HYSTEEIA. 
BY 
/ 
A. F. A. KING, M.D., 
Prof, of Obstetrics, etc., in the Medical Department of the Cohimbinn University 
Washington. D. C., and in the University of Vermont. Member of the 
American Gynecological Society: of the British Gynecological 
Society; of the Washington Obstetrical and Gynecological 
Society ; and of the Medical, Philosophical, Anthro 
pological, and Biological Societies of Wash- 
ington, D. C., etc. 
[Reprinted from the American Journal of Obstetrics and Diseases 
op Women and Children, Yol. XXIY., No. 5, 1891.] 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891. HYSTERIA 
BY v 
A. F. A. KING, M.D., 
Prof, of Obstetrics, etc., in the Medical Department of the Columbian University, 
Washington, D. C., and in the University of Vermont. Member of the 
American Gynecological Society; of the British Gynecological 
Society; of the Washington Obstetrical and Gynecological 
Society ; and of the Medical, Philosophical, Anthro- 
pological, and Biological Societies of Wash- 
ington, D. C., etc. 
[Reprinted from the American Journal of Obstetrics and Diseases 
op Women and Children, Yol. XXIY., No. 5, 1891,] 
('W<3 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891. hysteria; 
The remarks I propose to present on hysteria in this 
paper are altogether unfinished, undigested, and immature. 
The ideas I have here put down are perhaps scarcely more than 
superficial suggestions that will certainly not hear rigid criti- 
cism. Unwise as it may be to present them thus incompletely, 
still they may be sufficient to indicate, however imperfectly, 
a line of thought upon this disease somewhat different from 
that followed by the recognized authorities. The protean 
malady must submit to being presented in as many different 
ways as it exhibits itself to us. 
The literature of hysteria is exceedingly voluminous. The 
nature and origin of the disease have puzzled the medical mind 
for many centuries; and the puzzle still remains unsolved. 
There must be something wrong in the method of investiga- 
tion : at least it would appear so from the meagre results that 
have ensued. The phenomena and symptoms exhibited have 
been closely studied and graphically described, but the “ why 
and wherefore ” of these phenomena are not at all satisfac- 
torily explained. 
To illustrate this point let me insert a few definitions of 
hysteria from the authors of leading text books. 
In Gould’s “ Yew Medical Dictionary,” just published, 
hysteria is defined as “ a functional disturbance of the ner- 
vous system, supposed by early physicians to be due to the 
disordered condition of the womb. It is now often consid- 
ered a reflex neurosis ; not with certainty known whether it 
1 Read before the Washington Obstetrical and Gynecological Society, 
April 25th, 1890. 4 
KING : HYSTERIA. 
is due to structural alteration of any part of the central 
nervous system, or to abnormal blood supply, etc.” 
In Aitken’s “Practice of Medicine” (vol. ii., page 339) 
this is the definition : 
“A complex morbid condition of all the cerebral func- 
tions, of a chronic kind, probably associated with some 
morbid state of the emotional or sensori-motor centres, and 
presenting every variety of alteration, so that the phenomena 
of hysteria simulate and mimic the phenomena of almost 
every other disease, while the most common and character- 
istic features of the affection are certain motorial changes 
of a convulsive nature and usually of paroxysmal occur- 
rence.” 
Roberts’ “Practice of Medicine ” (page 792) gives this de- 
finition : “ Hysteria is a very complex morbid condition, of 
the nature of which it is impossible to speak definitely. It 
belongs to the nervous disorders, but its exact seat cannot be 
localized, though probably the brain is most disturbed.” 
Bennett’s “ Practice of Medicine ” (page 448) classifies hys- 
teria with chorea, tetanus, etc., under a special section of 
“ Spinal Disorders.” The author writes as follows: u Hys- 
teria— any kind of perverted nervous function, connected 
with uterine derangement. Nothing can be more vague than 
this term.” 
Flint (“ Practice of Medicine,” page 692) writes : “ The 
name hysteria, as commonly used, embraces a multiplicity of 
morbid phenomena. It is used to denote an abnormal con- 
dition of the nervous system and the mind which enters 
largely, as a morbid element, into a great variety of affec- 
tions.” 
Bristowe (“ Theory and Practice of Medicine,” page 1007) 
says : “It is difficult to describe, still more difficult to define, 
hysteria. It may, however, in general terms be said to be a 
functional disorder of the nervous system, occurring mainly 
in females from the age of puberty upward, in which the 
will, the intellect, the emotions, sensation, motion, and the 
various functions which are under the influence of the ner- 
vous system, are involved, or apt to be involved, in a greater 
or less degree.” 
G-raily Hewitt (“ Diseases of "Women,” page 417) remarks : KING : HYSTERIA, 
5 
“In considering the subject of hysteria, I feel that I am 
endeavoring to handle a subject treated of ever since medi- 
cine was a science, but never satisfactorily. The investiga- 
tions concerning it have never come to a point, have never 
resulted in any proposition or position calculated to receive 
universal acceptation ; its nature is confessedly open, in fact, 
to doubt. My early reading . . . was such as to give me the 
impression that there was very little to be learned about it. 
Much that was stated seemed vague and contradictory, and 
the endeavor to make a satisfactory study of the subject ap- 
peared to be so much time thrown away.” These last remarks 
of Dr. Hewitt refer to his “ early reading,” but I think they 
would be equally applicable to the latest literary productions 
on the subject of hysteria. 
Perhaps the best dissertation on hysteria of modern date is 
that by Prof. J. Bussell Reynolds in his “ System of Medi- 
cine” (vol. ii., pp. 82-107). On page 83 he remarks: “It is 
almost impossible to frame an accurate ‘ definition ’ of the dis- 
ease.” Further on (p. 97) he states : “ There is, however, one 
thing common to all cases of hysteria, and that is a perturbed 
condition of the nervous system. The essential character of 
this morbid state is an exaggeration of involuntary motil- 
ity, and a diminution of the jpower of the will (all italics 
mine); the emotional, sensational, and reflex movements are 
in excess, while the voluntary are defective. . . . The will is 
determined by anything rather than by judgment, while ideas, 
feelings, and fancies exert an undue influence. . . . Reflex 
movements, which in health are under some control, are not 
only exaggerated in their individual intensity, as a part of the 
hysteric state, but, from the weakness of volition, are allowed 
to run such riot that they pass beyond all bounds of healthy 
influence.” 
From these definitions it will be at once seen that only the 
phenomena (symptoms) of the disease are stated. No one of 
these definitions attempts to indicate, with any degree of pre- 
cision, the nature and origin of the observed phenomena, 
further than to ascribe them to functional derangement of the 
nervous system. 
But why should this functional perturbation of the nervous 
system occur? To answer this question is the first step to- 6 
KING : HYSTERIA. 
ward comprehending the nature of the disease. Until it is 
answered we can make but little progress. In attempting to 
answer it, let us try to approach the matter, by way of experi- 
ment, from several different standpoints. Perhaps we might 
start out with the supposition that there are different varieties 
of hysteria, whose etiology and pathology require to be sepa- 
rately considered. The term “hysteria” is almost as indefi- 
nite as the term “fever ”. Both words convey the idea of a 
well-known group of phenomena; but as the “fever” group 
varies so much in its nature and origin, giving us many varie- 
ties of fever, so, it would seem likely, may this be true of the- 
“hysteria” group. 
To simplify the present discussion, let us try the experi- 
ment of eliminating all forms of hysteria but one, and so con- 
fine our investigation to this one alone. The other forms may 
fall in line afterward or stay out. There is no more reason 
why all forms should have the same explanation than there is 
that all fevers should have the same etiology and pathology, 
which we know they have not. 
I propose then, as an experiment, that we consider the most 
common form of hysteria as it occurs in the female ; and per- 
haps it might be well to assign this condition a definite name. 
Let us call it sexual hysteria in woman. Hundreds of cases 
of hysteria have been recorded in males, but these do not well 
belong to an “ Obstetrical and Gynecological Society,” nor 
shall I attempt any explanation of them. Though there are 
many cases, on record, they are, nevertheless, extremely rare 
when compared with the more common form of hysteria in 
women. 
Returning, then, and confining our remarks to sexual hyste- 
ria in woman, let us, again by way of experiment, assume as 
a working hypothesis that a typical case of hysteria, when it 
first begins in a young woman, is not, strictly speaking, a dis- 
ease at all, but rather a mere modification in the physiological 
government of the body, executed by the automatic action of 
the ruling nervous system, for some definite, natural purpose. 
The ultimate objects that underlie all the functions of the 
body as they are determined by the government of the ner- 
vous system, are mainly two, viz., the preservation of the life 
of the individual, which comes first and is of first impor- KING : HYSTERIA. 
7 
tance; and, second, the preservation or perpetuation of the 
species. From what we already know of hysteria, there is 
much to suggest that the hysteric process would be more 
nearly allied with the second object than with the first. But, 
reserving any statement on this point for the present, let us 
set down some of the most prominent phenomena that are 
recognized as common characteristics of the hysteric process. 
To prevent confusion I name these characteristics in an ac- 
cidentally arranged numerical order. 
1. The time of life during which hysteria most usually oc- 
curs is between puberty and the “ change of life,” i.e., during 
the age of reproduction. To this there are exceptions, just 
as, exceptionally, menstruation, ovulation, and reproduction 
may occur before the normal period of puberty or after the 
climacteric. 
2. It is not a solitary disease, and does not occur when the 
subject is alone. True, the patient may be temporarily alone, 
as in a room adjoining one occupied by other persons who 
may be expected to come at any time, upon any outcry or 
sign of distress indicating the occurrence of a hysteric parox- 
ysm. Should the patient, however, be thoroughly convinced 
that no one is near, and not likely to be for a long time, the 
hysteric attack will not occur. 
3. In the customary hysteric attack the individual appears 
to he unconscious, hut is not really so. The eyes are closed, so 
that an untaught observer would conclude: This woman does 
not or cannot see. On being spoken to no reply is obtained, 
and the same untaught observer readily concludes : This wo- 
man is either deaf or dumb, or both, as well as blind, or she 
is unconscious. On being touched or handled, provided it be 
not so roughly as to cause actual pain, no recognition of feel- 
ing is manifested, no resistance is exhibited. Should the arm 
be placed extended, it remains so; flex it, and it remains 
flexed. So- of other parts of the body. 
4. Every woman who exhibits the phenomena of a hyste- 
ric attack is always ashamed of it afterwards—instinctively 
ashamed. She will always deny, never acknowledge it; and 
when accused or told of it will become offended and angry. 
This is an inherited and fundamental feature of the process. 
5. It occurs most often in single women, or rather in those, 8 
KING ; HTSTEEIA. 
whether single or married, whose sexual wants remain ungrat- 
ified. “It is sometimes cured by marriage ” (Watson’s “ Prac- 
tice,” p. 455). “ Marriage makes it worse, unless pregnancy 
occur” (Graily Hewitt, page 425). Hippocrates said: “A 
woman’s best remedy in this disease is to marry and bear chil- 
dren ”(“ Cyclop. Pract. Med.,” yoI. ii., p. 573). J. Connelly 
in this “ Cyclopedia ” further remarks upon “ the disappear- 
ance of hysteria after a long-desired marriage,” and that “ in 
many of these cases all the mischief is removed by marriage, 
which, by awakening the natural functions and normal sympa- 
thies, allays the whole series of morbid actions” (vol. ii., p. 
573). “ Carter on Hysteria ” (pp. 35, 36) observes : “ The 
sexual passion is more concerned than any other single emo- 
tion, and perhaps as much as all others put together, in the 
production of the hysteric paroxysm.” He further remarks 
upon the liability to hysteria in women of strong passions 
temporarily or permanently separated from their husbands. 
It has been attributed (I think by Sir Benj. Brodie) to unsuc- 
cessful coitus from the pain due to a large penis. 
6. The hysterical woman does not present any external 
evidence of disease—does not look like an ill woman. Her 
beauty (whatever its degree) is not impaired. Even during 
convulsion “ there is no distortion of the countenance ” (Ait- 
ken’s “ Practice,” vol. ii., p. 340). Dr. Wood remarks (quoted 
by Aitken, p. 341): “ One of the most striking circumstances 
connected with the disease is the general integrity of the 
nutritive process; the patient continues plump and rosy.” 
Even in cases long laid up from hysterical joint affections, it 
has been especially remarked (Aitken, vol. ii., p. 341) “ there 
is no wasting of the glutei muscles, nor flattening of the natesP 
And in cases of so-called hysterical paralysis the apparently 
paralyzed muscles do not atrophy. 
In falling during a “ fit ” (Reynolds’ “ System of Medicine,” 
vol. ii., p. 96) “ the patient does not fall in such a manner as 
to hurt herself or tear her clothes; there is somebody there 
who shall see the phenomenon.” . . . “ The hysteric patient 
gathers her robe around her and falls gracefully.” In a word, 
the process of hysteria, pure and simple, as it is in the begin- 
ning, does not impair the physical Ijecmty of the woman. In- KING : HYSTERIA. 
9 
deed, many of these patients are peculiarly attractive to the 
other sex. 
7. “ There are many facts to show that warmth of climate 
and the seasons of spring and summer conduce to a produc- 
tion of the hysteric condition, but it has yet to be shown what 
is the element comprised under those terms which is of etio- 
logic moment” (Reynolds’ “System of Medicine,” vol. ii., p. 
-85). Yet we know : 
What men call gallantry, and gods adultery, 
Is much more common where the climate’s sultry.” 
—Byron’s Don Juan, canto i., verse Ixiii. 
“ Summer’s indeed a very dangerous season, 
And so is spring about the end of May ; 
The sun, no doubt, is the prevailing reason.” 
—Don Juan, canto i., verse cii. 
8, The hysterical paroxysm is a temporary and short affair. 
The helpless creature, who seems to have lost all her senses 
and sensations, is in a few minutes up and about, apparently 
as well as ever. 
9. Certain regions of the body which appear to be painfully 
byperesthetic are relieved by firm pressure, rough handling, 
and succussion, while light touches or gentle pressure are 
“agonizing in the extreme.” If attention be directed else- 
where, the touch gives no pain. 
10. Idleness, want of occupation, a life without a purpose, 
strongly conduce to hysteria. “ The liability to hysteria,” 
says Sir Benj. Brodie (“Lectures on Local Nervous Affec- 
tions,” p. 37), “is in fact, among females, one of the severest 
penalties of high civilization. It is among those who enjoy 
what are supposed to be the advantages of affluence and an 
easy life that we are to look for cases of this description, not 
among those who, fulfilling the edict of the Deity, 1 eat their 
bread in the sweat of their brow.’ ” 
11. The hysteric patient delights in evoking sympathy. 
She loves to be fondled and caressed ; and, usually, the more 
of this treatment she receives the worse she gets. 
12. The will of the hysteric is perverted and defective, 
while ideas, thoughts, fancies, and emotions exhibit excessive 
activity. She believes she cannot speak, or move, or walk, 
but, on sudden fear or alarm, does either and all very quickly. 10 
KING : HYSTERIA. 
Hence she appears to be “ acting a part.” In some instances 
a hysterical “ fit,” although not strictly volitional, is yet a 
matter of surrender, and might be prevented under the pres- 
sure of an adequate motive. “ The existence of real danger ” 
(i.e., danger to life) “ throws hysteria into temporary abey- 
ance” (Carter, page 144). 
I have now recounted twelve of the common characteristics 
of sexual hysteria in woman—characteristic phenomena de- 
termined by the governing nervous system. The nervous sys- 
tem is so organized as to produce these results instinctively 
and automatically. Since we have not yet been able to dis- 
cover any utility in the actions thus set up by the nervous 
centres of government, we speak of hysteria (see definitions 
previously given) as a “ perturbed,” “ disordered,” and “ab- 
normal” function (or condition) of the nervous system. 
But is there no “ method ” in this “ madness ” of the central 
government ? Why has this nervous system commanded, or 
permitted, in these cases, that emotion should run riot and 
“ volition ” be temporarily put in abeyance ? By what in- 
herited instinct, or property, acquired through ages of an- 
cestry, is the government of the body impelled to this unique 
performance.? To answer this question we must go back to- 
primitive woman: no adequate reply will be possible in 
civilized communities. We must regard a human organism 
as an animal, for such it is ; and such a regard cannot demean 
or disgrace it. 
Now, ‘‘it has been seen that in the lower animals the effects 
produced bg emotional excitement are immediately made sub 
servient to some useful purpose, having reference either to 
the reproduction of the species or to the preservation or sus- 
tentation of the individual • and it is probable that in them 
each kind of feeling is invariably followed by its special and 
proper consequences. But in man this is far from being the 
case” (“Carter on Hysteria,” page 18). 
Let us, however, go back to aboriginal woman—to women 
of the woods and the fields. Let us picture to ourselves a 
young aboriginal Yenus in one of her earliest hysteric par- 
oxysms. In doing so let us not forget some of the twelve 
characteristics previously mentioned. She will not be “ acting KING : HYSTERIA. 
11 
lier part ” alone, or, if alone, it will be in a place where some 
one else is likely soon to discover her. It is only necessary to 
assume one unwarranted fact (and that is one of a limited two) 
to understand all the rest, viz., that this “ some one else ” shall 
be a male instead of a female. To carry out this hypothetical 
case, let this Yenus be now discovered by a youthful Apollo 
of the woods, a man with fully developed animal instincts, but 
without moral, legal, or religious restraint—without, in fact, 
the environments of civilization. He and she, like any other 
animals, are in the free fields of Nature. He cannot but ob- 
serve to himself: This, woman is not dead ; she breathes and 
is warm; she does not look ill; her beauty is wrell preserved ; 
she is well nourished, “ plump and rosy.” He speaks to her ; 
she neither hears (apparently) nor responds. Her eyes are 
closed. He touches, moves, and handles her at his pleasure ; 
she makes no resistance. What will this primitive Apollo do 
next? He will cure the fit and bring the woman back to 
consciousness, satisfy her “emotion ” and restore her “ voli- 
tion ”—not by delicate touches that might be “ agonizing ” to 
her hyperesthetic skin, but by vigorous massage, passive mo- 
tion, and succussion that would be painless. The emotional 
process, on the part of the woman, would end, perhaps, with 
mingled laughter, tears, and shame ; and when accused after- 
wards of the part which the ancestrally acquired properties of 
her nervous system had compelled her to act, as a preliminary 
to the event, what woman would not deny it and be angry ? 
But the course of Nature having been followed, the natural 
purpose of the hysteric paroxysm accomplished, there would 
remain as a result of the treatment—instead of one pining, 
discontented woman—two happy people and the probable be- 
ginning of a third. 
Speaking, then, of natural hysteria when it first begins and 
under natural circumstances (that is to say, without the en- 
vironments and restraints—moral, social, legal, educational, 
and religious—of civilization), we should, from what has now 
been said, reach some such definition as the following; 
Natural, primary, sexual hysteria in woman is a temporary 
modification of the nervous government of the body and in 
the distribution of nerve force (occurring for the most part, as 12 
KING : HYSTERIA. 
we see it to-day, in prudish women of strong moral principle 
whose volition has disposed them to resist every sort of liberty 
or approach from the other sex), consisting in a transient ab- 
dication of the general, volitional, and self-preservational ego, 
while the reins of government are temporarily assigned to the 
usurping power of the reproductive ego, so that the reproduc- 
tive government overrides the government by volition, and 
thus, as it were, forcibly compels the woman’s organism to so 
dispose itself, at a suitable time and place, as to allow, invite, 
and secure the approach of the other sex, whether she will or 
not, to the end that Nature's imperious demand for repro- 
duction shall he obeyed. 
This is the natural function of primary sexual hysteria 
eonsidered physiologically. Can we, strictly speaking, call it 
“ disease ” f 
Before proceeding further I must indulge myself in a some- 
what personal remark. What I have now said might, by an 
ill-disposed critic, be contorted or misconstrued into an accu- 
sation that every hysterical woman is guilty of impure desires 
and is the victim of sexual passion. This is not so. On the 
contrary, what I have stated tends rather to exonerate, and 
completely exonerate, the hysterical person from any such 
charge. The view I have presented traces back the origin of 
the phenomena of hysteria to the automatic action of a govern- 
ing nervous system, acting in obedience to the great principle 
of race perpetuation, which has been developed and handed 
down from generation to generation through long ages of an- 
cestry. The hysterical patient is no more to blame and no 
more responsible for her condition than she is accountable for 
the number of vertebrae in her spinal column, the foundation 
of which was laid thousands of generations ago. 
Returning now to remark further upon the duplex govern- 
ment of the body by the nervous system in hysteria cases, 
I think it most probable that the so-called “double per- 
sonality” and “double consciousness” of hysteric persons, 
which of late years has so much puzzled the French psycho- 
logists, is to be referred to a want of agreement or balance 
of power between the reproductive ego, the object of whose 
government is 'preservation of the race, and the self-preserva- 
tive ego, the object of whose administration is preservation of KING- : HYSTERIA. 
13 
the individual. When a woman says “ I will” it is her first 
personality—what she calls herself—that wills. It is by this 
will power that she decides to walk, to work, obtain food, 
and perform all the acts necessary to maintain individual life- 
in the struggle for existence. If now, when she reaches the 
age of puberty and child-bearing, the imperious demands of 
the reproductive ego clamor for fulfilment, and she again 
says “ I will” and acts accordingly, then there arises no con- 
flict between the two departments of government, and, as a, 
rule, no hysteria. On the other hand, should she decide, with 
regard to the reproductive demand, to say “ I will not ” and 
act accordingly, at once there occurs a want of harmony—“ a. 
disturbance ”—between the two departments of government. 
The department of the creative activities, sustained, as it 
by the hereditary rights of ancestral precedents, practices, and 
habits, is clamorous for the exercise of its reproductive func- 
tion. The executive government of the woman’s first per- 
sonality, her volitional ego (for extraneous reasons of her 
own, usually of a sociological rather than physiological kind), 
opposes and resists the reproductive demand. These are the 
conditions under which hysteria is liable to occur, and to 
which its origin may be traced. When it does occur, there is. 
produced a temporary subjugation of personal volition and 
personal consciousness, automatically compelling the woman’s 
organism to surrender to the government of her reproductive 
personality, either with or without the designed physiological 
purpose of the process being accomplished—in civilized life, 
often without it; in prehistoric or natural life, usually with 
it. While, as just stated, hysteria is liable to occur under 
the conditions given, it does not always do so. This is easily 
explicable as follows: Should the woman’s habits, and occu- 
pation, and modes of thought be of such a kind as to insure 
a daily expenditure of nervous energy in muscular exercise, 
intellectual activity, social amusement, and unemotional play, 
etc., so as to absorb any surplus of nerve force that would 
otherwise flow towards the reproductive object, then she will 
escape hysteria. Her nerve energies are, in fact, being ex- 
pended in matters pertaining to the self-preservational object 
—upon matters naturally directed towards obtaining a living. 
But now change the conditions : place the woman in abject 14 
idleness, both muscular and mental; supply her with' the 
most luxurious food, which she obtains without any effort of 
her own ; add solitude instead of social diversion, and litera- 
ture which shall direct her thoughts into emotional channels; 
let there be no expenditure of nerve force in the struggle for 
existence, and, therefore, no natural channel for distributing 
surplus nerve energy other than reproduction, which last 
she, of her own will, refuses to undertake—let this mode of 
life be continued, and sooner or later hysteria will usually 
result. 
KING : HYSTERIA. 
There are many familiar events that illustrate this duplex 
government of the body, and which show the normal superior 
influence of the self-preservational ego over the reproductive 
one. And this comparative rank is as it should be. The 
life of the individual is necessarily of first importance; for 
if that be sacrificed in securing impregnation, it avails no- 
thing : the ovule cannot develop in the dead. Hence we find, 
a patient in the quasi-unconscious condition of hysteria, 
.should she be deluged with cold water or burned with fire, 
will resume consciousness, get up, and run away. The water 
and fire convey to the governing nervous system the im- 
pression of danger to life. At once the temporary admin- 
istration of the reproductive ego is deposed; at once the 
self-preservational ego reassumes the reins of government. 
Only thoroughly frighten a hysterical woman—convey to her 
nerve centres the impression that life is in danger—and 
though she should have remained (apparently) paralyzed for 
years, she will get up and walk. The twm departments of 
the government instantly readjust their powers in order to 
protect the individual life. It occurred to me some time 
ago that the treatment of a hysterical attack in accordance 
with the principle above stated—i.e., by calling into play the 
action of the self-preservational ego—might conveniently be 
achieved by simply holding the woman’s nose and closing her 
mouth, so as to convey to the central nervous system the im- 
pression of danger to life from suspended respiration. I was 
therefore gratified to find later on that such a plan had been 
long ago tested and found successful. Hr. Hewitt speaks of 
it as “Dr. Hare’s plan of suffocation.” In describing a case 
(“Hewitt on Women,” pp. 422, 423) Dr. Hewitt says: “Slap- 15 
ping of the face and placing strong liquor ammonia under the 
nostrils had no effect, but she was quickly subdued by Dr. 
Hare’s plan of suffocation” . . . “Subsequent to this she 
had many similar attacks, sometimes as many as five or six in 
a day. They were all stopped by the suffocating process,” 
KING : HYSTERIA. 
The self-preservational nerve centres have acquired, ages 
ago, a proper appreciation of the importance to life of respira- 
tion• they soon appreciate the hesoin derespirer, and automati- 
cally adopt measures to remove it. Possibly, if we could make 
a device to produce a sound closely resembling that of a rattle- 
snake, and place it near the person of a hysteric woman 
(without her knowledge), the nerve centres, by a sort of 
ancestral memory, would perhaps recognize the signal of 
danger and prompt the woman to speedily change her place, 
much as a mouse instinctively avoids its natural enemy, the 
cat. 
This dual government, or double personality, of the human 
body—the two departments of reproduction and self-preser- 
vation—have been referred to, almost unknowingly, by the 
most ancient of writers. Even good old St. Paul, who is 
stated to have written his Epistle to the Romans in the year 
60 a.d., tells us (in chapter vii.) that sin had wrought in him 
“all manner of concupiscence” or lust (verse 8). Then he 
goes on to describe the conflict of himself with his second or 
reproductive personality, thus: “ That which I do, I allow 
not: for what I would, that do I not; but what I hate, that 
do I.” “To will is present with me ; but how to perform 
that which’is good, I find not.” “For the good that I would, 
Ido not: but the evil which I would not, that I do.” “How 
if I do that I would not, it is no more I that do it, but sin 
that dwelleth in me.” “ I find then a law, that when I 
would do good, evil is present with me.” “ I see another 
law in my members, warring against the law of my mind, 
and bringing me into captivity to the law of sin which is 
in my members.” This simply illustrates the conflict be- 
tween the emotions of the reproductive ego and the volition 
of the personal, self preservative ego —a conflict noted over 
and over again by poets and dramatists in modern times, as il- 
lustrated in one of Byron’s characters (in “ Don Juan”), who, 16 
“ swearing she would nder consent, consented.” So Bucking- 
ham, in counselling Gloster to accept the crown, says: 
KING : HYSTERIA. 
“ And be not easily won to our requests ; 
Play the maid’s part, still answer nay, and take it.” 
—Richard 111., act iii., scene vii. 
In addition to these Biblical, poetic, and dramatic references, 
let me cite a few quotations of more modern date and more 
scientific value. In referring to the discussion on double con- 
sciousness, raised by himself, at the Paris Congress of Physi- 
ological Psychology recently, Dr. Alfred Binet says : “ The 
problem that I seek to solve is, to understand how and why 
in hysterical patients a division of consciousness takes place ” 
(Open Court, December 12th, 1889, No. 120, page 1983). 
“In other words, the question we ask is, What are the 
psycho-physiological conditions that determine the formation 
of a second consciousness?” (page 1984, ibid.). He further 
observes (Open Court, No. 112, October 17th, 1889, page 
1887): “We know of observations in which this second 
personality, ever awake, is seen gradually to develop more 
and more, and to assume the initiative in conduct, instead 
of the first personality which is temporarily annihilated.” 
Again: “ The facts above set forth have led me to the 
assumption that there may exist in hysterical patients two 
rational faculties, that are mutually ignorant of each other.” 
And still again he repeats: “ I believe it satisfactorily estab- 
lished, in a general way, that two states of consciousness, not 
known to each other, can co-exist in the mind of an hysterical 
patient ” (page 1887). 
This, perhaps, is not the place nor a proper society for the 
discussion of psychological matters. I leave it, therefore, 
after remarking that I believe the true key to the under- 
standing of Binet’s problems, as well as to the phenomena of 
so-called “hypnotism,” “somnambulism,” “ automatism,”etc., 
is to be found by recognizing the two departments of physiolo- 
gical government—creative and conservative—individual pre- 
servation and race preservation. When the two departments 
execute their respective functions of government successfully 
and in harmony with each other and with Nature, no abnormal 
phenomena will be encountered. When otherwise, the result 
will be reversed. KING : HYSTERIA. 
17 
Since I have spoken of “primary sexual hysteria in woman” 
as a modification of nerve government designed to accomplish 
a physiological purpose, it is very apparent that old-standing 
chronic cases, lasting for years and drifting into hystero- 
epilepsy, etc., require a different explanation. This explana- 
tion will be found, perhaps, somewhat as follows: We must 
constantly bear in mind that in dealing with the hysteric 
process of to-day we are dealing with it while the woman 
is surrounded by the environments of civilization, and not 
by the ancient environments of ancestral times. This makes 
a vast difference. To study successfully any natural pro- 
cess we must stpdy it in its natural state, with its natural 
surroundings. Now, it is scarcely likely that primary ances- 
tral hysteria would ever fail (perhaps not once in a thousand 
times), with ancestral surroundings, of securing the accom- 
plishment of the physiological purpose for which I have sug- 
gested it was designed; and this would at once end the hys- 
teric process. On the contrary, in civilized life, the hysteric 
process not attaining its designed result, we find it being re- 
peated over and over, five or six times a day, for perhaps 
weeks, months, or even years, in obedience to the same nervous 
mechanism of government'which prompted it in the begin- 
ning. Hence what should naturally have been a transient and 
temporary affair has become the reverse. That portion of the 
nervous system other than what belongs to the intellectual 
and volitional ego of the individual, has no intelligence at all, 
but is simply an automaton, acting in obedience to qualities 
acquired from ancestors. It cannot appreciate, therefore, in 
determining the hysteric process, that the design of the pro- 
cess is to be thwarted by the customs of modern society, by 
the laws of states, the edicts of thrones, and the tenets of re- 
ligion, which constitute so potent an element in the environ- 
ments of civilization. Under these circumstances the hysteric 
process is useless and superfluous, and ludicrously impotent 
of any physiological result. From frequent repetition it be- 
comes a habit of the nervous system—“nerve force flows read- 
ily through habitually used channels”—hence it is likely to 
recur, and does so recur, under slight emotions that have no 
direct relation with reproduction. The original natural object 
of hysteria (which ought to have been promptly attained) be- 18 
king: hysteria.- 
comes buried so deeply in accumulated and repeated disap- 
pointments that the automatic nervous system lias no inher- 
ited quality that enables it to meet the unnatural emergency. 
It keeps on, like any other machine, all the time instigating 
the woman’s body to do over and over again that which, 
under the circumstances, is useless. If the physiological view 
of hysteria (as I have presented it) be true, the occurrence of 
the hysteric process in the presence of females, and when no 
male is near, becomes ludicrous. The imperious impulses and 
emotions of the sexual instinct are so overpowering and man- 
datory ; the preparations for reproduction in the female organ- 
ism, and the consequent accumulation of nerve force, so ex- 
tensive, that the preliminary event of insemination cannot be 
ruthlessly and recklessly postponed over and over again with- 
out seriously disturbing the functions of the nervous system ; 
and this “functional disturbance of the nervous system” is 
the disturbance constantly referred to in the text-book defi- 
nitions of hysteria previously quoted. It is, in fact, a dis- 
turbance in the gubernatorial function of the nervous system, 
consequent upon a part of the territory governed (the repro- 
ductive part) refusing to obey those laws of hsature which it is 
the chief office of the nervous system to administer and enforce 
as best it can. 
There is yet another class of cases that need further expla- 
nation, viz., those cases occurring in married women who have 
had children. Of these I might say, though not perhaps quite 
fairly, they may not belong to the “ sexual hysteria ”we are 
here considering. Emotions other than sexual may disturb 
the functions of the nervous system and produce quasi-physi- 
ological hysteria. Furthermore, are we always quite sure that 
the hysterical habit was not acquired before marriage, and, 
having become chronic, persists, in spite of marriage, after- 
ward % Moreover, the results of childbirth or abortions may 
leave lesions, traumatic or otherwise, of the reproductive or- 
gans themselves, which may produce, as it were artificially, 
functional disturbance of the nervous system resembling the 
hysteria we have called physiological. The process of emesis, 
produced by poisonous matters in the stomach, is, though not 
a normal process, yet a natural one, and serves the purpose oi 
ejecting the offending substances. Emesis, however, may be 19 
KING : HYSTERIA. 
produced by tickling the throat with a feather, even though 
the stomach be empty. The one is natural (and useful) eme- 
sis, the other artificial (and useless). So with natural and 
artificial hysteria. The nervous system, like an automatic 
machine, reacts in obe'dience to environing actions, and the 
hysteric and emetic processes are produced without any intel- 
ligent perception on the part of the gubernatorial automaton 
as to what the result will be. Hysteria, howrever, from or- 
ganic lesion of the reproductive organs is not so common as 
Avas once supposed. I agree with Goodell, who, in an excel- 
lent lecture in the Philadelphia Medical News (December 
7th, 1889), lays great stress upon the statement that the 
symptoms so often attributed to uterine-diseases are really 
neurotic troubles. 
TREATMENT. 
To test the truth of Avhat has been thus far said, let us next 
consider the principles of treatment dedncible therefrom, and 
their efficacy. There are several methods of treatment which 
experience has demonstrated are severally efficacious in dif- 
ferent cases. 
1. Marriage.—This is Nature’s remedy, and will, in the 
large majority of cases, be effectual if not unduly postponed. 
2. Oophorectomy.—When the ovaries are taken out the pa- 
tient becomes a female eunuch. The organs of reproduction, 
over which the nervous system presided, are no longer per- 
forming, or likely or able to perform, their natural function; 
the body goes back to its ante-puberic, or on to its post- 
climacteric, state. Physiological hysteria can now accomplish 
no utilitarian purpose. It will cease to occur, for the reasons 
stated. 
3. Narcotics, Alcoholics, etc.—By opium*, alcoholic stimu- 
lants, etc., Avhich stiimdate the nerve centres pertaining to the 
cerebral functions of volition and the self-preservative ego, 
these centres may temporarily regain the ascendency over, and 
take precedence of, the reproductive ego, and so dispel or post- 
pone hysteria. The benefit, however, could be only tempo- 
rary, and the method of treatment should not be resorted to, 
on account of the liability of the nervous system to attain the 
opium or alcohol habit, either of which would be more dan- 
gerous than the hysteric process. 20 
"RING : HYSTERIA. 
4. Intellectual and Muscular Exercise.—These exercises 
simply mean phases of effort on the part of the self-preser- 
vative ego to maintain life—to struggle for existence. They 
require constant volitional effort on the part of the patient, 
and when volitional effort has become a habit, whether from 
necessity or choice, the nerve force will flow through these 
now accustomed channels, will be diverted from the channel 
leading to reproductive effort, and the hysteria will be re- 
lieved. The volitional effort on the part of the patient, how- 
ever, must be enforced by circumstances (poverty, etc.), or by 
the will of another person compelling her to perform the re- 
quisite amount of mental and muscular work or play. In the 
absence of marriage, and without spaying, this constitutes the 
most rational and scientific method of curing chronic hysteria; 
but it is exceedingly difficult, tedious, and bothersome, and 
requires that the “ other person ” exercising volitional control 
of the patient should be almost constantly present. 
5. Valerianetc.—There is something extremely unique 
and inexplicable in the effect of valerian upon hysteric pa- 
tients. The subject of hysteria may present all the phenomena 
of hysteric “unconsciousness,” and, when a little fluid extract 
of valerian is forced into her mouth, recover all her faculties 
in a few seconds. This we have all repeatedly witnessed. The 
valerian cannot have been absorbed so quickly. Can its pecu- 
liar efficacy be attributed to its peculiar odor f It may here 
be observed that musk, camphor, asafetida, etc.—medicines 
with strong odors—are among the best medicinal remedies for 
hysteria. The odor of burnt rags or burnt feathers or hair- 
popular remedies for hysteric paroxysms—may be more easily 
explained : they may suggest to the self-preservative nerve 
centres the idea of fire, and consequently danger to life. Was 
there, in ancestral times, any snake, or other natural enemy of 
man, that possessed the odor of valerian ? If so, the effect of 
the medicine in awakening the self-preservative ego by con- 
veying a sense of danger to life, and so restoring normal con- 
sciousness, would be apparent. 
The points considered, or suggested for consideration, in the 
foregoing remarks, are as follows : 
1. The natural history, origin, and pathology of hysteria 
have- not been thus far satisfactorily explained. The disease KING ; HYSTERIA. 
21 
lias been regarded as a functional disturbance of the nervous 
system, the nature of which is not settled. 
2. Are there not different varieties of hysteria, as there are 
different varieties of fever? 
3, The most common form of hysteria in women is inti- 
mately related with the reproductive and sexual functions, 
and should be designated as “sexual hysteria in women.” 
4. Is it strictly correct to call this condition a “ disease ” f 
Should it not rather be regarded as a functional modification 
of the nervous government of the body, designed for the pur- 
pose of race preservation ? 
5. Many of the more common characteristics of hysteria— 
viz., (a) the time of life at which it occurs ; (h) its not being a 
solitary disease; if) the unconsciousness exhibited being only 
apparent, not real; (cl) the woman being ashamed of it after- 
ward ; (e) its occurrence chiefly in women who do not repro- 
duce, and its cure by reproduction ; (f) the woman preserv- 
ing her beauty ; (y) the paroxysms being short and temporary ; 
if) the season of the year at which it is most prevalent; (i) its 
occurrence in the higher walks of life ; (j) the patient longing 
for sympathy, etc.—suggest that the hysteric process among 
primitive women in prehistoric times was favorable to secure 
the approach of the other sex. 
6. The influence of the hysteric process in this direction 
indicates that primarily, and without the environments of 
ci\ ilization, approach of the other sex would by it be accom- 
plished. 
7. The modification of nerve government which produces 
the hysteric process consists in a temporary abdication of the 
self-conservative ego and an usurpation of power by the re- 
productive ego. The conflict between these two departments 
of government has been unknowingly recognized for many 
centuries, and explains the well-known “double personality” 
or “ double consciousness ” of hysterical patients. 
8. The physiological function of hysteria, as it occurred 
before civilization, was to secure insemination. The purpose 
was then usually accomplished. The function of hysteria in 
civilized communities not being accomplished, the cases be- 
come chronic and drift into all sorts of irregularities, far re- 
moved from the original type, and presenting phenomena that, 22 
KING : HYSTERIA. 
taken alone, appear to conceal, cover up, or even antagonize 
any idea of functional utility. 
9. The rationale of modern successful methods of treat- 
ment is in accord with the preceding views, and tends to cor- 
roborate their correctness.