could walk unaided. Of course she was very weak. But she regained strength with phenomenal rapidity, and soon made a complete cure. Since then her health has been of the best.

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N another case there was brought to the clinic conducted by an eminent Boston neurologist, Dr. Morton Prince, a young woman afflicted with attacks resembling what is known as Jacksonian epilepsy, a dread and incurable disease. The attacks took the form of convulsive spasms of frequent occurrence, lasting several minutes at a time, involving the abdominal muscles, the diaphragm, and the muscles of the larynx, and presenting a frightful spectacle to all who chanced to see them. Her parents had been told by more than one physician that she was undoubtedly a victim of epilepsy, and they readily believed this, the more so since one of them, the mother, was herself an epileptic.

But Dr. Prince, like the physician in the case of the girl with the tubercular hip, as a result of his clinical examination found reason for thinking that a wrong diagnosis had been made. He took the parents aside, and questioned them privately. "How long," he asked, "has she been this way?"

"For many months."

"And before then? Did she never have any attacks like these?

"Never."

"When did they first come on?”

"She had a bad fright, fainted, and was for a long time delirious. It was while she was in her delirium that the fits began."

"I'm. And what did you say when you saw them? Did you talk about her condition in her hearing? Did you say that she must be epileptic?"

The parents glanced at each other. "Perhaps we did. But she couldn't understand us. She was out of her head."

"That doesn't matter," said Dr. Prince. "I fancy she understood you fast enough. Previous

to this, had she ever been afraid that she might be attacked by epilepsy like her mother?"

"Yes, indeed. Ever since she was a child she has worried about that more or less. But, doctor," hopefully, "do you mean to say that you don't believe she is epileptic?"

"I believe," was the reply, "that she thinks she

is an epileptic, which in her case amounts for all practical purposes to the same thing as being one. But I also believe that if I can persuade her to think differently, she will no more be tortured like this."

A prediction which, it is enough to say, was abundantly verified by the results of the simple drugless treatment which Dr. Prince proceeded to apply. Only a few weeks and the spasm-racked sufferer was once more a healthy, efficient member of society.

NOW

OW, I have cited these cases not because of their singularity, nor with any desire of exploiting them as "miraculous cures," but because they afford a vivid view of what is one of the most wide-spread and disastrous, and certainly the strangest, of all diseases. This is the disease, hysteria.

Most people undoubtedly will feel surprised at being told that hysteria is a separate and distinct disease in itself, like cancer or tuberculosis. When they think of it at all, they think of it as merely the manifestation of a peculiar temperament which causes persons to weep or laugh immoderately at small provocation. Thus we hear a great deal about "hysterical laughter" and "hysterical tears." As a matter of fact, your true hysteric seldom laughs and seldom weeps to any great extent. Thus hysteria shows itself in a much more serious way-namely, in the mimicry of the symptoms of all sorts of other diseases.

above all, of the diagnostician means that may be employed in order to avoid terrible blunders by enabling the physician to discriminate with certitude between symptoms of hysterical origin and symptoms caused by organic maladies requiring treatment by drugs or by the surgeon's knife.

IN

N the cases I have cited we see hysteria simulating the symptoms of tuberculosis, paralysis, epilepsy. There is, without exaggeration, scarcely a disease which it cannot mimic, thus leading in thousands of instances, to useless drugging and unnecessary and dangerous operations. If, for this reason alone, it is a duty incumbent on every physician to learn all he can about hysteria-for which purpose I would advise him to study carefully the writings of the great masters on the subject, particularly Janet, Ribot Babinski, Freud, Prince, and Sidis. It is also important for the layman to acquaint himself with at least its fundamental facts, for hysteria is to a large extent a preventable disease Especially, as we shall find, is knowledge of hysteria important to parents, to the fathers and mothers who would see their children grow up to healthy, robust manhood and womanhood.

And, to summarize the fundamental facts very briefly, it is known to-day, as a result of scientific investigation conducted along novel lines, that hysteria, no matter what physical symptoms it may display, is first, last, and all the time a mental disease; that it has its immediate cause in frights, griefs, worries, and other experiences occasioning profound emotional disturbance; that these act, either directly or indirectly, as "suggestions" giving rise to the particular symptoms later developing; and that, being caused by suggestion, hysteria is likewise curable by suggestion without the use of medicine of any kind.

I

faith-healing, it may confidently be affirmed that one is dealing not with actual organic maladies, but with hysterical affections. There is, however, this additional and most important fact to be noted: that, nine times out of ten, not even hysteria will yield to such rough-and-ready theraphy, but requires the most delicate manipulation to make sure of a permanent cure. And this for an excellent reason.

Hysteria, as was said, is caued by distressing experiences of an emotional character. These may occur long before the appearance of any symptoms of disease, and, so far as conscious recollection is concerned, may have been quite forgotten by the sufferer. Indeed, whether they occur immediately prior to, or long before, the development of the symptoms, the rule is that they are thus forgotten; being, in technical language, "dissociated from the upper consciousness." But such dissociation does not imply that they have been completely blotted out of remembrance. So far is this from being the case that it is now known that they persist as subconscious memories; and persist, moreover, with all the vividness and intensity of their original emotional coloring. It is to this subconscious persistence that the continued manifestation of the symptoms is due. As one distinguished authority, Dr. Sigmund Freud, has well said, "Hysterical symptoms are so many monuments to forgotten emotional experiences.

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"YSTERIA, in a word, is primarily a disease of lost memories, and the effectiveness of its treatment by mental means—the only means that ever are effective in handling it— usually depends on the skill with which these memories are recovered by the physician, so that he may know exactly what it is that he has to suggest away. Since they are preserved only in the subconscious, it becomes necessary for him to burrow into the subconscious; and this he can do, if he has had the proper training.

NVARIABLY, when one hears of disease symptoms disappearing at word of command, as happened to the girl with the "tubercular" hip; disappearing as a result of shock, to recall the amazing experience of the paralyzed Mrs. Sandford; or, finally, disappearing in consequence of "faith," as in many of the cures unquestionably effected by exponents of Christian Science, New Thought, and other systems of

But the narration of a few concrete cases will make clearer than columns of disquisition would the methods employed in, and the marvelous results obtained by, the psychological treatment of hysteria, the genesis and development of this strange disease, and its truly many-sided nature. For it can simulate not only almost every known bodily disorder but also the insanities.

Thus, in one most striking instance, the victim, a young villager known in Dr. Pierre Janet's medical report only by the name of Achille, presented all the symptoms of what in olden times would have been regarded by superstitious persons. He is said to have been of a rather timid and morbid disposition as a youth, but had married happily, and had had no special ailment until he was thirty-three years old. Then, following his return from a business journey, he became unexpectedly somber and taciturn, and soon lost all power of speech. One local physician declared that he was suffering from heart disease, another pronounced him diabetic. Both agreed that his condition was serious, and the outlook most unfavorable; a prognosis that found ample confirmation when he took to his bed, said farewell to his friends, and stretched himself out motionless.

For two days he lay seemingly dead, while his wife mourned at his side. Shortly before noon of the third day he suddenly regained consciousness, sat bolt upright, with his eyes wide open and staring, and burst into a terrible laugh-"a convulsive laugh which shook all his limbs; an exaggerated laugh, which twisted his mouth, a lugubrious, satanic laugh which went on for more than two hours." Leaping out of bed he refused all attentions and to every question answered: "There's nothing to be done! Let's drink some champagne! It's the end of the world!"

At last, exhausted, he fell asleep, but when he awoke affairs were far worse. He writhed in terrible convulsions, uttered fearful imprecations, and repeatedly tried to commit suicide. All the time he kept saying that he was not responsible for the blasphemies he uttered; that he was compelled to utter them by the devil that had entered into him. This sort of thing went on for months, and it was ultimately decided that instead of being diabetic or having heart-disease, he was quite insane. Accordingly he was taken to Paris and committed to the great asylum of the Salpêtrière.

H'

ERE for the first time he came under the observation of a physician competent to treat him. Dr. Janet's practiced eye at once recognized the case as one of hysteria; and he knew that some great emotional shock must be responsible for his patient's ravings. In order to learn what this was he sought to hypnotize poor Achille, but failed dismally, being met with mocking laughter from the demon that was tormenting him and that professed to speak through him. However, Dr. Janet did not despair. He had often been confronted before by conditions fully as difficult, and long experi

ence had qualified him to cope with any ordinary devil. He determined, in fact, to make the malignant intruder himself hypnotize Achille.

"I will not believe in your power over this man," said he, "unless you give me proof of it." "What proof?"

"Raise his left arm, without his knowing it.”

Up went Achille's left arm, to his vast surprise. Then followed a series of suggestions, all of which the devil exultantly and unsuspectingly executed as proofs of his power. Finally came the supreme suggestion to which Dr. Janet had been cunningly leading:

"But can you put Achille soundly to sleep in that armchair?"

Presto! Achille was in the chair, sound asleep. And in that moment he was freed forever from the tormenting devil. For, while he sat in the hypnotic sleep, Dr. Janet by patient questioning was able to draw from him precisely the information indispensable to a cure.

H

E had been living, it appeared, in a kind of day-dream, by self-suggestion swollen to a hideous nightmare, the product of his own remorseful brooding over an act of infidelity to his wife committed during the business trip taken just before his illness. A gloomy anxiety to conceal this led to his increasing taciturnity, and morbid fancies as to his health, intensified by the unwise suggestions of the village doctors grew on him until in his day-dream he believed himself actually dead and given over to the devil for punishment. As Dr. Janet, in reporting the case, observed:

"When one dreams that one is dead, what is there left to dream? What will be the end of the dream in which Achille has been living for six months? The end will be simple enough-it will be hell. During the two days that Achille remained immovable and like one dead, he was dreaming harder than ever. He dreamed that now that he was dead indeed, the devil rose from the abyss and came to take him. The poor man, as in the hypnotic state he retraced the series of his dreams, remembered the precise moment when this lamentable event took place. It was about eleven in the morning; a dog barked outdoors, incommoded, no doubt, by the smell of brimstone; flames filled the room; numbers of little fiends scourged the unhappy man, or drove nails into his eyes; and through the wounds in his body the devil entered to take possession of head and heart."

The demon that tortured Achille was, quite manifestly, his remorseful self; the symptoms he displayed were nothing more than symbolical indications of the torments which his morbid

imagination pictured him as deserving, and which, through the power of self-suggestion, he was actually forced to endure. The method of his cure was quickly worked out by Dr. Janet. As is well known, all manner of hallucinatory images can be imposed on hypnotized subjects; and, availing himself of this fact, Dr. Janet, after giving Achille verbal suggestions to modify and explain away the miserable memory of the offense he had committed, caused him to see a hallucinatory image of his wronged wife, gazing at him affectionately and with pardon in her eyes. By such means-means infinitely more effective than the old theological method of bell, book, and candle was the demon in him exorcised. When he awoke from the hypnotic sleep he was perfectly tranquil, and, after a few days of ordinary medical treatment to restore his shattered strength, was able to return to his native village and take up anew the life of a normal man.

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NORTUNATELY, it is comparatively seldom that when hysteria simulates an insanity it develops such a painful derangement as this. The form it ordinarily takes is that of a simple obsession or fixed idea; a form, however, terrible enough for the patient and his friends. A typical instance is afforded by a case once treated by Dr. Isador H. Coriat, a Boston neurologist who, under the leadership of Drs. Prince and Sidis, have done much in the way of investigating and successfully applying the principles of psychopathology, or medical psychology.

Exceedingly trivial, to all outward seeming, was the incident responsible for the hysteria that afflicted one of Dr. Coriat's patients. This patient, until she came under his care, had long been vainly seeking relief for a curious combination of disease symptoms. These had first set in one night when, just as she was falling to sleep, she was aroused with a sensation as if she was going insane. Her thoughts seemed confused and jumbled, her head whirled, her heart palpitated, and she felt panic-stricken. The attack was of about ten minutes' duration, and was repeated nearly every night thereafter, with a marked tendency to last longer and longer.

The patient, in her normal state, could give no explanation for the strange attacks but, when questioned in a state of "experimental dissociation," she was able to throw much light on them. It turned out that, following a period of fatigue, due to her efforts to entertain some friends, she had undertaken a long journey before she was fully rested. While on the train she became greatly interested in a novel in which there was given a long and vivid description of the abnormal fears felt by one of the principal char

acters. That night she had her first attack of the symptoms just described.

Theoretically it could be assumed that the emotions aroused within her by the reading of the passage in the novel had acquired hysteria producing force; and the soundness of this view was demonstrated when, following the application in hypnosis of suggestions aimed at eradicating from her subconsciousness all recollection of the novel, the symptoms in question promptly disappeared.

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ORE often hysterical affections have their rise in frights and shocks of a manifestly severe character. Railway accidents constitute a frequent cause. In one case, reported by Dr. Janet, a traveler in a European railway carriage, while the train was in full motion, imprudently got down on the step in order to pass from one door to another. Just as he put his foot on the step he saw that the train was about to enter a tunnel, and it occurred to him that his left side, which projected, might be crushed against the wall. The idea so terrified him that he fainted, but luckily fell inside the carriage and was dragged to safety by the other occupants, his left side not even being grazed. Notwithstanding which, on his return to consciousness it was found that his entire left side was paralyzed.

In another case, which I cite on the authority of Dr. T. A. Williams of Washington, D. C., a brakeman on a freight train, owing to the giving way of a stirrup, was thrown from his train while it was going at the rate of only ten miles an hour. He tumbled against an earth embankment, rolled over a couple of times, and lost consciousness for half an hour. When he came to, he felt weak and faint, but managed to get to his home. The next day he complained of severe pains in his back, and a little later lost all use of his legs. He remained crippled for more than three months, and in the meantime brought suit against the railroad company for heavy damages.

The company, naturally, sent a physician to examine him, and fortunately for itself and the brakeman, chose one who knew a great deal about nervous disorders. His report was brief and to the point. In effect, he said:

"The tests I applied to your employee prove conclusively that he has received no organic injury. It is a case of hysteria, and I believe that by appropriate treatment he could be restored to a certain extent within one month, and that within three months he could be made fully capable of pursuing any laborious vocation he desired. I believe it would aid materially in his recovery if he were assured of a reasonable compensation for the shock sustained."

Acting on this recommendation the company