beating of the feet, jactitations, etc., followed by hysterical crying." 2 Definite figures are of much greater value than 1 See, for instance, D. Buxton, Anastheties, p. 204. Dr. Silk remarks that sexual emotions during anaesthesia are " rarely observable in men."
f J. F. W. Silk, Manual 0/ Nit. Ox. Anastkesia.
Google 272 MAN AND WOMAN.
general observations, and these on the whole fully confirm the general impressions already recorded. Thus Mr. Gunn has found that females are much more liable to vomit after anaesthetics than males; of about 2000 males and nearly 2000 females who were anaesthetised at Moorfields Ophthalmic Hospital 51 per cent of the females and 40 per cent of the males were sick; 1 it must be added that Dr. Silk finds vomiting, both in childhood and adult age, more common in males, though he also finds that excessive evolution of intestinal flatulence under anaesthesia occurs almost exclusively among women. It is to Dr. Silk that we owe the most valuable contribution yet made to the precise knowledge of sexual differ- ences as revealed by anaesthetics. 2 Of his 1000 cases 240 were in men, 760 were in women; the average age in each sex was 24 years. It is the tendency to muscular movement which may be most easily observed. Rhythmic movements, such as swinging the legs, beating time to music with the hands, etc., were observed 27 times; it is impossible to say in what class of patients such movements are to be expected; 6 (or 2.5 per cent) of Dr. Silk's male cases showed such movements; 21 (or 2.8 percent) of the female cases. The excess of females is here scarcely perceptible; it is much more marked in regard to rigid muscular contractions of an opistho- tonic character; it was noted in only 17 (or 7.1 per cent) males, but in 89 (or 1 1.7 per cent) females. A tendency to opisthotonus was observed in 7 males (or 2.9 per cent) and in 44 females (or 5.8 per cent). Erotic symptoms were found by Dr. Silk to have undoubtedly occurred in six cases out of the whole series, and always in women, with one exception in 1 R. Marcus Gunn, Brit, Med. Journal, July 21, 1883.
1 J. F. W. Silk, " An Analysis of a Series of 1000 Nitrous Oxide Administrations Recorded Systematically," Trans. Odontological Soc., June 189a I am indebted to Dr. Silk for further elucidations regarding several points, and also for additional figures.
Google HYPNOTIC PHENOMENA. 273 young unmarried women under the age of 24. In- voluntary micturition occurred ten times, invariably in females; twice in children under 14 (which was, relatively, a large proportion, t\e. t 20 per cent), the. remainder in women between that age and 40.
I take these results chiefly from the published paper already mentioned, but recently Dr. Silk has been good enough to place in my hands the general results of a very much larger number of cases — not less than 5119, of whom 1 7 19 were males, 3400 females; 889 were children under the age of 15. The anaesthetic used was chiefly, although not exclusively, nitrous oxide. The results of this larger investigation con- firm, while at the same time to some extent modify- ing, the results founded on the smaller number of observations. It was found that there was a decided excess of vomiting among males, defecation and rhythmic movements were about equal in the two sexes; in all other respects females were in a majority, and usually in a very large majority. Thus the tendency to opisthotonus occurred 74 times instead of 46 times, as it should have done in order to agree with the male ratio. Erotic phenomena occurred 18 times, but only once in a man; to preserve the male ratio they should only have occurred twice among the women. Micturition occurred 23 times in women, in- stead of 8 times which would have been in the same proportion as among the males, in whom it occurred only 4 times. If we separate the children (under 15) from the adults, we find that rhythmic movements occur almost exclusively in adults; intestinal rumbling occurs almost exclusively in adult women. Of the 4 male cases of micturition only one was in an adult, but of the 23 female cases 16 were in adults; the erotic phenomena were of course exclusively in adults.
The evidence furnished by the human organism under the influence of anaesthetics, which abolish conscious and voluntary action, is peculiarly reliable 18 Google 274 MAN AND WOMAN.
and the figures here given, which include a sufficient number of cases to insure trustworthy results, all point more or less plainly to one conclusion: hypnotic phenomena are more frequent and more marked in women than in men; the lower nervous centres in women are more rebellious to control than those of men, and more readily brought into action.
METEOROLOGIC SENSIBILITY.
This is not, strictly speaking, a form of sensibility at all, and it has no connection with any of the sense- organs. It is really a form of what we shall later on be concerned with as "affectability," and is therefore allied to emotional states. It may perhaps be fairly considered among hypnotic phenomena.
Atmospheric changes are announced, some time in advance, by modifications of the electric, barometric, thermic, hygrometric, and possibly magnetic condi- tions, and by a number of other physical changes, to which, for the most part, civilised people have become insensitive.
Animals, however, of all kinds — sheep, pigs, fish, ducks, grouse, etc. — can perceive these changes, and understand what they foretell. It has indeed been said by an acute observer of animal life that "there are few animals which do not afford timely and sure prognostications of changes in the weather. ' n In man, although the meteorologic sense, as Beaunis calls it, is not universal, it is by no means uncommon to find individuals who are very sensitive to the approach of atmospheric disturbances, mere especially to storms. This sensibility may be exhibited by varying phenomena — heaviness of the head, general discomfort, a sense of oppression, vague pains, etc Thus a snowstorm may be invariably preceded by gastric disturbances, nervous irritability, mental and 1 St. John, Wild Sports of the Highlands, chap, xxxiii.
Google HYPNOTIC PHENOMENA. 275 general depression a day or two in advance; and rheumatic subjects often experience pains in their bones with barometric certainty. Beaunis states (as also Gavarret had previously stated) that such sensi- bility is more common in women and in children, and although I am not aware that any statistical proof of this has yet been brought forward, any one whose attention has been called to this point will probably have observed the greater frequency of meteorologic sensibility in women. The best subjects are of nervous or neurotic temperament Meteorologic sensibility is not only shown in relation to changes in the weather; it is also shown by susceptibility to the influence of seasonal changes. One form in which this sensibility to season exhibits itself is by special tendency to general nervous depression of the organism during a particular period of the year, usually the spring; I am acquainted with too few cases of this idiosyn- crasy to be able to say whether it is more frequent in women, though I am inclined to think that it is.
Sensibility to the influence of seasonal changes is shown in a marked manner by the prevalence of insanity and suicide during the spring and summer months. Suicide by no means necessarily implies insanity; it involves, however, a similar condition of mental instability, and it is largely subject to the same cosmic laws.
Morselli, in his monograph on Suicide, notes in women the quicker development of suicidal tendency during the summer season or the first warmth of spring. " The greater proportion of suicides among women," he remarks, " is manifest, whether during the whole season (Italy, Prussia, and Saxony) or in the warmest months of June (France) or July (Bavaria). In Italy and Saxony is to be noted the same prevalence of suicides among women in the months of April and May, while the proportion offered by women in certain warm months (as July Google 276 MAN AND WOMAN.
in Bavaria) largely exceeds the highest monthly average of men." Turning to the question, "What is the monthly average of suicides through mental disease in the two sexes?" Morselli found from the data he collected that "among women violent deaths through madness are proportionately more numerous in those months which, by reason of their average temperature, operate fatally — that is, in April, when the first heat, though not intense, is felt exceedingly by the cerebral organism not yet accustomed to it, and in July, when the average monthly temperature reaches the maximum of the year."
It must be added that some slight examination of the suicide rates that I have been able to make, considering them not by month but by season, do not altogether confirm Morselli's conclusions. In Saxony, for example, during the years 1876-79, I find that while 28.5 of the total male suicides took place in the spring, only 26. 1 of the female suicides were committed during that season. And if we group together the Teutonic and Scandinavian countries — Prussia (1869-72), Saxony (1876-79), Den- mark (1874-78), Norway (1866-70), Sweden (1833-51) — it will be found that out of a total of 18,836 male suicides 28.3 per cent occurred in spring, and out of a total of 4815 female suicides 28.2 occurred in spring; while 30.3 per cent of the male suicides and 29.3 per cent of the female suicides were com- mitted in summer; 22.5 per cent male suicides and 23.6 per cent female suicides were committed in autumn, and precisely the same percentage of 18.9 male and female suicides took place during the winter. This shows no marked sexual differ- ence, and the preponderance of women in the autumn is almost exactly balanced by the prepon- derance of men in the summer. Morselli's con- clusions cannot be accepted unreservedly without further investigation.
Google HYPNOTIC PHENOMENA. Iff As to the varying incidence of insanity, month by month, in the two sexes, I do not possess much evidence. So far as I am aware, the question of any sexual difference in this respect has not been raised. Figures of 2669 admissions to asylums in France, supplied by Parchappe to Bucknill and Tuke, 1 seemed to show that men were more affected by season than women. The result is different, how- ever, if we turn to the very much larger figures (nearly 40,000) supplied by Scotch asylums during eighteen years. 2 Per 1000 men during the years 1865-74 the excess of admissions during the spring and summer over the autumn and winter was 54, and during the years 1880-87 it was 58. For women dur- ing the first period the excess in spring and summer over autumn and winter was 66, and during the second period 76. During the three spring months the pro- portion of male insane admitted was 27. 1 per cent, that of females 27.5 per cent Or, expressed in another way, while in the months of January during these years the admissions of men and women were nearly equal, being 1493 men to 148 1 women, in May there were 1669 men admitted to 1952 women, being a large excess of women. The greater sensitiveness of women to this seasonal influence is therefore in Scotland fairly constant and well marked.
On the whole, there is still need of further investigation before it can be asserted as a general rule that the chief varieties of meteorologic sensi- bility are more marked in women than in men.
Daily observations of the pulse-rate, temperature, etc., all furnish a fruitful field for the investigation of the various monthly, yearly, and other physiological rhythms, which has at present been very little exploited.
1 Manual of Psychological Medicine, 1858, p. 249.
* Reports of Board of Commissioners in Lunacy, Scotland, 17th Report, p. 26, and 31st Report, p. 28. Quoted, with many observa- tions on the physiological influence of season, in Leffingwell's Influ- ence of Seasons upon Conduct (Social Science Series), 1892, pp. xoi, Google 278 MAN AND WOMAN.
There is also an interesting connection between meteorologic sensibility and seasonal influences on the rate of bodily growth. The investigations of Wretlind in Sweden, and of Wahl, and especially Mailing- Hansen in Denmark, have shown that season exercises a very marked influence on the rate of growth of children. It is not yet quite clear to what extent this seasonal influence is connected with the influence of holidays, but there is no doubt that it is very largely a genuine and regular physio- logical phenomenon. Malling-Hansen has shown that from the point of view of body-growth there are three seasons in a child's year: — (1) from the end of November or beginning of Decem- ber until the end of March or beginning of April; during the whole of this period, development, both as regards height and weight, is at a low ebb; (2) from March-April until July- August; during this period there is great development in height but no increase in weight, even some loss; (3) from July- August to November-December; this is the period of growth in weight; the daily increase is at this time three times as great as during the winter, but increase in height is at a minimum.
There are slight independent oscillations in growth, chiefly depending on changes in temperature; thus Malling-Hansen shows that even an elevated temperature lasting only a few days will produce an increase in growth. It is of great interest to observe that the period of physical quiescence corresponds almost precisely with the period of emotional quiescence, as shown by the comparative infrequency of insanity, suicide, murder, and offences against chastity. I have not seen Mailing- Hansen's original memoir, and cannot say whether his figures show any marked sexual differences.
NEURASTHENIA AND HYSTERIA.
Neurasthenia and hysteria are probably the typical nervous disorders of women. Our attention is called to them here because in their main outlines they exhibit the characteristics common to hypnotic phenomena generally.
Neurasthenia, as it is now generally called, — or spinal irritation, nervosism, etc., as it was formerly called, — is not a modern complaint It is at least as old as Hippocrates, the Father of Medicine, although it was only during the present century that — owing chiefly to Beard in America and Bouchut in France — it has been fully described. Even now, however, Google HYPNOTIC PHENOMENA. 279 neurasthenia is only a large collection of vague nervous symptoms which not all authorities can reckon as a definite disorder; thus Schule and Mendel are inclined to class a large number of such cases as hypochondriasis, while others would consider them as mild examples of melancholia, hysteria, etc. It is of no interest from our present point of view how the phenomena are classified or what they are called. There is general agreement that under any name they are much more common in women. In the experience of some authorities as many as fourteen out of every fifteen cases are women, though this is no doubt an excessive proportion. The symptoms are, generally speaking, a weakness of the nervous system — including both brain and spinal cord — due partly to insufficient or inappropriate nutrition and partly to faulty development, showing itself by a tendency to over-action and irritability of the nervous system, morbid sensibility, and mental anxiety. It may present all degrees of intensity, and although it is not a definite organic disease, the neurasthenic condition is the soil on which organic nervous diseases may grow. It is the " neuropathic diathesis/' The study of neurasthenia throws so much light on the nature and on the beginnings of the nervous and hypnotic conditions which are especially common in women, that it seems worth while to indicate its chief outlines. I will especially follow the admirable and precise account given by Professor Rudolf Arndt of Greifswald in his article on " Neurasthenia * in the Dictionary of Psychological Medicine. The distinct peculiarities of neurasthenia are negative rather than positive. We are sure to find either hypochondriacal or paralytiform or epileptoid or hysteroid symptoms, but they are not sufficiently developed to enable us to say that hypochondriasis or melan- cholia or general paralysis, epilepsy or hysteria or locomotor ataxy, is really present, although any of these diseases may possibly emerge ultimately; it must be remembered that there is no function without an organ, and therefore no functional dis- order without an organic basis which may develop into a definite disease.
Although in neurasthenia there is really deficient nervous power, there appears, in accordance with a well-recognised law Google 2$0 MAN AND WOMAN.
of nerve-stimulation, to be an increase of nervous energy. This is because there is a decrease of nerve-resistance, and the nervous system responds too readily and too emphatically to a slight degree of stimulation. This exaggerated excitability, which is characteristic of neurasthenia, is therefore closely associated with that loss of complete control which we have found to be an essential element in all hypnotic phenomena. At a later stage this increased excitability rapidly decreases; the nerve becomes blunted or paralysed, and fails to respond adequately even to strong stimulation.
Sensory nerves being normally more excitable than motor, hyperesthesia, or morbid sensibility, appears somewhat earlier than muscular weakness: these two symptoms — hyperesthesia and muscular weakness — are the chief characteristics of neur- asthenia. No objective foundation can be found for the hyper- esthesia, which is the most common phenomenon, so that it is often regarded as imaginary, although it is far from imaginary to the patient, and may cause misery during the greater part of life. All kinds of unpleasant sensations and pains are felt in all parts of the body, and, as in all sensations and pains the brain must take part, we have in neurasthenia an element of what has been called cerebral irritation. This cerebral irritation is often shown by all sorts of morbid dreads which may find a kind of basis in the abnormal sensations. Thus we may have agoraphobia or the fear of open spaces, claustrophobia or the fear of enclosed spaces, anthropophobia or the fear of being with others, rupophobia or the fear of being dirty, nyctophobia or the fear of night, and a vast number of other fears to which it is not worth while to give names. (A vivid literary picture of such morbid obsession is to be found in a chapter of Borrow's Lavengroj it is undoubtedly taken from life.) In the simplest and most elementary form these fears may be called natural; in their most pronounced form, and carried beyond all control of reason, they belong to the domain of insanity; in neurasthenia we have them in an intermediate stage.
The abnormal motor phenomena correspond to the sensory. At first they are excessive, as they are in all varieties of hypnotic phenomena; spasmodic cramps and twitchings are present with great frequency, but languor and immobility may also be present The pupils are dilated or unequal; the tendon reflexes are exaggerated; yawning is often frequent, and there is a tendency to blush, which Beard and other authorities consider as a very characteristic symptom of neurasthenia.
Neurasthenia is a general condition of agitation of the nervous system, and it is not surprising that we find it with especial frequency in both men and women Google HYPNOTIC PHENOMENA. 28 1 who overstrain their brains, in artists and writers and those who are over-strenuous in social move- ments. Hysteria, which is one of the chief of the more definite diseases to which neurasthenia may lead, has no necessary connection of this kind with mental tension. It occurs with much greater fre- quency among those whose nervous activities are unemployed.
Although one of the greatest of the old English physicians, Sydenham, laid our knowledge of hys- teria on a sound and scientific basis, the word has too often been used in a loose and inaccurate sense, or even as a mere term of abuse, and it is only within recent years that it has been somewhat more rigidly defined and its nature more precisely investi- gated in detail. This advance is very largely owing to the initiative of Charcot and to the brilliant and painstaking students of nervous disease who have grown up around him at the Salp&riere. 1 Hysteria is a disease which affects the whole nervous system, and more especially the brain; it is, as Charcot taught and is now usually agreed, essentially a psychic disease. 2 If we try to make clear to ourselves the broad general character of the mental phenomena in hysteria, we shall find that they may be summed up in one word — suggestibility. 8 Response to suggestion is a funda- mental normal character of all nervous tissue. Even among bees it is said that when a band of brigand bees enter a strange hive to despoil it of honey, the owners of the hive are themselves sometimes so carried away by the contagion of rapine that they 1 For a clear and judicious summary of the present position of know- ledge regarding hysteria, see Gilles de la Tourette, Traite* clinique et therapeutique de VHystirie % d'apres V enstignement de la Salpeiriere, Paris, 1 89 1. For a still more recent discussion of the latest definitions of hysteria, see the articles by Pierre Janet in the Archives de Neuro- logic, vol. xxv., 1893.
8 See the admirable chapter on the mental condition in hysteria in Gilles de la Tourette's Traiti clinique \ etc., 1891, pp. 486-555- Google 282 MAN AND WOMAN.
will even go over to the robbers' side and assist in destroying the result of their own labours. The same irrational suggestibility is found among healthy human beings, at all events in an incipient state. An English prison matron confessed that sometimes when she heard the women under her care " break out " (as it is called) and commence smashing and destroying everything they could get hold of, it was as much as she could do to restrain herself from joining in; and many persons have experienced a similar impulse. In hysteria this tendency is so heightened that it becomes irresistible, and may be aroused by the faintest suggestion from without, and also from with- in. Thus there is what Huchard, who belongs to a somewhat older school, calls moral ataxy. 1 And Fe>6, in allusion to this almost uncontrollable response to stimuli, has called the hysterical subject " the frog of psychology."
Dr. Conolly Norman (who considers that "weakness, with irritability, is the fundamental note of the hysterical character") has the following observations on "hysterical mania," a form of insanity which is combined with hysteria: — " The sufferer from hysterical mania is exceedingly emotional. The pain of melancholia is unknown, the appearance of depression is very shallow. A trifling and passing depressive emotion is re- sponded to by instant tears, perhaps with loud outcry and by a great display of grief, but the feeling is quite temporary. There is a certain hyperesthesia showing itself by a too quick response to every emotional irritation without any permanent substratum of painful feeling. In a similar way there is a sharp irritability of temper without the constant state of anger which will some- times occur in other forms of mania. The entire emotional state is unstable in the extreme, and the expression of emotion bears a peculiar whimsical and uncertain character, such as is also seen in the entire conduct of the patient. Impulse is very apt to be translated into action with alarming rapidity. Impulse and whim sometimes rise almost to the dignity of ruling motives in a mind incapable of forming any fixed resolution." (Art. "Mania, Hysterical," in Diet of Psych. Med) 1 Huchard, " Caractere, mceurs, £tat mental des Hystenques," Arch* de Neurologic, 1882, p. 187.
Google HYPNOTIC PHENOMENA. 283 This mental mobility, emotional facility, and uncontrollable response to stimuli have frequently led to charges of wanton deception and simulation against the hysterical. Such charges are quite unfounded. "The real deceiver/' as Gilles de la Tourette well remarks {Trait/ dinique^ etc, p. 527), "is an active and reasoning being; the hysterical, when they deceive, are not conscious of the deception; they are passive beings, photographic plates which register and show forth their impres- sions as they have received them, sometimes amplified, indeed, but always with the good faith of unconsciousness. * Decep- tion' is a word which has been abused beyond measure in hysteria, so as to have been made the characteristic of a morbid species. It must be added that this has been largely due to ignorance."
Clouston has defined hysteria as " the loss of the inhibitory influence exercised on the reproductive and sexual instincts of women by the higher mental and moral functions." {Edinburgh Med. Journal^ June 1883, p. 1123.) The loss of the complete control exercised by the higher centres is undoubtedly an essential character of hysteria as of hypnotic phenomena gener- ally, but it is not usually accepted that there is necessarily any sexual element in hysteria. Formerly the sexual element in hysteria was somewhat exaggerated; there is now a tendency to unduly minimise it. Sexual irritation in any crude form, or any gross disease of the sexual organs, is certainly not essential in hysteria, although many of the symptoms of hysteria can be traced back to a sexual origin. It is noteworthy also that, as Lombroso points out {La Donna Delinqucnie, p. 613), the criminal offences of the hysterical very largely revolve round the sexual functions. There is often some perversion of the sexual emotion, so that, though the hysterical may crave for love and tenderness from the opposite sex, normal sexual relations may be indifferent or repulsive. Both among the "possessed" of former days and in modern times it has been noted that erotic dreams are very frequent in the hysterical, but that they are often painful rather than pleasurable. The mistake of sup- posing that there is some special connection between hystena and the sexual organs has probably arisen from the undoubted fact that in women the organic sexual sphere is of greater extent than in men. When, therefore, the higher controlling centres are to some extent paralysed we must expect to find all sorts of phenomena traceable to a sexual origin more prominent in women. It is not so in hysteria only, but in nearly all varieties of nervous and mental disorder.
It is necessary to say a word as to the relative frequency of hysteria in the two sexes. Up till Google 284 MAN AND WOMAN.