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From Popular Science Monthly Volume 17 June 1880  (1880) - Hysteria and Demonism II -  Charles Robert Richet

As we study more closely the attacks of epileptic hysteria, we perceive that, in the face of this violent appearance of disorder, the disease has its regular, distinct periods. Nothing is at hazard. Every symptom, however unordered it may seem, appears in its turn with a surprising regularity, we might almost say punctuality. M. Charcot and his pupils have shown that the demoniac fits embrace three well-characterized periods.

The first period is analogous to the attack of epilepsy proper. An abrupt loss of consciousness takes place. The patient falls to the floor; her muscles contract, stiffen; her face turns blue; the features are wrought into a horrible grimace; the arms bend; the hands clinch; in a few instants afterward the muscles quiver with convulsive tremblings, which at first grow more marked, then become weaker and weaker. At last, the muscles, exhausted by the long and violent strain, relax, and a deep, stupid sleep succeeds the convulsive spell.

The second period  -This lasts only for a little while, and then begins the second period, which M. Charcot calls the period of clownism, because it recalls the curious attitudes and contortions of the clowns in the circus. At this stage the patient executes prodigious bounds; the body, bent into the arc of a circle, rests on the bed only by the head and feet; the face is disfigured, sometimes terribly so, and the twisted features give it a hideous expression; and at times the whole body will bound up, then fall heavily upon the bed. "The patient goes into a fury against herself," says M. P. Richer, describing one of the attacks; "she tries to scratch her face, to tear her hair, she utters pitiful cries, she hits her breast with her fist so hard that the attendants have to interpose a cushion; she springs at the persons who are around her, tries to bite them, and, if she can not get at them, tears everything within her reach, the bedclothes, her own clothes, bellows like a calf, strikes the bed with her head and her fists as if she could never get enough of it; she jumps up, throws her arms around, bends her legs up and kicks them out again, shakes her head back and forth uttering hoarse cries all the time, or, if she sits down, twists her body around from one side to the other, and keeps her arms moving."

Not less surprising than the violence of the attack is the ease with which it can be stopped. All the excess ceases at once on simply compressing the abdomen. The demoniac spell originates apparently in the ovary, for, on pressing the hand on the abdomen precisely at the point that answers to the ovary, the rage immediately ceases. The poor demoniac, restored to herself, casts an astonished look at the persons around her, as if she does not understand why they are there, for she was alone when she was seized, and has been unconscious since. She keeps her consciousness as long as the ovary is compressed, and is able to put the clothes in order, to talk, laugh, and enjoy herself cheerfully with her associates; but, if the compression is relaxed a little, the attack begins again with all its original force, to cease again if the ovary is compressed anew.

By a coarse but intelligible comparison, the working of this pressure may be likened to the action of a faucet on the flow of water in a pipe. The flow ceases when the valve is turned off, to begin again as soon as it is turned on. The patients at the Salpêtrière understand the relation so well that, when one of them is attacked, the others straightway go to her bed and press on her abdomen, for several hours if it is necessary, till the fit is over. The attack is marked by a complete absence of mind. The intellectual life is entirely suspended, but is resumed at the end of the fit, just as if nothing had taken place. If a remark has been begun and is interrupted, it is resumed on recovery at the point where it was interrupted.

We call these attacks indifferently demoniac fits or fits of hystero-epilepsy, because it was believed for a long time that demons were the real living agents that provoked the terrible morbid phenomena. The symptoms are the same, and it is only necessary to read the description of the demoniac attacks of the past to recognize their identity in all points with the hystero-epileptic fits of the present. ……………..

The third period- The strange acrobatic attitudes which characterized the preceding phase are not observed in the third period. The limbs are no longer cast about in every way, in obedience to the exaggerated excitation of the spinal marrow. Cerebral life, which has been suspended since the beginning of the attack, has returned, and consciousness has, at least partially, appeared again.

Now, hallucinations of every kind arise, sometimes gay, sometimes sad, sometimes amorous, sometimes religious or ecstatic. Whenever any image rises in the mind, the movements of the limbs, the expression of the face, the general attitude of the body, respond at once to its character. These poses, these passional attitudes, have a vivacity, a vigor of expression, that can not be found anywhere else. The most skillful actor would never be competent to represent fear, menace, anger, with as much truthfulness and power as these poor hysterical girls, whose demeanor is influenced by the agitations of a raving and changeable delirium.

One crosses her arms and raises her eyes to heaven in an attitude of religious admiration, as if she saw the clouds opening to show her the saints or God. Another talks in tender words to her little girl, from whom she has been separated for a long time. Another sees monstrous animals, lizards with red snouts and blood-shot eyes, or enormous bats, and her features express unspeakable horror.

Generally there are two types of delirium, gay and melancholy, answering to corresponding forms of hallucination. The two frequently appear in combination, taking each other's place with marvellous rapidity. M.——, says M. Paul Richer, "is with Ernest at a pleasure-party in a restaurant near Paris, where the tables are set under trellises adorned with flowers and climbing plants. At the right is a negress surrounded with strong-armed black men who are tattooed, and entirely naked, who seize her by the hair and are about to scalp her. The blood runs in streams over the face of the unfortunate woman, who utters lamentable cries, and calls for help. On the left is a very different spectacle: Ernest has a throng of friends who accompany other young women. All the personages have no other clothing than a broad, red girdle, except Ernest, who wears a Spanish costume. They sit at the table, eat oysters, drink of a white wine, sing, and laugh."

Each patient generally has a form of delirium peculiar to herself, so that the different attacks in the same subject always bear a resemblance to one another. The same personages appear, the same scenes are repeated in all the attacks. The order in which the hallucinations come on does not vary, and one who has witnessed a few attacks suffered by the same patient can always judge when the end of the fit is near from the nature of these hallucinations. With one, it is indicated by a flourish of military music; with another, by the noise of a railroad-train; with another, by the appearance of monstrous animals—vipers, crows, frogs, rats. The regularity of these mad deliria is indeed surprising. Listening to the vociferations, the bowlings of the sufferers, it would seem as if chance alone directed the horrible drama. In reality, all is foreordained, regulated. The tumult goes on with the mathematical precision of a well-adjusted clock.

Fantastic as the delirium of the patients during their attack may appear, it always has a cause and occasion. The hallucinations of a demoniac resemble the real episodes of her life, particularly the one which has had the most influence in the development of her malady. It is true, as we have already said, that the principal cause of hysteria is hereditary predisposition; still, an accident is needed, an exterior provocation for the first nervous crisis, some event which may be grave or light, to determine the outbreak of a malady which has been brooding for a long time.

This event is often a fright, a violent emotion, some grief, a disillusion.

Then, in the attacks of delirium, the things and persons that were the occasion of the emotion—fright, grief—reappear as hallucinations.

This influence of what has happened in the past establishes an important difference between the delirium of the insane and that of persons suffering from hysteria. The visions of the insane, whatever they may be, generally have no immediate relation to anterior events, while the form of delirium in hysteria is nearly always determined by an incident which has formerly played an important part in the life of the patient.

The visions of beasts and monsters are common to all delirium. They appear whenever a fever has deranged the cerebral functions, and are the generally recognized marks of alcoholic delirium.