951

of unemployment. All these, like the grim shapes which

guarded the gate of VERGIL’S Hades,"Morbi, trtstisqne Senectus,

et Metus, et malesuada Fames, ac turpis MgestM,"

are ever present to the poor man, and it is against spectressuch as these that institutions like Toynbee Hall offer pro-tection. There is no compulsion to be made better or

happier, those who attend do so of their own free will, and,moreover, a process of natural selection is at work, for it is

only those who have the aspiration towards higher thingsthat have the energy to avail themselves of such aids as

evening classes and lectures. Thus the best men are lifted

out of the rut of poverty and hopelessness, and the spark of

personal ambition which is just alight within them is fannedinto a flame. Neither are the benefits all on the side of the

poor, for those who give their services-the clergy, the

lawyers, the physicians, and the ordinary educated laymen-come into touch with their fellows of a class to which theywould otherwise be strangers. Thus the divisions between

class and class are narrowed, either side learns from the

other, and the feeling of personal help is mutual. It is this

intense personal zeal which is evident in the ToYNBEE

letters, and it is for the preservation of this we hope to seefuture legislation for social reform take thought.

Modern Views of Hysteria.THERE is probably no disease which is capable or exciting

greater differences of opinion than that to which the name

hysteria is given. No doubt much of this conflict of view is ,due to the use of the word, for, even among those who havemost deeply studied the subject, the connotation of the wordis widely different, and phenomena which by some are

denominated hysterical are said by others to be incorrectly sodefined. In this country comparatively little of an authorita-tive character has been written on the nature of hysteria.Much, however, has been done to rescue from that category,and to relegate to their appropriate pigeon-holes, manyclasses of true organic nervous disease. Probably the twomost striking instances of this are the numerous cases of ill-defined disseminated sclerosis which 20 years ago were

almost invariably regarded as hysterical, and the even

more important, because so much more tragical, cases of

myasthenia gravis to which acuter attention has been givenmore recently. But it would seem that now hysteria, as adefinite disease, is exciting more interest among English I

neurologists, and nothing is more calculated to stimulate and

develop and direct this interest than the number of Brainwhich has been recently published. This number constitutes

almost a symposium on hysteria, for it contains Dr. J. A.

ORMEROD’S address, as President of the Neurological Sectionof the Royal Society of Medicine, on « Two Theories of

Hysteria," an able and scholarly yet critical examination of

the views of Professor JANET of Paris and Professor FREUD

of Vienna ; and, no doubt through a happy inspirationof the editor, Dr. H. HEAD, a paper by Dr. S. A. K.

WILSON on 11 some Modern French Conceptions of

Hysteria," and a systematic account of " Freud’s Con-

ception of Hysteria" by Dr. BERNARD HART. All these

papers show a wide and intimate acquaintance with the i

subject on the part of their authors. Even the earlywriters who regarded the hysterical condition as de-

pendent upon the actual vagaries of the womb round

the body recognised the two aspects of the disease-

the physical, consisting of convulsion, contractures, and

paralysis, and also the psychical, consisting of mental

peculiarities and emotional disturbances ; and the later viewswhich still clung to disturbances of the generative organsand functions as the cause, and invoked ovarian pressure and

the regulation of menstruation for its cure, recognised thisdouble aspect of the symptomatology. And this peculiarityof the disease, which naturally leads some of its investi-

gators to attach most importance to the physical side, whileothers lay undue stress upon the psychical, is no doubt

accountable, in some degree at least, for the completefailure that has so far attended all efforts to arrive at a reallysatisfactory clinical account of the disease, far less at any-thing like a convincing theory of its causation. This" infinite variety," while it satisfies all, is a snare to all, andas Dr. WiLSON remarks: To the individual who is not so

absorbed in science as to lose his sense of humour it may

seem that hysteria, the while she responds so nobly to the

appeals of the advocates of the various theories, is quietlysmiling in her sleeve 1 "-and remaining as elusive as ever.The three theories which are examined in the papers before

us are those of BABINSKI, of JANET, and of FREUD.

BASmsm’s view would seem to be the direct sequel to thoseof CHARCOT, yet, paradoxical as it may seem, it also con-

stitutes a revolt from the great master. Under CHARCOT’S

magnetic teaching his hysterical patients were like clay inthe hands of the modeller, and all symptoms were producedat the slightest suggestion. Consequently the domain ofhysteria was widened so as to include not only those whowere real sufferers, but those who were responsive to sug-gestion and even the simulator and malingerer. BABINSIH,

recognising the curious conglomerate which had come

together under the name of hysteria, set himself, if not

to define, at least to limit the symptomatology. He

denied that the so-called stigmata are characterised byany fixity, and he asserted that symptoms like hemi-

ansesthesia and visual contraction are conspicuous bytheir absence. He even asserted that in 100 consecutive

cases of hysteria he had failed to find hemianmsthesia.

in a single patient I Yet although BABINSKi’S work mayseem to be destructive, this destruction is really with theview of arriving at a definition of hysteria. Such a result

is finally reached by contending that the manifestations of

hysteria have only two attributes that are essential-the

property of being reproducible by suggestion and the property.of disappearing under the extensive use of persuasion. This:

v

of course, is not a definition, but merely a statement ofcertain conditions which any definition must fulfil. He-

finally defines it as I I a special psychical state capable ofgiving rise to certain disturbances with characters of theirown: it manifests itself principally by primary symptoms.and by secondary or accessory symptoms. The former can

be reproduced by suggestion, with rigorous exactness in,

certain subjects, and can be made to disappear under the-sole influence of persuasion. The secondary symptoms-are strictly subordinated to the primary ones." It.

952

will thus be seen that in BABlNSKl’H view the relation

of suggestion to the phenomena of hysteria is an essential

one, and probably the strongest objection to its acceptancehas been expressed by DUFOUR when he says that " in

accepting the definitions we define a disease by the relationbetween the patient and physician, thereby employingtherapeutic rather than etiological terms." Such an objec-tion would seem to be unanswerable.

The two other theories have underlying them the

conception that besides the ordinary mental phenomena- perceptions, feelings, and thoughts of our daily life

of which we are all conscious-there are impressions of

all kinds pouring in upon us from our own organs and

from the outside world, as well as memories and ideas fromthe past constantly rising up in us, of which we have no

personal consciousness. Yet under certain conditions

these subconscious ideas may emerge into consciousness.

They may also, it is said, group themselves in systemsof their own, so that a second self may grow upindependent of our known self. This process is

called the dissociation of personality. According to

JwE2’s theory the essential of hysteria is a restriction

of the fields of personal consciousness. The hystericalmind can take in much less than the ordinary mind, its

comprehensiveness is less, just as the visual field in a

hysterical patient is restricted, and when the field of

personal consciousness is thus narrowed the subconscious

mental conditions tend to become obtrusive. Mental con-

ditions like amnesia-in which strange gaps in memoryoccur-and physical conditions like a hysterical fit, whichis likened to an attack of somnambulism, can both, it is

said, be explained on such a theory, and to some the

explanation may seem adequate, but to others not

.so satisfactory. It is further claimed that the theoryis competent to throw much light on the nature of

fixed ideas and other psychasthenic phenomena. FREUD’S

theory, which, it may be said, rests upon the recognitionof subconscious mental states, may be described in broad

outline almost in Dr. ORMEROD’S words. Every event

which appeals to our emotions, and particularly to painfulones such as fear or anger, raises in the mind a dis-

turbance, stress, and strain, which he calls the "affect";this latter generally finds an appropriate expression in

an act of retaliation or perhaps in tears or bad language.But if this does not take place, what happens ? A process

may occur-it does not necessarily do so-a so-called

"conversion of the affect"-some physical and bodilyoccurrence being provided to take the place of the mentaldistress. Such bodily act will gradually become automatic,and so a new disease arises, although it is really the affect

"

of an old memory. Thus a patient after prolonged weepingon the sudden death of her husband may develop a varyingbut persistent facial spasm. This power of the conversion of

the " I affect " is, according to FREUD, a special characteristicof hysteria. When the distressing idea is repressed butthe distress persists there results, not hysteria, but a

psychasthenia with fixed ideas, phobias, and such like.

What, then, are the ideas which give rise to hysteria?,The answer to this depends upon the psycho-analysis whichis at once a part of the theory and a means of eliciting the

facts upon which the theory is based. According to FREUD,these ideas on the repression of which the hysterical condi-tion arises are sexual ideas, but it will at once be understood

how dangerous psycho-analysis may become if the analyserhas in his mind the idea of getting at some long-buriedsexual memory. So that, however much the theory mayhave to recommend it on psychological grounds, it cannot,for the present at least, be regarded as therapeutically helpful,and we very much doubt whether there is adequate groundfor attaching the importance which FREUD does to sexual

ideas. It is to be hoped that the perusal of this necessarilybrief review will lead many of our readers to betake them.

selves to the original articles, and we congratulate the editorof Brain and his contributors on furnishing English neuro-

logists with a brief but comprehensive treatise on the latest

conceptions of hysteria.

Annotations.

THE MIND OF A CHILD.

"Ne quid nimia." "

THE story. of the seamstress of Montmartre, MargueriteAudoux, is well known to many of our readers, who willhave learned from various articles, whether they have read" Marie-Claire" or not, how the author lived her odd,detached childish life, first in a country convent, then

upon a remote farm, then again in the convent, until

lastly, at the age of 18 or thereabouts, she went to

Paris, working amid squalid surroundings and with failingsight, but never, it seems, without a certain inward

contentment, as a poorly paid needle-woman. To those who

have not read this simple tale we recommend its perusalsincerely-it must have a real interest for medical men.

Marguerite Audoux, the seamstress, drifted by accident-such accidents could more easily happen in Paris than

anywhere-into a little circle of artistic enthusiasts, limners,sculptors, and men and women of letters, and presently shemade to them the shy confession that she, too, had beenwriting for several years. Then she produced for their criticismthe little book "Marie-Claire" which now has made her

famous, for M. Octave Mirbeau’s words have found echo in

many places when he declared that of its kind it is withoutparallel in French letters. Prefacing a conscientious if

somewhat uninspired English translation Mr. Arnold Bennettdescribes it as a divine accident, and after a careful readingof it, in the light of the author’s personal history, few, wethink, would hesitate to endorse at any rate the sense ofthis verdict. Told throughout with delicate reticence,with an admirable, and we must suppose intuitive,selection of the right word and incident, it is difficult to

think of any completer and more transparent revelation of achild’s growing mind than is here presented to us-MargarieFleming, had she lived, might perhaps have produced asimilar book. This reason alone, apart from its literaryinterest, may commend it to every medical man whose prac-tice brings him into frequent association with young children.At the last analysis the work is seen to be no more thana very wise arrangement of extraordinarily vivid visual

memories ; though the fact that the reader instinctivelyrecognises their essential I I rightness " shows that they arenot merely the records of an extravagant or unhealthyimagination, but the revival, admirably lucid, of impres.sions common, in kind at any rate, to every childhood.And this is why perhaps, for us who have so largely