Hysteria In The Medical Casebook

 

This Week

For our second week looking at Victorian psychiatry we are going to have a look at an extremely outdated diagnosis – Hysteria. This is not a chapter for the fainthearted!

 

Sherlock Holmes And The Adventure Of Masongill Hall

A story to accompany publication of The Medical Casebook Of Sherlock Holmes And Dr John Watson.

Sherlock Holmes has retired to his farm on the Sussex Downs, whilst Dr John Watson has become a GP in the Yorkshire Dales. Watson is struggling to deal with the first weeks of the COVID outbreak, yet Holmes discovers that an old enemy is about to carry out a terrible crime right under Watson’s nose. It is down to the heroic Watson to save the day.

Available from the Amazon Kindle Store.

 

Hysteria

Hysteria + Sherlock

I’m going to concentrate on references to hysteria in two of the stories, and just note brief mentions in three further stories. 

Hysteria makes an appearance in “The Adventure Of The Engineer’s Thumb”. The story tells of a young engineer, Victor Hatherley, who is conned into giving an opinion on a broken hydraulic press, used to make counterfeit coins. Hatherley is clever enough to recognise the purpose of the machine, and has to make a daring escape from the counterfeiter’s clutches. Whilst descending the building, he clings to a second floor windowsill in order to lower himself into some bushes. But the head counterfeiter, Colonel Lysander Stark, attacks him with a cleaver, and chops off his thumb. It is an exciting tale, and one that ends with the counterfeiter gang all escaping.

On arriving back in London after his ordeal, Hatherley heads straight to 221B Baker Street to consult with Holmes.

“Oh my night could not be called monotonous,” said he, and laughed. He laughed very heartily, with a high, ringing note, leaning back in his chair and shaking his sides. All my medical instincts rose up against that laugh.

“Stop it!” I cried; “pull yourself together!” and I poured out some water from a carafe.

It was useless, however. He was off in one of those hysterical outbursts which come upon a strong nature when some great crisis is over and gone. Presently he came to himself once more, very weary and pale-looking.

“I have been making a fool of myself,” he gasped.

“Not at all. Drink this.” I dashed some brandy into the water, and the colour began to come back to his bloodless cheeks.

“That’s better!” said he. “And now, Doctor, perhaps you would kindly attend to my thumb, or rather the place where my thumb used to be.”

He unwound the handkerchief and held out his hand. It gave even my hardened nerves a shudder to look at it. There were four protruding fingers and a horrid red, spongy surface where the thumb should have been. It had been hacked or torn right out from the root.

Our second main story is “The Musgrave Ritual”. Reginald Musgrave enlists Holmes in solving the mystery of the disappearance of his butler and maid. The plot involves coded messages [the ritual], buried treasure, and the English Civil War.

The butler, Richard Brunton, is the first to go missing. Musgrave learns of his disappearance from Rachel Howells, a second maid in the house, and recently jilted by Brunton.

“He is gone. No one has seen him. He is not in his room. Oh, yes, he is gone, he is gone!” She fell back against the wall with shriek after shriek of laughter, while I, horrified at this sudden hysterical attack, rushed to the bell to summon help. The girl was taken to her room, still screaming and sobbing, while I made inquiries about Brunton.

Rachel Howells then disappears.

“For two days Rachel Howells had been so ill, sometimes delirious, sometimes hysterical, that a nurse had been employed to sit up with her at night. On the third night after Brunton’s disappearance, the nurse, finding her patient sleeping nicely, had dropped into a nap in the arm-chair, when she woke in the early morning to find the bed empty, the window open, and no signs of the invalid. I was instantly aroused, and, with the two footmen, started off at once in search of the missing girl.”

Brunton has managed to decipher the ritual, and discovered the location of the treasure vault. But it is covered by a heavy flagstone, which he can’t lift alone, and he has to enlist the help of Rachel. Brunton then descends into the vault and hands the treasure up to her.

What smouldering fire of vengeance had suddenly sprung into flame in this passionate Celtic woman’s soul when she saw the man who had wronged her—wronged her, perhaps, far more than we suspected—in her power? Was it a chance that the wood had slipped, and that the stone had shut Brunton into what had become his sepulchre? Had she only been guilty of silence as to his fate? Or had some sudden blow from her hand dashed the support away and sent the slab crashing down into its place? Be that as it might, I seemed to see that woman’s figure still clutching at her treasure trove and flying wildly up the winding stair, with her ears ringing perhaps with the muffled screams from behind her and with the drumming of frenzied hands against the slab of stone which was choking her faithless lover’s life out.

Here was the secret of her blanched face, her shaken nerves, her peals of hysterical laughter on the next morning.

The Musgrave Ritual” is a cracking story, and appears on Conan Doyle’s own list of his favourite Sherlock Holmes stories. His portrayal of Rachel Howells is, however, the weakest part of the story – the poor girl is initially branded as hysterical, and then as impulsively driven by her fiery Welsh temperament. She doesn’t even get a conclusion at the end of the story [or even a name!].

Of the woman nothing was ever heard, and the probability is that she got away out of England and carried herself and the memory of her crime to some land beyond the seas.

Moving onto our brief mentions of hysteria, we head firstly to “The Sign Of Four”. Thaddeus Sholto’s housekeeper [who is again not given a name], is delighted to see Mary Morston.

“God bless your sweet calm face!” she cried, with an hysterical sob. “It does me good to see you. Oh, but I have been sorely tried this day!”

Our companion patted her thin, work-worn hand, and murmured some few words of kindly womanly comfort which brought the colour back into the others bloodless cheeks.

Next we are off to “The Man With The Twisted Lip”, which we will visit in more detail in a couple of our drug addiction chapters. Holmes is engaged by Mrs St Clair to locate her missing husband, Neville.

“I should very much like to ask you one or two plain questions, to which I beg that you will give a plain answer.”

“Certainly, madam.”

“Do not trouble about my feelings. I am not hysterical, nor given to fainting. I simply wish to hear your real, real opinion.” 

Finally, we return to “The Adventure Of The Empty House”. Holmes makes his dramatic reappearance after the “hiatus”, unsurprisingly shocking all around him [we will come to Watson’s reaction in our Faint chapter].

“I came over at once to London, called in my own person at Baker Street, threw Mrs. Hudson into violent hysterics, and found that Mycroft had preserved my rooms and my papers exactly as they had always been. So it was, my dear Watson, that at two o’clock to-day I found myself in my old armchair in my own old room, and only wishing that I could have seen my old friend Watson in the other chair which he has so often adorned.”

 

Hysteria In Victorian Times 

My readers might not recognise hysteria as a medical condition, more an expression of extreme emotion [which is generally how Conan Doyle is using the term in the preceding excerpts]. Yet in Victorian times “hysteria” was very much a medical diagnosis, and a very interesting one to look at. It was a diagnosis that was heavily entwined with sexism and misogyny.

Let’s start with the derivation of the word hysteria. It comes from the Greek word “hystera”, meaning uterus or womb. Thus our modern term for removing the uterus is hysterectomy.

The term hysteria came from the belief that the condition related to a displacement or dysfunction of the womb [sometime called a “wandering womb”]. Hysteria was thus an exclusively female condition. And the term is ancient. Amazingly there is an Egyptian papyrus, the Kahun Papyrus, dated to 1900 BC, which scholars have translated as describing a hysterical disorder related to spontaneous uterus movement.

The first physician to coin the term hysteria was the so-called father of our profession, Hippocrates, who practised in Ancient Greece, in the 5th century BC. Hippocrates’ theories in this area are horrifying today. He believed that hysteria was caused by a restless and migratory uterus, and identifies the cause as poisonous stagnant humours, which, due to an inadequate sex life, have never been dispelled. His solution is thus that all women must get married and have regular sex, and regularly bear children, thus widening a woman’s canals, and promoting cleansing of the body.

We then head to our historical texts. A warning here that there are some horrific views expressed in the Victorian medical literature regarding hysteria.

I don’t think, unlike in my other chapters, I need to do any commentary here. I will just reproduce the words of the doctors of the time [of course all male].

A pure neurosis due to defective energisation of the nerve cells of some part of the nervous system, most probably the cerebral cortex. In hysteria the highest functions of the mind are in abeyance or perverted, and the patient is unreasonable and more or less devoid of that power which goes by the name of “the Will.” [5]

The determining causes of such seizures often supply important information; quarrels, disappointments in love, excitement, vexation etc, may be named as the more obvious of these. Disturbance of the sexual organs and functions [disordered menstruation, amenorrhoea, change of life etc] are likewise important. [15]

Thus, in the same manner as hysteria is transmitted from the mother to the daughter, so are psychical perversions transmitted to their children from insane or silly parents, and passionateness and evil inclinations are impressed upon the youthful mind. [4]

In the ordinary slight cases which cannot as yet be considered as mental diseases, we see, sometimes together with marked motory-sensitive anomalies, sometimes without them, as a predominating affection, the peculiar hysterical disposition, viz, immoderate sensitiveness, especially to the slightest reproach – tendency to refer everything to themselves; great irritability, great change of disposition on the least or even from no external motive [humors, caprices], and not the slightest reason can be given for the change they often exhibit tender sympathy for other female individuals, peculiar eccentricities, very lively intellects [in young girls, pleasure in learning, etc]. [4]

Serious hysterical mental disorders are manifested principally in two different forms. In the first place as acute attacks of delirium and excitement even to developed mania. Such maniacal attacks are sometimes observed in very young girls, and manifest themselves by vociferation, singing, cursing, aimless wandering; occasionally by more formal delirium, attempts at suicide, nymphomaniacal excitement, occasionally by delirium of a religious or demoniacal character; or there are attacks of all kinds of noisy and perverse, but still coherent, actions. [4]

The chronic form of hysterical insanity may show itself in the form of melancholia or mania. At first, moderate, but easily noticed, changes of character are observed; greater seriousness, egotism, great care of health is manifested – indecision and absence of will, impatience, violence, tendency to anger. The patients always grow lean, anaemic, occasionally quite marasmatic; they suffer from constipation, from disorders of digestion and menstruation. The symptoms almost always become aggravated at the menstrual period. [4]

The mental derangements are numerous, emotional manifestations arise without a proper exciting cause, she may be very loving, even erotic without any advances from the other sex; she may manifest hatred without cause; she is fond of attracting attention, of commanding whilst herself bedridden, of getting sympathy; her whims, cravings and caprices are truly extraordinary. [5]

Any hysterical fit may set in suddenly, under the influence of some violent mental emotion; but more generally it is preceded by altered spirits, by a sensation of pressure, and of constriction at the pit of the stomach, which feeling ascends to the throat, and is likened by the patient to the rising of a ball. She becomes more agitated, sobs, laughs, cries, her muscles contract violently, or she lies motionless, and apparently without the power of motion, until her seeming insensibility is disturbed by something she disapproves of, or fears. [3]

If the cases contained in this Clinical Report be carefully examined, it will appear that their treatment, cathartic medicines, mild vegetable tonics, light diet, exercise in the open air near the sea-shore, on foot and on horseback, tepid bathing and tepid hip-baths, and the proper regulation of the mind, were the most useful remedies, and that under this treatment the greater number were in the course of times restored to health. [16]

Other methods of treatment had been had recourse to in many cases by other practitioners of reputation without any temporary or permanent benefit. The following is a simple enumeration of these:-

Assafoetida, valerian, and ammonia.

Ammoniated tincture of guaiac.

Bromide and iodide of potassium.

Balls of mercury introduced into the vagina.

Sulphate of zinc and sulphate of copper.

Chloroform.

Bichloride of mercury and quinine.

Extract of aconite and camphor.

Tincture of sumbul.

Tincture of castor.

Cubebs and taraxacum.

Liquor potassae.

Acetic acid.

Strychnine and iron.

Leeches to the os uteri.

Dilating the os uteri with bougies.

Cutting the os and cervix uteri with hysterotomes and other cutting instruments.

Long-continued courses of speculum and caustic treatment.

Mesmerism, galvanism, and galvanic chains.

Homeopathy and hydropathy.

Cold and warm bathing.

Various mineral waters, especially those of Spa, Kreutznach, Homburg, and Kissingen.

Clitoridectomy; and lastly,

Cutting away the coccyx. [16]

 

Medical demonstration:-

“Etching by André Brouillet entitled: Jean-Martin Charcot Demonstrating Hysteria In A Hypnotised Patient At The Saltpêtriére.” [17]

Next Week

We’ll move into the area of addictions – the book has chapters on opiates, cocaine, alcohol and smoking, all of which I feel Dr Arthur Conan Doyle views as medical problems.   

 

Buying The Book 

The Medical Casebook of Sherlock Holmes and Dr John Watson is available from all good bookstores including Amazon USA, Barnes and Noble, Amazon UK and additional formats like Kindle.