Definitions: the Textual Tradition

Thus the questions raised by hysteria are not only legion but often directly contradictory. Is hysteria another word for ignorance, or the perfectly adaptable mimic? Is it a dramatic performance or a minor gynecological disturbance? Is it caused by the womb or has it no organic cause? Is it a wide-ranging category, a "non-verbal language,"^[53] or something universal but very specific? Beneath these questions lies the major one for anyone trying to write about the history of hysteria: that is, what definition should be used for the purposes of the present work? J. M. N. Boss takes what may appear to be an attractive option when tackling this problem; he writes, "In this paper the word 'hysteric' is used in the manner of the period of the writings referred to."^[54] As I have already shown, however, in the ancient period the word "hysteria" is not used at all; hysterikos , "hysteric," is used, but with the very specific meanings "coming from the womb"/"suffering due to the womb." One way around this problem would be to restrict the present study to those sections of the corpus traditionally seen as descriptions of hysteria; for example, those so labeled by Littré. As I have already shown, the diffi-

culty here is that Littré imposes his own distinction between "real" and "imaginary" movements of the womb, a distinction alien to the ancient Greek writers. An alternative would be to study all sections of the corpus in which the womb is described as moving to another part of the body, but this only reiterates the point that later writers use hysteria for symptoms with no organic cause, whereas the Hippocratics regard womb movement as something entirely organic.

The difficulties of deciding what constitutes hysteria for the purposes of a historical study are by no means unique; indeed, they are directly comparable to those encountered by J. Gabbay in his discussion of the disease concept "asthma." Gabbay asks how far we "can rely on present-day knowledge of asthma to analyse historically the social nature of medical knowledge"^[55] and concludes that we cannot assume that all writers in the past who used the term were referring to the same thing. With hysteria, of course, the problems are greater, because our sources are not even using a common name. Gabbay raises the question whether a diachronic study of a disease concept investigates a constant natural entity, or a vast range of different concepts,^[56] and shows how this question all too easily leads the historian to the stage of "historical paralysis."^[57] Like Medusa's head, the question, What exactly are we studying? turns the onlooker to stone.

Although it has this malign power, the question must at least be addressed, even in a negative way. To clarify: in the present work I am discussing neither all texts in which the writers name the condition they describe hysteria, nor all texts mentioning a particular combination of symptoms that I choose to label hysteria. Instead, I have chosen here to concentrate on a set of early texts conventionally linked by subsequent writers: a finite series of texts, each drawing on an increasingly fixed group of those written by earlier writers, yet each simultaneously—to some extent incorporating the ideas of its own age. I am thus studying hysteria from the perspective of a developing tradition of reading the Hippocratic corpus, a textual tradition that culminates in Littré. In order to illuminate the growth of this tradition, I will also draw on texts produced outside it in order to provide the necessary context for its origin and development.

Before turning to a more detailed study of the Hippocratic texts conventionally used as evidence for hysteria in ancient Greece, it is worth considering what implications the use of the label "hysteria" may have, for Littré and other writers.

The Greek adjective hysterikos means "from the womb"; as such, it is a purely physical description of cause, showing the part of the body from which other symptoms emanate. In a woman, as another Hippocratic

text puts it, "the womb is the origin of all diseases,"^[58] so it would be fair to say that, in Hippocratic gynecology, all diseases are hysterical. But this word cannot have the same nuances for us as for an ancient author.

Littré uses hysteria in a rather different way. In his Dictionnaire de la langue française (1863-77) he defines hysteria as follows: "Hystérie: maladie nerveuse qui se manifeste par accés et qui est characterisée par des convulsions, la sensation d'une boule qui remont de la matrice dans la gorge et la suffocation" (Hysteria: nervous disorder that manifests itself in the form of a fit and is characterized by convulsions, by the sensation of a ball rising from the womb into the throat, and by suffocation). To understand Littré's position, we must first understand the debate within which he is situating himself. Boss has traced the etiology of hysteria up to the seventeenth century.^[59] He argues that, before about 1600, the "hysteric affection" was, as the name implies, attributed to the womb. In the early seventeenth century hysteria was linked not only to the male condition known as hypochondria, in which the spleen was thought to give off vapors, but also to melancholy, found in both sexes. Robert Burton saw hypochondria and hysteria as forms of melancholy; Sydenham believed that both sexes could suffer from hysteria, but that in women it was the most common condition next to fever.^[60] Thus there was a shift in "the limits of hysteria, as it united with hypochondria and annexed parts of melancholy's crumbling empire."^[61] At the same time the cause of hysteria came to be seen as being the brain, or the whole person. In the eighteenth century, hysteria was increasingly classified as a neurosis; the excess blood naturally present in the female body led to increased nervous irritability, especially under the influence of too much meat, coffee, or tea and insufficient exercise.^[62] At this time, "According to the conventional medical wisdom, hysteria was a chronic, quintessentially feminine, disease resulting from the peculiar constitution and physiology of women."^[63] The only certain way to make sure one's fragile nerves were not further weakened was to conform to the "prevailing social and biological notions of womanhood."^[64]

By the mid-nineteenth century, when Littré was writing, some doctors believed that the cause of hysteria was a physical disorder of the womb; others did not.^[65] For most writers of this period, however they may have envisaged the mechanism of its production, hysteria nevertheless "was rooted in the very nature of being female."^[66] Pierre Briquet rejected the idea that the womb was responsible, preferring the explanation of a "neurosis of the brain" in someone of the "hysterical type"; in other words, the hysterical personality was a necessary part of the development of the disorder.^[67]

In some historical periods the implications of the label hysteria are

thus that the disease originates in the womb, while in others the implications are very different, hinting that there is no organic origin for the symptoms. Littré's dictionary makes his own position clear; he follows writers such as B. C. Brodie, who in a lecture published in 1837 wrote that "hysteria. . . belongs not to the uterus, but to the nervous system."^[68]