too before he made an impression on the Queen of Sheba. The poet who said,

Oh, woman, in our hour of ease,

Uncertain, coy, and hard to please, etc.,

did not know her, or he must have had an aggravated case of hysteria for a wife or sweetheart, and you have learned how to manage a case like that. Manage a wife right and you will have no trouble with her. Give her her own way in everything reasonable and she will prove to be the most amiable of creatures. I say this much on the subject from the stand-point of experience, and give you this advice on matrimony because I fear some of the many sweet girl graduates that in these merry months of Spring are blooming in the "rosebud garden of girls," will find out what nice fellows you are and lasso you with a matrimonial slip-knot even before the people find out what clever doctors you are.

I wish you to be prepared and not taken by surprise. I think it wise for you to get a wife, not only because the wisest of men approved of matrimony, but because I do not think you can help yourself. If you do not get a wife, a wife will get you. You are bound to capture or be captured.

And now we wish you health, happiness and prosperity, and in accordance with time-honored custom handed down to us from our most wise forefathers, that those who deserve well of the republic of science, of letters and of art, should be distinguished by peculiar and merited laurels, we bestow upon you these parchments, signed with our hands and witnessed with our seals. You are now Alumni of the Barnes Medical College, and may Heaven bless you and bestow upon you future merited rewards. May your lives be ever worthy the approbation. of your Alma Mater and the smiles of an approving Prov idence.

Association

of

of Hysteria with

Organic

Diseases of the Nervous System, Neuroses and Other Affections.*

SELECTED ARTICLE.

By H. BABINSKI, M. D., Paris,

Physician of the Hospitals of Paris; formerly Clinical Chief in the Department of La Salpêtrière.

THE

HE domain of hysteria is extending day by day, and it is only necessary to scan the bulletins of the different medical societies and special monographs to be convinced of this fact. It is undoubtedly one of the most fashionable affections, and I am, for my part, convinced that there are few persons, indeed, who, under certain circumstances and under the influence of occasional causes, more or less active, do not succumb to its power. This proposition, I adınit, is only applicable to hysteria minor. I believe, nevertheless, that hysteria major seldom develops except in subjects predisposed by birth or by neurotic antecedents, and is the appendage of a neuropathic aristocracy; the former, on the contrary, is within the reach of the whole world.

The field of this neurosis is still further enlarged by its association with maladies which are very unlike in character, and observations on this peculiarity have been

*This subject being new and of decided clinical importance, and requiring greater elaboration than it has yet received, we deem it proper to place the latest and only contribution thereon since our own article in the July ALIENIST of last year, before our readers.

already published, first in France, and later in other countries. I will mention particularly the works of M. Charcot, the pioneer in this field; those of MM. Raymond,2 Mathieu,3 Aurelles de Palladines, Seglas,5 Babinski, " Souques, Siredey,8 Oppenheim, Remak, 10 Bernhard,11 Mendel,12 Siemerling,13 Buzzard14 and Hughes.15 The principal affections whose co-existence with hysteria has been noted are sclérose en plaques, tabes, syringomyelia Morvan's disease, Pott's disease, facial paralysis, primitive myopathy, neurasthenia, agoraphobia, onomatomania, chorea, and Basedow's disease.

Notwithstanding the large number of publications on this subject already mentioned in the foregoing bibliographical index, the latter is, to my mind, far from being complete. The works in question are, for the most part, very succinct, giving the history of one or more typical cases, and, if we relied exclusively on them to appreciate the importance of these morbid associations in pathology,

1. (a) Leçons du Mardi (Association de l'hystérie avec la sclérose en plaques, le mal de Pott, le tabes, la myopathié, la neurasthénie). (b) Leçons recueillies par Guinon. Publications du Progrès Medical, 1892 (Maladie de Morvan et Hysterie). 2. Progrès Méd., No. 20, 1889 (Obs. de rhumatisme chronique associé à l'anesthésie hysterique).

3. Progrès Méd., No. 30, 1888 (Neurasthenie et hystérie combinées).

4. These de Paris, 1889. Associations morbides en pathologie nerveuse (Observations de paralysie alcool. de chorée, de maladie de Basedow associées à l'hystérie).

5. Bulletins de la Soc. Méd. des Hôpitaux de Paris, 1889, No. du 12 Avril (Coexistence chez un malade de l'hystérie et d'une variété spéciale d'onomatomanie --echolatie mentale).

6. Gaz. hebd. de méd. et de chir., 1891, p. 368 (Agoraphobia et hystérie).

7. Thèse de Paris, 1891. Etude des syndromes hystériques simulateurs (Association de l'hysterie avec le tabes et la sclérose en plaques).

8. Bulletins de la Soc. Med. des Hôpitaux de Paris, 1891, p. 537 (Tabes et hystérie).

9. Neurologisches Centralblatt, 1890, p. 488 (Sclérose en plaques, syringomyélie, paralysie.faciale et hystérie).

10

11.

Id., 1890, p. 499 (Hystérie et sclérose en plaques).

ld. (Hystérie et sclérose en plaques).

12. Id. (Hysterie et paralysie pseudo-hypertrophique).

13. Id., 1891, p. 22 (Ueber einen mit Geistess torung complicirte Fall von schwer Hysteric welcher durch congenitale anomalien des central nervensystem ausgezeichnet war).

14. Brain, 1890, Spring Number (On the Simulation of Hysteria by Organic Disease of the Nervous System).

15. ALIENIST AND NEUROLOGIST, July, 1892, St. Louis (Note on the Hysterical' Concomitants of Organic Nervous Disease).

we might suppose that cases of this character were relatively rare, which is not the fact. We have the right, however, to affirm, a priori, that any malady may be associated with hysteria, and nothing is, moreover, easier to conceive. If, for instance, a slight traumatism, or some other trifling cause, is capable of provoking hysterical manifestations in an individual who was perfectly healthy up to that time, it is quite natural that an organic or dynamic affection of the nervous system, a pre-existing pathological condition, of any kind, is capable of producing analogous effects, and, indeed, the association of hysteria with other diseases is, as I have observed myself, of very common occurrence.

This association may be unrecognized, either because the hysterical phenomena occupy first place in the symptomatic picture, and thus mask the concomitant affection, or because the latter, on the other hand, absorbs completely, to the detriment of the hysteria, the attention of the observer-a thing which happens frequently when have simply the manifestations of hysteria minor. In neglecting thus the one or the other of the two factors present, we are liable to err in therapeusis and diagnosis.

we

It is because of this failure to recognize the hysterical element in these cases of hystero-organic association that some physicians have advanced the idea that psychotherapeusis may modify, to a considerable extent-nay, even cure-these organic affections.

It is, therefore, essential that we bear in mind the possibilities of these associations and try to discover, in cases of this kind, how much belongs to each of these two factors. It is, I admit, a task which may often be very difficult.

I believe, for the reasons which precede, that it will not be uninteresting if some new cases of this kind are placed on record, and, among the many that I have observed, I will select a few which I think particularly worthy of attention, and will present them briefly.

OBSERVATION I.

Organic Spasmodic Hemiplegia; Contracture, Exaggerated Tendon Reflex, Epileptoid Movements of the Foot. Hysterical Sensitivo-sensorial Hemianesthesia. Rapid Disappearance of the Hemianesthesia After the Use of Magnetism.

A woman, 45 years of age, addicted to alcoholics, subject to nightmare, and showing the signs of arteriosclerosis, was admitted to la Salpêtrière in March, 1886, in the service of M. Charcot.

There was right hemiplegia consecutive to an apoplectic attack. The paralysis affected the upper and lower limbs and the inferior portion of the face. The hemiplegia had been present for six months when I examined the patient for the first time, and it presented at this time the classical characteristics of spasmodic hemiplegia due to organic disease of the brain.

The patient walked with difficulty, and, in moving, the upper extremity assumed normal position; its different segments were notably flexed, the one on the other; the motor troubles were more pronounced here than in the lower extremity; the right commissure was slightly deviated inferiorly. There was decided resistance, due to muscular rigidity, which could be overcome, to a certain degree, by making passive movements of the foot, the leg, the thigh, the fingers, the hand, the forearm, or the arm; it was impossible to raise the arm to the horizontal position.

The tendon reflexes were very much exaggerated in the upper and lower extremities, and epileptoid movements of the foot were easily induced.

There existed, also, a strongly-marked sensitivo-sensorial hemianæsthesia on the right side; the whole right side was completely insensible to touch, pain and temperature; the sense of position was likewise absent.

Right amblyopia with contraction of the visual field, obtunded hearing, loss of sense of taste and of smell on the same side, were present.

Magnetism was applied to the upper extremity on the right side for about half an hour. On re-examination, made after this application, the sensitivo-sensorial hemianesthesia, which, according to the statements made by