jump, struggle, cry.
• 6:41:36
  Instead of confining themselves to thinking the object, they seem to see it
• 6:41:40
  in reality or to hear it. They conduct themselves before our eyes like individuals
• 6:41:45
  who have perceptions and not ideas. They apply to imaginary words. Their facial
• 6:41:49
  expression is that of a person who hears. If we question them, they
• 6:41:53
  tell us without hesitation that they see Niagara before them, and the spectacle has
• 6:41:57
  so much intensity that it seems completely to efface the normal vision. Of the
• 6:42:00
  things that surround them. Other ideas become connected with the first, still with
• 6:42:07
  the same intensity and the same transformation into actions and perceptions. They seem to
• 6:42:11
  make a complete journey. They go along the edge of the falls, over
• 6:42:15
  the bridge, down the ravines, they receive the water in their face,
• 6:42:18
  et cetera. All these ideas grouped together form a very close association in their
• 6:42:22
  mind, and it will henceforth suffice to call up one to give birth to
• 6:42:26
  all the others. It is no longer necessary to say the word niagara.
• 6:42:30
  A mere vague noise brings about the whole dream. These associations are very important
• 6:42:34
  in suggestions, for they determine particular reactions of the subjects to such or such
• 6:42:38
  excitation. Thus, such a subject may have acquired the habit of convulsions or
• 6:42:44
  contractors of the limbs. When he sees an electric apparatus or is touched with
• 6:42:48
  a magnet, these patients have shakes in their muscles as soon as you put
• 6:42:52
  the electrodes of the apparatus on their arms. Even if the current does not
• 6:42:55
  pass through, others will experience burns or refrigerations, or will feel relieved when
• 6:43:00
  they see gold, silver, or iron plates applied to their limbs. It
• 6:43:03
  is that which has caused so many gross medical mistakes, alas what is left
• 6:43:10
  of the big books on the action of metallic plates, of resin plates,
• 6:43:14
  on the action of a breath indicated by Monsieur du Montpallier, on the action
• 6:43:18
  of passes of the hands turned point wise towards the subject. Another important characteristic
• 6:43:23
  of suggestion will manifest itself in the visceral domain. No doubt, certain ideas
• 6:43:29
  awaken also in us certain visceral sensations a slight nausea or a cycle sensations,
• 6:43:34
  but all that is very slight, just like the feeling of dancing. An
• 6:43:38
  essential tray of those patients, it was said, is that they make their
• 6:43:41
  thoughts penetrate into their viscera. The idea of vomiting brings about real vomiting.
• 6:43:47
  An imaginary purge with pure water brings about a real diarrhea. The menses are
• 6:43:51
  stopped or restored with pills of Meka parnis. This is again a very essential
• 6:43:56
  phenomenon, for it seems to come close to the real accidents which are to
• 6:43:59
  be of with patients in many circumstances. We may generalize the essential phenomena that
• 6:44:04
  take place in these different cases. The idea is always, as we have
• 6:44:10
  already remarked with regard to somnambulisms, a system of images, each of which
• 6:44:14
  has different muscular or visceral properties see the figure one in the first lecture with
• 6:44:19
  the normal man. These systems, which are always very numerous, stop one
• 6:44:23
  another and do not develop in suggestion. Each idea seems to develop to the
• 6:44:27
  maximum to give all it contains in the way of images, muscular movements and
• 6:44:32
  visceral phenomena. This complete development of all the elements contained in an idea is
• 6:44:37
  an essential characteristic of the phenomenon. But you may say this development can also
• 6:44:42
  be sometimes effected with us. A painter, a novelist develops his ideas,
• 6:44:48
  seeks for all their elements, renders them as living as possible. It is
• 6:44:52
  what all of us do when we try to perform some work. For then
• 6:44:55
  the idea brings about material movements of our limbs. The thought of looking for
• 6:44:59
  a book causes me really to look for it. This is quite true.
• 6:45:03
  But in all these cases the development only takes place through a particular mechanism.
• 6:45:07
  An accessory force is added to the idea by the will, namely attention personality.
• 6:45:14
  These words represent an ensembler of very powerful tendencies which are formed in us
• 6:45:18
  by all our past, And these tendencies are added to the idea too weak
• 6:45:22
  by itself to make it grow. You know the trouble, the voluntary and
• 6:45:26
  conscious effort that the development of his idea costs an artist in suggestion, you
• 6:45:32
  meet with nothing of the kind. There is no effort on the part of
• 6:45:34
  the subject, no addition of strength from his anterior tendencies, no work of
• 6:45:38
  his personality. On the contrary, he does not seem to realize the development
• 6:45:42
  of what takes place within him. As has often been recognized, he forgets
• 6:45:47
  his suggestions as soon as they are ended. He seems to be very little
• 6:45:51
  conscious of them while they are being executed. Very often he executes them without
• 6:45:56
  knowing it, quite subconsciously. In this connection, it is very important to
• 6:46:00
  remark that not all the phenomena executed by subjects of this kind are suggestions.
• 6:46:04
  They may, like normal individuals, act out of compliance with our desire,
• 6:46:08
  add to the idea, the force given them by the wish to obey,
• 6:46:11
  to ingratiate themselves with us by a regard to their interest or the fear of
• 6:46:15
  punishment. One should not say that a hospital patient whom one frightens and bewilders,
• 6:46:22
  and who hastens to execute any foolish act in order not to displease the
• 6:46:25
  physician is an individual beset with a suggestion. In order that there may be
• 6:46:30
  suggestion, it is precisely necessary that all these normal causes of development should be
• 6:46:34
  wanting, and that the idea should seem to develop to the extreme without any
• 6:46:38
  participation of the will or of the personal consciousness of the subject. Bear this
• 6:46:44
  definition in mind. Many authors who launched too precipitately into these psychological studies considered
• 6:46:51
  themselves satisfied when they had merely remarked the moral character of the phenomenon. They
• 6:46:56
  said that suggestion is an idea that penetrates into the mind of the subject and
• 6:47:00
  stops there. This is childish, as I have so often tried to show,
• 6:47:04
  any idea entering into the mind is not a suggestion. We recognize the
• 6:47:10
  fact ourselves. If we show astonishment at the phenomenon of suggestion, it is
• 6:47:15
  because we think it offers something abnormal and exceptional. The subjects themselves notice it.
• 6:47:21
  Their minds are not filled all day long with suggestions. They know very
• 6:47:25
  well how to distinguish what is suggestion in them from what is not. A
• 6:47:27
  patient has sometimes answered me in a vulgar but quite characteristic way, Sir,
• 6:47:33
  I do not know the reason, but the thing did not take. What
• 6:47:36
  do you mean you did not understand what I said? Yes, I understood
• 6:47:41
  quite well. Then you do not wish to do that you do not accept?
• 6:47:45
  I accept all you please. I am quite ready to obey you,
• 6:47:48
  and I will do it if you choose. Only I tell you beforehand that
• 6:47:52
  the thing did not take. With the preceding definition of suggestion, these answers
• 6:47:56
  of the patient would have no meaning. The idea, having penetrated into the
• 6:48:00
  mind and having been accepted, should be accounted a suggestion. Yet the patient
• 6:48:04
  was right. She has experienced suggestions, she knows what they are, and
• 6:48:08
  although she accepted the new idea willingly and with absolute confidence and obedience, yet
• 6:48:14
  she felt that things were not proceeding in the same way, and that it
• 6:48:18
  was not a suggestion. One should not fall into this exaggeration and take away
• 6:48:22
  from the word suggestion all precision of meaning as the ordinary psychological terms memory,
• 6:48:27
  association of ideas belief resolution designate distinct facts. So the word suggestion must also
• 6:48:34
  designate a very special fact, the complete development of an idea, which takes
• 6:48:38
  place without the will and the personal perception of the subject. Three. Now
• 6:48:45
  that you have formed a precise idea of suggestion and are not likely to confound
• 6:48:49
  it with any other psychological phenomenon, you will readily accept an inevitable consequence of
• 6:48:53
  this first remark, namely, that suggestion is no longer a commonplace and constant
• 6:48:59
  phenomenon. It presents itself only in certain cases and under certain conditions, which
• 6:49:03
  it is necessary to determine. Suggestion appears to us to present two great characteristics.
• 6:49:10
  First, it is a complete development. Second, it is a development
• 6:49:14
  independent of certain ideas. Both characteristics require certain conditions. It is necessary,
• 6:49:19
  in the first place, in order that an idea shall develop itself, that
• 6:49:22
  the innumerable images of which it is composed be awakened and arrange themselves in a
• 6:49:27
  series in a proper manner. This is not an unimportant condition, though it
• 6:49:33
  is not always met. Certain minds no longer retain images of their sensations,
• 6:49:37
  and above all, they no longer keep up the systematization of these images.
• 6:49:41
  They are incapable of calling them up and arranging them in a series. They
• 6:49:45
  are therefore not suggestible subjects. The type of such individuals will from the first
• 6:49:51
  come under the name dementia. It is quite plain that with an insane person
• 6:49:55
  the images are no longer systematized, and that consequently the ideas are no longer
• 6:50:00
  are either understood or developed. Much hope has been cherished for the therapeutics of
• 6:50:03
  insanity through suggestion. We are afraid this operation can be applied only to very
• 6:50:08
  special cases. Suggestion requires, in order to be developed, a mind relatively
• 6:50:14
  sane. The first condition of suggestion is a certain strength of mind, and
• 6:50:18
  some patients are not suggestible because they are, so to say, below suggestion,
• 6:50:22
  like some infected patients who are incapable of having fever. But ought we
• 6:50:27
  immediately to pass to the other extreme of opinion and maintain that suggestion is compatible
• 6:50:32
  with a mind normally healthy, and that it is continually met in the sanest
• 6:50:36
  persons. This is an opinion which appears to us equally unsound. Despite the
• 6:50:41
  affirmations of certain authors, we must confess that we have not succeeded in giving
• 6:50:45
  suggestions to people of normal, good health. It is useless to discuss the
• 6:50:49
  sense of the word health, and to pretend that ideal health does not exist.
• 6:50:55
  It were repeating the sophism of the Greeks regarding the bald headed man.
• 6:50:59
  We speak of men generally considered normal, without pathological or hereditary antecedents or personal
• 6:51:04
  blemishes in a neuropathic sense, without actual defects medically appreciable. If we take
• 6:51:10
  a person of that kind, a kind that is numerous, we must confess.
• 6:51:14
  And if we state to him that there is a little dog at the
• 6:51:15
  corner of the table where he is sitting, he will laugh in our face
• 6:51:18
  and experience no hallucination whatsoever. This fact appears to us incontestable. And to
• 6:51:25
  speak of suggestion with sane persons, one is obliged to consider quite different facts
• 6:51:30
  effects of education, habits, recollections, beliefs, et cetera. They are
• 6:51:34
  psychological phenomena which are apparently akin to suggestion, but the mechanism of which is
• 6:51:40
  very different. These facts have only gradually become automatic thanks to the patient's consent.
• 6:51:45
  These acts, even today are accepted by the individual who is aware of
• 6:51:49
  them and assimilates them with his personality. The result is that such actions are
• 6:51:53
  not aggressive, they are limited in their development by other thoughts with which they
• 6:51:59
  are brought into relation. Docile obedient persons disposed to think of others as having
• 6:52:03
  more intelligence and experience than themselves, and on account of this apt to believe
• 6:52:07
  what they are taught, are not suggestible persons. This complete automatic development of
• 6:52:12
  the personality in the fashion of a parasite is not met with in the normal
• 6:52:17
  mind. On the other hand, every time that we have established in a
• 6:52:21
  person unmistakable suggestibility, we have had no difficulty in demonstrating numerous and evident traces
• 6:52:26
  of mental disease more or less grave, such as an excessive absence of mind
• 6:52:30
  or even properly called anesthesias, attacks, paralysies, fixed ideas. We find
• 6:52:37
  in the past of such persons, all sorts of neuropathic accidents, and the
• 6:52:40
  simple fact that suggestibility is still persistent nowadays should impose great reserve on the physician
• 6:52:45
  in regard to prognosticating their future. Suggestibility with them should in fact not be
• 6:52:51
  considered a simple exaggeration of docility and normal belief. Such persons are often neither
• 6:52:56
  docile nor believing they have an unsteady undisciplined disposition. They themselves recognize that they
• 6:53:03
  do not succeed in believing. I have no more confidence in anybody. I
• 6:53:07
  have no confidence at all in you, they often say to me. And
• 6:53:11
  yet you can make them see through hallucinations all you wish. They are incapable
• 6:53:15
  of voluntary obedience, which demands strength of mind, and they undergo, in
• 6:53:18
  a sickly sort of way, all automatic impulsion. Thus we have admitted that
• 6:53:23
  suggestion cannot develop in sickly minds that it demands in order to attain to its
• 6:53:27
  full power, minds relatively sane. But we have just now demonstrated that it
• 6:53:33
  depends on a lack of synthesis, on a weakening of consciousness. Are not
• 6:53:37
  these two affirmations contradictory. A symptom may disappear in certain maladies and still remain
• 6:53:41
  a pathological symptom, the same with suggestion. It does not belong to all
• 6:53:47
  mental disorders, but it is the sign of a particular mental disease. It
• 6:53:52
  is necessary for its occurrence that the automatic association of the psychological elements be preserved,
• 6:53:56
  and that the actual synthesis of the phenomena be all altered or reduced.
• 6:54:00
  It requires as its essential condition and malady of the personality. It must be
• 6:54:07
  confessed that there is a particular disease which unites in a wonderful manner, the
• 6:54:10
  two essential conditions of suggestion, which are the preservation of automatism and the diminution
• 6:54:15
  of personal synthesis. This is the hysterical state. The study of all the
• 6:54:19
  accidents has constantly shown us these two characteristics. In hysteria. A tendency to
• 6:54:26
  suggestion and subconscious acts is the sign of mental disease, but it is above
• 6:54:30
  all the sign of hysteria. Let us take another point of view and consider
• 6:54:34
  all the patients be clinically regarded as hysterical. I say that you will almost
• 6:54:40
  always find again in them, without difficulty, all the phenomena of suggestion.
• 6:54:45
  First of all, you will find them experimentally. If you set aside the
• 6:54:48
  old quarrels and examine calmly all the subjects who have been presented as fine examples
• 6:54:52
  of suggestion, you will first see that most of them are somnambulists. Do
• 6:54:57
  not forget, in fact, that it it is in the hypnotic state that
• 6:55:00
  suggestion was first described. Now the hypnotic state is nothing but the reproduction of
• 6:55:06
  a hysterical somnambulism, and I do not hesitate to add in a hysterical subject.
• 6:55:11
  Next, it has been shown that suggestion exists in the waking state.
• 6:55:15
  With these same subjects susceptible of presenting hypnotism, there is no need to demonstrate
• 6:55:21
  this diagnosis. Then, suggestibility has been shown from time to time in individuals
• 6:55:26
  who were not and had not yet been hypnotized. Mistrust these observations. You
• 6:55:32
  must first ascertain whether the suggestions indicated were real suggestions, whether the observer,
• 6:55:37
  with his preconceived ideas, was not content with some naive obedience or alas with
• 6:55:41
  some comedy. But if the fact is true, and it is sometimes so,
• 6:55:45
  examine the individual clinically, and I assure you that you will have no
• 6:55:48
  difficulty in recognizing that he is hysterical. For my part, I have never
• 6:55:53
  seen a fine suggestible subject who was not clearly hysterical. And inversely, I
• 6:55:59
  have been able to make all the experiments of suggestion on the subjects who,
• 6:56:03
  on the other hand, had decided morbid accidents. Inversely, this relation between
• 6:56:08
  suggestibility and the hysterical neurosis can be verified in the clearest manner by studying the
• 6:56:14
  disappearance of suggestion. In fact, as suggestion does not exist with everybody,
• 6:56:19
  so you must not fancy that it constantly exists during all the life of the
• 6:56:22
  hysterical. There are many circumstances in which the suggestibility of hysteria tends to disappear.
• 6:56:30
  What is most interesting in this connection is that it disappears completely when the
• 6:56:33
  disease is cured a great number of those persons, after having kept for some
• 6:56:37
  time both the accidents and the mental dispositions that characterize this neurosis, recover completely
• 6:56:44
  well. At that moment, suggestions no longer take and these subjects bear themselves
• 6:56:48
  in regard to suggestions like normal individuals. This is a very important fact which
• 6:56:53
  I have already pointed out in connection with hypnotism. I have described it these
• 6:56:57
  twenty years, and the theory is, who will absolutely find hypnotism and suggestion
• 6:57:02
  in everybody? Have never applied a word to this argument. Besides, there
• 6:57:07
  are other circumstances in which the hysterical recovers, at least partially, for it
• 6:57:12
  is a very changeable malady in certain periods of rest of health, in certain
• 6:57:18
  somnambulisms, or in that which has been wrongly called the second state of felida.
• 6:57:22
  We have seen that the hysterical states disappear, you will likewise recognize that
• 6:57:27
  the suggestibility disappears. This symptom only reappears in a state of depression. Together
• 6:57:33
  with all the other accidents I described long ago, those women who are suggestible
• 6:57:37
  only three days a month during their menstrual period. Experimental suggestion has never existed
• 6:57:42
  with any persons, but with hystericals. By the side of this experiment you
• 6:57:48
  may place real, non experimental suggestions, which occur accidentally and are often the
• 6:57:52
  cause of accidents. I mean those accidents with which the patients are inspired by
• 6:57:56
  the events of their lives, and which, by developing themselves to an exaggerated
• 6:58:00
  degree, bring about at tax paralytic accidents or singular visceral diseases. Mala Branche
• 6:58:07
  related in the seventeenth century the story of a woman who, because she had
• 6:58:11
  seen a rider dragged by the foot, had a disease and a paralysis in
• 6:58:15
  her foot. We continually see facts of this kind nowadays. One patient had
• 6:58:19
  an amorrosis in her left eye because she has seen a child with scabs on
• 6:58:23
  its left eye, and another vomits incessantly because he has nursed a cancer of
• 6:58:27
  the stomach. In all these cases, if you examine the evolution of the
• 6:58:32
  disease, its symptoms, the accidents that preceded it, I do not hesitate
• 6:58:36
  to assure you that you will always again find the same neurosis. In a
• 6:58:41
  word, my opinion on this point has become more and more definite. Suggestion
• 6:58:45
  is a precise and relatively rare phenomenon. It presents itself experimentally or accidentally only
• 6:58:51
  with hystericals, and inversely, all hystericals, when we study them from this
• 6:58:56
  standpoint, present this same phenomenon in a higher or lower degree if we add
• 6:59:00
  that, as we shall see later, this psychological fact plays a great role
• 6:59:04
  in the formation of their disease. We may say that the most important mental
• 6:59:08
  stigma of hysteria is suggestibility. We have still to ask ourselves whether there are
• 6:59:15
  not other mental stigmata to be added to this one. End of Section thirteen,
• 6:59:21
  Lecture fourteen. The hysterical stigmata, the retraction of the field of consciousness,
• 6:59:26
  the common stigmata, other proper hysterical stigmata, absent mindedness, the contraction
• 6:59:33
  of voluntary movements, subconsciousness, transfers and equivalences, alternation, the elementary phenomena
• 6:59:41
  of consciousness, personal perception, conscious synthesis, the field of consciousness its variations,
• 6:59:48
  the retraction of the field of consciousness, the common stigmata, the feelings
• 6:59:52
  of incompleteness, the need of excitation, the need of attracting attention, lapses
• 6:59:56
  of the mental functions, the weakness of attention, emotional disturbances, troubles of
• 7:00:03
  the will, the incapacity of beginning or of stopping, the lowering of the
• 7:00:07
  mental level. The role played by suggestion in hysteria is beginning to be known,
• 7:00:11
  and I shall no longer raise too many protestations by presenting to you suggestion
• 7:00:15
  as a hysterical stigma. But I think it is well to go farther.
• 7:00:21
  We should not explain the whole of this so complex disease by this single phenomenon.
• 7:00:26
  For the present, I confine myself to remarking that in the mental dispositions
• 7:00:30
  of these patients there are to be found other facts of at least equal importance.
• 7:00:33
  These other fundamental phenomena are also stigmata. To my mind. Only I
• 7:00:38
  propose to you to divide them into two classes. Among these stigmata. Some
• 7:00:44
  deserve to be called proper. They have the same properties as suggestion itself.
• 7:00:48
  They are phenomena that exist in hysteria, but scarcely exist in any other disease.
• 7:00:53
  The others might be called common stigmata for the following reason. No doubt,
• 7:00:57
  they present themselves among him hystericals, and often in a high degree.
• 7:01:02
  But they do not exist solely among these patients, and they are to be
• 7:01:06
  found in other mental affections, in particular in the psychosthenic neuroses, which are
• 7:01:10
  closely akin to hysteria, though different from it. Let us dwell on the
• 7:01:14
  other stigmata proper, which are added to suggestion, and devote a few words
• 7:01:18
  to the common stigmata, which allow us to connect the neurosis we consider with
• 7:01:22
  the other disturbances of the mind. One suggestion let us not forget, is
• 7:01:29
  the development of an idea. It implies a positive phenomenon, the presence of
• 7:01:33
  an idea in the mind of the subject. We cannot connect with suggestion things
• 7:01:37
  that take place without the subjects being at all aware of them, without his
• 7:01:41
  realizing them, either consciously or subconsciously. Now, I do not believe that
• 7:01:45
  everything in hysteria is in relation with the thought of the subject. There are
• 7:01:49
  in these patients attitudes dispositions that not only are not intentional, but that are
• 7:01:55
  in relation with no thought of the patients. I should like to put in
• 7:01:59
  the first rank of these phenomena a very singular disposition of mind for which we
• 7:02:03
  have not even a very clear expression, namely, a disposition to indifference,
• 7:02:07
  to abstraction, to quite exaggerated absent mindedness. The fact is this, while
• 7:02:14
  paying attention to something, we turn from some other thing and cease to interest
• 7:02:17
  ourselves in other phenomena, which, however, reach our minds. While I
• 7:02:22
  am paying attention to what I am reading, I abstract myself from the noises
• 7:02:25
  in the street, though I still perceive them. This abstraction exists in hysteria
• 7:02:29
  in an astonishing degree. It was noticed early that it presents itself in regard
• 7:02:33
  to the sensations and to ideas. These patients appear to see but one thing
• 7:02:37
  at a time, and you become aware that they have no notion of another
• 7:02:41
  object, though it be very near the first. When they speak to one
• 7:02:45
  person, they forget that there are others in the room. They forget them
• 7:02:48
  so entirely that they would tell all their secrets before them with indifference. When
• 7:02:52
  they express some idea, you notice that their conviction is childish. It seems
• 7:02:56
  very strong because it rests on an astonishing ignorants. Objections, impossibilities, contradictions
• 7:03:03
  do not reach their minds in the least. The same limitation was observed in
• 7:03:07
  their movements. From the first. They can perform but one action at a
• 7:03:11
  time. The first indication you perceive of a mental disturbance with many girls is
• 7:03:15
  their incapacity to do, in spite of their good will, more than one
• 7:03:18
  errand at a time. This fact may even be made in some sort experimental.
• 7:03:22
  Here is an experiment that I have described under many forms, and that
• 7:03:26
  Monsieur pict of Prague has developed. You ask one of these patients to make
• 7:03:32
  a certain movement continually, for instance, to make on the table with her
• 7:03:34
  right hand the movement of playing on the piano. It is agreed that she
• 7:03:40
  must not discontinue this little movement, whatever may happen. At the same time,
• 7:03:44
  you ask her to perform some other simple acts, to open her mouth,
• 7:03:47
  to shut her mouth, to recite numbers. You always remark that the
• 7:03:51
  first movement the piano playing stops as soon as the second begins, and that
• 7:03:55
  it only recommences at the end of this second movement. Yet the subject had
• 7:03:59
  made mad up her mind to continue this movement. She had this idea in
• 7:04:03
  her head, but it became impossible for her as soon as she tried to
• 7:04:06
  do something else. It is this besides that gives a special appearance to all
• 7:04:11
  their accidents. By the side of the positive phenomenon consisting in the development of
• 7:04:15
  the somnambulic idea, in convulsions, in persistent emotions, there was a kind
• 7:04:21
  of lacuna, a complete oblivion of the present situation, an indifference to ridicule,
• 7:04:26
  an insensibility to fatigue, all of which we should not have had in
• 7:04:29
  their place. One would think that these subjects, when one's ill, forget
• 7:04:33
  all that is outside their present accident. They do not remember having been in
• 7:04:37
  another state. They do not conceive that one can be in another state.
• 7:04:41
  Hence that resignation, that absence of effort, which surprised us. The exaggeration
• 7:04:48
  of this disposition will bring about the phenomenon of subconsciousness. A great many things
• 7:04:52
  will exist outside the personal consciousness. You will be able to make the patients
• 7:04:56
  walk and act unknown to themselves. If the ideas you express do not attract
• 7:05:00
  their attention, and if they remain in that domain of absent mindedness, it
• 7:05:04
  will result in mediumship. As we saw before that the development of the ideas
• 7:05:10
  results in great somnambulisms. Can we say that this disposition to exaggerated absent mindedness
• 7:05:15
  is a consequence of the preceding symptom of suggestion. In fact, it is
• 7:05:19
  not so, for absent mindedness is not suggested to these patients and often is
• 7:05:25
  not even noticed. They have not the idea of this phenomenon, the importance
• 7:05:29
  of which they do not suspect. This singular absent mindedness is mostly noticed to
• 7:05:33
  by those around them, or by themselves only very late, several years after
• 7:05:37
  it has begun to develop itself. On the other hand, it is difficult
• 7:05:41
  to understand how suggestion, which is precisely the development of an idea, could
• 7:05:47
  explain this absent mindedness, which is indifference to an idea, a tendency to
• 7:05:51
  suppression. Lastly, suggestion itself appears to me to depend on that disposition,
• 7:05:56
  and to be much oftener its effect than its cause. It is precisely because
• 7:06:00
  the subjects have forgotten everything because they are no longer restrained by any sensation,
• 7:06:04
  by any thought relative to the reality that surrounds them, that they allow the
• 7:06:08
  ideas suggested to them to develop freely. Suggestion and absent mindedness do not produce
• 7:06:15
  each other. They are too parallel stigmata, one of which cannot exist without
• 7:06:18
  the other. This special absent mindedness is a stigma peculiary hysteria. First of
• 7:06:25
  all, you do not find it in the normal individual. Normal consciousness,
• 7:06:29
  as philosophers say, is always a fully illuminated point surrounded by a strong p
• 7:06:33
  number. With the hysterical the per number is wanting. This fact is brought
• 7:06:37
  into evidence by their quite peculiar visualed field. You do not find in any
• 7:06:41
  normal individual that odd vision which sees very clearly in one point and sees nothing
• 7:06:47
  around this point. Nor is this absent mindedness to be met with in the
• 7:06:51
  same fashion in the other maladies of the mind. Individuals who are tired are
• 7:06:55
  inattentive, but their minds are vaguely on the stretch, no doubt, they
• 7:06:59
  search you to nothing, but they have a vague notion of everything. Their
• 7:07:03
  sensibility is attenuated. I grant, but it is distributed over the whole of
• 7:07:07
  their body. Their vision is diminished, but their visual field remains broad.
• 7:07:11
  In a word, the symptom I wish to describe to you is not in
• 7:07:14
  attention. It is a suppression of all that is not looked at directly.
• 7:07:18
  And I do not believe that it is to be found in this form in
• 7:07:21
  the other diseases of the mind. So I make it a stigma proper to
• 7:07:25
  hysteria as suggestion itself. A third phenomenon, which besides depends on the preceding
• 7:07:30
  ones, will make you understand these strange stigmat are still better. It is
• 7:07:36
  the phenomenon of transfers and equivalences. I was seeking one day to cure a
• 7:07:41
  small localized accident, to restore the motion of the right wrist with a patient
• 7:07:45
  whose fist was contracted. You know that to succeed one must strongly direct the
• 7:07:49
  attention of the subject to the diseased organ which she has forgotten, determine sensations
• 7:07:55
  in it, move it passively in every way. Then, when the motion
• 7:07:57
  has been a little restored in used the subject voluntarily to move this wrist.
• 7:08:03
  This work is long and troublesome, and has to be begun over and over
• 7:08:07
  again with hystericals. When it has proceeded for some time, the result seemed
• 7:08:11
  marvelous. The right hand had opened and moved freely in every way. The
• 7:08:15
  patient left the laboratory very happy and proud. She re entered it a few
• 7:08:19
  moments later in despair. It was not worth while making such efforts, she
• 7:08:25
  said, presenting her left fist, which was contracted exactly in the same way
• 7:08:27
  as her right fist had been a few minutes before. I have cited this
• 7:08:32
  adventure because it struck me by the circumstances in which it occurred, namely,
• 7:08:37
  in a quite naive patient, having no notion of the phenomenon, and without
• 7:08:41
  the operator or herself having had the least idea of it beforehand. You know
• 7:08:45
  that the result is not always like that. During a certain period from eighteen
• 7:08:49
  seventy five to eighteen ninety, this phenomenon, which is called transfer, was
• 7:08:55
  very much sought after and often provoked artificially. It was said to be brought
• 7:08:59
  about by the macare nical action of certain substances. Thus, the magnet had
• 7:09:03
  pre eminently the power of provoking transfers to cure a paralysis of the right side
• 7:09:07
  a big magnet was placed in the bed of the patient near her right side.
• 7:09:11
  The paralysis was then found to disappear on that side and to become localized
• 7:09:15
  on the left side. When the magnet was withdrawn, the paralysis reappeared on
• 7:09:19
  the right side, and after several oscillations of this kind, it vanished.
• 7:09:23
  Other substances metals in particular, Sometimes the electric current had similar effects and transferred
• 7:09:30
  symmetrically from one side to the other. The disturbances of sensibility as well as
• 7:09:33
  those of motion. You remember that this phenomenon was very much studied by Burke
• 7:09:38
  and du Montparlliers, who ascribed to it very odd laws. Some physicians said
• 7:09:44
  they had found the means to make the oscillations either slow or rapid, to
• 7:09:47
  fix the disturbance on one side or the other, et cetera. Others went
• 7:09:51
  even further. They invented the change of the color sensations, which were transformed
• 7:09:56
  into their complementary colors. The patients, after having seen red, saw green,
• 7:10:00
  after having seen yellow, they saw violet. They called this polarization,
• 7:10:04
  and by means of the magnet tried to polarize also the feelings. Lastly,
• 7:10:10
  for absurdity, has no limits. They tried to transfer a phenomenon from one
• 7:10:14
  subject to the other. They placed two subjects back to back, and thanks
• 7:10:18
  to the magnet, the paralysis of the first passed into the second, and
• 7:10:22
  after a few oscillations disappeared, it became a convenient therapeutic process. No doubt,
• 7:10:29
  there are in all this many childish errors. Many of these observations a
• 7:10:33
  phenomena of suggestion and training. They depend on the direction that is given to
• 7:10:37
  the attention of the subject. This could not but be gradually recognized, so
• 7:10:41
  that in science, as in politics, we saw a violent reaction. The
• 7:10:45
  very notion of the phenomenon of transfer was suppressed, and the fact that there
• 7:10:48
  is some little truth in it was overlooked. In my opinion, this passage
• 7:10:52
  of an accident from one side to the other is not necessarily the result of
• 7:10:56
  a suggestion. It sometimes takes place unknown to the subject and to the operator,
• 7:11:00
  and that very naturally. It is a very particular application of a disposition
• 7:11:06
  which is very general with the hysterical, and of which a thousand other applications
• 7:11:10
  are to be observed, namely the disposition to equivalences. Hysteria, in fact,
• 7:11:15
  is a very singular malady, the cure of which one never dares assert.
• 7:11:19
  It is often easy, through some psychological process or other, to cause
• 7:11:23
  such or such a determinate accident to disappear. Besides, these accidents often disappear
• 7:11:30
  of themselves in consequence of an emotion of some shake, or even without reason.
• 7:11:34
  But when an accident has disappeared, especially when it has disappeared too quickly,
• 7:11:38
  we should not at once cry out a victory. First of all,
• 7:11:41
  the same accident is very likely to soon reappear. Then the following strange thing
• 7:11:47
  very frequently occurs. Another apparently quite different accident takes the place of the first.
• 7:11:52
  A girl of twelve presented incoercible vomitings which had brought her to a very
• 7:11:56
  serious state of inanition, Thanks to certainly excitations of the sensibility during its somnambulic
• 7:12:02
  state, I succeeded in making her eat with more sensibility, in regularizing her
• 7:12:07
  digluticians, and she no longer vomits. This seems all right, But from
• 7:12:11
  that moment this girl, till then perfectly intelligent, enters into a state of
• 7:12:15
  mental confusion and delirium, and it becomes impossible to stop this delirium without the
• 7:12:19
  vomitings. Beginning again, let us remark by the way that this singular alternation
• 7:12:25
  between disturbances of the stomach and deliriums is one of those that are oftenest observed.
• 7:12:30
  I have noted down five fine examples of them, but other identical facts
• 7:12:34
  are to be observed. One patient has contractors in her limbs, and when
• 7:12:38
  the contractors disappear, mental disturbances. Another has hysterical coughing, and alternating with
• 7:12:45
  it crises of sleep. A man had a foot contracted in the position called
• 7:12:48
  varrus. He was cured through somewhat mysterious processes which frightened him. He could
• 7:12:55
  now walk freely, but he lost his voice for three months. When his
• 7:12:59
  voice returned, he had gastric accidents and abdominal contractures. In another case,
• 7:13:03
  the contractors of the trunk were healed and replaced by phenomena of amorrosis, and
• 7:13:07
  so on indefinitely. The accidents seem to be equivalent and to have the property
• 7:13:12
  of bearing on one side or the other, provided they exist somewhere, You
• 7:13:17
  would think that the subject can choose, but cannot do without a disturbance localized
• 7:13:21
  in some place or another. If you understand this law of equivalence as well,
• 7:13:26
  you will see that the transfer from the right side to the left side
• 7:13:27
  is but a particular case of it. It is even a particularly simple form
• 7:13:32
  of equivalents, for the sensations of the symmetrical parts are very similar and can
• 7:13:37
  very easily be replaced by one another. No doubt, in many diseases of
• 7:13:41
  the mind we observe instability. But this quite special form of instability, which
• 7:13:45
  replaces one definite accident by another apparently quite different, and that suddenly and clearly
• 7:13:51
  is again very characteristic. I think it results from a general disposition of the
• 7:13:56
  hysterical mind, which urges it to move in its entirety to one side,
• 7:14:00
  while neglecting the rest of the body and mind, then to move in its
• 7:14:03
  ensemble in another direction while forgetting the first. This is connected with the preceding
• 7:14:07
  phenomenon of suggestion, and constitutes the last of the stigmat a peculiary hysteria that
• 7:14:12
  I wish to point out to you. Two. Can we summarize these three
• 7:14:18
  stigmata suggestion, absent mindedness, and alternation into a single general idea that will
• 7:14:23
  enable us to conceive the essential character which manifests itself in these mental troubles.
• 7:14:29
  I proposed formerly to characterize this mental state by an expression that is perhaps singular,
• 7:14:34
  but that may be serviceable. You will find it in my work on
• 7:14:38
  the psychological automatics in eighteen eighty nine, and in my book on the Mental
• 7:14:42
  State of Hystericals eighteen ninety four, which was very well translated into English by
• 7:14:47
  Missus c Rowland Causon in nineteen o one. I proposed to summarize this somewhat
• 7:14:52
  peculiar mental state by the words retraction of the field of consciousness. Let us
• 7:14:57
  try to understand the meaning of this general expression. The word consciousness, which
• 7:15:03
  we use continually in studies on the mental state of our patients, is an
• 7:15:07
  extremely vague word which means many different things. When we use it, in
• 7:15:11
  particular to designate the knowledge the subject has of himself, of his sensations and
• 7:15:15
  acts, it means a rather complicated psychological operation, and not an elementary and
• 7:15:21
  irreducible operation, as is generally believed. If I say, for instance,
• 7:15:25
  I feel a pain, I feel that I move my arm, they take
• 7:15:27
  place in my mind rather complicated phenomena, which we can analyze in the following
• 7:15:32
  manner. In the first place, there occurs, somewhere in my brain on
• 7:15:36
  the occasion of an outer excitation, a small fact, both physiological and psychological,
• 7:15:41
  which corresponds to a phenomenon of pain, to an elementary sensation of motion.
• 7:15:45
  The great physiologist Heutzen said that the brain may be compared to a spacious
• 7:15:49
  hall filled with innumerable small electric lamps. From time to time, certain little
• 7:15:55
  lamps kindle here and there. This is what is designated by the isolated word
• 7:16:00
  sensation of pain, sensation of vision, sensation of motion. In the scheme
• 7:16:04
  I have drawn Fig. Twenty one, Each separate little cross of the upper
• 7:16:07
  line designates one of those little phenomena V V prime, V double prime when
• 7:16:14
  it is a question of the vision, T T prime, T double prime,
• 7:16:18
  when it is a question of the sensations of touch, and so on.
• 7:16:21
  But the complete consciousness, which is expressed by the words I see,
• 7:16:25
  I feel a movement, is not completely represented by this little elementary phenomenon.
• 7:16:30
  It contains a new term, the word I, which designates something very complicated.
• 7:16:34
  The question here is of the idea of personality of my whole person.
• 7:16:38
  It is the union of present sensations different from the little sensation considered from all
• 7:16:44
  past impressions, from the imagination of future phenomena. It is the notion of
• 7:16:48
  my body, of my capacities, of my name, of my social position,
• 7:16:52
  of the part I play in the world. It is an ensemble of
• 7:16:56
  moral, political, religious thoughts. It is a world of ideas, the
• 7:16:59
  most most considerable, perhaps that we can ever know, for we are far
• 7:17:03
  from having made the tour of the domain of personality. There are, then,
• 7:17:07
  in the I feel, two things in presence of each other, a
• 7:17:11
  small new psychological fact, a little flame lighting up feel, and an enormous
• 7:17:15
  mass of thoughts already constituted into a system. I. These two things mingle
• 7:17:22
  combine, and to say I feel is to say that the already enormous personality
• 7:17:26
  has seized upon and absorbed that little new sensation which has just been produced.
• 7:17:32
  If we dared, and it is not altogether absurd, we should say that
• 7:17:34
  the eye is a living animal, extremely voracious, a sort of ameba,
• 7:17:38
  which sends out tentacles to seize and absorb a very small creature which has just
• 7:17:42
  been born at its side. After having represented in the first line of our
• 7:17:48
  schema, the elementary sensations or effective states or simply subconscious phenomena. We represent
• 7:17:53
  secondly a reunion, a synthesis of all these elementary phenomena, which are combined
• 7:17:59
  among themselves, and particularly combined with the vast and prior notion of personality.
• 7:18:04
  It is only after this sort of assimilation that we can truly say I feel
• 7:18:10
  I. Formerly proposed to designate this new operation by the name of personal perception
• 7:18:14
  p P, for it is indeed a perception, that is to say,
• 7:18:18
  a clearer and more complex consciousness. The word personal will prevent confounding this operation
• 7:18:22
  with the outward perception, of which we do not treat here, and will
• 7:18:26
  recall to mind that its essential character is the addition of the notion of personality.
• 7:18:33
  This figure is of course quite theoretical, for it supposes an absurd thing,
• 7:18:37
  namely, that a man becomes, at a given moment conscious of assimilates
• 7:18:41
  to his personality all the elementary sensations that are borne in all his senses.
• 7:18:47
  Think what enormous masses of phenomena must spring up in us constantly from all the
• 7:18:51
  points of our body, from the crowd of impressions made on our skin,
• 7:18:53
  on our mucous membranes, on the organs of our senses. By all the
• 7:18:57
  arter and inner phenomena, it is certain that a man never perceives them all.
• 7:19:03
  There are always, even in the most normal man, a quantity of
• 7:19:06
  impressions that are borne in one point of the skin, reach to the brain,
• 7:19:10
  determine a few reflexes awaken, Perhaps a few little states of elementary consciousness
• 7:19:15
  contribute no doubt to his general state of well being or discomfort, but are
• 7:19:18
  not clearly perceived by his personality. A part only of these elementary sensations gives
• 7:19:23
  rise to complete and personal perception. What is the number of those elementary phenomena
• 7:19:29
  that rise to complete consciousness? Of how many elementary sensations can we simultaneously have
• 7:19:34
  the complete consciousness? This is what I proposed to call the problem of the
• 7:19:38
  extent of the field of consciousness by analogy, as you see with the extent
• 7:19:42
  of the visual field. This problem is not clearly resolved, and psychologists have
• 7:19:48
  proposed very different figures. The only essential and certain thing is that this extent
• 7:19:52
  of the field of consciousness varies very much with individuals and their states of mind.
• 7:19:57
  An orchestral conductor hearing similarltaneously, all the instruments and following by reading or
• 7:20:02
  by memory, the score of the opera unites in each of his states of
• 7:20:06
  consciousness an immense number of facts. The individual who when asleep dreams and the
• 7:20:11
  patient during a crisis of ecstasy have, on the contrary, in their conscious
• 7:20:15
  thought a very limited number of facts. I think there are, on this
• 7:20:18
  point perpetual and very nice variations of our mental state. If you understand this
• 7:20:23
  psychological conception well, you can easily apply it to the preceding phenomenon that we
• 7:20:29
  have just noted. With our hysterical patients. Their first moral stigma suggestion already
• 7:20:33
  shows us the isolation of the ideal. It is because there is no reaction
• 7:20:38
  between the various impressions that each word, each emotion, each remembrance takes an
• 7:20:42
  inordinate development, which we call suggestibility. Suggestion, it is always said,
• 7:20:48
  depends on the absence of control. But control is nothing but the struggle,
• 7:20:52
  the competition of the various psychological states united in the same consciousness. If it
• 7:20:57
  is wanting, it is because the mind is too arrow to contain several ideas
• 7:21:00
  opposing one another. The second characteristic exaggerated absent mindedness, that abstraction, bringing
• 7:21:07
  on all the blanks of consciousness is but another aspect of the same phenomenon.
• 7:21:12
  Our schemer gives us the formula perfectly. Let us suppose Fig. Twenty two
• 7:21:18
  an individual who cannot see at a given moment more than three elementary sensations such
• 7:21:22
  as V V prime A. He will leave all the rest in his subconsciousness.
• 7:21:29
  At another moment, he will be able to turn to T T prime
• 7:21:32
  V or to M v prime A. At the first moment, he will
• 7:21:37
  look at and listen to a person who speaks to him, without troubling about
• 7:21:40
  the tactile sensations which continue to assail him. At the second moment, he
• 7:21:45
  will look at an object while touching it and appreciate the contact, without having
• 7:21:48
  consciousness of the surrounding noises. At the third moment, he will write at
• 7:21:52
  dictation, having the perception of the sound of the voice, of the vision
• 7:21:56
  of the letters, and of the muscular movements, but forget yetting and neglecting
• 7:22:00
  all the other elementary sensations as T T prime T double prime, M prime
• 7:22:04
  M double prime, V V double prime A prime A double prime. This
• 7:22:10
  individual is absent minded, and this Fig. Twenty two is an attempt to
• 7:22:14
  schematize what is called normal absent mindedness. Let us suppose that the field of
• 7:22:19
  consciousness becomes still more contracted. The patient can no longer perceive more than two
• 7:22:25
  elementary sensations at once. Of necessity two. He reserves this small share of
• 7:22:30
  perception for the sensations which seem to him, whether right or wrong, the
• 7:22:33
  most important, the sensations of sight and hearing. To have consciousness of what
• 7:22:38
  is seen or heard is of paramount necessity, and he neglects to perceive the
• 7:22:42
  tactile and muscular sensations, thinking he can do without them. Fig. Twenty
• 7:22:48
  three. At the outset, he might perhaps still turn to them and take
• 7:22:51
  them into his field of personal perception, at least for a moment, But
• 7:22:55
  the chance not presenting itself, the bad psychological habit is slowly formed. Nothing
• 7:23:00
  is more serious, more obstinate than these moral habits. There is a crowd
• 7:23:03
  of maladies that are only psychological ticks. One day, the patient, for
• 7:23:07
  he has truly become one, now is examined by the physician. The latter
• 7:23:11
  pinches his left arm and asks him if he feels it, and the patient,
• 7:23:15
  to his great surprise, is obliged to confess that he can no longer
• 7:23:18
  feel consciously. The two long neglected sensations have escaped his personal perception. He
• 7:23:23
  has become anesthetic. You may easily understand that the same notion of the contraction
• 7:23:30
  of the field of consciousness equally sums up the last phenomenon, that of alternations.
• 7:23:34
  It is because the field of consciousness remains contracted that you can never add
• 7:23:40
  one phenomenon on one side without taking one away from another side. If you
• 7:23:44
  force the subject by attracting his attention to recover the sensibility of the left side,
• 7:23:48
  he loses it on the right side. If you obtain the total tactile
• 7:23:52
  sensibility, the reduction of the visual field increases so much that the subject becomes
• 7:23:56
  momentarily blind, a thing we have observed a number of times without having foreseen
• 7:24:02
  it. If you wish to enlarge the visual field, the tactile anesthesia will
• 7:24:06
  increase the feebleness of these patients. Thinking continues, and they lose on one
• 7:24:11
  side what they seem to have regained on another. I am therefore inclined to
• 7:24:15
  think that this notion of the retraction of the field of consciousness summarizes the preceding
• 7:24:19
  stigmata, and we may say that their fundamental mental state is characterized by a
• 7:24:25
  special moral weakness consisting in the lack of power on the part of the feeble
• 7:24:29
  subject to gather to condense his psychological phenomena and assimilate them to his personality.
• 7:24:37
  Three. Formerly I stopped at this point my description of the hysterical mental state,
• 7:24:42
  implying that all the other disturbances of their character could be connected with the
• 7:24:47
  preceding ones. It no longer seems to me absolutely true to day. The
• 7:24:52
  hysteric malady is not absolutely isolated like other mental disturbances. It is a special
• 7:24:56
  form which constitutes a part of a much more considerable group, and which is
• 7:25:00
  more or less distinguished from the other diseases belonging to this group. The patients
• 7:25:06
  we consider are first and above all neuropaths, individuals whose central nervous system is
• 7:25:10
  weakened. Then they are hystericals. When their enfeeblement takes a particular form.
• 7:25:17
  I even affirm that they are more or less hysterical according as their malady takes
• 7:25:19
  a more or less decided turn in this determinate direction. The result is that,
• 7:25:25
  besides the properly hysterical stigmata, they have to general vague disturbances at once
• 7:25:30
  psychological and physiological, which belong to all neuropathic individuals. We cannot enter into
• 7:25:37
  the enumeration of these disturbances, which besides would be more interesting in connection with
• 7:25:41
  other subjects, but we must indicate them shortly under the title of common stigmata,
• 7:25:45
  which you understand now. I will point out to you in this connection
• 7:25:49
  certain feelings that play a role in the popular conception of hysteria. These subjects
• 7:25:53
  feel weak, dissatisfied with themselves. Their actions, ideas, feelings appear to
• 7:25:59
  them reduced, covered with a kind of veil. They are therefore perpetually tormented
• 7:26:03
  by a vague ennuis which they cannot overcome. Nui is the great stigma of
• 7:26:07
  all neuropaths. He must not believe that it depends on surroundings. The neuropath
• 7:26:12
  feels dull everywhere, and always for no impression. Any longer brings about with
• 7:26:18
  him lively thoughts that make him pleased with himself. These general sentiments of dissatisfaction,
• 7:26:23
  these sentiments of incompleteness, as I have christened them elsewhere, almost always
• 7:26:29
  give to the patient a peculiar ratitude or conduct. Either he is sunk in
• 7:26:33
  despondency and exhibits a doleful air, or he seeks everywhere for something that can
• 7:26:37
  draw him out of this state. Now he has but very few means at
• 7:26:41
  his disposal to rouse himself to come out of such a painful state. Either
• 7:26:45
  he will use physical and moral processes of excitation, walking, jumping, crying,
• 7:26:49
  or he will appeal to other persons and will incessantly ask them to excite
• 7:26:53
  him, to revive him through encouragements, through praises, and especially through devotion
• 7:26:57
  and love. You see what will result from these needs. These patients will
• 7:27:03
  be at the same time plaintive and agitated. They will commit all kinds of
• 7:27:07
  eccentricities. Because eccentricity excites them and draws attention to them. They must needs
• 7:27:11
  attract attention to themselves in order that people may take an interest in them,
• 7:27:15
  speak to them, praise, and above all love them. This need of
• 7:27:18
  attracting attention, of being praised and loved is one of the things that have
• 7:27:22
  been most remarked. In my opinion, it has always been wrongly interpreted.
• 7:27:29
  First of all, it is a clinical error to ascribe this character to hysteria.
• 7:27:33
  It sometimes exists in a very high degree with hystericals, but it is
• 7:27:37
  by no means a stigma peculiar to this malady. It exists as well in
• 7:27:40
  the psychosthenic. The amorous manias of daters and of patients laboring under obsessions,
• 7:27:45
  their mania of jealousy, their need of attracting attention to themselves are often much
• 7:27:51
  stronger and especially more enduring than with hystericals. This remark has very often caused
• 7:27:56
  errors of diagnosis. Besides these feelings of income sleakness, we might enumerate with
• 7:28:00
  our hystericals, as with all neuress, the next, whatsoever, the innumerable
• 7:28:04
  lapses of all the mental functions. We note in the intelligence a certain apparent
• 7:28:10
  vivacity associated with the fundamental state of laziness and especially of revery. These patients
• 7:28:15
  pay attention to nothing, can bear no mental work. Hysteria, like all
• 7:28:19
  neuroses, begins among girls with the cessation of their studies and the complete incapacity
• 7:28:25
  of learning anything. In fact, this incapacity of attention brings with it as
• 7:28:29
  a consequence the absence of memory. Events are not fixed in the mind,
• 7:28:33
  whereas old remembrances relating to periods previous to the malady are well preserved, and
• 7:28:38
  are even reproduced with an exaggerated automatism. Recent events pass without leaving any trace.
• 7:28:45
  It is a disturbance of the memory which I have described under the name
• 7:28:48
  of continuous amnesia. It is frequent with hystericals, but it is not proper
• 7:28:52
  to them, and it must be considered only as a common stigma. The
• 7:28:57
  same alterations are found in the feelings which are weakened. The subjects who seem
• 7:29:02
  so emotional in reality feel nothing vividly. They are indifferent to all new feelings,
• 7:29:07
  and confine themselves to reproducing with an automatic exaggeration of few old feelings.
• 7:29:11
  Always the same. Their emotions, which seem so violent, are not just.
• 7:29:17
  That is to say, they are not entrappole with the event that seems
• 7:29:19
  to call them up. You always hear the same cries, the same declamations,
• 7:29:25
  whether the question is of a surprise or of a happy or an unfortunate
• 7:29:27
  event. Lastly, the disturbances of their will are well known. The patients
• 7:29:33
  no longer will, or rather they can no longer do anything. They can
• 7:29:37
  no longer make up their minds to anything, hesitate indefinitely before the least thing.
• 7:29:42
  I think even that they can no longer make up their minds to sleep,
• 7:29:45
  and in many cases, the so serious insomnia of neuropaths is a phenomenon
• 7:29:49
  of abulia, for they cannot even make up their minds whether they will remain
• 7:29:53
  awake or asleep. Of course, it is especially new actions that will become
• 7:29:57
  difficult, and for a long time the patients go on with old actions without
• 7:30:02
  being able to stop, before they enter a state in which they no longer
• 7:30:04
  do anything. This incapacity of beginning an act or an effort of attention,
• 7:30:11
  and this incapacity of stopping it when it is once begun, bring about the
• 7:30:15
  most serious disturbances. Most of the accidents might easily have been stopped at the
• 7:30:18
  outset. We begin to dream because we wish to do so. Revery is
• 7:30:22
  so pleasant. We begin to eat sparingly in order to be thin, to
• 7:30:26
  have a small waist, and not to look like Mamma. We begin an
• 7:30:30
  annoyance, get into tantrums. But we were provoked to it. All this,
• 7:30:33
  as the patients will themselves confess, might have been very easily stopped at
• 7:30:37
  the beginning. But the act continues more and more automatically, and the patient
• 7:30:41
  can no longer stop it. Herself. It becomes a delirium, an anorexia,
• 7:30:45
  and an attack. When I have begun something, we heard a patient
• 7:30:49
  say, I must go on with it. I cannot stop. I would
• 7:30:52
  break the windows, kill myself. I fall into an idea, as down
• 7:30:56
  a precipice, and the declivity is hard to climb again. No doubt you
• 7:31:02
  will find all these phenomena of abulia with all neuropaths, but that is not
• 7:31:06
  a reason for neglecting them. With hystericals, they constitute with them common stigmata,
• 7:31:11
  which add themselves to their proper stigmata, and besides, often assume a
• 7:31:15
  particular aspect under the influence of the latter. It is easy to summarize in
• 7:31:19
  a word, to these general disturbances of neuropaths. It is a mental depression
• 7:31:25
  characterized by the disappearance of the higher functions of the mind with the preservation and
• 7:31:29
  often with an exaggeration of the lower functions. It is a lowering of the
• 7:31:33
  mental level. So we may say, in short, that hystericals present to
• 7:31:37
  us the following stigmata a depression, a lowering of the mental level, which
• 7:31:41
  takes the special form of a retraction of the field of consciousness. End of
• 7:31:48
  Section fourteen. Sect. Fifteen General definitions. Review of the typical symptoms of
• 7:31:53
  hysteria, the positive and negative phenomena in somnambulism with amnesia, in agitations,
• 7:32:00
  with paralysies and anesthesias, The general idea of the contraction of the field of
• 7:32:04
  consciousness and of the lowering of the mental level. Definitions of hysteria, their
• 7:32:11
  congruency psychological definitions, the need of precision in these definitions. Definitions of hysteria
• 7:32:18
  as a disease by suggestion. Discussion of these definitions fixed ideas without relation to
• 7:32:23
  the medical form of the accident, the physiological and psychological laws unknown to the
• 7:32:27
  patient, the conditions of suggestion. Hysteria as a form of mental depression,
• 7:32:33
  characterized by the contraction of the field of personal consciousness and a tendency to the
• 7:32:37
  dissociation and emancipation of the system of ideas and functions that constitute personality. The
• 7:32:45
  laws of localization, the part played by the difficulty of the function by psychological
• 7:32:49
  automatism, by the anterior weakening of the function by the localization of the emotion.
• 7:32:56
  In these lectures on the Great Symptoms of Hysteria are I have tried to
• 7:33:00
  present a rapid picture not of all the symptoms of hysteria, but of the
• 7:33:03
  essential ones, in order that you might form a just idea of a singular
• 7:33:07
  malady of which everybody speaks, and which but few physicians know well. I
• 7:33:12
  have only presented to you with the typical cases and forms around which it is
• 7:33:17
  easy for you to group, the degraded forms and confused aspects which most diseases
• 7:33:21
  offer in practice. We must try now to sum up these descriptions, and
• 7:33:26
  to derive from them some general conception of the whole disease. One allow me
• 7:33:33
  first to remind you, in a few words, of the essential pictures you
• 7:33:37
  should keep before your eyes in order to form a general idea of the hysterical
• 7:33:40
  disease. We have studied somnambulism together. I no longer say hysterical somnambulism,
• 7:33:47
  for there is no more any somnambulism for us outside of hysteria. We have
• 7:33:52
  studied it under its simple and typical form of monoideic somnambulism, than in its
• 7:33:56
  more complete forms of fugues of polyidae somnambulisms, of artificial somnambulisms. You remember
• 7:34:03
  that we have always recognized in it the exaggerated development of an idea, of
• 7:34:07
  a feeling, of a psychological state, in a word, of a system
• 7:34:11
  of thoughts which takes place outside the memory and the normal consciousness. This dissociation
• 7:34:18
  of a psychological system is manifested not only by the preceding development, but also
• 7:34:22
  by amnesia, bearing not only on the somnambulic period, but even in remarkable
• 7:34:26
  cases, on the whole of the idea and of the feeling. When later
• 7:34:32
  we studied various accidents bearing on the movements of the limbs, we recognize that
• 7:34:37
  small systems of movements, and sometimes great systems, rich and old, constituting
• 7:34:41
  real functions, develop themselves without control to an exaggerated degree, and give rise
• 7:34:47
  to ticks and careers of various kinds. This lack of control is manifested through
• 7:34:52
  negative phenomena closely connected with the preceding ones, paralyses and anesthesias, which seem
• 7:34:56
  to play here the same role as the amnesias somnambulism. When we came to
• 7:35:02
  the sensorial functions, we saw the same agitations under the forms of ticks,
• 7:35:06
  of pains, and of hallucinations, accompanied with certain losses of control, which
• 7:35:11
  constitute various anesthesias bearing on the special senses as well as on the general sensibilities.
• 7:35:18
  In connection with these anesthesias, we remarked more clearly than we had done
• 7:35:22
  in connection with the preceding phenomena, the real nature of these amnesias, of
• 7:35:26
  these paralysies, in a word, of these disappearances of functions. The function
• 7:35:30
  is far from being destroyed. It continues to exist and often even develops to
• 7:35:34
  an exaggerated degree. It is only suppressed from one very special standpoint. It
• 7:35:41
  is no longer at the disposal of the will or the consciousness of the subject.
• 7:35:45
  Surprising as it is, we recognized the same facts not only in the
• 7:35:48
  complex function of speech, but even in the visceral functions. The refusal to
• 7:35:52
  eat, vomitings, hysterical dysinears are not diseases of the stomach or lungs.
• 7:35:57
  They consist in a kind of im emancipation of the cerebral and psychological function.
• 7:36:02
  Relative to these organs. There is now an exaggeration independent of the function.
• 7:36:07
  Again, and more often, a disappearance from consciousness of these organic wants and
• 7:36:11
  of the acts that are connected with them. Finally, in our last lectures,
• 7:36:15
  we sought in the very character of these patients, in the status of
• 7:36:18
  their minds, for fundamental stigmata, allowing us to recognize and understand the malady.
• 7:36:23
  We succeeded in bringing into evidence. On the one hand, stigmat a
• 7:36:27
  proper to hysteria, suggestion absent mindedness, carriage to unconsciousness alternation which we summarized
• 7:36:34
  in the general idea of retraction of the field of consciousness. And on the
• 7:36:38
  other hand, general stigmata, the absence of attention, the lack of feeling
• 7:36:42
  and of will, which are connected with depression, with the lowering of the
• 7:36:45
  mental level. This is a clinical picture that must suffice us in practice.
• 7:36:52
  If we remember these chief facts by comparing with them the complex and less clear
• 7:36:56
  cases that practice presents to us, we shall succeed in appreciating the head hysterical
• 7:37:00
  disease fairly, justly, while avoiding many prejudices and errors that are still very
• 7:37:03
  common nowadays. Unfortunately, the human mind is not so easily content. It
• 7:37:11
  is fond of dangers and quarrels, and we feel the need of formulating concerning
• 7:37:15
  hysterical disease general conceptions, interpretations, definitions, which are much more exposed to
• 7:37:21
  criticism and error. It seems to me that it is in some way a
• 7:37:25
  medical fashion to give definitions on hysteria. Already, in the old Book of
• 7:37:30
  Brachet in eighteen forty seven, there were at the beginning about fifty formulas passed
• 7:37:33
  in review. Though la Seig said that hysteria could never be defined, and
• 7:37:38
  that the attempt should not be made. Since that declaration, everybody has tried
• 7:37:42
  to define it. I have discussed in my little book on Hysteria about ten
• 7:37:48
  definitions, and I have been foolish enough to present a new one. Of
• 7:37:52
  course, physicians have continued to define it, and since that time ten others
• 7:37:56
  or so have been proposed. We must obey the fashion by saying a few
• 7:38:00
  words about these definitions. Let us try to derive from them without attaching too
• 7:38:06
  great importance to the terms, a general idea that suffices us in practice.
• 7:38:11
  Two, I am wrong in laughing at the definitions of hysteria and observing to
• 7:38:15
  you their abundance, which in these matters is not a proof of truth.
• 7:38:21
  These definitions have evolved, they have made visible progress, and though they appear
• 7:38:25
  numerous nowadays, they come so close to one another that they blend together.
• 7:38:30
  Do not forget that we are speaking of medicine, and that this is rather
• 7:38:33
  a special domain, less calm and serene than high mathematics. You should not
• 7:38:37
  ask too much of the virtue of a physician, or hope that he will
• 7:38:41
  confine himself to repeating the definition of a predecessor. Even if he does not
• 7:38:45
  cite his name, What would be left for him. He must needs change
• 7:38:49
  something in these definitions, were it but a single word, in order to
• 7:38:52
  appear to innovate, which in medicine is indispensable. I do not exaggerate in
• 7:38:57
  telling you that nowadays three fourths of the definitions of hysteria are nearly identical.
• 7:39:03
  Thus, I shall perhaps surprise you by telling you that there is no opposition
• 7:39:07
  between the definitions that gloriously entitle themselves physiological and those that modestly call themselves psychological.
• 7:39:14
  No doubt there would be a great difference if these authors had seen,
• 7:39:17
  really seen, a lesion characteristic of the neurosis, and if they had connected
• 7:39:22
  the evolution of the disease with this lesion. Never fear, one can make
• 7:39:26
  nowadays a so called physiological definition at smaller cost. It is enough to take
• 7:39:32
  the most commonplace psychological definitions and replace their terms with words vaguely borrowed from the
• 7:39:36
  language of anatomy and the current physiological hypotheses. Instead of saying the function of
• 7:39:41
  languages separated from the personality, one will proudly say the center of speech has
• 7:39:47
  no longer any communication with the higher centers of association. Instead of saying the
• 7:39:52
  mental synthesis appears to be diminished, one will say the higher center of association
• 7:39:56
  is benumbed, and the feat will be done. I recommend to you,
• 7:40:00
  in this connection to read the last book of Monsieur Jose Ingenieros, published at
• 7:40:06
  Buenos Aires in nineteen o six. In the first chapter, which I do
• 7:40:10
  not understand very well on account of my imperfect knowledge of Spanish, he shows
• 7:40:14
  that many of the definitions of modern physicians are equivalent, and I am quite
• 7:40:18
  of his opinion. So there is an ensemble of points on which all the
• 7:40:21
  authors agree, and it is those which we shall have to bring into evidence.
• 7:40:26
  Charcour used to say that hysteria is an entirely psychic malady. This opinion
• 7:40:30
  was discussed at his time. There were still some remainders of the old uterine
• 7:40:34
  and genital theories. There were still some attempts to connect hysteria with various nervous
• 7:40:40
  lesions. Doctor Bastian's book in England, a very interesting book, is very
• 7:40:44
  courageous. He had the pretension to localize different hysterical accidents in different corners of
• 7:40:49
  the medulla, of the bulb, or of the lower centers of the encephalon.
• 7:40:55
  That there is no truth in those old conceptions, that hysteria will not
• 7:40:57
  be recognized later as resis resulting from some unknown disturbance of the secretion of a
• 7:41:02
  vascular gland, or from some lesion of a nowadays badly defined nervous system.
• 7:41:07
  I should not dare assert, but one thing is certain, namely that for
• 7:41:11
  twenty years everybody has departed from this view of the matter, and that the
• 7:41:15
  psychological conception has the mastery. I again observed to you that I consider the
• 7:41:19
  pretended physiological definitions as mere translations of the psychological ideas. This point is almost
• 7:41:26
  agreed on by every one. But now difficulties begin. Of what kind of
• 7:41:30
  psychological disturbance is it? A question we should not, under pretense of psychology
• 7:41:36
  confusedly link hysteria with the vague group of mental diseases and the old nervosismos.
• 7:41:41
  On this point, the work of a distinguished physician, doctor Dubois of Berne,
• 7:41:45
  interesting from other standpoints, is in my opinion, absolutely pernicious. The
• 7:41:51
  psychological interpretation should not suppress what is good, what is excellent in our ancestors
• 7:41:56
  works. Now, the last century produced a monumental work, namely clinical work
• 7:42:02
  with infinite patience and penetration. All those great clinicians introduced order into a real
• 7:42:07
  chaos. They ranged the diseases in groups. They enabled us to recognize these
• 7:42:11
  groups. Improvements should consist in consolidating this edifice and not in throwing it down.
• 7:42:17
  To say, under pretense of psychology that a somnambulism is identical with any
• 7:42:21
  delirium, that hysterical vomiting is a mere derangement, to be confounded with manias
• 7:42:26
  of doubt, or with melancholias, or even perhaps with the tix of idiots
• 7:42:30
  is to go two hundred years back, and it would be much better to
• 7:42:33
  suppress the psychological interpretation and to be content with the clinical description. Consequently,
• 7:42:40
  in making hysteria or a psychological affection, we do not intend at all,
• 7:42:44
  as Monsieur grace seemed to believe to confound it with some sort of other or
• 7:42:48
  mental malady. We even say that it is nowadays the most characteristic disturbance of
• 7:42:52
  all, and that it is important to distinguish it well. The first psychological
• 7:42:59
  note that appears to meet a result with the greatest clearness from all the contemporary
• 7:43:03
  works is a notion relative to the importance of ideas in certain hysterical accidents.
• 7:43:08
  Chalcourt, studying the paralysies, had shown that the disease is not produced by
• 7:43:12
  a real accident, but by the idea of this accident. It is not
• 7:43:18
  necessary that the carriage wheel should really have passed over the patient. It is
• 7:43:22
  enough if he has the idea that the wheel passed over his legs. This
• 7:43:25
  remark is easy to generalize. There are such kinds of fixed ideas in somnambulisms
• 7:43:30
  and fugues, the idea of one's mother's death, the idea of visiting tropical
• 7:43:33
  countries, et cetera. There are such ideas in systematic contractures, for instance,
• 7:43:38
  when a patient seems to hold her feet stretched because she thinks herself on
• 7:43:42
  the cross. There are such ideas in visceral disturbances, and I have shown
• 7:43:47
  you the observation of a patient who died of hunger because she had the fixed
• 7:43:51
  idea of the turnips she had eaten when at school. These remarks have been
• 7:43:53
  well made on every side. It has also been established that with hysterical ideas
• 7:44:00
  have a greater importance and above all a greater bodily action than with the normal
• 7:44:03
  man. They seem to penetrate more deeply into the organism and to bring about
• 7:44:08
  motor and visceral modifications. It is a point which was again emphasized by messieurs
• 7:44:14
  Romatieu and Roux in a recent paper they devoted to hysterical vomiting. What characterizes
• 7:44:19
  hystericals, they said, is less the fact of accepting some idea or other
• 7:44:23
  than the action exercised by this idea on their stomachs or intestines. At the
• 7:44:30
  same time, the studies on suggestion, which have been very numerous, have
• 7:44:33
  allowed clinicians to realize experimentally through the action of ideas, many phenomena analogous to
• 7:44:38
  hysterical accidents. So it may be said that the most common conceptions of hysteria
• 7:44:44
  turn on this character. Maybeus in eighteen eighty eight, after Schalcot said we
• 7:44:48
  may consider as hysterical all morbid modifications of the body that are caused by representations.
• 7:44:55
  Strompel in eighteen ninety two, Bernheim, Oberenheim, and more recently Barbinski
• 7:45:00
  have repeated each of them, of course, with a slight change in the
• 7:45:03
  words quite similar definitions. A phenomenon is hysterical, said Babinski, when it
• 7:45:08
  can be produced through suggestion and cured through persuasion. Let us take no account
• 7:45:14
  of the end of the sentence. The treatment and cure are delicate things.
• 7:45:18
  Much might be said on those cures through persuasion. Let us only retain the
• 7:45:22
  beginning. Hysteria is defined by a suggestion. It is absolutely the conception of
• 7:45:29
  Chalcourt and Mabius, hysteria through fixed ideas and hysteria through representation. This word
• 7:45:34
  suggestion, which besides one takes care not to define, is taken simply in
• 7:45:38
  the sense attached to it by all the preceding authors, namely that of a
• 7:45:42
  too powerful idea acting on the body in an abnormal manner. It is easy
• 7:45:48
  to remark here a unity of a great number of contemporary conceptions. Three.
• 7:45:55
  I do not object very much to the preceding definitions. If more precision were
• 7:45:59
  given to the meaning of the word suggestion, these definitions would be agreed on
• 7:46:02
  by everybody. Besides, these definitions bring back all the accidents of the neurosis
• 7:46:07
  to a symptom. We have put in the first rank among the stigmata to
• 7:46:11
  the suggestibility. So they are very scientific and useful. It is one of
• 7:46:15
  the first results of all the psychological work that has been done on hysteria.
• 7:46:21
  However, I had already discussed them in eighteen ninety four and still think them
• 7:46:23
  insufficient. As my arguments have been very little contradicted, I will try to
• 7:46:27
  formulate them more clearly. In the first place, I believe that this conception
• 7:46:33
  of hysteria is more just in theory than in practice. It rather summarizes a
• 7:46:38
  systematic interpretation than the clinical observation. It is we who have repeated that the
• 7:46:44
  accidents seem to be brought about by ideas. It is not quite exact that
• 7:46:48
  we always observe these ideas in a few cases, and they are always the
• 7:46:52
  ones that are repeated the patient. It is true as the idea that he
• 7:46:56
  has paralyzed. I thought he says that my leg was crushed. I had
• 7:47:00
  the idea that my leg no longer existed. The consecutive paralysis with anesthesia of
• 7:47:06
  the limb seems to be the exact translation of his idea, But it is
• 7:47:11
  a singular exaggeration to apply this indifferently to all hysterical accidents, and to say
• 7:47:15
  unreservedly with Monsieur Bernheim, the hysterical realizes his accident just as he conceives it.
• 7:47:22
  This is to come back to a kind of contemptuous accusation against the patient.
• 7:47:26
  Formerly the physician said to the patient, you are paralyzed, you have
• 7:47:30
  crises of sleep because you are willing to have these accidents. Now it is
• 7:47:34
  recognized that he is not willing to have them, but it is still maintained
• 7:47:37
  that he thinks of them. You have such or such a crisis, with
• 7:47:41
  such or such an accident because you think of it. I say that this
• 7:47:45
  is not true. There are many hystericals who do not think of the accidents
• 7:47:48
  they have. First of all, with some patients, the accidents develop insidiously
• 7:47:53
  unknown to them. They become anesthetic, paralytic, anorexic, a morotic,
• 7:48:00
  without in the least suspecting it. Clinical practice shows you this every day.
• 7:48:04
  What shall we do, then, with the observations already cited by La Seige,
• 7:48:08
  in which it is the physician who reveals to the subject an anesthesia or
• 7:48:11
  the blindness of one eye which he was not aware of. In other cases,
• 7:48:17
  it is incontestable that the accident develops with details, with an evolution that
• 7:48:21
  the patient does not know. Whatever Monsieur Biernheim may say about it, I
• 7:48:26
  do not admit at all that hystericals have at will paralysies with or without anesthesias.
• 7:48:32
  I do not admit that these patients know what happens in their somnambulisms,
• 7:48:34
  that they combine the disease beforehand. If these patients have fixed ideas, and
• 7:48:41
  I acknowledge that this is very frequent, it should be well remarked that these
• 7:48:45
  fixed ideas have no relation to the medical form of their accident. One has
• 7:48:49
  the fixed idea of her mother's death. It is not at all the fixed
• 7:48:53
  idea of somnambulism and of its laws. Another has a fixed idea relative to
• 7:48:57
  the flight of his wife, who wrote him. It is not the fixed
• 7:49:02
  idea of dumbness. Much oftener than is believed, the accident develops independently of
• 7:49:07
  the ideas of the subject, whether the subject does not think of it or
• 7:49:10
  thinks of something else. I should like to present in the second place,
• 7:49:15
  an argument which is still weak, but the importance of which will grow more
• 7:49:18
  and more. It relates to the physiological and psychological laws of hysterical accidents,
• 7:49:23
  laws of which we are ignorant and of which the subjects are ignorant. Like
• 7:49:26
  us. When we see a crowd of accidents evolve according to these laws,
• 7:49:32
  which we painfully describe, we cannot say that they are due to auto suggestion.
• 7:49:37
  I remind you of the laws of somnambulisms, which, in my opinion,
• 7:49:41
  are capital Somnambulism is followed by an amnesia, which bears not only on
• 7:49:45
  the abnormal period, but often also on the idea itself that fills it,
• 7:49:49
  and on all the feelings connected with it. This amnesia disappears, and all
• 7:49:53
  the apparently lost remembrances are restored when the subject comes back into the same somnambulism.
• 7:50:00
  In the case of Irene, which I take as a type, there
• 7:50:03
  is in the waking state an amnesia not only of the crisis, but also
• 7:50:07
  of her mother's death, of the three preceding months, and of all that
• 7:50:10
  is connected with her affection for her mother, and during the fits. All
• 7:50:14
  these remembrances are perfect to the subjects who show us applications of these laws,
• 7:50:18
  and in my opinion, they are very numerous. Do these subjects know them?
• 7:50:22
  Have they? The idea of having such an oblivion in connection with their
• 7:50:26
  somnambulism are very unlikely. They would much rather have the contrary idea, that
• 7:50:32
  of being obsessed by their remembrance, Like the psychosthenics. The more hysterical paralysies
• 7:50:37
  are studied, the more laws of a similar kind will be discovered. I
• 7:50:41
  have observed to you that the accidents bear on functions. It is true that
• 7:50:47
  these functions often ust appear to be identical with those which the vulgar have themselves
• 7:50:51
  recognized, the function of alimentation, the function of walk, the function of
• 7:50:55
  the movements of the hand. In this case, you will tell me the
• 7:50:59
  paralysis my I very well be brought about by an idea, since the popular
• 7:51:03
  idea coincides with the very limits of the paralysis. This is true in general
• 7:51:07
  simply because the popular ideas are true. The great divisions of the functions correspond
• 7:51:12
  to the great divisions of the organs, and the popular analysis has been correct.
• 7:51:17
  That is all. But there are some cases in which the popular analysis
• 7:51:21
  proves ignorant, and in which hysterical paralysis analyzes the functions much better than good
• 7:51:26
  sense does. Why are the disturbances of speech accompanied with right sided hemiplegay?
• 7:51:32
  Why are there cases of hemianopsia. How is it that there are distinct paralysies
• 7:51:36
  of monocular vision and of binocular vision. Why are there disturbances of accommodation?
• 7:51:41
  If you pass on to contractures, do you really believe that the patient has
• 7:51:45
  the idea of rigidity without fatigue, without increase of temperature, that he has
• 7:51:49
  the idea of that modification of the reactions of that slowness of the muscular shake.
• 7:51:55
  I am convinced, for my part, that hysterical contracture has its own
• 7:51:59
  laws. Quite pecure it presenting us, as I told you, a degradation
• 7:52:03
  of the contraction of the striated muscles. All this is outside of the thought
• 7:52:07
  of the subject. As I told you at the beginning. It will be
• 7:52:11
  later a matter of astonishment that physicians should have attributed to the caprice of the
• 7:52:14
  subject all the psychological and physiological laws that will be discovered in these various accidents.
• 7:52:21
  Lastly, I insist on a third argument. These definitions have a meaning
• 7:52:25
  only on condition that the words fixed, idea, and suggestion are used in
• 7:52:27
  a particular sense. This sense should be that with hystericals, ideas do not
• 7:52:33
  conduct themselves as with everybody. It is of no use for me to represent
• 7:52:37
  to myself that I am asleep. I do not therefore sleep. All these
• 7:52:41
  authors imply tacitly that these ideas act in a special manner on the mind at
• 7:52:47
  organism. I answer that it is this special action that is the essential point.
• 7:52:52
  It is this action that constitutes hysteria. And you have not the right
• 7:52:56
  to make a definition in which you tacitly imply what is essential. Begin by
• 7:53:00
  defining what you call suggestion, and afterwards you may say, if you choose,
• 7:53:03
  and if it is true, that hysteria is a disease due to suggestion.
• 7:53:08
  But to define suggestion, you will be obliged to introduce into your definition
• 7:53:12
  certain new notions which are precisely those I asked for. Four, you will
• 7:53:19
  be obliged to recognize that these ideas present themselves in special conditions, that they
• 7:53:25
  develop out of measure because they meet with no counterpoise in the mind, because
• 7:53:29
  they are isolated owing to a strange absent mindedness of the subject. In a
• 7:53:33
  word, you will recognize the other stigmata, absent mindedness and the retraction of
• 7:53:37
  the field of consciousness. When you have once admitted this retraction of the field
• 7:53:41
  of consciousness as one of the conditions of suggestion itself, why should you maintain
• 7:53:45
  that it can produce nothing but suggestions? Why should you not admit that this
• 7:53:49
  disease of the mind may be manifested by something else. If this retraction has
• 7:53:55
  given too much power to certain ideas, does it not produce, on the
• 7:53:57
  other hand, some blanks? Can it not isolate and emancipate one function and
• 7:54:03
  suppress another from consciousness? We then arrive at another group of definitions in which
• 7:54:08
  I range mine. They are definitions, in my opinion, more profound,
• 7:54:12
  into which enter the phenomena of dissociation of consciousness, such as is observed in
• 7:54:17
  all hysterical disturbances. Suggestion itself is but a case of this dissociation of consciousness.
• 7:54:23
  There are many others beside the one, in somnambulisms, in automatic words,
• 7:54:27
  in emotional attacks, in all the functional paralysies. Many authors Gurney,
• 7:54:33
  Meyers, Laurent Breyer and Freud, Benedict Oppenheim, Jolly Pick Morton Prince of
• 7:54:40
  Thought, like me, that a place should be made for the disposition to
• 7:54:42
  somnambulism was not the somnambulic attack Harass the type of hysterical accidents in eighteen eighty
• 7:54:48
  nine. The disposition to this dissociation, and at the same time the formation
• 7:54:53
  of states of consciousness, which we propose to collect under the name of hypnoid
• 7:54:57
  states, constitute the funder mental phenomenon of this neurosis, said Messieur Breyer and
• 7:55:03
  Freud of Vienna in eighteen ninety three. The point which seems to me to
• 7:55:07
  be the most delicate in this definition is to indicate to what depth this dissociation
• 7:55:11
  reaches. In reality, we might say that the dementias themselves are dissociations of
• 7:55:17
  thought and of the motor functions. We must remember that in hysteria the functions
• 7:55:22
  do not dissolve entirely, that they continue to subsist emancipated with their systematization.
• 7:55:29
  What is dissolved is personality, the system of grouping of the different functions around
• 7:55:33
  the same personality. I maintain to this day that if hysteria is a mental
• 7:55:38
  malady, it is not a mental malady like any other, impairing the social
• 7:55:42
  sentiments or destroying the constitution of ideas. It is a malady of the personal
• 7:55:48
  synthesis. And I will take up again, very slightly modified the formula I
• 7:55:52
  have already presented. Hysteria is a form of mental depression characterized by the retraction
• 7:55:56
  of the field of personal consciousness and at tre tendency to the dissociation and emancipation
• 7:56:02
  of the systems of ideas and functions that constitute personality. Five. Let us
• 7:56:07
  leave two general discussions and come back to a more clinical conception of things.
• 7:56:12
  The most important problem is not for me to understand what hysteria in general is,
• 7:56:18
  but to account for the practical evolution of the accidents with such or such
• 7:56:22
  a person. The difficulty we meet with, then, is a difficulty of
• 7:56:25
  localization. How is it that with one person the hysteria bears on the arm,
• 7:56:30
  with another on the stomach, and that with a third it only reaches
• 7:56:33
  a system of ideas which it turns into a somnambulism. It is on this
• 7:56:38
  search for an interpretation proper to each subject, that one should dwell to my
• 7:56:41
  mind, much more than on general quarrels of definition. The starting point of
• 7:56:48
  hysteria is the same as that of most great neuroses. It is a depression,
• 7:56:51
  an exhaustion of the higher functions of the encavalon all the psychological operations do
• 7:56:56
  not present, as I repeat, the same difficult. There are some operations
• 7:57:02
  that are easy for all kinds of reasons, first because they are simple and
• 7:57:04
  only require the union of a small number of elements. Second because they are
• 7:57:08
  old, because their systematization was the work of our ancestors and is inscribed in
• 7:57:12
  strongly constituted organs. There are some other functions that are difficult because on the
• 7:57:18
  one hand, they are very complex, because they necessitate the systematization of an
• 7:57:22
  infinite number of elements, and because on the other hand, they are very
• 7:57:26
  new and require a present synthesis not yet inscribed in the organism. Now,
• 7:57:32
  our nervous strength, which we do not know at all, presents oscillations.
• 7:57:36
  When it is high, we easily accomplish the operations of the second group.
• 7:57:40
  We have an extended consciousness. We turn back from no new study or action.
• 7:57:45
  But there are many circumstances in which this nervous tension is lowered, especially
• 7:57:49
  with those hereditarily disposed. There are some physiological periods puberty, for instance,
• 7:57:56
  at which the vital forces seem to be busy elsewhere and to leave no great
• 7:57:59
  resource to the brain. There are diseases that, through a thousand mechanisms,
• 7:58:03
  through local lesions, through intoxication, through microbian infection, lower our nervous tension.
• 7:58:10
  Even in normal functioning, physical or intellectual fatigue is enough to produce momentarily
• 7:58:14
  the same result. Lastly, the fact is more difficult to understand, but
• 7:58:18
  incontestable emotion is characterized by this lowering of the nervous strength. Very likely,
• 7:58:25
  in emotion there is a great expense of nervous strength necessitated by the new problem
• 7:58:29
  suddenly set, and the emotional disturbance must come close to that of fatigue.
• 7:58:34
  However, it may be our patients have been exhausted through one of the preceding
• 7:58:37
  causes. If hereditarily predisposed, they are enfeebled by puberty, or they succumb
• 7:58:44
  to intoxication, fatigue, or emotion. The diminution, the lowering of the
• 7:58:48
  nervous tension may bring about a general lowering of all the functions, and especially
• 7:58:52
  of the highest This is what takes place in the psychosthenic neurosis, in which
• 7:58:56
  the localization on a special point exists in a rather slight degree. With hystericals,
• 7:59:03
  in consequence of particular dispositions, the lowering of the nervous strength produces,
• 7:59:07
  in some manner a superficial retraction. There is, as it were, an
• 7:59:11
  autonomy consciousness, which is no longer able to perform too complex operations, gives
• 7:59:15
  up some of them. There is, it is true, a general enfeeblement,
• 7:59:19
  which manifests itself through the common stigmata. But there is above all a
• 7:59:23
  localization of the mental insufficiency on such or such particular function. So we find
• 7:59:29
  again in hysteria the problem of localization, which is of great importance in this
• 7:59:33
  disease, no doubt, in a certain number of cases, the localization is
• 7:59:37
  effected through suggestion. An idea suggested from without attracts the thinking in one direction
• 7:59:44
  or another, and brings about Besides, according to laws, the subject does
• 7:59:48
  not know such or such automatic functioning, and such or such a loss of
• 7:59:51
  function. This is only a particular case. The localization may also be effected
• 7:59:56
  through a process akin to suggestion, but which is not identical with it.
• 8:00:00
  According to the laws of psychological automatism. I have often drawn your attention to
• 8:00:06
  those individuals who, having had an accident in certain circumstances, and having been
• 8:00:10
  cured, always recommence the same accident each time they experience an emotion, though
• 8:00:15
  it has no relation with the first. The man who was wounded by a
• 8:00:18
  railroad engine has a delirium in which he sees an engine coming towards him.
• 8:00:22
  This is quite simple. Eleven years afterwards, he sees his wife die,
• 8:00:26
  and he recommences the engine delirium. Another has the tick of blowing through one
• 8:00:30
  of his nostrils because he had a scab in his nose in consequence of a
• 8:00:34
  bleeding at the nose. He recovers from his tick, but he recommences it
• 8:00:38
  now because he loses his fortune, because his child is ill, et CETERA
• 8:00:44
  third law, the dissociation simply bears on a function that, for some reason
• 8:00:48
  or other, has remained weak and disturbed. Many of our patients become dumb
• 8:00:52
  after an emotion, but they were formally inclined to stammer. Their speech was
• 8:00:56
  quite insufficient. A girl's ride leg becomes paralyzed. The reason is that in
• 8:01:02
  her childhood her right leg was affected with rachitis. In the case of another
• 8:01:07
  girl, the paralysis of a leg is due to the fact that in her
• 8:01:10
  childhood the leg was affected with a white tumor and remained long in bandage.
• 8:01:15
  This remark relates specially to the very numerous cases of associated hysteria. A disease
• 8:01:19
  of any kind bearing on viscera, often an organic lesion of the medulla or
• 8:01:23
  of the brain in feebles or disturbs some function, and it is on this
• 8:01:27
  function that the hysteric emancipation is localized. So in certain cases, hysteria makes
• 8:01:33
  conspicuous some light symptoms of organic diseases of the nervous system quite at their beginning,
• 8:01:37
  by exaggerating them beyond all measure. The fact, for instance, was
• 8:01:42
  frequently observed in the cases of tibetic vomiting associated with hysteric vomiting. Fourth law,
• 8:01:49
  the function that disappears is the most complicated and the most difficult for the
• 8:01:53
  subject. This law applies chiefly to professional and social paralysis. Finally, fifth
• 8:02:00
  law, we remark a very curious fact which we recognize without always being able
• 8:02:06
  to account for it. The dissociation bears on the function that was in full
• 8:02:10
  activity at the moment of a great emotion. There are here some physiological laws
• 8:02:15
  that cause the chief disturbance to bear on this function, that make it probably
• 8:02:18
  through an association of ideas, through an evocation of the emotion, the most
• 8:02:22
  difficult for the subject. It is the study of these laws. It is
• 8:02:27
  the search for these conditions that constitute the important part of the study of hysteria.
• 8:02:33
  Leave the discussions of general definitions. They are premature discussions which bear on
• 8:02:37
  purely verbal differences. Retain from these lessons the importance that attach us to the
• 8:02:41
  study of the psychological functions, the necessity of analyzing, in each particular case,
• 8:02:47
  the mental state of the patient. If these lectures have inspired you with
• 8:02:52
  some interest for this kind of studies, if they can contribute to develop in
• 8:02:55
  your beautiful country the researches of pathological psychology. Beside the researches of experimental psychology
• 8:03:00
  so brilliantly represented, I think you will not have lost too much time in
• 8:03:06
  trying to understand a barbarous language. For my part, I deeply feel your
• 8:03:10
  kind attention and reception, and I am proud of having had for a few
• 8:03:14
  days the honor of teaching you, and of being the colleague of the Masters
• 8:03:18
  of Harvard University. End of Section fifteen