PART I—
HISTORICAL

One—
Once upon a Text:
Hysteria from Hippocrates

Helen King

Labels and Origins: a Name Without a Disease?

In the beginning was Hippocrates, the Father of Medicine, who freed the emerging science from the chains of superstition, introduced empirical observation and the bedside manner, and both identified and named "hysteria." So runs the established wisdom on the Hippocratic origins of both medical science in general and of the diagnosis of hysteria in particular. Yet recent work on Hippocratic medicine has called into question much of this tradition. Once it was an acceptable scholarly pursuit to debate the inclusion of particular treatises in the canon of "The Genuine Works of Hippocrates": now it is widely accepted that not a single text of the Hippocratic corpus can be attributed with any certainty to the Father of Medicine.^[1] In place of a canon of "Genuine Works," we have a diverse set of multi-author texts. Once the Hippocratic doctor was seen as a model of medical etiquette and morality: now he can be restored to his own historical and cultural context, where he becomes only one of the numerous brands of healer competing for clients in the ancient world, unafraid to improve his chances of employment by the use of tactics questionable by later standards.^[2] With the improved visibility made possible by the new Hippocratic studies, the time has surely come to reexamine the texts so confidently labeled by the nineteenth-century Dr. Robb as "Hippocrates on Hysteria"^[3] and to review the relationship between the text of the Hippocratic corpus, its interpreters over time, and the discussions of hysteria.

Since the Hippocratic texts are so often quoted—and misquoted—in

contemporary debates on the status of the diagnosis hysteria, such a study will not only contribute to the growing body of work on Hippocratic medicine and its place in ancient society but also inevitably feed into these debates. Eliot Slater, questioning the value of the diagnosis in our own times, has argued that "the justification for accepting 'hysteria' as a syndrome is based entirely on tradition and lacks evidential support."^[4] This tradition goes back to the alleged origin of the diagnosis of hysteria in the Hippocratic corpus, and it is only by reclaiming the relevant texts from their use in the tradition that we can understand and question the diagnosis in later centuries. If a fresh reading of the ancient texts shows that their use by the tradition is unwarranted, this will have important implications for the history of hysteria in general.

Recent work on hysteria in the Hippocratic corpus by medical historians, psychologists, and physicians is, almost without exception, based on the history of hysteria published in 1965 by Ilza Veith. On the name itself she wrote,

In the Egyptian papyri the disturbances resulting from the movement of the womb were described, but had not yet been given a specific appellation. This step was taken in the Hippocratic writings where the connection of the uterus (hystera ) with the disease resulting from its disturbance is first expressed by the term "hysteria." It appears in the thirty-fifth aphorism, which reads: "When a woman suffers from hysteria . . ."^[5]

Since the publication of Veith's book, these points have achieved canonical status. For example, R. A. Woodruff states that "the name, hysteria, has been in use since the time of Hippocrates"; P. B. Bart and D. H. Scully refer back to "the time of Hippocrates, who coined the name"; and S. B. Guze cites Veith as his only source for the "information" that "disorders diagnosed as hysteria have been encountered for about 2,500 years" and furthermore that, "as everyone knows, the term hysteria originated in Greek antiquity."^[6] These apparently confident assertions cover not only the origin of the word "hysteria," but also the very essence of ancient Greek gynecology. R. Satow, a psychotherapist and sociologist, asserts that "'hysteria' has been a label used for a potpourri of female ailments and non-ailments alike since antiquity. . . . The Greeks and Romans called almost all female complaints hysteria and believed the cause of all these female maladies to be a wandering uterus. . . . In various Hippocratic texts the term hysteria is applied to a large variety of female complaints."^[7]

What "everyone knows" is, however, not necessarily true. The earth is not flat, although once "everyone knew" that it was. Even leaving aside

the attempt to use Egyptian evidence, which has already been widely questioned,^[8] Veith's claims for Greek medicine are seriously flawed. As only one recent writer on hysteria, E. Trillat,^[9] has recognized, the "various Hippocratic texts" applying the term "hysteria" to many different complaints simply do not exist; moreover, to suggest that Hippocratic gynecology is about calling almost everything "hysteria" is a gross over-simplification. A total revision of our understanding of the tradition is thus long overdue.

Let us return to the text claimed by Veith as the inaugural moment of hysteria, "the thirty-fifth aphorism." It is a significant choice, since the Aphorisms is one of the most widely translated and best-known works of the Hippocratic corpus, believed for many centuries to have been written by Hippocrates himself as a distillation of the wisdom of a lifetime's clinical experience, and thus taken to be one of the most genuine works.^[10] Immediately, however, we encounter a difficulty; there is no "thirty-fifth aphorism." A. Rousselle^[11] has criticized Veith for reading back contemporary ideas into antiquity, but the problem is greater than this would suggest; Veith puts too great a trust in poor secondary sources. What she is referring to here is, in fact, Aphorisms 5.35 (L4.544), which does not use the term "hysteria" at all; instead, using the plural form hysterika , it begins Gynaiki hypo hysterikon enochloumenei , and it may be translated as: "In a woman suffering from hysterika , or having a difficult labor, a sneeze is a good thing."

What are these hysterika , and what is so good about a sneeze? Such questions plunge us directly into the heart of the hysteria debate. It is tempting to translate hysterika as "hysterics," but an apparently familiar word does not necessarily convey the meaning we would most naturally expect. Galen of Pergamum noted the difficulties of translating this aphorism (K 17b.824-825). Hysterika , he wrote in his commentary on the Aphorisms , could refer to all diseases of the womb^[12] or to only a particular condition called hysterike pnix (best translated "suffocation of the womb"), described by a number of post-Hippocratic writers and which will be discussed at length below, or to problems with the afterbirth, also known as ta hystera . He favors setting the aphorism in the context of hysterike pnix , for the following reasons. First, hysterika cannot refer to the afterbirth, because hystera and hysterika are not the same word. Second, it cannot refer to all diseases of the womb, because Hippocrates says that it is helped by sneezing. Clearly, not all diseases of the womb are helped by sneezing and, since Hippocrates cannot be wrong, Galen concludes that the passage must refer to hysterike pnix .

There is, however, no reason why we must follow Galen's line of ar-

gument since, despite his objections, there is nothing to prevent translating the phrase as "When a woman suffers from diseases of the womb." The argument that not all such diseases are helped by sneezing does not necessarily apply to pre-Galenic medicine. A sneeze expels various kinds of matter that may cause disorders, and thus has value in many situations; in a specifically gynecological context, substances such as mustard, black or white hellebore, and castoreum were widely recommended in the ancient world to promote menstruation or the expulsion of the afterbirth.^[13] Since retained menses were thought to be the cause of many female disorders, the expulsive value of a sneeze could often be beneficial.

It is in a passage of Pliny the Elder, written a century before Galen, that the sternutatory powers of mustard appear in the narrower context of "suffocation of the womb." Mixed with vinegar, mustard was thought to rouse women suffering from an epileptic fit or "vulvarum conversione suffocatas,"^[14] translated in the Loeb edition as "fainting with prolapsus" but more literally meaning "suffocated by the turning of their wombs." This may suggest another value of the sneeze, which was seen as being of particular importance in "suffocation." Many ancient writers discuss the difficulty of knowing whether a sufferer from the condition they call "suffocation of the womb" is, in fact, alive or dead. Pliny himself gives the case of a woman who lay as if dead for seven days with "conversio vulvae," turning of the womb.^[15] In such cases, it was necessary to test for life by holding a feather or a piece of wool at the nostrils. A sneeze was welcomed as evidence of the presence of life.

Sneezing, due to its expulsive powers, can thus be "a good thing" for many disorders affecting women, but by the first century A.D ., when Pliny was writing, it had come to be seen as particularly valuable in "suffocation of the womb" because it could recall to life a patient lying as if dead. It is thus possible that it had the first meaning in Aphorisms , but that this had been overlaid with the second by the time of Pliny. Galen, writing a hundred years or so after Pliny, put together the broad context of the Aphorisms passage and the more specific context of Pliny; the example thus makes us aware of the possible changing interpretations of a text over time.

Regardless of how we choose to translate the passage, it should above all be noted that this is not what Veith called "a specific appellation": a disease label. Veith admits that the form hysterikos , "from the womb," "connected with the womb," or, when applied to a woman, "liable to disorders of the womb," is "more frequently used,"^[16] but she does not acknowledge that it is in fact used exclusively, and moreover that the Aphorisms example is only a further case of this general type.

It is not difficult to find the source for this particular misconception on the part of Veith. The idea that it is in the Hippocratic corpus that hysteria is not only described but also given its name can be traced back beyond her to the Emile Littré edition of 1839-61, the gynecological volumes of which—numbered 7 and 8—appeared in 1851-53. For the present purpose, a study of these must concentrate on the additional French material supplied by Littré. This appears in two forms. First, for many of the Hippocratic texts he provides section headings for each chapter; these have no analogue in the Greek manuscripts. This applies to the three volumes of the Gynaikeia , known in English as Diseases of Women ,^[17] where several passages are headed "Hystérie." Second, additional material appears in the translation itself, where Littré uses the medical categories of his own time. The misplaced confidence of the title used by Robb in his article "Hippocrates on Hysteria"^[18] is based on translating Littré into English while simultaneously incorporating distinctions made only in the headings.^[19] As Rousselle has recently suggested, these owe far more to nineteenth-century debates and theory than to the Hippocratic texts they are supposed to summarize.^[20] Just as Adams aimed to make the Hippocratic texts that he selected as "The Genuine Works of Hippocrates" intelligible to "any well-educated member of the [medical] profession at the present day,"^[21] so Littré "read Hippocrates in his own image and in the image of the medicine of his time,"^[22] with the explicit intention of using Hippocratic wisdom to improve the medical practice of his own day. "Until the nineteenth century, medicine nourished itself on Hippocrates—or at least on that which it believed it could find in Hippocrates."^[23]

The section headings written by Littré go further than merely labeling certain sections "Hystérie." In addition to this, Littré distinguishes between imagined movement of the womb, which he classifies as hysteria, and real movement, which he describes as displacement. He thus makes such comments as, "This section appears to be a confusion of imaginary with real movements of the womb"; "This appears to be some displacement of the womb rather than hysteria"; and "The fact remains that there is confusion between imaginary and real displacements."^[24] He believes that the Hippocratic texts do not make sufficiently clear the distinction he seeks, in contrast to Veith, who—again, wrongly—claims that "the Hippocratic physician was aware of the importance of a careful differentiation between hysterical symptoms and those of organic disease."^[25] The writers of these ancient texts make no such distinction. They describe what is, for them, a real and organic condition: the movement of the womb (hystera ) to other parts of the body. Since it is Littré, rather than any Hippocratic physician, who is interested in the distinc-

tion, it may be suspected that Veith is basing her remarks on the Littrean section headings rather than on the Greek text.

The origin and process of transmission of the error in translation should now be plain. Littré read the Hippocratic corpus in the context of the mid-nineteenth century, in which hysteria was a recognized condition of debated etiology; he expected to find hysteria in the text, duly found it, and drew it out in the headings he wrote for the various sections. Robb translated into English the passages headed by Littré as "Hysteria," and subsequent readers of the Hippocratic corpus have accepted the categories imposed by Littré on his material. Taking only the Aphorisms passage, Littré translates "Chez une femme attaquée d'hystérie. . ." while Francis Adams gives "Sneezing occurring in a woman with hysterics," and J. Chadwick and W. N. Mann have "When a woman is afflicted with hysteria." In giving "When a woman suffers from hysteria. . ." Veith is following the widely available Loeb translation.^[26]

Thus the diagnosis of hysteria is one made not by the ancient authors of the texts, but rather by the nineteenth-century translator of the Hippocratic corpus. At this point it would be possible to argue that this is of only minor importance; granted, the tradition is wrong to claim that the Greeks invented the name and thus the diagnostic category of hysteria, but if the Hippocratic texts nonetheless contain the first clinical descriptions of hysteria, should we much concern ourselves with the origin of the name? As a result it becomes necessary at this point to begin to consider what we are to understand by "hysteria." When a translator reads the diagnosis into a text, this would seem to suggest the belief that there is a fixed entity called hysteria, constant over time and place, so that we can say with Chariot that "L'hystérie a toujours existé, en tous lieux et en tous temps,"^[27] and with D. W. Abse that "in fact, east and west, hysteria continues unabated in various guises."^[28] If we believe this, it will be of relatively little significance that the name "hysteria" is not Hippocratic. A concept may exist even if it is not named; as G. Lewis points out, the ancient Hebrews had no word for what the Romans were to call lex talio , the law of retribution in kind, but they did say "An eye for an eye and a tooth for a tooth."^[29] Further general questions about hysteria will also need to be addressed. Is it a disease like any other, and thus a fit subject for medical study and treatment? Is it a disease at all?^[30]

If hysteria is constant, found throughout history, worldwide, we can begin to talk about whether or not Hippocratic medicine recognized it, regardless of whether the Hippocratics named it, just as we can talk about whether tuberculosis, epilepsy, and gonorrhea were recognized. Furthermore, if it is historically constant, a body of text of the length of

the Hippocratic medical corpus should, statistically, contain some cases of it. Any decision that it is constant therefore prejudges the question of whether or not it existed in Hippocratic times: by definition, it must have done, and our task is only to find the sections in the texts which provide a more or less accurate match with our chosen clinical picture. This task, however, is complicated by the belief that hysteria, like chlorosis, is a disorder that apparently disappeared in our own century; as Trillat says, "L'hystérie est morte, c'est entendu."^[31] This could lead us to apply more stringent criteria to the Hippocratic texts, to conclude that hysteria was not present in classical Greece, and thus to revise our views on the significance of its apparent disappearance from the medical scene.

There are however two main obstacles standing in the way of a decision to treat hysteria as a historical constant. The first is that, unlike tuberculosis, epilepsy, and gonorrhea, hysteria is in no way a clearly defined disease entity for which most medical practitioners in our society would draw up the same list of symptoms; the second, that an integral part of the definition of hysteria often consists in its supposed ability to mimic symptoms of other diseases.

Contemporary medical writers on hysteria fall into two main groups. One group accepts that hysteria is "a valid, independent syndrome"^[32] and, in applying this label, makes use of the Perley-Guze criteria, which list over fifty symptoms in ten areas; exhibiting twenty-five symptoms in nine out of ten areas qualifies as hysteria, in the absence of any other diagnosis.^[33] One area is entirely concerned with menstrual difficulties;^[34] since menstrual suppression is by far the most common symptom in Hippocratic gynecology—for reasons that relate to the belief that amenorrhea indicates the presence of a dangerous reservoir of unshed blood^[35] —it should not be surprising that retrospective diagnosis of hysteria in the Hippocratic texts is common. The second group's position is conveniently summarized by Slater's (1965) lecture "Diagnosis of 'hysteria.'"^[36] The single quotation marks around "hysteria" say it all. Slater picks up the Perley-Guze point that the label hysteria is applied "in the absence of any other diagnosis" and concludes that the diagnosis merely indicates the "absence of relevant physical findings"; it is "a disguise for ignorance and a fertile source of clinical error . . . not only a delusion but also a snare" and "a way of avoiding a confrontation with our own ignorance."^[37] Edward Shorter suggests that diagnoses such as hysteria have often covered an undetected uterine infection.^[38] C. D. Marsden, too, points out that a high percentage of patients diagnosed as having hysteria turn out to have an underlying organic disease and concludes

that "there can be little doubt that the term 'hysterical' is often applied as a diagnosis to something that the physician does not understand."^[39]

Slater therefore argues that "the justification for accepting 'hysteria' as a syndrome is based entirely on tradition and lacks evidential support."^[40] F. Walshe's response to Slater, significantly using the same title but omitting the quotation marks around the word "hysteria," defends "the concept of hysteria as a nosological entity in its own right."^[41] The debate in medical circles continues, and Slater's contribution is discussed at length in Alec Roy's (1982) collection of essays, Hysteria .^[42] R. Mayou gives a fair summary of the medical situation when he writes that there is at present "no agreement about diagnostic criteria" for hysteria.^[43]

The second difficulty encountered in regarding hysteria as something constant is that, if anything is a widely accepted part of the definition, it is the suggestion that it can mimic the symptoms of any other disease.^[44] In this case, how can hysteria itself be a disease, and what is to prevent it from taking such radically different forms in different epochs as to be almost unrecognizable as the same condition? The corollary is also true; as Shorter puts it, "every organic disease imaginable . . . has at one time or another been classified as hysteria."^[45] Does a condition with such indistinct and shifting borders exist in any meaningful sense? As Trillat puts it, hysteria is "une maladie qui n'en est pas une, tout en l'étant . . ."^[46]

Nineteenth-century medical literature suggests that hysteria can manifest itself in a highly dramatic form; in the ideal type of Charcot's "grande hystérie," violent muscular contractions culminating in the arched posture (arc-en-cercle ), paralysis, loss of voice, retention of urine, anesthesia, and blindness. In a recent study of admissions for hysteria to the Edinburgh Royal Infirmary in the late eighteenth century, however, G. B. Risse found that only a minority of alleged victims had fits of this kind; most women sufferers had loss of appetite or other digestive problems, menstrual difficulties, and fainting spells, symptoms suggestive of many organic diagnoses.^[47] Yet one relatively constant feature of the diagnosis of hysteria in modern times is that it implies that the physical symptoms so labeled, whether dramatic or not, have no recognized organic cause. It should now be clear why hysteria has been described as "that most unsatisfactory of psychiatric syndromes."^[48]

Marsden's recent discussion shows the widest possible extent of the definition of "hysteria." "Physicians use the term to describe the symptom (conversion disorder or disassociation state), the illness (somatization disorder or Briquet's syndrome), the personality (histrionic), a form of anxiety (phobic anxiety after Freud), an epidemic outbreak (mass hysteria) and irritating patients (if female they are hysterical; if male they

are psychopaths)."^[49] The irritation felt by doctors toward hysteria patients is eloquently expressed in the words of a doctor writing in 1908, a time when the contracture or "drawing up" of a limb was a common symptom: "As Vance cut off the plaster cast from a 14-year-old girl whose leg had 'drawn up' a year previously, she cried, 'It is going to draw up; it is going to draw up,' at which Vance said severely, 'If it does draw up, I will break your d____d little neck.'"^[50]

Other contemporary writers argue for a restriction of the definition of hysteria, excluding the syndrome and the personality type and using hysteria only for a universal human reaction, comparable to anxiety or depression.^[51] Shorter's suggestions may be helpful here, insofar as they permit a degree of universality, while incorporating variation among cultures. He accepts that "'hysteria,' it appears, is a real psychiatric disease, in addition to being an epithet with which men have stigmatized women across the ages." However, he goes on, "the presentation of 'hysterical' symptoms tends to be molded by the surrounding culture" to a greater degree than that of, for example, the symptoms of schizophrenia. A major question to ask therefore concerns the social construction of the disease: Why is it that, from a wide repertoire of the possible, "certain symptoms are selected in certain epochs"?^[52] I will return to this important question, in relation to the Hippocratic texts.

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]

Hippocratic Hysteria: the Womb and Its Destinations

For the Hippocratic writers, however, the texts that have been used in the construction of hysteria described something resulting from a firmly organic cause, the movement of the womb. It is to the role of the womb that we must now turn. The Hippocratic texts suggest that movement of the womb is caused by menstrual suppression, exhaustion, insufficient food, sexual abstinence, and dryness or lightness of the womb, and that it can be cured by marriage and/or pregnancy, scent therapy, irritant pessaries, and various herbal concoctions administered by mouth, by nose, or direct to the vulva.

Since the womb is believed capable of movement around much of the body, these texts attribute a wide range of symptoms to womb movement. In searching for Hippocratic hysteria, we could therefore narrow down the field by identifying some combination of symptoms which so closely resembles the picture of hysteria in later historical periods that the problem of the absence of a disease label might be dismissed. The question raised by this approach is, of course, which historical period's image of hysteria we should take as our ideal type against which the Hippocratic texts are to be measured—hysterike pnix in the early Roman Empire? or the hysteria of the mid-nineteenth century? Another, more productive, way of approaching the problem is to start from the opposite end, asking which sections of the Hippocratic corpus have traditionally been used as evidence that hysteria was found in classical Greece. Robb's "Hippocrates on Hysteria"^[69] translates the Aphorisms passage and five chapters of the gynecological treatises: Nature of Woman , chapter 87; Diseases of Women book 1, chapter 7, and book 2, chapters 123-125. He also gives brief summaries of Diseases of Women book 2, chapters 126-127.

It is significant that these chapters are among the very small group of Hippocratic texts used in recent discussions of hysteria, the other major chapter most commonly brought into the debate being Diseases of Women 1.32.^[70] Robb also cites the appendix to Regimen in Acute Diseases , which distinguishes between pnix —a breathing difficulty usually translated as "suffocation"—caused by the womb and that caused by spasm

or convulsions: if the patient feels pressure from the fingers, it is from the womb; if not, it is a convulsion.^[71] However, close study of the above passages from Diseases of Women and Nature of Woman , so often the only examples of Hippocratic hysteria given in contemporary discussions, reveals that they have in common only a reference to the womb moving to another part of the body, and the symptom of pnix . The affinity between these is not, however, constant. For example, the womb may move in the absence of pnix , as in Diseases of Women 2.127 (L 8.272-274); this section is headed "Hystérie" by Littré. It is also worth noting that such features of nineteenth—and twentieth-century hysteria as grinding the teeth, loss of voice, cold extremities, and limb pains or paralysis do feature in the Hippocratic texts, often in the company of movement of the womb and suffocation, but may be found in the absence of either or both and may be attributed to a named organic cause; for example, in Diseases of Women 2.110 (L 8.234-238) they arise from a red flux.

The difficulties of finding a passage in the Hippocratic texts to serve as a paradigm for Hippocratic hysteria are increased when we look at Littré's classifications and at the texts themselves. Thus, of the six texts used by Robb,^[72] only four are in fact headed "Hystérie" by Littré: one chapter from Nature of Woman , 87 (L 7.408), and three from Diseases of Women , 2.123-125 (L 8.266-270). Not only do they give largely different combinations of symptoms and prescribe different remedies, but in none of them does even the adjective hysterikos , "from the womb," appear.

This last point is of particular interest. Since the noun is not used in this period, it is entirely irrelevant for M. R. Lefkowitz, in a discussion of fourth-century medicine, to claim that "the term hysteria means 'wombiness'."^[73] Maybe it does; but since it is not used, this is of little importance. One also searches for it in vain in the later gynecological writers of antiquity, such as Soranus and Aretaeus of Cappadocia, in whose work there does exist a condition thought to originate in the womb and to cause symptoms of suffocation, tooth grinding, loss of voice, and so on, but which is called not hysteria but hysterike pnix , "suffocation caused by the womb." The classic description of the symptoms that came to be collected under this label is Soranus's Gynecology 3.26-29; section 2.11 of Aretaeus is also headed "On hysterike pnix " (CMG vol. 2, PP. 32-34) but, unlike Soranus, he lists the remedies in a separate section, 6.10, "Treatment of hysterike pnix " (CMG vol. 2, pp. 139-141).^[74]

The theories of Aretaeus and Soranus will be discussed in detail below. However, it is worth discussing why neither the category of hysteria nor that of hysterike pnix has a place in Hippocratic medicine. Not

only does pnix exist as a symptom in the Hippocratic gynecological texts, and hysterikos as an adjective, but one of the sections used by Robb and many others—Diseases of Women 1.7 (L 8.32)—even introduces the description with "If pnix suddenly occurs." Nevertheless, in these texts the two are not explicitly brought together. Why should this be so?

One of the reasons why neither hysteria nor hysterike pnix is a Hippocratic category is simply that Hippocratic gynecology does not work by fitting collections of symptoms into preexisting categories. We can learn a great deal from studying the ways in which the Hippocratic writers choose to describe and to name disease. In many cases, ancient gynecology distinguishes and separates different combinations of symptoms according to cause and treatment, rather than subsuming many symptoms under a single disease label that "covers over all the clinical detail";^[75] it emphasizes description of symptoms rather than diagnosis.^[76] Any attempt to impose the diagnosis of hysteria on the Hippocratic texts may therefore risk distorting their approach to illness.

Indeed, looking at the Hippocratic corpus in general, not all Hippocratic texts name the diseases they describe. V. Di Benedetto distinguishes four ways of presenting a disease in these texts: as "another disorder," as "if" or "when" followed by one or more symptoms, as "if" or "when" followed by the name of a disease, or by giving the name of the disorder at the very beginning of the section. He suggests that these different ways of presenting disease reflect a culture in which the relationship between doctor and disease is defined in more than one way. The "if symptom x, therapy y" form is the most ancient, found also in Assyrian and Babylonian medicine, but in Hippocratic medicine it is slightly modified because the patient and the disease are separated and the possibility admitted that different patients may suffer in slightly different ways from what is nevertheless the same disease. Turning this last point on its head, the Hippocratic writers thus have the notion of a disease as something unitary which, due not only to the differences between patients in age, sex, temperament, and coloring, but also to variations in climate and season, may nevertheless manifest itself in a variety of ways. One disease: different symptoms, according to other factors affecting its presentation.^[77]

When the Hippocratic texts give a specific name to a disorder, it may be taken from the affected part; from the way in which the disorder presents itself; from the specific sensation caused; or from something that happens in the course of the disease.^[78] Although there is no name given to the disorder, or disorders, in the texts usually seen as "Hippocratic hysteria," their opening words are relevant here. These fall into two

categories. Some start by describing the movement of the womb: "When the womb turns to the head" in Diseases of Women 2.123 (L 8.266). Others start with the symptoms of pnix , suffocation: the opening of Diseases of Women 1.32 (L 8.76) translates as "If pnix suddenly seizes a pregnant woman." The later name hysteria comes from the part believed to be affected: the womb. However, in the Hippocratic texts being considered here, the focus is either on the part that causes the symptoms or on the symptom that seems to have a central position: pnix . I will shortly return to the specific significance of this sensation in classical medicine.

The texts traditionally used as examples of hysteria in the Hippocratic corpus exhibit several features that make it difficult to merge them into one picture. I now propose to discuss those most commonly used by later commentators in order of their appearance in the gynecological treatises, and to set them within the context of the imagery associated with "woman" in ancient Greece.

The first description of interest is the second chapter of Diseases of Women book 1 (L 8.14-22), a discussion of menstrual suppression in a childless woman. Menstrual suppression is of central importance in Hippocratic gynecology,^[79] due to a physiology of the female outlined in the previous chapter, Diseases of Women 1.1 (L 8. 10-14). Regular menstrual bleeding is seen as essential to female health—after maturity, outside pregnancy, and before the "drying out" of the menopause—because of the quality of female flesh. In women who have given birth, the body is "broken down" and its internal channels opened by childbirth and the lochia. A woman who has not given birth will suffer more pain if the flow of her menstrual blood is obstructed; because her body is more resistant, firmer, and more "thickly-packed," there is less open space into which the blood can travel. The writer of this chapter goes on to say that a woman's flesh is softer and of a looser texture than that of a man, and draws an analogy between female flesh and sheepskin, and between male flesh and a rug. If a fleece and a rug of equal weight are placed over water or in a damp place for two days and nights, the fleece will be found to have become much heavier than the rug. This is because sheepskin has a greater capacity to absorb water: a capacity shared with female flesh.^[80]

Aristotle's characterization of woman as "a deformed male" and "a mutilated male" is well known, as is its persistence in Western culture.^[81] However, Aristotle's biology may be seen as only one manifestation of the classical Greek belief that women are both fundamentally different from, and inferior to, men. In the seventh century B.C ., the poet Hesiod expressed this belief in chronological terms; women, the genos gynaikon

or "race of women," were created later than men. Before Zeus sent the first woman and mother of the "race," Pandora, as one stage in the sequence of gift and counter-gift between gods and men, men lived like the gods. The arrival of Pandora and her daughters creates the need for sexual reproduction and agricultural labor, since women are voracious consumers of all that a man can produce.^[82] In the Timaeus , Plato too presents women as a late addition to the human race; in the second generation of humanity, men who acted in a cowardly or unjust way in the first are reborn as women.^[83]

Defining the female in terms of the male is one way of expressing difference; chronology is another. Other images of male/female relations express it in other ways but show similar persistence: the agricultural metaphor, in which man ploughs the field that is woman and sows the seed in her passive body, or the war/childbirth opposition, in which man sheds the blood of others to defend the city in war, while woman bleeds from her own body and replenishes the city's stock of men.^[84] By locating female difference at the level of the flesh, Hippocratic medicine incorporates the ideas of fundamental difference, sexuality, and bloodshed into its image of woman.

The direct consequence of the difference between the flesh of the two sexes is that women absorb more fluid from the digestive process, needing menstruation to remove the excess from their bodies. As a result, in the Hippocratic texts women are often described as "wetter" than men. Women are loose-textured and soft to the touch, thus by their very nature retaining moisture, and this retention is even presented as the explanation for women having breasts.^[85] A further factor mentioned in Diseases of Women 1.1 is their way of life. A man does more strenuous and tiring work, which dries out any excess moisture he may have accumulated; women live sedentary lives, leaving menstruation as the only way of purging them of the excess fluid building up in their bodies.

It is in the context of these beliefs about the female body that Diseases of Women 1.2 should be read. In certain circumstances, even in the wet body of a woman, the womb may be deprived of sufficient moisture. The childless woman, due to the lack of spaces in her body in which moisture can be stored, is at particular risk, above all if she abstains from the "moistening" activity of sexual intercourse. In such a woman, the "dry and light" womb may suddenly "turn around"^[86] and move up in search of moisture. Menstruation stops, and if it does not occur for three months there will be pnix from time to time, intermittent fever, shivering, and pain in the limbs. If there is no bleeding by the fourth month, these symptoms will worsen and will be joined by those of thick urine,

a swollen abdomen, grinding the teeth, loss of appetite, and difficulty in sleeping. In the fifth month all symptoms will be worse; if the condition persists into the sixth month with no menstrual loss, it will have become incurable, and the woman will suffer the additional symptoms of vomiting phlegm, extreme thirst, discomfort if touched, gurgling sounds from the blood in the womb which is unable to come out, loss of voice or difficulty in making herself understood, and irregular breathing. Finally the abdomen, legs, and feet will swell: death is imminent.

The disorder described in Diseases of Women 1.7 is similar, although it does not follow this month-by-month pattern, but the explanation for the symptoms is different, since the central point seems to be that they depend on the location to which the dry womb moves. The affected group is described as women not having intercourse, but older rather than younger women because their wombs are lighter in weight. Elsewhere in these texts it is explained that the younger the woman, the more blood there is present in her body.^[87] If a woman's vessels are emptier than usual and she is more tired, the womb, dried out by fatigue, turns around and "throws itself" on the liver because this organ is full of moisture. This causes sudden pnix , by interrupting the route of the breath through the belly. During this pnix , the whites of the eyes are turned up, the woman is cold, and her complexion is livid; she grinds her teeth and has excess saliva, like a sufferer from Heracles' disease, another name for the condition that the Hippocratics usually called the sacred disease and which we would probably call epilepsy. Sometimes phlegm will run down from the head, causing the womb to leave the liver and return to its proper place, and the pnix will stop because the womb is now full of fluid and heavy. If the womb stays on the liver or in the area of the hypochondria for a long time, however, the sufferer will be choked; if it moves to the mouth of the bladder, it will cause strangury; or it may go to the limbs or side.

Diseases of Women 1.32 (L 8.76) gives an almost identical etiology for pnix and a very similar picture of symptoms, but it concerns the condition in a pregnant woman. Not only fatigue but also insufficient food can cause the womb to move; the womb itself is described as being overheated as well as dry. As in 1.7, phlegm—described as cold—may run down from the head and cause the womb to return to its proper position; if the womb does not return quickly, there is danger to the fetus.

The alleged hysteria texts in Diseases of Women 2.123ff. are much shorter than those so far discussed and give little information on the women most likely to be affected or on the mechanisms by which the

symptoms are produced. Instead, they start by naming the location to which the womb has moved (without saying why it has traveled there), then give a short list of "signs," and finally outline the treatment. Diseases of Women 2.123 (L 8.266) opens: "When the womb moves to the head and the pnix stops there, the head is heavy." The signs are that the patient says she has pain in the channels in the nose and under the eyes: there is lethargy and foaming at the mouth. The first treatment is to wash her with warm water; if this does not work, cold water or cooled boiled laurel or myrtle water should be put on the head, and the head anointed with rose oil. Sweet smelling fumigations should be applied below, foul smelling substances to the nostrils; she should eat cabbage and drink cabbage water.

Diseases of Women 2.124 (L 8.266-268) has an identical format and concerns movement to the heart; Diseases of Women 2.125 (L 8. 268-270) and 2.126 (L 8.270-272) concern movement to the hypochondria, for which drinks of castoreum and fleabane^[88] are among the recommended remedies. As is usual in these texts, a range of different substances is given, perhaps in order to aid the doctor in catering for a range of abilities to pay, or to allow for seasonal difficulties in obtaining the substances. In general, in addition to pessaries, washing, bandages around the body to keep the womb in place,^[89] oiling, and drinks, these texts make much use of fumigation, a frequent remedy for gynecological conditions.

The most detailed description of fumigation occurs in a text that is not traditionally used by later writers on hysteria: Diseases of Women 2.133 (L 8.284-286). This covers a forty-day program of pessaries and fumigations for a condition in which the womb moves to the hip joint, the mouth of the womb is closed and tilted, and the menstrual blood, unable to leave by its usual route, moves instead to the breasts. It is worth translating in full not only because of the details of the fumigation process, recommended to return the womb to its place and open it so that the menstrual blood can come out—part of the treatment for hysterical suffocation for many centuries—but also because it is only one of many chapters that could be used to show the existence of womb movement texts, the details of which the hysteria tradition chooses to ignore. Contributing to its neglect by the hysteria tradition is the fact that Littré diagnoses it not as hysteria but as "Obliquité latérale devenant chronique" leading to menstrual suppression, swollen breasts, and, eventually, breast cancer.

The description of fumigation reads as follows.

First give a fumigation to the womb. Take an earthenware pot with two-sixths capacity, put on it a dish, and fit them together so that no air can get in. Then pierce the bottom of the dish and make a hole. Put in the hole a reed, about a cubit long. The reed must be properly inserted in the dish so that no vapor escapes. When you have prepared this, place the dish on the pot and plaster it round with clay. When you have done these things, dig a hole in the ground, two feet deep, large enough to make room for the pot. Then burn firewood, until you have made the hole red-hot. When it is red-hot, take out the wood and the biggest and hottest pieces of charcoal, but leave the ashes and embers in the hole. When the pot is heated up and vapor rises, if the vapor is very hot, hold back; if not, she is to sit on the end of the reed, and pass it into the mouth [of the womb], then fumigate. If it cools, throw on red-hot charcoal, taking care that the fumigation is not too fiery. If, by adding the charcoal, the fumigation becomes more fiery than it should be, take away the charcoal. One should construct the fumigation in fine, still weather, so she is not cold: she should be covered with garments. In the pot you should put dry garlic, and pour in water so that it rises two digits above, and soak it well, and pour in seal oil too. Heat this. The fumigation must go on for a long time. After the fumigation, if she is able, she should wash her whole body as she pleases, the lower back and below the navel in particular. Give for dinner barley cake or wheat bread, and boiled garlic. On the next day, if she is weak from the fumigation, intermit that day: if not, go back to the fumigation. While she is being fumigated, if she is able to examine it, order her to touch the mouth [of the womb]. The fumigation itself inflates the womb, makes it more upright and opens it. It is because it is like this, and can do such things, that you should use a fumigation.^[90]

On the constituents of this fumigation, it is noteworthy that elsewhere in this treatise seal oil is described as the best substance to use in a fumigation for movement of the womb to the hypochondria.^[91] Garlic, like castoreum and fleabane, features because of its strong smell. In descriptions of therapy for womb movement, the olfactory qualities of substances often account for their use. The pattern is usually that fragrant substances are applied to the vulva, in order to attract the womb back, while foul-smelling substances are placed under the nostrils to drive the womb away from the upper parts of the body.^[92] In addition-and in apparent contradiction—fragrant oils may be rubbed on the head and strong-smelling substances drunk, often in wine.

Littré's diagnosis apart, there seems little reason why the womb movement described in 2.133 should have been omitted from the construction of the hysteria tradition. That section demonstrates the prevalence

of the combination of womb movement and menstrual suppression throughout Diseases of Women . Returning to the alleged hysteria texts, Diseases of Women 2.127 (L 8.272) is another description of movement of the womb to the liver, which defines the affected group in a way different from that of the writer of 1.7. Where 1.7 saw the most likely sufferer as an older woman not having intercourse, 2.127 suggests movement to the liver is more common in older unmarried women and young widows, especially the childless and the sterile, because these women lack the beneficial purging of childbirth and the lochia. Here the argument is more reminiscent of 1.2. Section 2.128 (L 8.276) discusses movement to the hypochondria, for which a fumigation followed by intercourse is recommended, and 2.129 (L 8.276) covers movement to the ribs, which can cause a cough, pain in the side, and what feels like a ball in the side. Section 2.130 (L 8.278) concerns movement to the hips or flanks, and 2.131 (L 8.278) movement to the middle of the waist, in which the drawing up of the limbs is mentioned as a symptom.

A further set of texts concerning womb movement may be found at 2.200ff.; two significant points for the later history of hysteria occur in 2.201 (L 8.384), where it is recommended that the patient's groin and inner thighs should be rubbed with aromatics to cure movement of the womb to the diaphragm, and 2.203 (L 8.388), where we read, "When the womb causes pnix , light a lamp and snuff it out under the nostrils" and, later in the same chapter, "Take a lamp, throw on it a little oil, light it, and when it is extinguished hold it near the nostrils." The first therapy is used in a famous passage of Galen, which will be discussed below: the second, also found in one of the texts used in the hysteria tradition, Nature of Woman 87 (L 7.408),^[93] occurs in many later discussions of hysteria.

It can be seen that the Hippocratic texts do indeed work by describing symptoms rather than giving a single disease name to these chapters, and that where they group symptoms and therapies together they do so according to the part of the body to which the womb is believed to have moved. Of these therapies, the recommendation of marriage/pregnancy occurs only in the discussion of womb movement to the hypochondria in Diseases of Women 2.128 (L. 8.276), which ends by saying that, after fumigation, the patient should sleep with her husband: "release from this disease, when she is pregnant." Nevertheless, it is this treatment for womb movement that has received most attention in the secondary literature, above all in the work of the psychoanalyst and classicist Bennett Simon, in his Mind and Madness in Ancient Greece . This includes a chapter titled "Hysteria and Social Issues," which opens with the familiar error:

"Hysteria, the disease of the 'wandering uterus,' was given its name by the Greeks."^[94] Simon's overall approach to hysteria combines that of I. M. Lewis's study of spirit possession, trance, and shamanism, which presents the possessed state as an indirect mode of protest used by powerless and peripheral sectors of society,^[95] with a Freudian model. According to what Simon calls a "psychodynamic understanding of hysteria," "a hysterical symptom, for a Greek woman, permitted a safe expression of certain unmet needs," as a result of which expression the doctor would intervene on the woman's behalf as the "wished-for good father."^[96] To summarize the "culturally sanctioned dumb show"^[97] that Simon envisages, an unmarried or widowed woman is supposed to feel sexually frustrated and to express this frustration by hysteria: the doctor then legitimates her wish by announcing that the cure consists in letting her have what she wants, since it is precisely marriage and childbirth that will make her healthy again.

This approach is inadequate because it shows little understanding of the institutional position of women, the ideal of marriage as universal, the ideal age at first marriage of fourteen for girls, and so on.^[98] It also fails to come to terms with the fact that, in most of the texts labeled "Hystérie" by Littré, the marital status of the sufferer is not given^[99] or she is explicitly described as married.^[100] In his discussion Simon cites only one Hippocratic passage, Diseases of Women 2.151 (L 8.326), in which the woman patient is said to suffer in the same way as those who are struck with the sacred disease. In another passage on this last disease, Simon reveals that, like Veith, he has not studied the Greek text of the Hippocratic corpus in sufficient detail. After a brief discussion of the "madness of Heracles," which "was considered by some to be a case of epilepsy,"^[101] Simon states, "To my knowledge, the Hippocratic corpus contains no mention of the mythical characters who went mad and were portrayed so vividly on the Athenian stage and in vase painting." However, as I have mentioned above, in Diseases of Women 1.7 (L 8.32) the writer states that women with the condition he describes resemble sufferers from "Heracles' disease"; hypo tes herakleies nousou , which Littré translates "aux épileptiques." The characters of myth, who had influenced the folk names of diseases, are thus present even in the Hippocratic corpus.

It is, furthermore, inappropriate to describe hysteria as a "safe expression" of a woman's needs when loss of voice, grinding the teeth, and "movement of the womb to the liver," far from being a safe way of attracting attention, may be the signal for the Hippocratic doctor to tie bandages around the patient's waist, place foul-smelling substances under her nose, insert beetle pessaries, inject hot oil into the womb, or

shower her with cold water. As examination of the texts has already shown, and contrary to what Simon implies, marriage and childbirth are rarely the prescribed remedies for this combination of symptoms,^[102] and it is also unusual for the remedy to consist of something that could be seen as a form of indirect sexual gratification; for example, fragrant ointments to be rubbed on the vulva^[103] or the vaginal insertion of objects specifically described as resembling the male sexual organ.^[104] Finally, it is inappropriate to use Simon's "psychodynamic model" when in Hippocratic medicine there is no line drawn between psychological and organic illness.^[105]

A similar approach to that of Simon is taken by Rousselle, who states that "Greek women had no legal right to make any decision regarding their own marriage: they could not ask a man to marry them, or even decide that they wanted to be married or to accept an offer of marriage, so it is perhaps not surprising that their impotent anger should take the form of a disease in which their womb was literally suffocating them."^[106] D. Gourevitch traces the disappearance of "the hysterical virgin from medical literature" between the Hippocratics and the medicine of the Roman Empire; she attributes this disappearance to institutional change since, if the age at first marriage falls even further, fewer girls will remain to become hysterical.^[107]

However, such approaches are rooted in our own society's views on what is normal for a woman, on the nature of hysteria, and on the relationship between medicine and sexuality. Yet for the writers of the Hippocratic texts—and probably for the patients they treat—intercourse and pregnancy rightly belong to the domain of the pharmacopoeia, due to their dramatic and beneficial physical effects. Not only does intercourse moisten the womb, thus discouraging it from moving elsewhere in the body to seek moisture, but it also agitates the body and thus facilitates the passage of blood within it. Furthermore, childbirth breaks down the flesh throughout the body and, by making extra spaces within which excess blood can rest, reduces the pain caused by the movement of blood between parts of the body. It causes complete purgation (katharsis ) of excess blood and may thus cure many women whose problems originate in menstruation. Since all disorders of women ultimately result from their soft and spongy flesh and excess blood, all disorders of women may be cured by intercourse and/or childbirth, to which marriage and pregnancy are the necessary precursors. There is thus nothing special about the prescription of these in cases of movement of the womb.

Hippocratic medicine thus gives a pharmacological interpretation to

what we may be tempted to see as the social processes of marriage and motherhood. We should, of course, never forget that the Greek word for mature woman, gyne , also means "wife." Womb movement, however, calls up a battery of other therapies, many of which-like the fumigation described above—make use of foul—and sweet-smelling substances. These therapies lie behind the assertion frequently made in later writers—but not in such authors as Soranus and Galen—that the Hippocratic womb was thought to be an independent living being, fleeing from foul smells but moving to seek out more pleasant odors. We must now decide whether any such belief is necessarily implied by the use of scent therapy.

Such therapy relies on the idea of connections existing between parts of the body, and in particular in the gynecological texts on the presence of a hodos or "way" from the nostrils and mouth to the vagina.^[108] This is never anatomically described but is implicit in many therapies used. For example, a test to determine whether a woman can conceive involves putting a clove of garlic or another strongly scented substance at one end of the hodos and discovering whether the scent reaches the opposite end. If so, there is no obstruction present, and the woman can conceive.^[109] Disorders of the womb can also be treated by using the hodos . A summary of treatments of the womb in Diseases of Women 2.137 mentions the top and the bottom of this tube as appropriate sites for the administration of medication.^[110] If the womb has moved upward, foul-smelling substances are held at the nose, pleasant-smelling substances to the vulva, so that the womb is simultaneously repelled from above and attracted down to its correct place.^[111] If the womb moves down, or starts to come out of the body through the vulva, foul smells are placed there and sweet smells at the nostrils to draw it up again.^[112] There is no explicit discussion of the mechanism by which such therapy is supposed to work.

Plato and Aretaeus: the Wild Womb?

It is significant for later medicine that these descriptions of scent therapy also contain no suggestion that the womb is animate; that is, that it is a living being with a desire for sweet smells and a revulsion for foul smells. This brings us to a further important passage, Plato's Timaeus 91a-d, a description of the womb as animal, which has been highly influential in the history of hysteria. The womb is seen by Timaeus of Locri as a living creature desiring union, which, if it remains unfruitful (akarpos ) beyond its proper season, travels around the body blocking passages, obstructing breathing, and causing diseases. C. M. Turbayne says "Plato's account

follows that of Hippocrates who, in his Sicknesses of Women , coined the word 'hysteria' and ascribed hysteria to the wandering womb."^[113] As one would expect, Veith is cited in a footnote.^[114] Furthermore, this link between womb and animal is taken by F. Kudlien to be the assumption behind the "well known ancient concept" of uterine suffocation.^[115]

Plato lived from about 498 to 347 B.C . and was thus writing at the same time as the authors of Diseases of Women , or a few years after. Is it therefore valid to merge his theories with theirs and conclude that the Hippocratic scent therapy necessarily implies the belief that the womb is animate, "a living thing inside another living thing," as the second-century A.D . medical writer Aretaeus later wrote?^[116] The difficulty with this approach is that there are clear differences between the gynecology of Timaeus and that of the Hippocratic corpus, and there is ample evidence that the idea of the womb being—or being like—an animal was disputed even in antiquity. Its best-known expression, apart from the passage in Timaeus , is in Aretaeus, who states that movement of the womb mostly affects younger women, whose way of life and judgment are "somewhat wandering" so that their womb is "roving" (rhembodes ). Older women have a "more stable" way of life, judgment, and womb. This in itself varies from the Hippocratic theories, which tend to link movement of the womb with older women, whose wombs are lighter.^[117] It is in this section too that Aretaeus describes the womb as hokoion ti zoon en zooi , usually translated as "like some animal inside an animal" but which could be less emotively rendered "like a living thing inside another living thing."

It has been suggested that the words of Aretaeus are based on a recollection of having read Timaeus at school:^[118] as may be seen from the work of Soranus, also writing in the second-century A.D ., this was certainly a very outdated idea in second-century medicine. Soranus explicitly rejects the claim of "some people" that the womb is an animal, although he admits that in some ways it behaves as if it were, for example, in responding to cooling and loosening drugs. He reinterprets the success of therapy involving sweet—or foul-smelling substances to attract or repel the womb, saying that these work not because the womb is like a wild animal emerging to seek pleasant scents and fleeing from foul ones, but because the scents cause relaxation or constriction.^[119] Galen, writing shortly after Soranus, discusses and rejects what he regards not as Hippocrates' but as Plato's theory of the womb as a living creature in On the Affected Parts 6.5. After quoting from Timaeus he writes, "These were Plato's words. But some [physicians] added that, when the uterus during its irregular movement through the body touches the diaphragm, it in-

terferes with the respiratory [movements]. Others deny that the uterus wanders around like an animal. When it is dried up by the suppression of menstrual flow, it extends quickly to the viscera, being anxious to attract moisture. But when it makes contact with the diaphragm during its ascent, it suppresses the respiration of the organism."^[120]

It is thus clear from Soranus and Galen that, at least by the second century A.D ., medical opinion was split on whether womb movement necessarily entailed assigning the status of "living thing" or "wild animal" to the womb. It may further be questioned whether Plato's account—or, perhaps, the Locrian's account, since it is by no means certain that the passage represents Plato's own views^[121] —is in any way following the Hippocratic Diseases of Women , as Turbayne argues. In general, Timaeus shows a strong humoral theory of disease in which the four humors are linked to the four elements: earth, air, fire, and water. The use of humoral theory in the Diseases of Women is minimal, perhaps because the female body is so heavily dominated by blood.

The description of the womb and of conception in Timaeus should be read in the context provided by the preceding sections on the human body, which show that analogies in which certain parts of the body are compared to living creatures are common in Timaeus . That part of the soul which is concerned with bodily desires is tied up in the body "like a wild creature";^[122] a disease is described as being like a zoon , in that it has a natural span of life.^[123] At the start of the second generation of mankind, all those who have proved cowardly or unjust in the first become women; it is at this point that the gods put into all human beings a zoon that desires sexual union. In males, the penis has a disobedient and selfwilled nature, "like a zoon " and, like the savage part of the soul, it does not obey reason, the logos .^[124] When the womb is described, all that is different is that it is no longer put beside the zoon in a simile, but appears in a metaphoric relationship; not "like a living thing," but "a living thing desiring to bear children."^[125] In both cases what is significant is that the organ moves independently of the will, in an uncontrolled way. Since Plato/Timaeus has already mixed apparently nonfigurative uses of zoon (the gods put a living creature in all humans) with obvious similes (the penis is like a zoon ), it would be unwise to make too much of the way in which the womb is described. It should also be noted that animal analogies are used elsewhere for the organs. Not only woman is thought to have a zoon inside her, since Plato himself likens the penis to an animal, and in Aristotle it is the heart that is like an animal, this in turn being likened to the genitals in a further analogy.^[126]

In men, the zoon empsychon that makes the penis behave "like an ani-

mal" is in the seed, which comes from the spinal marrow.^[127] The theory of the origin of the semen is consistent with Hippocratic anatomy, which traces its path up the spinal cord, behind the ears and to the head.^[128] In the description of the corresponding part in woman, the womb, there are however some obvious differences from Hippocratic theories. Timaeus says that in coitus minute invisible and shapeless zoa are sown in the womb, where they will grow to maturity. Apart from the very general sowing analogy, this does not correspond to anything in the corpus; indeed, in the Hippocratic Generation 6 and 8, both male and female contribute seed, the sex of the child being determined by the strongest seed.^[129]

Aretaeus's analogy is thus not characteristic of the medicine of his time but, on the contrary, stands out as an anachronism: Plato's (or Timaeus's) medicine, while sharing some anatomical features with Hippocratic theories, demonstrates many individual points. Galen and Soranus mention the belief that the womb is not just like an animal, but is an animal, yet Galen ascribes this only to Plato. From the list of treatments of which he disapproves, Soranus apparently thinks that the use of scents in therapy tends to imply the belief that the womb is an animal. However, the central role of scent therapy in disorders of the womb in the Hippocratic texts does not mean that the Hippocratic writers would inevitably have regarded the womb as an independent animate part of the body; as Soranus's own explanation of why scent therapy works shows, it would be possible to use this technique within an entirely different conceptual framework, openly rejecting the animate womb theory.

I would also question whether we would be so ready to read into Hippocratic medicine ideas of the womb as an animal, were it not for the influence of the imagery of Timaeus on Aretaeus and on other writers to the extent that Galen finds it necessary to refute the theory. Our own medical theories play a part in this: because it is self-evident to us that the womb not only is not a living creature, but also cannot move around the body, any suggestion that it does so move is startling, demands explanation, and may be given more weight than it deserves.

Stifling and Suffocation: the Development of the Textual Tradition

In my discussion of the ways in which the Hippocratics classify disease, I have emphasized that the disease label hysteria, far from being applied in these texts for the first time, is a much later invention. The developing hysteria tradition uses only a selection of the Hippocratic texts on womb

movement; within this selection, it ignores the disagreement on such matters as the most susceptible category of woman, and the variation in symptoms according to the part of the body that the womb reaches in its quest for moisture. It also takes and merges distinctive images and therapies from these texts, regardless of their relative importance in Hippocratic medicine.

In the texts used to support this developing tradition, the symptom that stands out, and that is indeed sometimes used to introduce the Hippocratic disease description, is pnix , usually translated as suffocation. It is now necessary to consider the significance of this symptom in some detail. If we are to take seriously Shorter's suggestions that "the presentation of 'hysterical' symptoms tends to be molded by the surrounding culture" and that we should therefore be asking why "certain symptoms are selected in certain epochs,"^[130] we need to reject our fascination with womb movement—which was, after all, seen as unproblematic by classical Greek writers—and instead explore the implications of pnix in the very specific context of classical Greek medicine.

In his recent history of hysteria, Trillat poses a very pertinent question: is it the womb or the woman who suffocates in these texts?^[131] He suggests that this is not clear from the Hippocratic texts; however, unlike the Littré translation, the Greek text is often relatively straightforward on this issue, due partly to the convention by which Hippocratic writers often used plural terms for the womb. This enables us to see that, although in some cases it is the woman who suffers from the pnix ,^[132] it is generally the womb that is "stifled"; for example, "When the womb (sing.) stifles"; "If the womb (plural) arrives at the heart and stifles (plural)."^[133] I am proposing the translation "stifles" rather than "suffocates" for reasons that will shortly become clear.

In order to grasp the implications of pnix , the stifled womb that in turn stifles the woman, it is necessary to return to the question of what the Hippocratic writers—and the culture within which they practiced—understood to be the nature of woman. "Not only was the cause of hysteria rooted in the very nature of being female, but also in the belief that that nature was prone to disorder": thus W. Mitchinson, in a recent article on nineteenth-century Canadian medicine.^[134] This interest in nature takes on a different coloring in the key hysteria text of the early seventeenth century, Edward Jorden on "the suffocation of the mother," which was written to show that this disorder should not be "imputed to the Divell" but rather has "its true naturall causes."^[135]

In Jorden's sense, nature is also fundamental to the Hippocratic texts. One of the achievements of Hippocratic medicine which it is common-

place to admire is its movement away from explaining disease as divine in origin—the result of displeasing a deity, as in the opening of the Iliad , or of failing to fulfill a ritual obligation—in favor of natural explanations.^[136] The Hippocratic text usually quoted in this context is On the Sacred Disease , in which the alarming symptoms of epilepsy are shown to have a natural explanation, making it no more and no less sacred than any other disease. In the Hippocratic Diseases of Women 2.151^[137] an explicit comparison is drawn between a group of symptoms classified by Littré as hysteria and the sacred disease. It would be wrong to conclude from this that medical writers in the ancient world had correctly understood the similarity between the mechanisms by which these two disorders, as we define them, are produced; what is important is the suggestion that there is a natural explanation not only for the symptoms produced by womb movement but also for that movement itself.^[138]

For the history of medicine, it does not matter that the "natural" explanations given—the movement of the womb around the body, the constitution of the female—are ones in which we do not believe; what is important is that nature, not the gods, is thought to be responsible. There is however a further aspect of the production of the symptoms which explains why they naturally affect only women; women, by nature, have wombs, and "the womb"—implying both "not the gods" and "no other part of the body"—"is the origin of all diseases" according to the Hippocratic text Places in Man .^[139] Menstruation is, as the second-century A.D . writer Soranus puts it, "the first function" of the womb,^[140] and the writer of the Hippocratic text Nature of the Child describes as "simply a fact of her original constitution" the naturally wetter and more spongy flesh of the female which makes a woman produce excess blood.^[141] This blood moves to the womb every month prior to leaving the body in that flow that is, among other names, called he physis , "nature,"^[142] or ta kata physin , "the natural things."^[143]

For the Hippocratic writers, then, menstruation and nature are synonyms; all diseases of women come from the womb and thus from the nature of female flesh, the wet and spongy texture of which causes the accumulation of large amounts of blood, making menstruation necessary to female health. As Generation 4 puts it, "if the menses do not flow, the bodies of women become sick."^[144]

The symptom of pnix arises from the nature of woman. There is some disagreement in the ancient medical writers as to whether women are by nature hot or cold. For Aristotle, whose ideas on this point were historically more influential than those of the Hippocratics, women are cold, too cold to concoct blood into semen.^[145] Difficulties arise with this

position because, in humoral pathology, blood is hot and wet. If women have more blood than men, surely they should be hotter than men? In the debate given by Plutarch in Moralia ,^[146] a doctor takes up precisely this position in order to argue that women are the hotter sex; this is also the argument used to prove women's hot natures by "Parmenides and others," according to Aristotle,^[147] and a related argument appears in the Hippocratic Diseases of Women 1.1,^[148] which says that "the woman has hotter blood, and because of this she is hotter than the man."

It is however possible to argue that women are cold, despite their excess blood. Other speakers in the Plutarch passage claim that menstrual blood is not normal, "hot" blood, but a cold and corrupt form. The Hippocratic writer of Regimen 1.34 does not go this far; he accepts that menstrual blood is hot but argues that, since they purge the hot every month, women end up being cold!^[149]

There is also a third option; the womb, due to the way in which its role in conception and gestation is imagined, can be classed as hot, whether or not the menstrual blood or the woman herself is considered cold. Aristotle, for whom women are cold, can thus retain the traditional analogy by which the womb is compared to an oven.^[150] This analogy appears in a wide range of types of source material. By committing necrophilia, the tyrant Periander of Corinth was—in the words of the historian Herodotus—"putting his loaves into a cold oven."^[151] In the Dream Book of Artemidorus, an important source for ancient imagery, a hearth (hestia ) and a baking-oven (klibanos ) can represent women, because they receive things that produce life. Dreaming of seeing fire in a hearth means that your wife will become pregnant.^[152] In the Hippocratic texts Generation and Nature of the Child there are several occasions in which the womb is described in terms of the heat it generates, in one of which the embryo is compared to bread baking in an oven. Intercourse heats the blood and thus produces heat in the whole body, and the development of the seed in the womb is due to its being in "a warm environment."^[153] Whether women are classified as hot or cold, they have within them an oven to heat the seed.

How should this influence our understanding of pnix? The sensations of suffocation and stifling are not necessarily identical. Suffocation implies an obstacle preventing breathing; in this it resembles strangulation but, whereas the former suggests to us something over the mouth and nose, the latter suggests something around the neck. Stifling additionally implies heat, which is why it is to be preferred as a translation of pnix . Overlap is of course possible, since pressure around the neck or over the mouth may also cause a feeling of heat. Greek words related to pnix ,

such as pnigos and pnigmos , mean stifling heat, while a pnigeus is an oven. Support for the importance of heat in pnix in the period of the Hippocratic texts may be gained from Aristophanes' play Frogs , in which the god Dionysus asks the hero Heracles for a way to Hades which is neither too hot nor too cold. Heracles suggests "by rope and stool"—that is, to hang oneself. Dionysus replies, "No, that's stifling."^[154] Heracles goes on to suggest hemlock, which is rejected as "too cold." The use of a hot/cold opposition again associates pnix with heat.

It is thus because the Hippocratic writers have absorbed the traditional and powerful image of womb as oven that they associate its movement with the production of excess heat. This suggests a further aspect of the common recommendation of pregnancy as the best cure for many disorders of the womb; if nothing is cooking in a woman's oven, its heat will overwhelm her in some way unless something is done to use up that heat. The underlying image of womb as oven in these texts could account for other symptoms. Women with pnix feel cold at their extremities, perhaps because all their body heat moves toward the womb.

In the cultural context of Hippocratic medicine, pnix thus implies something more than "difficulty in breathing." It points us to something fundamental to that culture's image of the female, as an oven in which the seed is cooked. The supposed movement of that oven to other parts of the body in search of moisture to dampen down the fire can therefore be seen as causing heat in the affected part; the womb itself is stifled, and this can be transmitted to the woman sufferer. Being a woman, for the Greeks of this period, means having an oven inside you; an oven that is a natural—and socially acceptable—target when a physical cause is sought for dramatic somatic manifestations.^[155]

I have already demonstrated the variations within the Hippocratic corpus on such questions as the heat or coolness of the woman and the most likely category to suffer from womb movement. There is one Hippocratic passage in which pnix is explicitly linked to physical obstruction of breath. This is Diseases of Women 1.7, in which the womb, dried out by fatigue, moves to the liver because this organ is full of moisture. The result is sudden pnix , due to what is described as the interruption of the route of the breath through the belly. It is this etiology, rather than the general image of woman, or womb, as hot, which is taken up by later writers seeking to account for pnix . However, due to their general beliefs about the role of breath, heat still plays a part in such theories.

In later classical medicine pnix apparently becomes simply obstruction of respiration; however, nothing in the history of medicine is really simple. The implications of the shift in terminology require further explo-

ration of the conceptual universe of these writers, since respiration itself does not have the meaning we would most naturally assume.

The difficulty of using words such as respiration, veins, arteries, and pulse is that we regularly employ them within an anatomy and physiology completely different from those of ancient writers. Furthermore, theories of breathing, nutrition, and blood movement were themselves changed many times before William Harvey, and not necessarily as part of a linear process of experiment and discovery. To translate the Hippocratic phlebs (channel) as "vein" is to imply it is different from another sort of channel that is an "artery." The distinction between arteries and veins was probably first made by Praxagoras of Cos in the late fourth century B.C ., not in the context of an emerging theory of the circulation of the blood around the body, but instead because he believed blood and pneuma traveled through different systems.^[156]

Respiration is an excellent example of these difficulties, which also allows us to look at the presentation of hysteria in one of the immediately post-Hippocratic writers most relevant for the hysteria tradition: the fourth-century B.C . philosopher Heracleides of Pontus (ca. 390-310 B.C .). Although we may use respiration to mean breathing in general, behind the word inevitably lies our knowledge of the process by which oxygen is taken in and carbon dioxide given out. If we translate the title of a treatise by Galen, De usu respirationis , as "On the use of respiration," it may be difficult for us to appreciate the implications of the term within the science of the second century A.D . and before. A theory once widely held however is that of skin-breathing, discussed from before the time of Hippocrates to that of Galen. In the mid-fifth century B.C ., the philosopher Empedocles proposed that all living things breathe through the pores of their skin.^[157] Plato preserves a version of skin-breathing that also accounts for the movement of blood in the body; air enters through the skin to replace that exhaled through the nose and mouth, while also entering through the nose and mouth to replace that exhaled through the skin. The resulting movement, rather than the heart, is thought to be responsible for sending blood to those parts of the body requiring its nutriment.^[158] When Galen uses words for respiration, he includes within it skin-breathing.

Aristotle suggests that the function of respiration is to cool the innate heat generated in the body by food; Galen goes further, arguing that breathing occurs "for the sake of the innate heat" and, elsewhere, that "the use of breathing is the conservation of the innate heat."^[159] By this he means that breathing regulates the innate heat either by fanning it or by cooling it.

Skin-breathing and innate heat play an important role in Galen's theory of "hysterical suffocation," especially in relation to a story that becomes part of the hysteria tradition: the apparently dead woman whose revival is described in a lost work by Heracleides of Pontus. In his discussion of the most severe form of hysterical suffocation in On the Affected Parts 6.5 Galen refers to this story as follows:

For [Heracleides] says that that woman who had neither breath nor pulse could only be distinguished from a corpse in one way: that is, that she had a little warmth around the middle part of her body.^[160]

After Heracleides, Galen says, doctors developed tests for the presence of life: wool held at the nose, or a vessel of water on the navel. In the later tradition a deep concern remains over the ability of hysteria to mimic death—particularly since one of the symptoms is supposed to be the absence of any pulse—and stories are told of women mistaken for dead who revive on the edge of the grave.^[161] Although Apnous is lost, the story of the woman is repeated in several other writers of antiquity. The closest to Galen in both wording and time is Diogenes Laertius, a writer of the third century A.D ., who states that the woman's body was apnoun kai asphykton , "without breath or pulse," for thirty days. As well as this last detail, Diogenes Laertius adds further information about the circumstances, and this is duplicated in other writers.^[162] The story told by Heracleides apparently concerns Empedocles, who told his friend Pausanias how he had realized the woman was not dead from observing the innate heat. Clearly she was able to breathe through her skin, and eventually recovered, much to the amazement of the onlookers who attributed this to a miracle performed by Empedocles.

This story was very popular in the sixteenth century; one medical writer of that period who used it was Pieter van Foreest. Instead of following Diogenes Laertius, who said that the woman was without breath or pulse for thirty days, he uses the version given prior to Galen, by Pliny in the first century A.D .^[163] This sets the story within a discussion of souls that leave the body and return to it, which is in turn followed by accounts of people who recovered from apparent death. Pliny writes, "This topic is the subject of a book by Heracleides, well known in Greece, about a woman who was seven days without breath but was called back to life." Van Foreest repeats the "seven days" as well as Pliny's remark that "the female sex seems particularly liable to this disease, since it is subject to turning of the womb."^[164] In his scholia on this section, van Foreest follows Galen's theory on the innate heat, which is also used to account for the coldness of the extremities. He then states that learned authorities

all agree that patients with this condition should not be buried until the third day.^[165] Why should he give the third, rather than using seven or thirty? Perhaps the solution is to be found in the use of the story in early Christian writing. Origen (ca. A.D . 185-ca. A.D . 254) refers unbelievers to it in the context of Christ's resurrection from the dead: although Origen does not say how long the woman in the story in Heracleides lay dead, the figure of three days may come from this analogy.^[166]

Galen was thus not the only ancient writer to associate the story with a condition of the womb; however, where Pliny merely says that women are more likely to suffer in this way because their wombs move, Galen gives a full etiology accepting the theories of innate heat and skin-breathing.

Galen and His Influence: Winners and Losers in the Textual Tradition

Thus far, this chapter has covered the Hippocratic origins of the hysteria tradition in detail, while also mentioning the distinctive contributions of a small group of other writers: notably Plato and the second-century A.D . medical writers Aretaeus, Soranus, and Galen. It is however important to consider the question of the significant period between the fifth/fourth century B.C ., when the Hippocratic texts used here were being written, and the second century A.D . This is not an easy question to address. For the period immediately after the Hippocratics, literary medical sources are sparse. Works cited in later writers have not survived; we often read the extant fragments through the hostile eyes of an opponent, so that it is difficult not only to trace and date significant changes, but even to know what exactly was written.

Heracleides of Pontus (390-310 B.C .), whose lost work Apnous —mentioned by Pliny, Galen, and Diogenes Laertius among others—has already been discussed, is the only fourth-century writer other than Plato who is incorporated into the hysteria tradition. Other writers of the period are briefly introduced to the tradition, only to be rejected. Thus, for example, Soranus describes and criticizes the therapy used for hysterical pnix by Diocles of Carystos, who also worked in the fourth century B.C .; he "pinches the nostrils, but opens the mouth and applies a sternutative; moreover, with the hand he presses the uterus toward the lower parts by pressing upon the hypochondriac region; and applies warm fomentations to the legs."^[167]

In the third century B.C . important advances in anatomy were made in association with the medical school of Alexandria; the work of He-

rophilus of Chalcedon in particular is said to have included dissection of animal and human subjects, neither of which was practiced by the Hippocratics. For the history of hysteria, even more important than the fact that Herophilus is credited with being the first to identify the Fallopian tubes and ovaries is the attribution to him of the first description of the ligaments (which he called membranes) anchoring the womb in the abdominal cavity, a discovery which, in a positivist science, would have proved false the theory that the womb is capable of movement around the body.^[168]

No discussion by Herophilus of suffocation caused by the womb survives. His follower Mantias, who lived from around 165 to 90 B.C ., wrote on pharmacology, and one of the two surviving fragments of his work with a gynecological theme concerns hysterical suffocation. This fragment too is transmitted in the work of Soranus, who tells us that Mantias recommended playing flutes and drums when an attack was imminent, and giving castoreum and bitumen with wine when an attack was over. It is interesting that the discovery of the "membranes" does not appear to have significantly changed the therapy.^[169]

A further source for the period from the third to the first centuries B.C . consists of the surviving papyrus fragments from Greco-Roman Egypt, giving recipes, some of which may be identified as originating in the Hippocratic corpus. One very ancient collection of recipes, largely based on Diseases of Women and dating to the third or second century B.C ., mentions "suffocation from the womb" but recommends dried otters' kidneys in sweet wine—the only time this recipe occurs in Greek literature.^[170] A further recipe is given for a cough after the suffocation. Another papyrus dated to around 260-230 B.C . is too fragmentary for any reconstruction of the recipe, but it concerns a "hysterical woman" (gyne hysterike ); in the following line it is possible to read the word pnigmos .^[171] A papyrus from the early first century B.C . is even less legible, but the editor's reconstruction includes the words hysterikai and hysterikais .^[172] Papyri therefore show that Hippocratic recipes and variations on them continued to circulate in the ancient world; taken with the fragment of Mantias, they give further support to the proposal that the disease category hysterike pnix existed as a diagnosis in the second century B.C .

The next significant literary source comes from the Roman world: Celsus, writing in the early first century A.D . Book 4 of his work is arranged according to the parts of the body, and includes a chapter on diseases of the womb.^[173] This begins with a description of an unnamed but violent (vehemens ) illness that comes from the womb, an organ Celsus regarded as second only to the stomach in its influence on the rest of

the body. The condition he describes takes away the breath, so that the woman falls down as if she had epilepsy; however, unlike in epilepsy, the eyes are not "turned," there is no frothing at the mouth, and the sinews are not stretched. Instead, the patient sleeps. Some women suffer from this throughout their lives. Celsus does not investigate the etiology of the condition, but he gives recommendations for treatment: venesection, cupping-glasses, an extinguished lamp wick or other strong-smelling material held to the nostrils, cold water poured over the patient, hot wet poultices, and massage of the hips and knees. To prevent further attacks he recommends that the woman should abstain from wine for a year, be massaged regularly, and put mustard on her lower abdomen daily so that the skin reddens. He adds some suggestions for emollients, drinks (including castoreum), purges, and fumigations.

Some of this material is familiar; the cold water, lamp wick, and castoreum, for example, are no different from the Hippocratic recommendations, nor is the concern to distinguish the condition from epilepsy. Other suggestions are new; in particular, venesection, although used in the Hippocratic corpus, has not previously been discussed in association with this condition. As P. Brain has recently shown, although Galen gives the impression that venesection was a common therapy in the Hippocratic texts, it is in fact found only about seventy times in the entire corpus, and Diseases of Women contributes only one example.^[174] In Soranus it is recommended for hysterical suffocation, while for Galen it is the remedy of choice for menstrual suppression.^[175]

In the second century A.D . three medical descriptions of hysterical suffocation were produced, of differing importance to the growth of the hysteria tradition. By far the most influential in subsequent centuries was the work of Galen of Pergamum, although his triumph was not complete until after the eleventh century A.D ., when the translation of Arabic texts into Latin returned Galenic theory to the West. Until that time, although Arabic physicians were heavily influenced by Galenism, the many short gynecological treatises produced in the West were largely based on Soranus's Gynecology . However, this work was also disseminated in the East, through the Byzantine encyclopedists who used Soranus for their gynecological summaries. Its subsequent fortunes have been influenced by the fact that, although writers such as the sixth-century Aetius used it extensively, it survives in just one manuscript: the late fifteenth-century Paris BN gr. 2153 (Paris, Bibliothéque National, Greek manuscript number 2153), only discovered and identified by Dietz in 1830. The second-century writer most heavily influenced by Hippocratic sources was however neither Galen nor Soranus, but Aretaeus of Cap-

padocia, who had considerably less impact than either of the others on the later history of hysteria. Neither Soranus nor Aretaeus was translated into Arabic; nor, however, were the Hippocratic Diseases of Women and Nature of Woman , so that the Arabic descriptions of uterine suffocation derive from the Galenic version and its later interpreters: Oribasius, Aetius of Amida, and Paul of Aegina. The triumph of Hippocrates over Galen was delayed until the availability of printed Latin editions of the Hippocratic texts in the late sixteenth century.^[176] I now propose to look in turn at the texts of Aretaeus, Soranus, and Galen, establishing their contribution to the tradition, before turning to their use in late antiquity and beyond.

As has been discussed above, the description of hysterike pnix in Aretaeus's Of the Causes and Symptoms of Acute Diseases is today best known for its description of the womb as being "like an animal inside an animal," less emotively rendered as "like one living thing inside another." Like the Hippocratic writers, Aretaeus not only believes that the womb can move within the body but also advocates scent therapy, in which foul odors such as pitch, burned hair, an extinguished lamp, or castoreum are applied to the nose and fragrant substances rubbed into the external genitalia; unlike them, however, he knows of the membranes anchoring the womb in place.^[177] To us, the children of the "scientific method," these points may seem contradictory, but Aretaeus manages to combine them.

He describes the womb—"the seat of womanhood itself"—as being "all but alive," moving of its own volition upward to the thorax, or to left or right within the lower abdomen. It is when it moves upward and remains there for a long time, pressing violently on the intestines, that the patient experiences pnix , described as being like epilepsy^[178] without the spasms. Pressure is put on the liver, diaphragm, lungs, and heart, causing loss of breath and voice, while the carotid arteries are squeezed as a result of "sympathy" with the heart, causing a heavy head, loss of sensation, and deep sleep. Aretaeus then mentions a similar condition, characterized by pnix and loss of voice, which does not arise from the womb; the two differ in that only in cases arising in the womb will scent therapy help, and only in these cases do the limbs move.

When the womb moves up the body there will be "hesitation in doing her tasks, exhaustion, loss of control of the knees, dizziness, and her limbs are weakened; headache, heaviness of the head; and the woman feels pain in the channels at either side of her nose."^[179] The pulse will be weak and irregular, the breathing imperceptible, and death follows suddenly; it is difficult to believe that it has occurred, since the patient

has such a lifelike appearance. Recovery, too, happens suddenly; the womb rises up very easily, and just as easily returns to its place. Here Aretaeus uses another image, as vivid as that of the "living thing inside another living thing": the womb sails high in the water like a tree trunk floating, but it is pulled back by its membranes, of which those joining the neck of the womb to the loins are particularly capable of distending and contracting in a way that is likened to the sails of a ship.^[180] The condition is more likely to affect young women, since their way of life and understanding are "wandering," less firmly based.

Aretaeus thus combines womb movement with anchoring membranes, while continuing the exploration of a number of key themes in the hysteria tradition; for example, the difficulty in telling whether a sufferer from this condition is dead or alive, and the resemblance to epilepsy. Although much of the therapeutic material is Hippocratic, in particular the use of scent therapy, fumigation, and sneezing,^[181] he follows Celsus rather than the Hippocratics in recommending venesection from the ankle, while adding that one should pull out hairs from the patient in order to rouse her.^[182] He introduces the idea of "sympathy" in order to explain how the highest parts of the body can be affected by the womb; although the membranes prevent it from traveling that far, the womb can nevertheless exert an influence on these parts.

The survival of such Hippocratic ideas in the late antique and medieval worlds will be discussed later. However, as I have already mentioned, the main influence on late antiquity came from Soranus, the Hippocratics being read largely through the eyes of Galen until the mid-sixteenth century and beyond.^[183] Sections of Soranus's work were translated from Greek into Latin by Caelius Aurelianus in the fifth century, and—more important in terms of his later influence—by Muscio in the sixth century, thus making his ideas available in the Latin-speaking West. As for the Greek East, Soranus was the main source for the gynecological sections of the encyclopedias of Aetius of Amida in the mid-sixth century and Paul of Aegina in the seventh century, becoming in the East "la bible de la gynécologie et de l'obstétrique jusqu'à la Renaissance."^[184] What did Soranus contribute to the textual reservoir drawn on by the hysteria tradition?

The ideas of Soranus, in contrast to those of Aretaeus, are set in the context of the theories of the "methodist" medical sect. This arose in the first century A.D . in response to the dogmatist and empiricist positions. The fundamental difference between the latter two sects lay in their beliefs concerning the best way of acquiring knowledge. Where the dogmatists, despite some differences of opinion, agreed on the use of obser-

vation, dissection, and experiments in order to speculate on the "hidden causes" of diseases, the empiricists believed that no form of research could ever lead to an understanding of nature, and thus that the only route to knowledge was through the accumulated experience of past cases, which the practitioner could combine with his own experience in order to choose the correct therapy. Where the dogmatist was interested in causes, the empiricist looked for cures.

Methodism, in contrast to these sects, was based on a strict division of causes of symptoms into three conditions of the body: status laxus , in which the body or affected part is lax and wet, leading for example to a flux; status strictus , a constricted and dry state, of which amenorrhea was seen as a case in point; and status mixtus , a combination in which some parts of the body are constricted and others lax. Treatment characteristically began with a three-day fast, then built up the patient through diet and exercise, before moving on to aggressive treatments such as vomiting, shaking, or sneezing.^[185]

While Soranus is never a slave to the "method,"^[186] it is methodist theory that leads him to reject some commonplaces of Hippocratic medicine. For example, there is no place in the method for Hippocratic ideas of the superiority of right over left. Nor does Soranus accept the theory that the female body is qualitatively different from the male in terms of the porosity of its flesh; women are the same as men, except that they have some different organs, but even these organs are made of the same substance and subject to the same conditions. As a result of this reasoning, there is no place in Soranus's gynecology for the Hippocratic theory that menstruation is essential to female health as a means of purging the excess blood that naturally accumulates due to the wet and spongy consistency of female flesh. On the contrary, Soranus goes so far as to say that menstruation is bad for a woman's health, except insofar as it is necessary to conception. Intercourse is harmful, and permanent virginity is best for both men and women. Pregnancy, thought by earlier writers to relieve certain gynecological disorders, is in fact bad for women; it leads to exhaustion and premature old age.

Soranus also rejects the Hippocratic idea that the womb moves to other parts of the body. The womb cannot move; although he rejects dissection in principle, he quotes Herophilus of Chalcedon's research as proof that it is held in place by membranes.^[187] Soranus nevertheless accepts that there is a condition in which the major symptom is pnix , but he attributes it to inflammation of the membranes around the womb causing a status strictus .^[188] In particular he rejects any idea that the womb is an animal; it "does not issue forth like a wild animal from the lair,

delighted by fragrant odors and fleeing bad odors,"^[189] and he attributes this misunderstanding to its ability to respond to certain agents by stricture or relaxation. In treating the condition, he completely rejects the usual list of substances employed in scent therapy (they cause torpor and upset the stomach), together with sneezing (too violent) and intercourse; sexual intercourse cannot cure disease, since it has such bad effects on even a healthy body. Venesection is acceptable, however, after the patient has been warmed and rubbed with olive oil in order to relax her. The condition exists in both an acute and a chronic form, and treatment should take account of this.^[190]

While the gynecological theories of Soranus continued to circulate widely in both East and West through their use by the encyclopedists, the dominant influence on medicine as a whole in the Greek East was not Soranus but Galen. Where suffocation of the womb is concerned, Galen's descriptions eclipsed those of Soranus; writing as late as 1937, P. Diepgen describes Galen's picture of the hysterical attack as still being recognizable.^[191]

In his treatise On the Affected Parts , Galen himself calls the condition either hysterike pnix or apnoia hysterike , "absence of breath caused by the womb." Aretaeus had managed to combine the anchoring membranes with movement of the womb, while Soranus rejected womb movement and attributed the symptoms to inflammation of the membranes; Galen's new etiology was, however, to prove the most influential in the history of hysteria. He accepts that the womb is indeed the origin of the condition, but in place of movement to another part of the body, or inflammation, he blames retention of substances within the womb. The disorder manifests itself in a number of different forms—sometimes through lying motionless with an almost imperceptible pulse, sometimes through weakness while the patient remains conscious, and sometimes through contracture of the limbs.^[192]

A much-quoted section of On the Affected Parts reads: "I myself have seen many hysterikai women, as they call themselves and as the iatrinai call them."^[193]Iatrinai , literally "female healers," may also be translated as midwives. Hysterikai is usually translated as "hysterical" but, in view of what has already been said about ancient medical terminology, it would be more accurately translated as "suffering from the womb." In a recent article, Trillat attaches great significance to this passage. As has already been mentioned, Trillat recognizes that the word hysteria never appears in the Hippocratic corpus; however, on the basis of this passage of Galen, he asserts that it is in Galen's work "qu'apparait le mot d'hystérie," albeit in adjectival form.^[194] Of course, this is not particularly

significant since, as I have already shown, the adjective hysterikos also appears in the Hippocratic corpus. However, Trillat goes on to use the Galenic passage as the basis for his statement, "Hippocrate adopte la théorie populaire et rejette le nom. Galien rejette la théorie mais adopte le nom" (Hippocrates adopts the popular theory and rejects the name. Galen rejects the theory but adopts the name).

This raises many questions. There is little evidence for the theory of the wandering womb in classical Greek "popular thought" apart from Plato's Timaeus , and Plato is hardly the Greek equivalent of the man on the Clapham omnibus. In the Roman Empire of Galen, there may be better grounds for believing that women described themselves as hysterica . A relevant passage from outside the medical corpus is Martial, Epigrams 11.71, where Leda tells her aged husband she is hysterica as a device to make him summon young doctors to carry out what was then thought to be the standard treatment, sexual intercourse. Moreover, can we accept that it is Galen who "adopte le nom"? We have already seen that the evidence of papyri from the third and second centuries B.C ., taken with the fragment of Mantias preserved in Soranus, suggests on the contrary that the category hysterike pnix existed at least four hundred years before Galen. Indeed, elsewhere Galen distances himself not only from the word hysterikos —referring to "the so-called hysterical symptoms"—but also from pnix , saying that apnoia , absence of breath, is a more appropriate term.^[195]

The passage from Martial is also of interest in that Galen too—unlike Soranus—regards sexual intercourse as beneficial for sufferers, and in his new etiology of the condition this therapy, mentioned in the Hippocratic corpus but only as one of many recommendations for suffocation caused by the womb, is given a central role. He considers that those most vulnerable to the disorder are "widows, and particularly those who previously menstruated regularly, had been pregnant and were eager to have intercourse, but were now deprived of all this."^[196] This passage is interesting, not only because it omits the childless, seen as particularly susceptible in several Hippocratic texts, but also because it points Galen toward the cause of the problem. He does not accept the Hippocratic etiology of womb movement in search of moisture, since dissection proves that it cannot occur; the womb may seem to move, but "it does not move from one place to another like a wandering animal, but is pulled up by the tension" of the membranes holding it in place.^[197]

Why do these membranes become tense? He suggests that it is because they are filled with menstrual blood, unable to move into the womb either because of its thickness or because the orifices through which the

blood passes into the womb are closed. Thus one cause of the condition is menstrual retention. This is not however the origin of the most severe form of hysterike pnix . Galen believes that women too contribute "seed"; this is not an entirely new idea, since some Hippocratic writers believed in its existence. For Galen, female seed does not elevate the female to an equal position with the male, since it is naturally inferior to male seed.^[198] Seed too can be retained in the womb, where it presents far more of a threat to health than retained menses.^[199] Galen goes on to compare the effect of such retained substances to that of the bite or sting of a poisonous creature; small amounts cause dramatic and possibly fatal symptoms.^[200] Retained seed can rot, causing noxious humors to affect the rest of the body through "sympathy"; for Galen, as for Aretaeus, this is how the breathing can be affected without the womb moving to put physical pressure on the diaphragm. It is an infinitely malleable concept that can claim Hippocratic credentials: On Joints (57) describes the "brotherly connections" that exist between parts of the body, permitting, among other things, the wanderings of the womb.^[201] Thus, where the Hippocratics attributed different groups of symptoms to the different organs to which the womb could move, Galen suggests that the basic cause is retained matter, different symptoms owing most to the nature of this matter; for example, black bile leads to despondency.^[202]

Monica Green has pointed out that it is of particular interest that, despite his rejection of the belief that the womb is a wandering animal, Galen nevertheless manages to retain the use of the full scent therapy. On the Method of Healing, to Glaucon includes a brief reference to its use in treating a "rising" womb, while in another treatise Galen lists substances—including castoreum and burned hair—to be placed at the nose of a woman with this condition.^[203] In a passage from On the Affected Parts taken up by the hysteria tradition, Galen describes the case of a woman who had been a widow for a long time and who was told by a midwife that her symptoms were due to her womb being "drawn up." The woman applied to her external genitalia "the customary remedies" (details of which are not given here) for this condition and passed a quantity of thick seed; the suggestion appears to be that rubbing in the traditional scented ointments causes orgasm, and thus releases the retained matter.^[204] For Galen, both menstrual blood and seed must be evacuated, otherwise they will become toxic and poison the body; scent therapy continues, but its rationale changes.

The third century A.D . is, in many ways, a hiatus in the development of the hysteria tradition. One source that should be considered here is a papyrus from Greco-Roman Egypt, which has been dated to the third

or possibly the fourth century A.D . In a collection of magical spells, one is included to be used in cases of "the rising up of the womb." It calls upon the womb to "return again to your seat, and that you do not turn into the right part of the ribs, or into the left part of the ribs, and that you do not gnaw into the heart like a dog, but remain indeed in your own intended and proper place."^[205] This fascinating source shows that the idea of a mobile and animate womb continued to flourish in the context of popular belief; the reference to it gnawing "like a dog" should perhaps be read in the context of Greco-Roman ideas concerning the insatiable sexual appetites of dogs—and women—together with the connection between kuon , meaning dog, and kuein , meaning to be pregnant. In this spell we are not very far from the womb of Plato's Timaeus , running through the body when its desire to conceive is thwarted.^[206]

In the late fourth century A.D ., a further literary source is of interest because it makes explicit the identification of the Greek hysterike pnix and the Latin suffocatio . This is the Book of Medicines of Marcellus Empiricus, which gives remedies for the disorder in a section on acute and chronic conditions of the head. It identifies only two symptoms—severe head pains and suffocation—which, if originating in the womb, "the Greeks call hysterikg pnix ." The condition is considered comparable to epilepsy, frenzy, and dizziness, except in its organ of origin.^[207]

Further Contributions to the Tradition

The Greek East

Returning to the set of connected texts which makes up the hysteria tradition, the Byzantine empire preserved many medical ideas of antiquity through the work of encyclopedists such as Oribasius, Aetius, and Paul of Aegina.^[208] Such writers, often dismissed as "the medical refrigerators of antiquity" working in "une époque de stagnation," were nevertheless more than compilers whose labors have preserved for us the work of earlier writers; "not dumb copyists," they selected and paraphrased, added and cut material, according to the specific needs of their audience.^[209] Although they may add little new to our picture, they are of interest because they combine the elements of Soranus's and Galen's accounts in different ways. Thus, for example, it will be seen that both Aetius and Paul use Soranus, but—like Galen—bring back the scent therapy that he had rejected. Both use Galen's ideas of retained matter that must be expelled, while Aetius repeats the story of the widow. It is also in the work of these encyclopedists that certain remedies for the condition become standardized, while it is through them that many of the ideas of earlier writers reached Islamic medicine.

In the upper echelons of the Byzantine world, knowledge of classical literature was regarded as the mark of an educated man. Medical education too was largely textual, traditional, and classical. We know of very few teaching centers in the fifth to seventh centuries A.D .; those students who neither came from a medical family nor were apprenticed to a physician were obliged to rely largely on texts for their instruction in both theory and practice.^[210]

Alexandria again became an important medical center from the late fourth century A.D .; the medical student there would read about eleven Hippocratic treatises—including the Hippocratic Aphorisms and Diseases of Women —and fifteen or sixteen texts from the Galenic corpus. The Hippocratic texts were, however, read through a "Galenic filter."^[211] Alexandria is associated with the seventh-century encyclopedist Paul of Aegina, whose work was itself based to a large extent on the fourth-century, seventy-volume work of Oribasius. It is easy to underestimate the work of Oribasius, Paul, and their successors. N. G. Wilson summarizes: "Very little can be said of any positive achievement of Alexandrian medicine. Paul admits openly in his introduction that he contributes practically no original material of his own." However, he goes on to point out that Paul's work circulated widely,^[212] and it is important to see which parts of the hysteria tradition were strengthened by the choices made by such writers.

Oribasius's compilation, derived from the work of Galen, Soranus, and a number of lost works, was itself summarized in two editions of nine and four books respectively. His description of the anatomy of the womb and other female sexual organs, explicitly taken from Soranus, survives in the seventy-volume version of his work.^[213] For his discussion of hysterike pnix , which survives in the nine-volume Synopsis , Oribasius uses the lost work of Philumenos of Alexandria,^[214] which recommends bandaging the extremities, rubbing the lower limbs, and scent therapy; foul odors at the nostrils, and sweet oils injected into the womb. Shouting at the patient and provoking sneezing are also acceptable, with bleeding once she is conscious. Castoreum is also highly recommended; even on its own, it may produce a cure. In an earlier chapter Oribasius gives further remedies for pnix , including the by now familiar list of foul-smelling substances, namely bitumen, castoreum, gum resin, pitch, cedar resin, extinguished lamp wicks, burned hair, rue, asafetida, onion, and garlic.^[215] This closely resembles the list of substances Soranus criticized earlier writers for using; and, of course, Soranus also disagreed with the use of loud noises to rouse the patient. Thus, despite following Soranus's anatomy of the womb, Oribasius takes his remedies from the traditions Soranus despised.

The capital of the Byzantine empire, Constantinople, was another medical center. Oribasius worked there in the fourth century, and it was later to be associated with Aetius of Amida—whose sixteen-volume compilation, made in the sixth century, was based on Oribasius and others—and with Alexander of Tralles, whose twelve-volume Therapeutica was probably written a few decades after Aetius.^[216] The work of Oribasius, Aetius, and Paul was later transmitted through the collection of medical knowledge compiled by Theophanes Nonnos in the tenth century. Nonnos worked as part of a deliberate program to stimulate learning, initiated by the emperor Constantine Porphyrogenitus, who was concerned with encouraging education and himself wrote several books and poems.^[217]

Aetius based his description of hysterike pnix on Galen's On the Affected Parts , merging this with the Philumenos material preserved by Oribasius.^[218] He accepts that the womb, which only seems to move, causes the condition, the higher organs being affected through "sympathy." Using the Galenic model of the body, he describes how spasms reach the heart via the arteries, the brain through the spinal marrow, and the liver through the veins.^[219] As a means of discovering whether or not the patient lives, he repeats a test given in Galen, by which either a woolen thread was placed at the nostrils, or a bowl of water on the navel.^[220] However, even if no movement occurred in the wool or the water, he warned—again, following Galen—that it was possible that life remained. He sees the disorder as seasonal; it happens mostly in winter and autumn, especially in young women who use drugs to prevent conception.^[221] This appears to be a special concern of Aetius, although it recalls Plato's image of the womb deprived of the offspring it desires, running wild through the body. For Aetius, as for Galen, the cause of the symptoms is the decay in the womb of seed or other material, which cools: the coldness is then passed on to the brain and heart.^[222] He cuts out the story from Heracleides, but repeats—indeed, claims as his own eyewitness account^[223] —Galen's story of the widow who felt "pain and pleasure at the same time" before expelling the corrupt seed; here, however, a little more detail is given by Aetius, so that we are explicitly told that the remedies used consisted in sweet ointments rubbed into the genitalia, something that is recommended again later in this passage.^[224] Like Philumenos and Oribasius, Aetius recommends shouting at the patient and repeats word for word the advice of Philumenos-Oribasius that "castoreum alone often cures."^[225] The status of scent therapy is reinforced, even increased.

The description of hysterike pnix given by Paul of Aegina^[226] in the

seventh century follows Aetius closely, but states that the womb itself "rises up"^[227] to affect by sympathy the carotid arteries, heart, and membranes. The patient loses her senses and her power of speech, the limbs being "drawn together." The cause—as in Galen—is the womb being full of seed or of some other substance that becomes rotten.^[228] Most sufferers die suddenly during the spasms; the pulse becomes frequent and irregular, and asphyxia then follows. Breathing, at first faint, is cut off. The condition is most prevalent in winter and autumn, and most affects the lascivious, and—in almost the exact words of Aetius—those who use drugs to prevent conception.^[229] During the attack the extremities should be bandaged and the patient rubbed all over. Foul-smelling substances—including stale urine—should be placed at the nostrils, and cupping and anal suppositories used. Sweet-smelling substances should be employed in order to draw the womb back to its proper place. To rouse the patient, one should shout at her roughly and induce sneezing with castoreum, soapwort, and pepper.^[230] Like Soranus and Oribasius, Paul separates treatment for the fits, or paroxysmoi , from treatment for the whole body; the latter begins with venesection^[231] and goes on to purging, exercise, and baths.

Although the tendency in the East was toward the compilation of encyclopedias, one independent Greek text, probably from the sixth century, survives in a ninth-century manuscript. This is the Book of Metrodora , a practical treatise in many ways reminiscent of Hippocratic medicine. It includes some remedies for hysterike pnix , which make use of the traditional foul- and sweet-smelling substances, namely castoreum, rue with honey, and pig's dung with rose water.^[232]

Thus in Byzantine medicine a composite picture of hysterike pnix was built up, incorporating the Galenic belief in retained substances poisoning the body, Soranus's anchoring membranes, Hippocratic scent therapy, venesection as in Celsus, and a belief in the value of sneezing, derived from the Hippocratic Aphorisms and Galen's commentary on them, which will be discussed in detail below. Although the main authorities, Soranus and Galen, had vigorously denied that the womb could move, this idea came close to being reinstated by Paul of Aegina. Aetius preserved the Galenic tests to determine whether the patient still lived, while writers with otherwise divergent views agreed on the therapeutic value of castoreum.

The Latin West

In the West, meanwhile, the picture was in some ways very different. Although the Aphorisms circulated widely, few of the works of classical

medicine survived, especially after knowledge of Greek declined during the fifth and sixth centuries. Although in northern Italy some Byzantine commentaries and encyclopedias were adapted into Latin during the sixth century—among them, the work of Oribasius—most "new" medical texts were short works based on Soranus.^[233] The late fourth- or early fifth-century^[234] Latin version of Soranus by Caelius Aurelianus survived into the Middle Ages, while the fifth- or sixth-century version by Muscio circulated more widely. Muscio plays down Soranus's attack on the idea that the womb moves around the body, going so far as to add to Soranus's introduction to the condition a new phrase claiming that the womb rises up toward the chest.^[235] Thus the versions of Soranus that circulated in the West included womb movement from an early date.

Several of the texts produced in the West originated in Africa, among them the works of Caelius Aurelianus and Muscio. Predating these is the late fourth century Euporiston of Theodorus Priscianus, a pupil of Vindicianus, whose own Gynaecia was a text on parts of the body and their development in the womb. Originally written in Greek, the Euporiston was translated by Theodorus Priscianus himself into Latin.^[236] This version contains a section entitled De praefocatione matricis , which follows the constriction/relaxation approach of Soranus, omits womb movement, but includes scent therapy. In A.D . 447 another African writer, Cassius Felix, took a different approach, publishing an encyclopedia allegedly based on Greek medical writers of the logical, or dogmatic, sect, but in fact owing much to Soranus as translated by Caelius Aurelianus; this contains a very Hippocratic description of hysterical suffocation, incorporating womb movement as well as scent therapy.^[237]

Other Latin texts of this period survive and are probably more representative than the African works of medicine in the West after the fall of Rome. A dialogue allegedly between Soranus and a midwife, apparently designed as a midwives' catechism, is preserved in a ninth-century manuscript but may date to the sixth century; this is the Liber ad Soteris .^[238] Another short text from this period is the Gynaecia by pseudo-Cleopatra.^[239] It mentions a condition called suppressiones vulvae , the main symptom of which is difficulty in speaking and which thus may be identified with hysterike pnix ; however, womb movement is not mentioned, nor is scent therapy advised.

The ancient Hippocratic theories were not, however, entirely lost to the West. Between the fifth and seventh centuries A.D . many Hippocratic texts were translated into Latin at Ravenna, among them Aphorisms and Diseases of Women (1.1, 1.7-38, and extracts from 2).^[240] Several texts on womb movement and suffocation are included in such translations.^[241]

Also translated was Galen's On the Method of Healing, to Glaucon , with its reference to scent therapy for a moving womb; the Ravenna commentator considers that, by using scent therapy, Galen is apparently endorsing the wandering womb theory.^[242]

It is, however, as misleading to regard the work of the scholars of Ravenna only as translation as to dismiss the Byzantine writers as mere compilers. It is important to understand the purposes for which they used these texts, since these in turn influenced the translation. These purposes fall under two headings: practice and instruction. Hippocratic medicine was seen above all as being of immediate relevance for medical practice; the Ravenna texts are thus not academic editions, but manuals. As a result the more theoretical or speculative Hippocratic texts were neglected, while those selected for translation were adapted according to the different moral and historical context within which they were now to be used.^[243] The second, closely related aspect instruction led to the recasting of some texts in new formats in which extracts were set out in question-and-answer form, as dialogues like the Liber ad Soteris , as calendars, as visual representations, or as letters. The letter format, direct and personal, was very popular, an example being the Epistula ad Maecenatem , the Letter to Maecenas . Also known as the De natura generis humani , this comprises extracts from the Hippocratic Diseases of Women (1) and from Vindicianus. The Epistula ad Maecenatem is found in the ninth-century manuscripts Paris BN Lat. 7027 and Paris BN Lat. 11219, and in these manuscripts it includes two passages of Diseases of Women used in the hysteria tradition: 1.7, on movement of the womb to the liver, and 1.32, on movement of the womb in a pregnant woman.^[244] The late eighth century/early ninth century manuscript Leningrad Lat. F.v.VI.3 is a handbook including Latin translations of sections from Diseases of Women , one of which is our 2. 127, a further description of the movement of the womb to the liver. In the recipes given for cures, substitutions are made in the pharmacopoeia according to what was available in the period.^[245]

The Arab World

Another route of transmission of Hippocratic ideas to the West was through the Arab world. The most obvious contact between medical systems took place after the Arabs took Alexandria in A.D . 642, possibly while Paul of Aegina was there; the medical school at Alexandria continued to exist until around A.D . 719, probably still using Greek as its language of instruction.^[246] The great age of translation began in the ninth century; Greek manuscripts were taken as booty in conquest, and

those translating them into Arabic—sometimes through the medium of Syriac—enjoyed royal patronage. From this time onward, versions of Hippocratic texts, based on several manuscripts, were produced; the most famous early translator was Hunain ibn Ishaq al-'Ibadi—known to the West as Johannitius—the Christian son of a druggist, who was also responsible for translating works by Galen, Oribasius, and Paul of Aegina. Hunain also listed all the works of Galen that had been translated into Arabic or Syriac by about A.D . 800; these included such key works in the hysteria tradition as On the Affected Parts, On Difficulty in Breathing , and the commentary on the Aphorisms , from which the Hippocratic Aphorisms themselves were excerpted and then transmitted separately.^[247] There thus exists a striking contrast between East and West in the ninth century; as R. J. Durling puts it, "Whereas European knowledge of Galen was limited to a few Galenic works, and those either unimportant or clearly spurious, Arabic translations of almost all his writings were made." Something similar occurs with regard to much of the Hippocratic corpus; in contrast to the Latin West, where emphasis was placed on translating those texts of immediate practical value, the Arabic translators did not neglect the more theoretical and speculative treatises, so that the "Arabic Hippocrates" is more complete than the "Latin Hippocrates."^[248] This does not, however, apply to Hippocratic gynecology; neither Diseases of Women nor Nature of Woman was translated into Arabic, although two Byzantine commentaries on Diseases of Women 1.1-11 were in circulation in the Arab world before the eleventh century, together with Byzantine medical encyclopedias.^[249]

The main means by which Greco-Roman ideas were transmitted was through the compilation of new encyclopedic works. The Firdaws al hikma (Paradise of Wisdom) of 'Ali ibn Rabban at-Tabari (810-861) was completed in 850 and includes approximately 120 quotations from the Hippocratic corpus, and a large amount of Galenic material, together with extracts from other Greek and Islamic writers such as Aristotle and Hunain.^[250] At-Tabari believes that the essential wetness of woman leads to menstrual loss; retained moisture sinks to the lowest part of the body and then comes out, "just as in a tree the excess moisture comes out as gum."^[251] In his section on uterine disorders, he includes suffocation of the womb. He writes, "Sometimes, through damming-up of menstrual blood and lack of sexual intercourse, vapours develop." He explains that the retained blood becomes thick, and produces vapors that then affect the whole body, causing such symptoms as painful breathing, palpitations, head pain, and suffocation of the womb.

A further discussion of suffocation occurs in the context of womb

movement. The womb can lean to one side, but sometimes it actually rises up until it reaches the diaphragm, causing suffocation. "Then the woman loses consciousness, with the result that her breath is stopped. Then one puts a bit of wool under her nostrils in order to see whether she is alive or dead." The cause here is not menstrual blood, but accumulated seed; if there is an "excess, lack or absence" of intercourse, seed will accumulate in the womb, rot, and become poisonous and thick. The womb then moves to the diaphragm and the woman suffocates.^[252]

Thus womb movement was readily combined with a Galenic etiology of retained seed or menses, but to this mixture at-Tabari added the explanatory device of vapors. Where Greco-Roman writers employed the concept of sympathy to account for the effects of the womb on other parts of the body, writers in the Arab world also used vapors; as we shall see, this development entered the western hysteria tradition when texts were translated from Arabic to Latin from the eleventh century onward.

The next writer from the Arab world who should be considered here is Muhammad ibn-Zakariyya' ar-Razi (Rhazes), whose Kitab al-Hawi , a twenty-four-volume collection of excerpts from Greek, Arabic, and Indian writers known in Latin as the Continens , was written around A.D . 900.^[253] Also translated into Latin was his Kitab al-Mansori , which includes a chapter on uterine suffocation. Here Rhazes gives a basically Galenic account of the condition, including retained menses and seed, the patient falling down as though dead, and scent therapy; he includes the recommendation that a midwife should rub the mouth of the womb with a well-oiled finger. He does not say that the womb moves, although he describes a sensation "as if something is pulled up."^[254]

The work of 'Ali ibn al-'Abbas al-Majusi, known in Europe as Haly Abbas, was produced in the tenth century A.D . It too combines Hippocratic etiologies with a predominantly Galenic approach, often read through the eyes of Paul/Aetius; but al-Majusi plays down the membranes anchoring the womb, claiming instead that the womb can move around the body. He includes both sympathy and vapors. He explains that suffocation of the womb is a very dangerous condition because sympathy leads to the vital organs, the brain and heart, being affected. If a woman does not have intercourse, a large quantity of seed will collect and will "stifle and extinguish the innate heat." Retained menstrual blood has similar effects.^[255]

In a separate section on treatment, he retains the Hippocratic scent therapy, but explains its success partly in terms of vapors. Bad smells administered to the nose rise to the brain, "warming, dissolving and diluting the cold vapors," but also driving the womb back down.^[256] For

al-Majusi, the womb is "more or less an independent living being," yearning for conception, annoyed by bad smells and leaning toward pleasant smells. Plato's description of the womb as an animal desiring conception was known to the Arab world through Galen.^[257] Al-Majusi also recommends sexual intercourse as a cure, especially for virgins, whose strong desire for sex and thick menstrual blood predisposes them to the condition.^[258] In the absence of this, he repeats the Galenic therapy of instructing a midwife to rub sweet-smelling oils on the mouth of the womb, and states explicitly that this has the same effect as intercourse, in warming and thinning the seed, so that it can drain away and the woman can "find peace."^[259]

Also working in the tenth century was Ibn al-Jazzar, whose main work was the Kitab Zad al-Musafir in seven books. This was a particularly important source for medieval European medicine; it was translated into Latin, Greek, and Hebrew, and is known in Latin as the Viaticum .^[260] Book 6, chapter 11, describes suffocation of the womb; the condition begins with loss of appetite and the chilling of the body, which is attributed to corruption of retained seed, particularly in widows and young girls of marriageable age. From the seed a fumus —a smoke, or vapor—rises to the diaphragm, because the diaphragm and womb are connected; then, since further connections exist between the diaphragm and the throat and vocal chords, suffocation ensues. similar problems may result from retained menses, and scent therapy and the application of fragrant oils to the mouth of the womb are recommended. Repeated here is a version of the story given in Galen of the woman who lay as dead but was known to be alive by the presence of innate heat; here, however, Galen rather than Empedocles becomes its hero!^[261]

Finally, Ibn Sing (Avicenna), born in A.D . 980, included discussions of hysterical suffocation in his Qanun (the Canon ); translated into Latin by Gerard of Cremona in twelfth-century Toledo, this influential text was printed thirty-six times in the fifteenth and sixteenth centuries.^[262] He devotes four successive chapters to the condition, its signs and cures, and the preferred regimen for sufferers. He bases his description on Galen as interpreted by Aetius, favoring sympathy (communitas ) over vapors, and including the test for life with a piece of wool and the story of the widow; cures include phlebotomy and the rubbing of scented oil into the vulva, while the regimen includes the use of foul-smelling substances at the nose and sweet scents at the vagina.^[263]

Thus it can be seen that the distinctively Hippocratic features of womb movement, scent therapy, and the therapeutic value of sexual intercourse survived even in the directly contradictory environments of

Galenic theory and Islamic culture. Despite the rejection of the moving womb by both Soranus and Galen, it soon returned to the fore in the explanations of hysterical suffocation given by writers and compilers in both East and West. In the Arabic world, Soranus's Gynecology may not have been translated, so his attack on the theory of the mobile womb may have remained unknown;^[264] as for Galen, although he explicitly rejects Plato's womb-as-animal theory in On the Affected Parts , he implicitly accepts it in To Glaucon , thus leaving the matter open for future commentators. Such elements of the hysteria tradition as the wool test for life and the story of the widow and the midwife, retained by the Byzantine encyclopedists, continue to survive in Arabic medicine; the story of the woman raised from apparent death by Empedocles is found in Ibn al-Jazzar but plays a minor role, perhaps because the short reference to it in Galen is insufficient for its reconstruction.

In terms of the most likely victims for the condition, it is of interest that Galen's preference for widows is ignored; virgins become a prime target. This is not a return to Hippocratic etiology since, as I have argued above, the Hippocratic hysteria texts rarely give a particular target population for womb movement; furthermore, when a particular group is specified, this tends to be the childless in general (since their flesh is not "broken down"), older women not having intercourse, or young widows. The Hippocratic text that may be at the root of this interest in virgins is one that was available in the Arab world, since it is cited twice by Rhazes: the Diseases of Young Girls .^[265] This is a short and vivid description of a condition that arises not from womb movement, but instead from retention of menstrual, or possibly menarcheal, blood. The target population consists of parthenoi —meaning young girls, unmarried women, and/or virgins—who are "ripe for marriage" but remain unmarried. Their blood is described as being plentiful due to "food and the growth of the body." If "the orifice of exit" is closed, the blood that has moved to the womb ready to leave the body will travel instead to the heart and diaphragm, causing visions, loss of reason, and a desire to commit suicide by hanging. The author states that he orders girls with this condition to marry as quickly as possible; if they become pregnant, they will be cured. I would suggest that this text, retrospectively diagnosed as hysteria by several writers during this century, lies behind al-Majusi's interest in the thick blood of a virgin and in intercourse as a cure, as well as explaining Ibn al-Jazzar's target population of girls of marriageable age.^[266]

Finally, in these writers, a new explanatory device is used to account for the effects of the womb on other parts of the body: vapors. Yet the

concept of sympathy continues to exist, sometimes—as in Ibn al-Jazzar—involving very precise connections between particular organs of the body.

The Meeting of Three Worlds

Returning to western Europe, most of Galenic medicine had been lost with the decline, from the late fourth century onward, in knowledge of the Greek language.^[267] Soranus dominated gynecology in general; his writings, perceived as shorter and more practical than those of Galen, were preserved in abridged Latin versions that reinstated the womb movement he had so vehemently rejected. Hippocratic medicine fared worse, although Aphorisms continued to circulate after its translation into Latin in the sixth century; the Ravenna translations also included some of the sections of Diseases of Women describing womb movement. Some Galenic treatises, too, were translated at Ravenna; however, whereas 129 works of Galen were translated into Arabic, only 4 existed in Latin before the eleventh century. One of these was the practical work On the Method of Healing, to Glaucon but, as has been discussed above, this can be read as a further reinstatement of the wandering womb. The third volume of Paul of Aegina's encyclopedia, which includes his largely Ga-lenic description of hysterike pnix plus details of scent therapy, was translated into Latin, but probably only in the tenth century.^[268]

The emphasis in the West lay firmly on the instructional and practical aspects of ancient medicine; thus the traditional therapies for hysterical suffocation were transmitted when discussions of its causation were not. The category of suffocation of the womb appears in several anonymous collections of texts from the eighth to the twelfth centuries. I have already mentioned Leningrad Lat. F.v.VI.3, a Latin manuscript dating from the eighth or ninth century which contains several short texts on gynecology, all of which show some resemblances to the second book of the Hippocratic Diseases of Women .^[269] Of these, De causis feminarum gives practical advice on what to do "si vulva suffocantur" (if the womb is suffocated), giving the Greek name for the condition as "styrecersis": is this a garbled form of hysterike pnix or hysterika ? The patient should be given burned and pulverized stag's horn in wine or, if she has a fever, in hot water.^[270] Another text in this collection, the De muliebria causa , claims that "uribasius"—Oribasius, the only authority named in these texts—recommends one drachma of agaric for suffocation of the womb.^[271] This is repeated in a section of the following text, the Liber de muliebria , which later gives a more complex recipe for suffocation of the womb, in which the patient is choked at the neck, so that it is turned back to the chest.^[272]

It was in the eleventh and twelfth centuries that Galenic treatises were returned to the West, through the translations from Arabic into Latin made by Constantine the African in the late eleventh century at Salerno and Monte Cassino; a few Galenic treatises were translated directly from Greek into Latin in the twelfth and thirteenth centuries, and these translations are usually of higher quality.^[273] The effect of Constantine on the history of medicine cannot, however, be overemphasized; his arrival in Italy with a cargo of books of Arabic medicine, which he translated into Latin at Monte Cassino, transformed the "theoretical impoverishment" into which medical knowledge in the West had fallen. For our purposes here, what is most significant is that his translations included Galen's commentary on the Hippocratic Aphorisms , and works of al-Majusi and Ibn al-Jazzar.^[274] Constantine translated much of the Kamil of al-Majusi as the Liber Pantegni ; this work was translated again in the early twelfth century by Stephen of Pisa as the Liber Regius and was printed in 1492 and 1523. The Kitab Zad al-Musafir of Ibn al-Jazzar was translated in an abbreviated form as the Viaticum , while Constantine's Expositio Aforismi is a translation from the Arabic of Galen's commentary on the Hippo-cratic Aphorisms .^[275]

What effect do these texts have on the hysteria tradition in the West? We have already seen the wide range of variations that can occur on the theme of womb movement. In the Hippocratic texts a dry, hot, and light womb rises in search of moisture; Soranus believes that the anchoring membranes prevent any movement, while for Aretaeus, although the womb moves it is pulled back by its membranes, thus affecting the higher parts of the body only through sympathy. In Galen the problem is a womb filled with retained seed or menses, rotting to produce coldness. In Arabic medicine a Hippocratic mobile womb becomes a mobile womb with Galenic contents, and vapors as well as sympathy explain its effects on the higher parts. In the Latin West the focus on Soranus had been combined with acceptance of womb movement; while some extracts from Hippocratic gynecology circulated, Galenic theory was lost until the eleventh century.

The return of Galenic medicine from the Arabic world led to yet another variation on this theme of womb movement and its mechanisms. It was in the twelfth century at Salerno in southern Italy that the texts of the Hippocratic corpus, Soranus, and Galen finally came together after their varied travels through the Latin West, the Greek East, and the Islamic world.^[276] The result was not a critical comparison of these traditions, but instead the decline of Soranus and the rise of the Galenic medical system of humoral balance and imbalance. One of the "masters"

of the school of Salerno in the twelfth century was Johannes Platearius. In his description of suffocation of the womb, in the late twelfth-century encyclopedia and textbook De aegritudinum curatione , he combined Galen and Paul of Aegina with Ibn al-Jazzar's claim that the symptoms were caused by vapors rising from the corrupt seed, menses, or other retained humor. However, Platearius went a step farther than this, suggesting that it was not the vapors, but the womb filled with vapors, that rose in the body to put pressure on the organs of breathing.

Green has argued that, since the Latin translations of al-Majusi's Kamil omitted the later section in which he describes scent therapy in terms of the womb as an animal annoyed by foul smells and seeking pleasant scents, this particular merger of the mobile womb with Galenic theory may come, not from Islamic medicine, but from the survival of the idea in popular thought in the West.^[277] Other features of Platearius's description are more familiar, showing the overall dominance of the Galenic material found in the newly available Arabic sources; he recommends the Galenic tests of the woolen thread at the nose of the patient, or a glass flask full of water placed on her chest, and among his suggested cures one finds sneezing provoked with castoreum or pepper, and the use of foul scents at the nose and sweet scents at the vulva. However, here too Green points out that non-Galenic ideas surface; although Galen never specifically advised marriage as a cure, Platearius recommends it if the cause is retained seed. Again, al-Majusi did explicitly prescribe sexual intercourse as a cure; but, again, this was omitted from the Latin translation of his work.^[278] It seems that the survival of Hippocratic theories—the wandering womb from Diseases of Women and the therapeutic value of intercourse from sections of that treatise and from Diseases of Young Girls —should not be underestimated.

Another writer associated with Salerno in the twelfth century is the female physician Trota, whose name is associated with a number of treatises of this period which are found in nearly a hundred manuscripts from the thirteenth to fifteenth centuries.^[279] Suffocation of the womb is mentioned in both the more empirical Ut de curis , which refers to it occurring in young girls with epilepsy, and the more theoretical and Ga-lenic Cum auctor .^[280] The Cum auctor version owes much to Ibn al-Jazzar, although it does not specify conclusively whether suffocation results from vapors, or the womb itself, rising up inside the body. Scent therapy is recommended, and the story of the woman who lay as if dead but was known to be alive through the presence of the innate heat, is transmitted through the Cum auctor ; as in Ibn al-Jazzar, Galen becomes its hero.^[281]

The influence of Galenic theory grew with the translation of other

important Arabic texts into Latin; in particular, Ibn Sina's Qanun . The work of Soranus became "virtually obsolete by the thirteenth century";^[282] the gynecological works of the Hippocratic corpus languished in the wings until the sixteenth century. However, one Hippocratic text remained in the center stage: the Aphorisms , including the section on gy-necology with the text with which this chapter began, the alleged origin for the label/diagnosis hysteria , 5.35: "In a woman suffering from hysterika , or having a difficult labor, a sneeze is a good thing."

Aphorisms circulated in both the Latin West and the Arabic world; in the latter, from before A.D . 800, it was coupled with the commentary of Galen, In Hippocratis Aphorismi . This commentary, probably written in A.D . 175, was restored to the West when Constantinus Africanus translated it from Arabic into Latin in the eleventh century. In terms of its printed editions in the Renaissance, it was the third most popular Ga-lenic treatise after Ars medica and De differentiis febrium .^[283] The central position of the Aphorisms from the eleventh century onward results not only from its perennial popularity as a series of practical tips,^[284] but also from its inclusion in the Articella , a group of medical writings "used for centuries at Salerno and elsewhere as a textbook for introductory courses in medicine."^[285] The central text of the group is Hunain ibn Ishaq's Isagoge , in Constantine's translation from the Arabic; in addition to the Aphorisms , the nucleus also contains Galen's Tegni (the Ars parva ), the Hippocratic Prognostics , Theophilus on urines, and Philaretus on pulses.

I have argued that the opening words of Aphorisms 5.35 can best be translated "In a woman suffering from hysterika ," where hysterika means disorders of the womb. But this translation depends on reading the text without the Galenic commentary that instead pushes for a very specific translation, hysterike pnix . By looking at changes in the Latin translation of this aphorism, it is possible not only to trace its gradual incorporation into the hysteria tradition, but also to provide a test case for the period in which the humanists began to carry out philological work on the Galenic and Hippocratic texts. When were these texts read as the object of serious study? It is the brief Aphorisms , not the lengthy Galenic commentary, which occupied a central place in the medical curricula of the Renaissance. Despite its impressive printing history, I would argue that Galen's commentary was little read before the sixteenth century.

The earliest Latin translations of Aphorisms , found in manuscripts dating from the eighth to the twelfth centuries A.D ., can be traced back to fifth/sixth-century Ravenna.^[286] Such Latin translations are very literal, the writers apparently having an equally weak grasp of both Greek and

medicine. The translation reads "Mulieri de matrice laboranti aut diffi-culter generanti, sternutatio superveniens, optimum" (In a woman troubled by the womb or giving birth with difficulty, a sneeze coming on unexpectedly is best).^[287] At this period, then, the aphorism was not associated with hysteria or suffocation of the womb.

The Articella uses a different Latin translation of the Aphorisms , possibly produced in the eleventh century, and linked to the name of Con-stantinus Africanus. It is not known whether this was made from a Greek manuscript of Aphorisms , or by merely extracting the aphorisms from a copy of Galen's commentary. Whatever its source, it gives for 5.35, "Mulieri que a matrice molestat aut difficulter generanti: ster-nutatio superveniens bonum." It thus differs little from the Ravenna translation; a sneeze becomes "good" instead of "the best thing," and the womb continues to "distress" or "trouble" the woman. Fifteenth-century printed editions of the Articella retain slight variations on this translation, which remains the most commonly used well into the sixteenth century.^[288] Some editions give two translations, setting this so-called versio antiqua beside the traductio nova of Theodorus Gaza. The new translation runs, "Mulieri quam vitia uteri infestant, aut que diffi-culter parit, si sternutamentum supervenit, bono est." The opening words, "In a woman in whom disorders attack the womb," again keep this aphorism within a very general gynecological context. Another variation in printed editions of the Articella is to print both translations together with a rearrangement of the Aphorisms by the part of the body discussed, on a capite ad calcem lines; thus the edition of 1519 gives this aphorism under "Concerning sneezing" and "Concerning the female generative organs."^[289]

A further development in the printed versions of the Articella is that, where the manuscript versions gave only the Hippocratic text of the Aphorisms , the printed editions from 1476 give Galen's commentary beside it. Galen is thus "given a privileged status compared with other commentators."^[290] However, an important question remains: Did anyone read the lengthy commentary, which sets it firmly in the context of hysterike pnix , as opposed to uterine disorders in general? Galen considers that apnoia , or absence of breath, is more accurate than "suffocation," seeing a spontaneous sneeze both as a "sign" (semeion ) that the patient has revived, and as a "cause" (aition ) of recovery, since in itself it revives the patient.^[291] However, despite Galen's conclusion that hysterika is equivalent to hysterike pnix , the connection with the translation of the Hippo-cratic aphorism is not made. Neither the terminology of suffocation nor that of hysteria appears in the Latin of the Aphorisms ; instead, the woman

is said to be "troubled by the womb" or to have "disorders attack the womb." Reading the long discussion of the meaning of hysterika in Galen's commentary should lead to a change in the translation of the aphorism, away from this general terminology and toward that of hysterical suffocation, but no such change is made at this time.

It is in the fifteenth century that the first signs of close study of Galen's commentary and its implications for the translation of the aphorism appear, in the work of Ugo Benzi (1376-1439). Benzi wrote commentaries on the Canon of Avicenna, the Tegni of Galen, and the Hippocratic Aphorisms , omitting books 3 and 7; this last was probably first published in 1413 or 1414 while he was lecturing on medicine in Parma, but it was later revised. Like his contemporaries, of course, he still based his translations not on the Greek, but on "the medieval Latin versions from the Arabic." Although he follows the versio antiqua translation, he improves the Latin, discusses the views of Galen and Avicenna on uterine suffocation—in particular, on whether it is the womb or merely vapors that rise up the body—and also glosses the aphorism as follows: "Sternutatio superveniens mulieri suffocationem matricis patienti aut difficulter pari-enti est bonum" (A sneeze spontaneously occurring in a woman suffering from suffocation of the womb or a difficult labor is a good thing).^[292]

The translation of Theodorus Gaza is used by Lorenzo Laurenziani (ca. 1450-1502),^[293] while Niccolò Leoniceno (1428-1524) gives both this and the verso antiqua beside his own translation, which begins with another variation on the theme of general uterine disorders, "Mulieri qua uterinis molestant."^[294]

The connection between text and commentary is made conclusively only in the 1540s, when the Aphorisms are first the object of detailed philological interest. The availability of printed Greek and Latin editions of the Galenic and Hippocratic works from the 1520s onward had no immediate impact but, after twenty years, comparison of the text both with the Greek manuscripts of Aphorisms and with Galen's commentaries is made, and the aphorism becomes explicitly "hysterical."

Antonio Brasavola's annotated edition of the Aphorisms and its Ga-lenic commentary was printed in 1541 at Basel. It discusses not only Galen's commentary but also the use of hysterika in Marcellus's commentary on Dioscorides, Philotheus, and Paul of Aegina. Brasavola (1500-1555) reasserts the identity of hysterika as hysterikg pnix , but still he does not take the step of adjusting the translation of Aphorisms 5.35, instead giving a variation on Leoniceno's translation, which reads: "Mulieri, quae uterinis molestatur, aut difficulter parit, superveniens sternutatio, bonum."^[295]

The earliest translation I have found in which the terminology of the suffocation of the womb is directly applied to Aphorisms 5.35 is that of Leonhart Fuchs (1501-1566). Printed in 1545, this gives "Mulieri quae ab uteri strangulationibus infestatur, aut quae difficulter partum edit, sternutamentum superveniens, bonum." Here, for the first time, the translation itself becomes "hysterical"; "in a woman who is attacked by uterine suffocation," a translation justified by Fuchs on the grounds that Galen and Philotheus explain that hysterika equals suffocation here. He goes on to demonstrate that the basis of his translation is the comparison of Greek manuscripts, discussing whether a word in Galen's text should read lunga or pniga .^[296]

The edition of Guillaume Plancy (1514-ca. 1568) takes the process a stage further. In this publication of 1552 the Latin reads "Mulieri hys-tericae, aut difficulter parienti, sternutamentum superveniens, bonum." A note justifies the translation by a reference to Galen's On the Affected Parts 6.5.^[297] The connection has been made, not only between aphorism and commentary, but between the Galen of the commentary and the Galen of On the Affected Parts .

Once the aphorism has reentered the hysteria tradition, it is—with a few exceptions—there to stay. Claude Champier (fl. 1556) also mentions "vulvae strangulatus," while Jacques Houllier (ca. 1510-1562) follows Plancy's translation.^[298] In keeping with his general interest in a return to the Greek classics in order to end error in medicine, Houllier also recalls Hippocratic ideas, giving a further type of suffocation due to a dry womb seeking moisture, for which a sneeze is less beneficial than baths.^[299]

Thus, once the aphorism is read—rather than merely printed—in the context of Galen's commentary, it ceases to be understood as a reference to disorders of the womb in general, and comes to be absorbed into the hysteria tradition, that set of connected texts repeated by successive commentators on suffocation of the womb.

Glancing at its fortunes in vernacular editions, the English translation of the Aphorisms of 1610 by "S. H." gives "Sneezing hapning to a woman grieved with suffocation of the wombe, or having a painfull and difficult deliverance is good."^[300] This is also found in a seventeenth-century manuscript in the British Library, Sloane 2811.^[301] A commonplace book of the seventeenth century includes a Latin translation of the Aphorisms , giving "Mulieri hysterica, aut difficulter parienti sternutamentium su-perveniens bonum"—a variant of Plancy—and an English translation, reading "Sneezing happening to a woman seized with suffocation of the womb: or that hath a difficult deliverance: is good."^[302] The comment on

this aphorism is that sneezing shakes off noxious humors and restores the natural heat that was almost extinguished. In the same book appears a work entitled "Select Aphorisms concerning the operation of medica-ments according to the place." This contains a section (pp. 121^v -122^r ) on "Hystericalls" which describes how the womb is drawn to aromatics and repelled by their contraries. It discusses how this mechanism works, and roundly rejects the belief of "some sotts" that the womb possesses "the sense of smelling." Even in the seventeenth century scent therapy is defended, but this does not mean that the womb is regarded as an animal.

If the old discussion of the implications of scent therapy for the status of the womb as, in the words of Aretaeus, "a living thing inside another living thing" is still itself alive and well in the seventeenth century, has the hysteria tradition made any progress over the two thousand or so years of its existence? I would argue that some change has, by this time, occurred. The tendency before the sixteenth century was toward an accumulation of descriptions, explanations, and remedies. Some features—such as scent therapy at both ends of the body, the use of an extinguished lamp wick to rouse a patient, and the application of aromatic oils to the sexual organs—went back to Hippocratic medicine, as transmitted by Galen. Others, although derived from the Hippocratics, were transformed by Galen's reinterpretation; for example, Hippocratic pnix concerns a hot womb seeking moisture to douse its fire, yet after Galen it becomes "obstruction of respiration," and the womb is seen as being filled with cold and corrupt substances rather than being hot and light. Other features remained in the tradition despite all that could be said to condemn them, most notably, the wandering womb, in coexistence with apparently contradictory features such as anchoring membranes.

Tradition or Truth?

By the mid-sixteenth century, the hysteria tradition was complete: the translation into Latin of texts from the Arabic and Greek made available virtually the full range of authors discussed above. Every commentator on suffocation of the womb knew which ancient authorities to consult for a description. Since these ancient authorities had themselves known and used the work of many of their predecessors, it is not surprising that the result was often merely further repetition. Latin and Middle English treatises from the thirteenth to fifteenth centuries tend to be heavily dependent on the Arabic writers' versions of Galen, and retain the features of scent therapy, provoking a sneeze as a cure (as opposed to

welcoming a spontaneous sneeze), venesection, and therapeutic intercourse.^[303] However, in the mid-sixteenth century something new does occur: the stated desire to compare authorities, not only with each other, but with reality.

As an example of this we may take the work of Pieter van Foreest (1522-1597), Observationum et curationum medicinalium , Book 28 of which concerns women's diseases.^[304] As the title suggests, rather than simply repeating the authorities, he also presents cases that he himself has seen. Observations 25-34 concern suffocation of the womb, covering cases due to retained seed or menses in widows, in pregnant and other women, and of varying severity. Rhazes, Ibn Sina, and Galen are cited; Galen is particularly favored and, although he is a supporter of the Hip-pocratic revival, van Foreest accepts Galen's attack on the Hippocratic theory that the womb dries out and seeks moisture.^[305] He notes that the ancients believed the womb itself traveled the body, whereas "more recent writers" believe it is vapors that rise. The motif of the woman who uses hysteria to manipulate men is reintroduced, echoing Martial's epigram on women who announce they are hysterica in order to have intercourse with a young doctor; van Foreest states that some women simulate hysterical suffocation by imagining sexual intercourse, and he cites the "notorious poem" mocking this.^[306]

His use of his own observations is first suggested when, after repeating Galen's statement that the symptoms from retained seed are worse than those from retained menses, he adds, "And this is true."^[307] Even Galen must be tested against experience. Observation 27 repeats the story of the woman who lay as if dead, based on Pliny, and gives the standard tests for life, adding that a sneeze is more reliable than the wool or water tests. Observation 28 includes Galen's story of the widow who was cured after passing some thick seed. In Observation 30, on hysterical suffocation in pregnancy, he gives two cases he himself has seen, one dated to October 1589, while in Observation 31 he describes the case of a woman called Eva Teylingia, who was married in 1561 and was known to his wife. She was unsuccessfully treated by several named doctors for suffocation, and "on the third day I myself was called." Van Foreest's therapy—based on foul-smelling substances placed in the navel—was successful. In Observation 33 he gives the case of a girl of twenty, treated in September 1579, and in Observation 34 he gives a case dated March 1566.

Such works as this were used by Edward Jorden in his treatise of 1603, A Briefe Discourse of a Disease Called the Suffocation of the Mother .^[308] What is most striking about this work, in which he sets out to show "in a vulgar tongue" that symptoms "which in the common opinion are imputed to

the Divell" are in fact due to the suffocation of the womb, is not the use of authorities such as Hippocrates, Galen, Pliny, and Ibn Sina, but his citation of recent cases seen and reported by men such as van Foreest, Amatus Lusitanus, and Andreas Vesalius.

Is this, then, the triumph of experience over tradition? It is not. As T. Laqueur puts it, "Experience, in short, is reported and remembered so as to be congruent with dominant paradigms."^[309] Many elements of the hysteria tradition have an extraordinary vitality as paradigms, continuing to be repeated well into the nineteenth century. To take one example, Jorden himself repeats the story of the woman who lay as if dead but was known to be alive by the presence of the innate heat; he uses the version given by Pliny.^[310] This story has inordinate staying power, turning up many times in seventeenth-century literature; for example, Guillaume de Baillou (1538-1616) claims that many women are being buried alive because it is wrongly assumed that the absence of a pulse indicates death.^[311] In the nineteenth century, Thomas Lay-cock's Treatise on the Nervous Diseases of Women has a section on "Apparent Death" citing Diogenes Laertius's version of the same story, here diagnosed by Laycock as hysteria. As a general rule, Laycock recommends delaying burial in such cases until there are signs of decomposition.^[312] He refers readers to Leigh Hunt's play A Legend of Florence , first performed in 1840, the year of publication of Laycock's own work. In this play, the moral and married Ginevra, receiving letters from a nobleman who declares his love for her, has a fainting spell and is mistakenly buried—fortunately, in an open vault. She wakes up but has difficulty persuading the people of Florence that she is not a ghost:

I am Ginevra—buried, but not dead,
And have got forth and none will let me in.
                      (act 4, scene 4)

This highly popular piece of drama, seen by Queen Victoria a number of times and regarded as Leigh Hunt's greatest dramatic success, was in turn based on Shelley's "Ginevra," published in 1821.^[313] In Shelley's version, Ginevra marries a man she does not love and, on her wedding night, falls into a trance that drifts into death itself, in order to keep faith with her disappointed lover.

They found Ginevra dead: if it be death
To lie without motion or pulse or breath,
With waxen cheeks, and limbs cold, stiff, and white,
And open eyes . . .
                      (lines 145-148)

Shelley's words echo Diogenes Laertius's third-century A.D . account of the woman "without breath or pulse" but preserved, according to Galen, by her innate heat. Such powerful motifs as apparent death weave in and out of the medical accounts of suffocation of the womb and of later hysteria. Do such elements survive simply because they make such good stories? Or is the persistence of certain parts of the tradition evidence for the accuracy of that tradition, and thus for the accuracy of the diagnosis of hysteria?

Throughout this chapter I have emphasized how medicine worked as a series of texts. Medical education, particularly where it concerned women's bodies, was based on the text in the Byzantine, Islamic, and medieval worlds; even after publication of Vesalius's De humani corporis fabrica in 1543, "anatomy and surgery continued to be taught from books rather than from experiment and observation."^[314] Specifically, in the texts of the Hippocratic corpus, neither the diagnosis of hysterike pnix nor of hysteria is made. The womb moves, causing a range of symptoms according to its eventual destination. At an unknown date, possibly—from the medical papyri—in the second century B.C ., a disease category of suffocation of the womb is created by the merger of a number of discrete Hippocratic texts giving symptoms, causes, and therapies. Galen challenges the label, but keeps the concept and develops a different explanation based not on womb movement so much as retained blood and seed. In the early Roman Empire, further stories are added to the disease picture, surviving in the different cultural climates of the Latin West, Greek East, and Arabic world. Particularly resistant to change are two of the original Hippocratic components, womb movement and scent therapy: so too is the need to give the concept antiquity by tracing it back in its entirety to the father of medicine.

I would suggest that what we hear in such texts as those discussed here is not the insistent voice of a fixed disease entity calling across the centuries, but rather what Mary Wack has called "the rustle of parchments in dialogue."^[315] Indeed, it is rarely even a true dialogue. Deaf to pleas from anatomy and experience, the texts continue to tell one another the traditional stories. The language may shift—the womb travels, vapors rise, sympathy transmits symptoms through the body—but the message remains the same: women are sick, and men write their bodies. Nineteenth-century hysteria, a parasite in search of a history, grafts itself by name and lineage onto the centuries-old tradition of suffocation of the womb, thus making Hippocrates its adopted father. It is time that father disowned his hybrid child.

Acknowledgments

Sections of this chapter have been presented to the Pybus Club (Newcastle, 1985), the Classical Association Triennial Meeting (Oxford, 1988), a conference organized by the Wellcome Institute for the History of Medicine (London, 1990), and the Liverpool Medical History Society/Society for the History of Science (Liverpool, 1991). I am grateful to all who made suggestions as to its improvement on these occasions, but above all to the careful and generous scholarship of Monica H. Green and Mark Micale.

Two—
"A Strange Pathology":
Hysteria in the Early Modern World, 1500-1800

G. S. Rousseau

Some will allow no Diseases to be new, others will think that many old ones are ceased; and that such which are esteemed new, will have but their time: However, the Mercy of God hath scattered the great Heap of Diseases, and not loaded any one Country with all: some may be new in one Country which have been old in another. New Discoveries of the Earth discover new Diseases . . . and if Asia, Africa, and America should bring in their List, Pandoras [sic] Box would swell, and there must be a strange Pathology.
—SIR THOMAS BROWNE, "A Letter to a Friend, Upon Occasion of the Death of his Intimate Friend"

It will always be a mistake . . . to treat past philosophies in a decontextualized way, viewing them simply as addressed to a canonical set of distinctively philosophical themes. Even the most abstract intellectual systems cannot be regarded simply as bodies of propositions; they must also be treated as utterances, the rhetorical aims and purposes of which we need to recover if we are to understand them properly. Moreover, once we commit ourselves to recontextualizing the great scientific and philosophical systems of the past in this way, we must guard above all against the tendency to reconstruct their intellectual context with anachronistic narrowness.
—QUENTIN SKINNER, New York Review of Books

I

Even in the earliest historical periods in the murky ages between 1300 and 1600, old man Proteus offers a steadfast clue to understanding the evolution of hysteria. In its progression from the Greeks to the medieval world, hysteria—as Helen King suggests—was transformed many times, such that by 1400 it was understood as something different from the conceptions given it by Hippocrates and Soranus. Vast cultural shifts—religious, socioeconomic, and political—as well as the growth of medical theory in the Renaissance, prompt hysteria to continue its prior altera-

tions and constructions after approximately 1500; so that by the period of the French and American revolutions it assumed a different set of representations altogether.

These historical transformations and representations—specially their protean ability to sustain the existence of a condition called hysteria without a stable set of causes and effects or, more glaringly, a category identifiable by commonly agreed upon characteristics—constitute the substance of this chapter. Throughout I will be attempting to explain how a category—hysteria—evidently without a fixed content can endure throughout the course of history.^[1] Furthermore, among all medical conditions hysteria formed the strongest critique of the traditional medical model up to the advent of psychiatry and psychoanalysis. Before approximately 1800 its discourses were compiled by doctors who were themselves often terrified of their hysterical patients, as is evident in the early Malleus Maleficarum . Hysteria is a unique phenomenon in the entire repertoire of Western medicine because it exposes the traditional binary components of the medical model—mind/body, pathology/normalcy, health/sickness, doctor/patient—as no other condition ever has.

My purpose here is dual: to show what hysteria was thought to be, as well as trace its representations. Within this goal I have a set of alternatives: whether to focus on what doctors chose to make of hysteria, or to gaze at its representations by those who were not doctors. Inevitably I work here sporadically as a historian of science and medicine whose eye is never far from the medical alternatives doctors chose to take, while inquiring into the representations of hysteria made by those who were not doctors. This is the "as is" (history) and the "as it could have been" (representations) of hysteria, strewn with a broad range of metaphors and language that attached to the condition.

But even in a historical and representational treatment like this one, it is easy to forget that for the modern era the history of hysteria extends over a period of four centuries (1400-1800), and because this somewhat synchronic view enables us to chart the flow of hysteria in its recorded versions, we possess certain advantages over both the doctors and the patients who were entrapped in their particular moment. This angle of vision is, of course, double-edged: we are also entrapped by our moment, and many voices of hysteria must have been lost over the centuries. Nevertheless, modern methods of research permit access to a wide body of knowledge about this condition not available before.^[2] Furthermore, some disjointed concepts pertinent to hysteria's transformations must be considered: in our time, when the revolt against Freud has been so vehement, it is important to remember that he launched

his psychoanalysis exclusively on the basis of his studies of hysterical women. As a consequence, hysteria in our century has assumed a more important role in psychiatry than have other categories.^[3] Although the diagnosis of hysteria in both women and men has virtually disappeared in our time, in practice its symptoms have been transformed into the medically sanctioned "conversion syndrome" and then (mysteriously and perplexingly) have gone underground.^[4] It is easy to forget that the ancient threat of an invasive and irrepressible female sexuality, a patent menace in epochs studied in this chapter, is in the lay imagination today far from having been removed in our own time.^[5] Indeed, the social oppression of women throughout history has only recently—since the eighteenth century—been acknowledged in any organized way, and this restraint bears serious implications for hysteria. Finally—and it will seem extraneous in this discussion about a complex but nevertheless presumed-medical category—because so much of hysteria in the period 1500-1800 is embedded in discursive practices, much more sensitive attention must be paid to language if we hope to disentangle hysteria's transformations.

We are thus presented with something of a paradox. On the one hand, hysteria appears to be a category without content; on the other, hysteria has an amorphous content incapable of being controlled by a clear category. The history of hysteria (pace Dr. Ilza Veith, the already-mentioned Freudian medical historian who amassed a great deal of information about hysteria) is therefore only a part of the story I tell here. Its representations count as much. No matter how complete any history, its discursive facet can only hope to be one part, its total realism requiring a larger canvas than historical narrative. The challenge I face is that I aim to "fill up" both categories (the medical category and its broader nonmedical representations) at the same time—a double task. But both require amplification, even when conjoined as they are here. Moreover, the medical category itself is so inadequate for the early period (1500-1800) that I often rebel against its constraints. The history of hysteria is as much the "his-story" of male fear—in this case literally his-story—as the history of Dr. King's hysterie pnix or any other wandering wombs. It is also the history of linguistic embodiments, rhetorics, and emplotments, many of which remain to be decoded and interpreted here.^[6]

Two truths then seem to emerge with rather startling disparity: first, that Dr. Thomas Sydenham, acclaimed as the "English Hippocrates," rather than Charcot or Freud, is the unacknowledged hero of hysteria (his entrance to my story is necessarily delayed until a later section as my organization is essentially chronological); second, that language,

rather than medicine (either theory or therapy), is the medium best able to express and relieve hysteria's contemporary agony. (The same conclusion can be drawn concerning other conditions, such as depression, but conventional hysteria or twentieth-century conversion syndrome is different in that its somatic involvement is much greater.) This is the conjunction of language and the body: hysteria's radical subjectivity. And as I shall suggest below, hysteria is also the most subjective of all the classifications of disease. These are bold assertions, and no one at this time wants to promote a history of medicine based on heroes and heroines. But writing—perhaps self-expression through any of the arts, rather than treatment with drugs or psychotherapy—alleviates the modern hysteric's pain and numbness best.^[7] To validate this claim we will prove that there remains no better medical therapy for contemporary hysteria, certainly no more effective remedy when hysteria is, as in Sydenham's version of the 1680s, presented as a "disease of civilization" rather than as organic lesions caused by psychogenic factors.^[8] If we ask what the three hundred years between 1500 and 1800 can teach us about hysteria, the answer can be found by looking at two factors: gender-based pain and social conditions, neither of which falls within accepted categories of modern medicine. It is consequently no small wonder that to its observers hysteria has continued to be one of the most elusive of all maladies;^[9] less so—as I suggest—to writers, poets, or artists, who have often adopted a gaze that differs from the traditional medical one. If we assign to hysteria a broad repertoire of gender-based pains caused by social conditions, we have the beginnings of a definition that pleases few medical theorists. We provide a set of contents incapable of being bound together by any logically constructed and demonstrably coherent category,^[10] and so our contents will be unsatisfactory to philosophers.

Moreover, of all the diseases classified in this early modern period, hysteria has been the medical condition most likely to generate private languages and discourses—languages that capture the cries and whispers of unspeakable agonies, most of which do not remain as single narratives because patients never recorded them. This was as true in the sixteenth and seventeenth centuries as it is of the twentieth. Hysteria's expressions of physical and emotional numbness and of chronic pain were captured in a personal, often disjointed, medium, most striking in its intrinsic subjectivity. Subjectivity, above all, has been the teleology of the annals of hysteria in Western civilization.^[11]

More specifically, mourning and melancholia, especially the grief and ecstasy associated with hysteria, are the shadow-categories that have haunted modern theories of subjectivity and representation since Freud. But even Freud intuited the history of this development in his inau-

gural linking of Hamlet and Oedipus Rex in his discovery of the Oedipus complex, in which Hamlet came to represent the figure that proves (and ruefully denies) the Oedipal rule, as much as literary criticism has taken Hamlet as its exemplary defective (hence modern) tragedy. And modern theorists (including Jacques Lacan, Walter Benjamin, and Nicolas Abraham) have repeatedly returned to Hamlet's disordered grief as touchstones for their insight into subjectivity and representation. From these positions it is only a short step to the feminist, psycho-analytic, and deconstructive attempts to articulate a supplementary position before, within, or beyond the interpretative paradigms practiced in Freud's (and Oedipus's) name. In our time, these have embraced—in brief—the literary, psychoanalytic, and deconstructive symptoms of hysteria: in Hamlet's famous phrase, the "forms, moods, shapes of grief."^[12]

But if mourning and melancholia have haunted modern categories of subjectivity and representation, language alone has recognized the silences beyond itself (i.e., beyond verbal language and discourse) to which the (usually female) hysteric has had to ascend if her desire, not always limited to the sexual realm, was to be acknowledged. The point is admittedly elusive, even if concretized in a tangible history of medicine. Historically speaking, hysteria has been the condition beyond others that wedded the body to body language, especially to gestures, motions, gaits, nonverbal utterances. As such, it never reflected—certainly not in the Renaissance or Enlightenment—a simple ontology of the mind or of mind functioning together with body, but rather captured the chronic numbness and ineffable despair usually incapable of being grasped in the subtleties of written language.^[13]

Ever since the Cartesian revolution of the seventeenth century and perhaps even before then, the philosophical concept of body had been of little use to theories of hysteria—viewed, as we shall see, as a metaphysical medical category—nor have mind and body, in conjunction, offered solutions to unravel the riddle of hysteria. Perhaps the difficulty arises from the suppressed desire of those who have presented themselves with hysterical symptoms. Language and desire; more precisely, desire in language; Julia Kristeva's yoking of these loaded words and their difficult concepts proved more useful, especially for the unspeakable realms of pain that she believes transcend language: the metalinguistic spaces.^[14] Language and desire may ultimately be the only categories through which the hysteric can arrive at self-understanding: language used in the act of self-analysis and offering balm to heal the hysteric. The traditional remedies discussed later in this book have usually produced little improvement.

Michel Foucault speculated in his history of madness about the "hys-

terization of women's bodies" through which the pejorative image of the "nervous woman" had been constituted.^[15] Such negative imaging was necessary in patriarchal cultures that confined power solely in the males to ensure civic cohesion. But Foucault's analysis would have been richer, and certainly more complete, if he had included the "hysterization of women's language," especially as it had been muted with the passage of time. For hysteria has been the condition paradoxically both constituted by and consistently misinterpreted by medical observation; the condition that neither the mere presence of the physician (whether appearing as savior or soothsayer) nor the persistence of his therapy can control. Sequences of despair, pain, numbness, and conversion syndrome ultimately could not be cured by makeshift remedies or the herbal concoctions of the Renaissance and Enlightenment apothecaries. Today, instead of examining the fabric of the society perpetuating this chronic physical and mental pain,^[16] we deny (perhaps imprudently) that hysteria exists. We drug patients until the pain is obliterated, the despair forgotten; until physicians can claim that questions such as "where has all the hysteria gone?" cease to exist as valid medical concerns.

II

I have suggested that a broad overview such as this cannot be narrated without remembering that we today are subject to all the tensions and confusions of contemporary culture.^[17] Our versions of modernism necessarily differ from those of other readers, but a narrative of the evolution of thought about hysteria without interjections and self-conscious reflections, sans broad contexts and even problematic digressions, will not proceed much further than Veith's narrowly conceived diachronic history. This may seem small justification, but it actually advances the understanding of hysteria. In this context it makes sense to inquire eclectically into the cultural transformations that affected hysteria as the world moved from the Middle Ages to the Renaissance, and from there to the period of the seventeenth century, when so many of the salient features of Enlightenment hysteria were established. The relation of hysteria to witchcraft is also germane here. Set the chronological dials to the tenth or eleventh century, and few witches are to be found in Europe. By the fourteenth and fifteenth centuries they roam the continent, having over-taken it.^[18] To which specific conditions is their proliferation to be attributed? And, more significantly, were these witches female hysterics in disguise? The question is hard to answer authoritatively, but it assumes (rightly I think) that hysteria has a content that can be misinterpreted

or disguised. Even more crucial to the culture of the Renaissance, it was hysteria more than any other phenomenon that played a major role, as I maintain below, in the demystification of witchcraft.

Despite the variety of explanations for the historical rise of witchcraft, none is satisfactory, and given that the matter is central to the evolution of hysteria and its growth in the Renaissance, it merits discussion here. So many explanations have been tendered, with so many agendas underlying them and in so many historical contexts ranging from political history to the role of women in early European society, that no one theory has prevailed.^[19] Nor, on balance, does one explanation seem more reasonable than another. The account offered by Jules Michelet, the great French social historian of the nineteenth century, may therefore be as valid as the alternatives, although Michelet recounted it as myth rather than fact, and his narrative suggests a playful naughtiness as well.^[20] Michelet claimed that during one of the interminable medieval crusades, women, who had been left alone on their farms, out of boredom began to converse with the animals and plants, the trees and birds, even the clouds and the moon.^[21] Apparently no one objected to this behavior. But eventually the men returned and found their women talking to the creatures of nature, to the trees and the wind. It was then, Michelet says, that men, finding this babbling intolerable, invented witchcraft. From the start, witchcraft was—he suggests in the parable—a male idea, even a male invention. To silence the women, the men burned them and branded them witches.

This explanation for the genesis of witchcraft seemed as reasonable to Michelet as any other version. But for Marguerite Duras, the contemporary French writer who retells Michelet's myth fable in several of her short stories and uses it as a leitmotif, it becomes a potent myth that captured the essence of the masculine suppression of female desire and female discourse. Whether in its Micheletian or Durasean version (or in some other form), the fable suggests a direct line from the late Middle Ages to fin-de-siécle Vienna; from the women who once knew how to speak freely to the wind and the clouds to those now—like Duras, Kristeva, and other feminists—whose crusade in our century seeks to retrieve the female speech (Kristeva's utterances of jouissance ) that once was theirs.^[22] Considering the degree to which phallocratic and patriarchal discourse continue to be major concerns of our contemporary intellectual dialogue, as Elaine Showalter shows in chapter 4, the historical discourse of hysteria cannot be conceptualized or reconstructed as a specialized province of medical history. Hysteria, even in its early medical versions among the ancient Greeks, represented more than a set of

medical diagnoses and pharmaceutical therapies. From the start it was emplotted in discourses that extended beyond the medical domain and opened to a vision embracing a wider culture and broader civilization than the medical one could ever imagine. It was the public language embodying the female's plight. And it was for good reason then, as we shall see, that Sydenham observed that hysteria was, and always had been, "a disease of civilization," a seemingly mysterious pronouncement requiring broad contextualization before we can understand what he meant.

The salient historical point is that modern hysteria or conversion syndrome, as distinct from ancient hysterike pnix , first rises to prominence as an explicit diagnostic category within the development of demonology. This is why the relation between content and category, already mentioned, is so crucial for an understanding of hysteria's development before Freud, and why its anomalous mixture of gender and social conditions (especially religion) makes it a unique malady throughout the realm of medicine. By the time of Chaucer and Boccaccio, Christianity had affirmed a cosmology that viewed creation as embodied with spiritual powers, both angelic and demonic. Christ's disciples and their followers over the centuries had been locked in an apocalyptic struggle against the armies of the night, as every English epic from Spenser to Milton and Blake had acknowledged. Satan could possess the human soul, turning victims into demoniacs, and individuals—especially witches—could enter into compacts with the devil. From the late fifteenth century, in a movement peaking in the seventeenth, authorities, ecclesiastical and secular alike, comandeered the courts to stop the epidemic spread of witchcraft, and concomitantly clamp down on the rise of hysteria it was engendering.^[23] It was then impossible to distinguish between individual and mass hysteria, or even to know if the two categories existed. The wrath of the rabble, the crowd, the mob, was not understood as it would be in the eighteenth century. Besides, mass hysteria is a nineteenth-century invention that exists nowhere in the vocabulary or intellectual purview of the periods surveyed here, even if its effects were often felt.^[24]

Though some witches were self-confessed, most were identified through public accusations. To sustain the charge of witchcraft, certain standard behavioral and physical identifications (especially the stigmata diaboli ) normally had to be proven. Given that witchcraft was held to be a mortal offense everywhere in the realms of Christianity, it was crucial that such tests be judicially convincing. Meticulous courtroom procedures were developed throughout Europe to winnow true demoniacs and witches from those erroneously or falsely accused—those whose

prima facie manifestations of possession were due to other causes—to illness, accident, suggestion, or even fraud. Expert witnesses were heard, especially physicians; often these were the same physicians who were compiling medical definitions of hysteria.^[25]

The doctors by 1400 had generated no single theory or even multiple theories of hysteria.^[26] They continued to ponder the links among sexual physiology, pleasure, and love, but they were uncertain of the proper emphasis to be given to any of these, let alone the roles of cause and effect. Mary Wack's conclusion about women and lovesickness in the Middle Ages and early Renaissance is surely correct. "In any case," she writes, "it is clear that a certain branch of medical writers on lovesickness began to consider it a disease linked to the sexual organs and their humors."^[27] Hysteria had not yet become the exclusive medical category it would be in the early decades of the seventeenth century. There is no reason to assume that in the legal domain doctors entertained greater doubts about the existence of diabolism than did other experts: indeed, physicians' testimony was often accusatory and ended in executions. But familiarity with the vagaries of the human organism, especially when sick, fevered, or maniacal through the ravages of natural disasters such as floods, storms, earthquakes, and so on, and the opportunity to vie with the clergy for authority over the human body, often led doctors to insist that supposed signs of possession—tics, convulsions, anesthesias, swoonings, hypnotic trances—were the work of illness rather than Satanism.^[28]

Substitute "nervous" or "neurotic" for "demonically possessed," and a remarkable parallel between this early modern world and our own develops.^[29] That is, the physicians then were asked to distinguish between real and false witches based on certain anatomical conditions; our doctors, at least since Freud altered the face of hysteria through his psychoanalytic reforms, distinguish between genuine conversion syndrome and somatic derangement caused by neurotic or psychotic agency. The first variety (conversion syndrome) entails so-called genuine hysteria, the latter no hysteria at all. Yet such demarcation clarifies the entire point of conversion syndrome. And here, precisely at this impasse between the two, our feminists have contributed a perspective that cannot be ignored despite their patent lack of medical expertise. Indeed, it may be that the feminists' psychological distance from this professional medical world, where so much other than scientific cause and effect is at stake, has permitted their deep insight into this matter.

The feminists have demonstrated that Marguerite Duras's writings, for example, thrive on notions of the transformation of hysteria—espe-

cially the intuition that hysteria in our century is alive and widespread, though often invisible to the gazer who cannot read its signs, but it is transformed, like Proteus, in its signals and modern dress.^[30] Although Duras has not pursued the social consequences of her argument (she is, after all, no sociologist), it would not be hard to do so. For if the medieval hysteric's geographical locale was the farm on which she toiled and conversed with family and neighbors; if the Georgian woman's world was the Ranelagh and Vauxhall Gardens where she paraded, and the town and country houses where she sought pleasure;^[31] if the Victorian woman's interior purview was the dark bedroom in which she pretended to see nothing at night, certainly not her husband's naked body and aroused sexual organs; then today these locales have not disappeared but have been transformed into other social locations: the health club, the bedroom with its paraphernalia of biofeedback machines, the therapists' waiting rooms, the pain clinics, even the beauty salons and ever-proliferating malls.^[32] Paradoxically, it seems today that these are the locales of health and therefore of pleasure and happiness. Yet it may be, upon closer observation, that they are merely the places where modern hysteria—what our vocabulary calls stress—has learned to disguise itself as health .

The method used in the detection of witches in the early period also bears such close parallels to methods of the last two centuries that they cannot be overlooked, not merely because of their similarities but also because they provide clues to the nature of hysteria itself. Here it is interesting to note that the signs and symptoms of hysteria have remained constant over many centuries. From the late Middle Ages to the Salem witch-hunting trials in New England (and even later), the same methods to detect witches were used to detect other medical conditions.^[33] In the early period, women were pricked with sharp needles to locate the devil's claw: that insensitive patch of skin was considered the infallible sign of witchcraft. Five centuries later—in the late nineteenth century—the great medical clinicians like Dr. Pierre Janet in Paris were still declaring that medical practice had gone no further: "In our clinics," Janet proclaimed, "we are somewhat like the woman who sought for witches . We blindfold the subject, we turn his head away [notice that the pronoun has changed its gender], rub his skin with our nail, prick it suddenly with a hidden pin, watch his answers or starts of pain; the picture has not changed."^[34]

Numbness—an unfeeling patch of skin—was still the sign of possession and witchcraft five centuries later. The concept of numbness altered its versions during the Enlightenment, as we will see, but it remained a

constant test at the peripheries of the early and late period (Renaissance and modern), and there is even evidence that the condition existed in the middle period (Enlightenment), despite the absence of the word numb from the hysterical patient's vocabulary. A century after the appearance of the nineteenth-century narratives about women like Charlotte Perkins, who as a hysteric became permanently numb , Duras continues to write stories about the literal physical numbness of contemporary women, and our finest feminist critics continue to proclaim that hysteria, although officially diagnosed by the physicians as having disappeared, is still with us . The evidence lies in some of the titles of their recent work: Alice Jardine, Gynesis: Configurations of Woman and Modernity; Roberta Satow, "Where Has All the Hysteria Gone?"; Dianne Hunter, "Hysteria, Psychoanalysis, and Feminism: The Case of Anna O"; Patricia Fedikew, "Marguerite Duras: Feminine Field of Hysteria."^[35]

The questions raised by this development may appear less than scholarly but must be put nevertheless. Why all this writing about hysteria if hysteria has disappeared? How can numbness have been the semiotic of hysteria as long ago as the sixteenth century, disappeared for centuries, and reappeared in the last century? Stated otherwise, what has been the middle zone of hysteria—its high Enlightenment versions? Has it returned, so to speak, in the modern witch's (i.e., today's hysteric) numb patch of skin?^[36] What is the pathology of hysteria if numbness has continued (admittedly with major lapses in the Enlightenment) to be its major sign—the basis of its semiology—over seven or eight centuries? And how does Helen King's Hippocratic story relate to this lingering malaise? Even holy women and saints of the early period—the Margery Kempes and Saint Theresas—had presented themselves with signs that were interpreted as hysterical by those who examined them, further evidence of the many physical shapes and forms that numbness could take in its religious guises.^[37] Here it is wise to remember that King left us with hysteria as a condition capable of afflicting women only . Seven centuries later, Victorian women remained its main victims despite abundant new research conducted in the century from 1750 to 1850 demonstrating that male hysterics also abounded then. And in our time one has to look very far indeed to find a male correlative of the feminist position that hysteria still abounds but has gone underground.^[38]

The explanation for the persistence of hysteria throughout history lies in the concept of imitation. However, because imitation thrives on complex notions of representation (an elusive concept to begin with), this matter of the "content" of hysteria is incapable of swift and simple presentation.^[39] Representation is further complicated by the mysterious-

sounding notion, propounded by Sydenham, that "hysteria imitates culture" ; a discovery that makes him, rather than later physicians often associated with hysteria, the unacknowledged hero of that illness before Freud and Charcot.^[40] Sydenham was the first to proclaim that hysteria imitated other diseases, and he maintained—by implication—that hysteria was itself somehow an imitation of civilization: an idea as well as a linguistic construction that we shall need to explore if we are to grasp the evolution of hysteria in the early modern period. But how can an organic derangement, a bodily disorder, even a medical disease (if hysteria can be classified in this fashion in comparison to other organic diseases) imitate a society, a civilization, a culture? What can be meant by such a notion of imitation?

Sydenham observed that the crucial hysterical symptom was always produced by tensions and stresses within the culture surrounding the patient or victim. That is, the symptoms themselves (the conversion symptoms the patient presented) proved to be constant over time (involuntary swoonings, faints, fits, twitchings, nervous tics, eating and sleeping disorders), and the symptoms clearly differed from a more general "numbness." But the cultural tensions producing these symptoms varied enormously. Sydenham was not a cultural historian—he was a radical empiricist more than anything, an observer but he realized that the human conditions varied greatly from one period to another.^[41] In this context, because of him the concept of hysteria held by physicians over the previous two hundred years was transformed. For him the symptom leading to the condition of hysteria "imitated" the culture in which it (the symptom) had been produced.

It was not simply chance that the precise aspect of civilization producing the symptom should have been identified by Sydenham and applied by his followers in nervous categories and nervous language. Tension, stress, and the large constellation of concepts aligned to these words—all derive from a revolution in thinking about the body which occurred in the late seventeenth century.^[42] In amalgamating an old medical condition (hysteria) with new cultural beliefs and practices (especially the body's mechanico-nervous organization), Sydenham was not merely displaying that he was an original thinker but was himself enveloped in the science and society of his era.^[43] That much is patently clear. But it has been much less evident that the new footing on which he placed hysteria owed as much to the scientific milieu of his day—a post-Cartesian radical dualism that called attention anew to the nerves—as it did to any concept of imitation and representation, whether construed in medical or nonmedical terms.^[44] Furthermore, my own intrusion of Sydenham—

introducing him into the narrative long before his chronological appearance justifies itself is essential if his achievement as the major transformer of Enlightenment hysteria is to be understood. If we construe hysteria in this imitative way rather than viewing it narrowly as an neuropsychological puzzle, we begin to glean why women have been demonized for so long and why women continue to express their own brand of contemporary numbness in the twentieth century. For the condition that arises by the production of symptoms that imitate the stresses inherent in a civilization requires social—even sociological—as well as medical analysis. Even further, the gaze must be extended to mentalities other than the exclusively medical, such as that of Julia Kristeva, the physician who writes about language and desire, and about language itself imitating the raging desire of women.

III

These leaps from witches in the Renaissance to Dr. Sydenham, switching from Sydenham to Kristeva and Duras, are not as disjointed and disconnected as they may appear, for only by possessing some sense of the synchronic hysteria does the richness of its diachronic development emerge.^[45] This synchronicity amounts to the convergence of all theories of hysteria, past and present, as if one beheld them simultaneously in the mind. The chronological view is, naturally, less confusing. Even for a condition as perplexing as hysteria, the diachronic or chronological view suggests focus and precision even when there is none; it gives the illusion of a well-wrought argument when there are only a myriad of theories and dozens of fractured images of the hysteric. Three hundred years after Sydenham wrote his dissertation on hysteria,^[46] Duras presented hysteria as imitation in terms of a female numbness; Sydenham—in contrast—generated his theory of hysteria as imitation without any sense that he was the first "doctor" to have happened upon this insight. He merely observed from the hundreds of cases he treated that this was the truth. Sydenham and Duras may seem odd partners with no commonality; in the realms of hysteria, however, they share much territory. Duras's novels and poems capture the persistent anesthesia of modern women living on the verge of nervous breakdowns as a result of their socioeconomic, marital, and sexual duress. Sydenham's notion is that pathological conditions of the female nervous system produce the hysterical symptoms with which the patient presents herself, but like Duras—he believes the symptoms arise from social conditions that enslave not only women but also, as we will see, men. Duras's numb pain,

like the witch's claw, is the basis of three of her works: the short prose/poem The Malady of Death, La Douleur , and The Ravishing of Lol Stein , a story about two women (Lol Stein and Tatiana Karl), both of whom have settled for loveless marriages. Sydenham's women are not usually chronicled in this detail; few of his case histories survive apart from his medical notes.^[47] Duras's women are characterized by a numbing pain that has few somatic symptoms, except the sense that they are suffocating and (according to her female protagonists) the indescribable sensation characterized by the words void and death-in-life .^[48] Duras strives to describe the mental agony produced by the unrelenting, numbing pain. Unlike Sydenham's hysterics and those of Charcot, for her victims, no physical cause of their disturbances can be found. Duras's hysterics suffer nevertheless, sunk into their private hells, where they exist on the edge of total despair.

Duras's view opposes that of Ilza Veith, the medical historian who saw hysteria as an elusive medical disease whose code had never been cracked. Veith and Duras are contemporaries, Europeans of the same generation who lived through the Nazi holocaust and a revolution in the professionalization of women. Even so, Veith never explained why it was so important to crack the code in the first place. The medical historians of her generation, whose mind-sets were formed in the aftermath of the Freudian revolution in psychoanalysis, took it upon faith that hysteria was the most elusive, and therefore challenging, psychosomatic illness.^[49] In her noble attempt Veith summoned as her protagonists the major doctors in history: Hippocrates and Sydenham, Thomas Willis and Franz Anton Mesmer, the celebrated Charcot and Freud, on grounds that they had moved closer to its psychogenic etiology. But Veith left many questions unanswered and took a narrow, almost parochial, view. She never explored the role of women in society, their traditional, phallocratic image as creatures with an insatiable and voracious erotic appetite, nor did she probe the implications of Plato's view (Timaeus 91c), expanded by Aretaeus, that the womb was an animal capable of wreaking destruction,^[50] as it was exemplified in Euripides's Hippolytus , where it rages over Phaedra's body like an animal in heat. In this play, it seems never to have occurred to the stubborn patriarch, King Theseus, to relieve Phaedra's agony and (as Duras would claim) numbness, any more than it would have occurred to the Renaissance biologists to relieve the hysterical symptoms of their female patients by acknowledging the social stresses and the thwarted sexuality that produced this condition in the first place. Throughout these early periods women were regularly placed on trial by men for witchcraft, regularly perceived as fallen Eves

and despised for their seductive propensities; repression of their sexuality by authoritative men (in medicine, theology, the law) became the visible, public sign of an allegedly raging womb: a private gynecological disorder the men themselves claimed never to understand fully.^[51]

These differing opinions hardly complete the picture of hysteria but they do serve to bring out significant aspects of the medical condition and its social contexts that have usually not been addressed in the now dormant annals of European hysteria. For the history of hysteria has been so bogged down in the technical anatomy of uterine debility that its larger pathology and its cultural resonances have been overlooked.^[52] The Greeks did not employ a vocabulary of female numbness, any more than the horror-struck observers recoiling from Renaissance witches suspected numbness in the witch's claw, but a long-range view of hysteria demonstrates a continuity of its symptoms down through the ages despite its protean ability to transform itself. No matter what its medicalization has been, hysteria, at least until the early nineteenth century, has been so inextricably entwined with the lot of women that the two can hardly be separated. Unquenchable sexual appetite was long thought to lie at the very root of the malady, especially by theologians and moralists in early Christian times.^[53] And the noteworthy aspect of this voracious female desire in both its pagan and Christian forms is that besides being inherently contagious it was conceptualized as morally dangerous (to the individual, family unit, state, world community). Other women, observing its effects, would imitate it and develop their own versions. This voraciousness instilled male fear (engendering a type of male hysteria); the other dimension—contagion—was construed as a virulent form of miasma which patriarchy has always opposed, whether it be the patriarchy of the Athenian city-states or Nazi Germany, Stuart England, or the Fourth Republic of France.

But what is the source of this raging female appetite? Is it in fact ultimately theological ? Was it due to an innate lewdness within the female anatomy or psyche arising out of the labia over which women had no control, and which was living proof of a postlapsarian world whose irrepressible, erotic appetite was the scar women bore for the sin of the edenic apple? Or was the perception of this female appetite something else? Something culturally ordained? Something socially constructed? These are the types of questions uniformly avoided in the discussion about hysteria, revealing one reason why its reconsideration "before Freud" has been so long overdue. Only in our poststructuralist time, and in full view of the feminist avalanche of scholarship and dialogue, has the approximation of an answer begun to emerge. But—with a polite

riposte to the narrowly Freudian Veith—conventional explanations about sexual repression, depression, grief, virginity, and widowhood have been insufficient to fit the historical facts of the last twenty centuries. Hysteria may indeed be, as Alan Krohn has suggested, "the elusive disease";^[54] it has also been the transformative, protean condition par excellence.

IV

If this approach has validity, then hysteria will always be present in society unless some miracle occurs—it can never disappear altogether, because its essentially protean nature compels it "to imitate " other diseases.^[55] According to this line of reasoning, the unwritten history of hysteria—the history that lies beyond the narrow medical gaze—is not Veith's chronological summary of medical theories narrowly conceived, but rather a social history of hysteria placed in large cultural contexts that do not mute the gleanings of literary and artistic voices. This broad record, if appended to the medical one, is more revealing than the narrow "medical gaze" because hysteria itself is a reflection of the cultures it imitates.^[56] The matter to be dealt with in an approach such as this book hopes to promote thus raises the nature of the problem of hysteria itself . And hysteria the category, rather than the set of patients presenting symptoms over many centuries, becomes par excellence the barometer responding, through its finely tuned antennas, to the perpetual stresses of gender and sexuality. As such, it is also a barometer of the cultural stresses weighing on sexual relations and gender formations. The forms of the barometric responses in the Renaissance and Enlightenment constitute much of the contents that follow. (In this view the panic and presenting symptoms of the AIDS patient who internalizes his sickness and moral condition deserve the classification hysteria, although it is rarely given in our time and cannot, of course, apply to all AIDS patients.) Moreover, hysteria will always elicit controversy among so-called "internalist historians" as well as among positivistic doctors who remain unconcerned with its cultural dimensions^[57] —those who merely want to diagnose its symptoms and prescribe medications for its abatement, versus those observers, like Sydenham and Duras, who locate it in larger cultural contexts. The controversial dimension penetrates to every aspect of hysteria's "internalist history," and must not imply any criticism, for example, of Helen King's methodology. The point rather encompasses the difference between textual traditions of hysteria that persist over the centuries, and socially constructed categories that necessarily keep fashioning hysteria anew. The material I cover suggests that

hysteria continued to be redefined in the early modern world according to the terms of changing cultural dynamics, while always serving the interests of its somatizers and diagnosticians. Viewed sociologically, mass hysteria is not a category apart from personal, individual hysteria, but is rather another version of the same protean, imitative stress brought out into the light of public groups, private agony having gone public.^[58]

V

This approach, then, entails a social reconstruction of hysteria. In it, the hegemony of Hippocrates and his wandering womb, as we have seen in the previous chapter, is diminished and limited; it is to be read as another imaginative, if erudite, patriarchal voice in what will become during the Renaissance and Enlightenment a litany of voices making pronouncements grounded in imagination and observation but ignoring their cultural contexts. Male voices, such as those of Hippocrates and others discussed by Helen King who came later, cannot be omitted from the evolution of hysteria, but they must be located in larger contexts if hysteria is ever to transcend its local, internalist histories. Hippocrates could not have written as he did had he been female (Hippocrata), any more than a female Plato would have viewed the womb as an animal: voracious, predatory, appetitive, unstable, forever reducing the female into a frail and unstable creature. These views are those of men with little firsthand knowledge of this part of the female anatomy.^[59] Once the Renaissance and Enlightenment are considered, it becomes evident that considerations other than those of paganism and Christianity must be brought to light if hysteria is to be fully explained. We must understand the relation of hysteria to inspired personal vision, to shamanism, and in extremely cold climates to so-called Arctic hysteria, said to be the natural habitat of shamanism, a subject deemed of the first importance to comparative anthropologists in the early part of this century.^[60]

Gradually it becomes clear that few topics in this narrative are as important as the conception of women held throughout the course of history. The views of antiquity were not uniform, of course, but they seem to be so in contrast to the chaos of the early modern period, especially in the transition from medieval culture to the Renaissance. By the Elizabethan period, roughly 1600, it is no longer possible to invoke any major view of women, despite our postmodern temptation to do so.^[61] Women have already acquired a "history" that permits them to be seen from different perspectives, each view claiming to be equally valid. It is even said that this new diversity is one certain proof of female frailty, a

trait made especially resonant by the Shakespearean line: "Frailty, thy name is woman!"

This view of woman as the quintessence of frailty is the one the Renaissance grapples with. Woman, whether viewed in theological or medical contexts, whether by the ancient scholiasts or the derivative Aristotelian biologists and philosophers, whether concretized as weak virgin, bride of Christ, or as deranged Ophelia (another hysteric of course), continues to be conceptualized as part animal , part witch ; part pleasure-giver , part wreaker of destruction to avenge her own irrationality—anything but as strong, rational creature resembling homo mensicus , this view coexisting while men of the Renaissance debate the heresies of Gallilean astronomy and the subtleties of Cartesian physiology.^[62]

For these reasons, and others not provided here for lack of space, it serves no purpose to compile further narrow internal histories of hysteria classified according to various chronological periods or taxonomic schemes. Old man Proteus has been too sly for that. Although a route such as the mind/body relation appears on the surface to hold out infinite promise for theories of hysteria in the late Renaissance, it is also limited. The notion that mind/body dualism can crack the code, so to speak, of the "elusive neurosis" is doomed to failure, if anything resembling a complete explanation of how the patient proceeded from initial symptom to eventual physiological dysfunction is expected. Ultimately Descartes is a minor figure in our story, major though dualism is for hysteria in the epoch of its most formative transformation (as we shall see). Cartesianism did not change hysteria's destiny other than to erect a new, and long insurmountable, roadblock in the form of mental torment versus physical pain. But hysteria's definition had been troubled before the advent of the great dualist and would continue to be long after his demise and the decline of his philosophy in Europe.^[63]

Before Descartes's famous discovery of the pineal gland, the human amalgam of mind and body was thought to have made man unique among living creatures. Cartesian hysteria —if one can posit such a medical configuration—must be turned inside out to be seen for what it really is, or to ponder how it could have been conceptualized by its seventeenth-century viewers. Cartesian discussions of hysteria that got bogged down in mind and body, mind or body, as virtually all did, ultimately contributed little to the therapy or recovery of its victims, and, even worse, revealed nothing about its etiology. It was not Descartes or any other radical dualist who penetrated deeply into the nature of the disorder, but a practicing physician who, however dualistic his own intellectual formation had been, was not especially Cartesian in his approach

to medicine. This physician, moreover, laid more emphasis on experience and observation than on theory and philosophy, and for all his obeisance to the major scientific and philosophical currents of his time, recognized that in some profound way hysteria was culturally conditioned.^[64] This physician was Thomas Sydenham, and it is important that he should be viewed both diachronically and synchronically: located within his time as his place and time are historically approached, and also viewed synchronically and backward, as if the entire history of hysteria converged at the point where Sydenham's theory of hysteria sits poised directly in the center.

VI

An approach to hysteria which is at once broadly historical, cultural, and contextual but also recognizes the central importance of discourse and rhetorical encoding to this narrative continuum requires a high threshold of cultural explanation and a discussion of the role of realism and representation in the explication of the malady. The discourses of hysteria cannot be viewed as neutral texts generated independently of the considerations of gender, ideology, politics, religion, nationalism, and professional authority, as if (when considered in clusters by centuries or periods) they were so many neutral corpuses or bodies (here, too, the metaphors). It is sinful enough to consider hysteria in Western society only—a white European's version.^[65] To interpret these Western discourses on their own terms, without standing apart from their own systems and gazing at the role played by these narratives in the power structures in which they were generated, commits a crime that violates the first principles of the new enriched history. Produced under specific conditions at particular historical junctures, these narratives naturally reflect their moment as well as does any other writing, and it is therefore naive to imagine that the intricacies of realism and representation besetting other genres (especially prose genres) should disappear here. On the contrary, those dimensions of representation are all the more stringent here in view of the imitative nature of the condition of hysteria, and the temptation to rewrite the history of hysteria as a set of commentaries on a finite number of physicians—as Veith did—should be resisted. Sydenham's genius was the intuitive leap that recognized that culture and imitation—society and representation—could have the direst medical consequences for a malady that had bewildered doctors for centuries. He may not have been a sophisticated critic of language or its

representations; nevertheless, he gazed deeply into the copula of disease and representation as each had been generated by the culture.

Concomitantly, if Sydenham's theory of hysteria as imitation has scientific and medical validity, the most thorough student of hysteria, the one capable of explaining the most about the labyrinths of its historical evolution, will be the cultural historian who inquires into the gender-based origins of female suffering with an eye always vigilant to hysteria's discourses. It is not only that the history of medicine is incomplete; even cultural history is inadequate to the challenge of hysteria if discourse and representation are omitted. We may well inquire why this should be when so many other maladies have remained the exclusive territory of the medical gaze. Yet even these less perplexing illnesses have been poorly represented by their chroniclers. Despite the intuitive literary analyses of Susan Sontag in Illness as Metaphor , as yet there are no satisfactory cultural accounts of, for example, consumption, cancer, or even such seemingly monolithic medical conditions as the almost risible gout.^[66]

The diseases of the plague—bubonic fever, cholera, typhoid fever, influenza—have fared better than the above maladies in their narrative representations because it has been impossible to imagine and then represent them narratively apart from the historical conditions in which they arose. They are, of course, social diseases precisely because of their communicability, and their essential nature as "communicable conditions" mandates viewing them in social contexts. Even the novice historian sees that the first great European wave of bubonic plague cannot be considered apart from fourteenth-century socioeconomic conditions; that the advent of cholera in the Indian subcontinent cannot be narrated without focusing on empire and colonialism. But those maladies less apparently intrinsic to particular cultures have not fared so well.^[67] Loosely speaking, there has been a sense, strengthened by Susan Sontag, that each era has somehow produced and then mythologized a particular malady: the Enlightenment had its gout (was there ever a disease more indigenous to a culture?); the Romantics, consumption (well captured in the Keatsian aesthetic implied by the famous line, "Ah, what ails thee knight, alone and palely loitering?"); the decadents and aesthetes, tuberculosis; our own twentieth century, cancer and AIDS.^[68] However, although there is something in the notion, it remains loose: a figment of the historical imagination, a mere chimera; a metaphoric and analogous reading of medical history; a description of disease in relation to culture no one would want to construe literally.

The geography of hysteria lends itself to no such facile sets of interpretations. Occurring neither under conditions of contagion (like plague)

nor as the product of a culture's elusive mythology (we must never forget that the hysteric's pain is somatic, bodily, not imaginary), the hysteric's pain is real (the problem of realism again). Yet hysteria has been less tied to its cultural dimensions than any of these medical conditions, this despite Sydenham's notion that it always imitated that culture. Until the last two centuries, hysteria was the female malady par excellence, and when our best modern female critics reiterate that women writers must be hysterical, that they have no choice in the matter, they bring together the key signposts of the malady when viewed historically: feminism, the body, culture, and discourses. Thus an authority no less insightful than Kristeva has pronounced that "women's writing is the discourse of the hysteric"; Juliet Mitchell has added that in our time—and perhaps she would extend the claim to include all time—"the woman novelist must be an hysteric, for hysteria is simultaneously what a woman can do to be feminine and refuse femininity, within practical discourses."^[69]

Therefore, as we approach the next historical period after King's, we extend our gaze into the realm of the Renaissance and Enlightenment woman. How did her status differ from that of the medieval woman? Was her hysteria therefore different? We inquire into the new stresses creating numbness and panic and ask, Why was Renaissance woman thought to be so influenced by the moon and so possessed of the devil? We can readily see that the pathological symptoms of her hysteria would imitate the symptoms of other conditions: the fits and faints, as well as the tremors, tics, coughs, hiccups, grimaces, gnashing of teeth, pulling of hair, bashing of head, and all the other aberrations occasioned by the five senses. Other conditions may have produced the last of these symptoms, yet what caused the numbness and panic in the first place, and how did they get represented?^[70]

The feminist historians have demonstrated in a vast and important body of new scholarship that Renaissance women were experiencing profound stress and frustration; that as women were promised and therefore expected more, they found themselves actually receiving less in an increasingly complex society within an often confusing religious milieu.^[71] Woman's role was still seen as entirely domestic: centered on her household, often her farm, perpetually surrounded by her children, viewed as odd if she took time out for anything other than devotions and even more peculiar if her time was used for writing or painting or secular subjects. It was all too easy to denounce her as overly sexed, and label or stigmatize her behavior as deviant by pointing to the somatic signs noted by her male doctors: apothecaries as well as physicians and surgeons.^[72]

In the Renaissance and again in the nineteenth century, these somatic

dysfunctions were often called "stigmata" by physicians searching for the "stigma" of hysteria. The line from the fourteenth century to the nineteenth is almost continuous in this sense. Stigma was eventually altered to symptom in the semiology of clinical analysis—in the seventeenth century—and this may be why so many medical lectures appeared in the nineteenth century (like that of the French neurologist, Pierre Janet) entitled "the major symptoms of hysteria."^[73]

But hysteria had also been construed as the first cousin, so to speak, of medieval love sickness, a condition about which doctors of all types, theological as well as medical, had pronounced for centuries.^[74] During the Middle Ages love sickness was said to afflict both women and men, although women were said to have the much greater propensity for affliction. Among women, retained seed that became corrupted and poisonous was construed as the direct cause; this construction continued in the time of Johannes Weyer and Edward Jorden. Once love sickness was linked to female sexual organs by the sixteenth century, it was all too easy for medical doctors to construe it as a pathological condition of women only. The genderization of many of these conditions in the Renaissance—hysteria, love sickness, but not melancholy, which was often viewed as male—has never been told in any detail.^[75] Nevertheless, gradually over three or four centuries, the European doctors accomplished this feat of genderization for reasons that have been described as "patriarchal" by feminist historians but whose precise details elude even the best of this group of researchers. The result was a genderizing of love sickness that made it the favorite malady of diseased female genital physiology, usually said to lead directly to the furor uterinus with which doctors such as Jorden and Robert Burton will become obsessed.

The larger sexual and cultural dimensions of love sickness were as implicit in the Middle Ages as they would be through the eighteenth century, especially in the moral stigma attached to purging of the female seed from the vagina lest it wreak havoc. Both purging and retention were harmful to the woman once she had undergone puberty; sexual intercourse, in marriage, was the only acceptable option to her. In a Western anatomical model that had women ejaculating internally, there was no healthy space for a retained seed. Female orgasm was essential to the process of conception because the orgasm released the female seed, just as sexual intercourse was required if this seed were to combine with the male seed. Female seed constantly retained, whether through lack of sexual intercourse or excessive female masturbation, contained the source of anatomical imbalance and led to derangement. The only circumstances under which the male seed had to be purged were reli-

gious or moral, as when pubescent boys were encouraged to masturbate to diminish their sexual aggressivity, or when adult men were advised to do so while their wives were pregnant. There was no place for such male purging in the anatomical or medical sphere.

The codes pertaining to purging of seed and arousal to ejaculation were grounded in beliefs about the differences in male and female anatomy. As Mary Wack has commented, "the arousal was often achieved by a woman who manipulated the [female] patient manually,"^[76] and there was no equivalent among males of purging the seed from anywhere in the scrotum. The object was, of course, to arouse the woman to orgasm so that she ejaculated the retained putrifying seed. But such a highly charged practice could hardly have been expected to flourish in Christian lands, where the church vehemently objected to it and where medical doctors dared not state what they really believed about its medical efficacy for fear of ecclesiastical retaliation. Wack is no doubt correct in noticing that some of the medieval doctors—her excellent example is the fourteenth-century Bona Fortuna's Treatise on the Viaticum —did not write entirely in elisions but actually recommended masturbation by an obstetrix , and some even described the manual techniques to be used.^[77] Still, the discourse on sexuality from the fourteenth to the seventeenth century was not so liberal as to permit female masturbatory practices for the purgation of seed to flourish.^[78] More direly for the lot of women, female sexuality was checked and impeded in other ways than the recoil shown among male doctors when faced with the prospect of describing on paper an allegedly curative female masturbation therapy. But female morbidity was not limited then to the sexual organs. It also extended to the soul, which would soon also be genderized and pathologized in the form of possession and diabolic ecstasy. The common metaphor in all these applications was morbidity: whether of the sexual organs, the whole body, the eternal soul, or merely the passions of the mind. The trope of the pathological was reinvigorated as it had never been in ancient discourse.^[79]

What was said about men ? Their love suffering was rarely, if ever, linked to pathology of the sexual organs. Even Jacques Ferrand, the already mentioned author of the most widely read treatise on love sickness (1623), and Felix Platter (Platterus) are silent on this matter in their medical works on the subject, and Foucault` who understood the genderization of the sexual organs all too well, is less explicit than his inquisitive readers like.^[80] The explanation given to the few cases recorded is almost entirely psychological. Men were said to be amorous and suffer unrequited love just as women do, but the combination of work and respon-

sibility compelled them to drown their unrequited love in anger. Anger was their primordial passion: everything in history confirmed it. In fact, all known history could be interpreted, it was said, as responses to this male anger, which had been alternately unbridled and restrained: wars, peace, aggression, fear of annihilation, the lot.^[81] Besides, men were too busy in the workplace and arenas of politics to have the leisure—the argument went—for erotic reverie. Burton reflects this progression all too clearly in the psychological portions of The Anatomy of Melancholy . For men, a cycle was thus set up of erotic infatuation, unrequited love, love sickness, anger, and, finally, melancholy. Hysteria was preempted: nowhere did the sexual organs enter into the sequence, nor was there space for priapic phalluses or morbidly wandering scrotums. The key for men, as theorists of melancholy such as Burton understood all too well, was repressed anger . Their erotic disappointment centered on anger well suppressed and culturally validated, always predictably re-suiting in melancholy. Women were permitted no such amplitude. The role of anger was hardly considered a possibility for their erotic ills. Fear and terror consumed them, as did the nocturnal visions and spectorial world of incubi and succubi so common among those suffering from the hallucinations of love sickness and hysteria.^[82] But a female love sickness predicated mainly on psychological causes was unknown before Weyer and Jorden. Like the larger and more prevalent hysteria, love sickness continued to be conceptualized by the male physicians as something anatomical, physiological, humoral, pathological—an irreducibly feminine medical condition. No wonder that love sickness thrived, reaching something of a national epidemic in Western Europe by the time Ferrand published his medical classic work on "erotic melancholy" in 1623 and Shakespeare began to write plays.

Already by the sixteenth century Johannes Weyer (Weir), the Dutch physician, pronounced that hysteria was a bodily disease like all other medical conditions and must be semiologically construed (i.e., through signs and symptoms).^[83] A half century later, in 1603, Edward Jorden, the author of an influential work in the Galenic humoralist tradition titled A Briefe Discourse of a Disease Called the Suffocation of the Mother , claimed that the diabolic could be translated into the natural —that hysteria could have natural causes. This step was significant because it pointed the way for the largely male-authored medical discourses on hysteria that followed for three centuries, but it was less innovative than it may seem on the surface. Helen King provided some reasons in chapter 1, especially in discussing the doctrine of "vapors," but there are other reasons as well.

Veith summarized the works of these figures, especially Weyer, Ambroise Paré (the French physician), and Jorden, and has commented on their importance as successors to the Malleus Maleficarum (1494), the so-called "Witches Hammer," which she sums up as "the most extraordinary document to emanate from the witch mania."^[84] No reason exists to doubt her conclusion that "a careful study of this fantastic document reveals beyond doubt that many, if not most, of the witches as well as a great number of their victims described therein were simply hysterics who had suffered from partial anesthesia, mutism, blindness, and convulsions, and, above all, from a variety of sexual delusions."^[85] She has been persuasive in explaining the medicalization of hysteria in the light of its cultural and narrative dimensions. Veith also points out that Weyer took unpopular positions on hysteria. Having little theological or political ambition, he could pursue clinical observation with relatively little regard for the reception his views would receive. But it must also be noted that while Weyer was a shrewd observer, he made few theoretical advances when compared to Hippocrates and Harvey, Feuchtersleben and Freud, who were able to take more leaps than he did. Veith analyzes the story of the young hysteric, discussed in Weyer, said to vomit ribbons that she claimed had been inserted daily into her stomach by the devil. After praising Weyer for detecting the fraudulent nature of the account, Veith states: "Weyer was a superb observer, and though a skeptic, he was credulous."^[86] Veith's appraisal captures Weyer's double bind: on the one hand, he was doubtful of these supernatural explanations and resisted them; on the other, he remained a creature of his time, unable to extricate himself from notions of possession in hysterical cases. For his ambivalence, Weyer had to withstand the attacks of authoritative contemporaries such as Jean Bodin, the prestigious philosopher and economic thinker attached to the court of Henry III, who championed the theory of demonic possession in hysteria.^[87]

In establishing hysteria as a natural disease rather than a theological condition of the soul, it must be noted that Weyer and Jorden performed similar functions, but that Weyer saw more deeply into the female condition. He exonerated hysterics from the charge of diabolism and pronounced them innocent of witchcraft; he broke away from the regimens of physical and mental cruelty advanced by the Malleus Maleficarum (tortures of many types);^[88] and he sympathized with the predicament of women and compassionated with their violent dreams and phantoms, treating them as victims and patients rather than as malingerers and accomplices. Not enough is known about Weyer's life to ground these views securely in larger biographical contexts; still, whatever the

particulars of that Dutch life of the sixteenth century, Weyer can be viewed as a type of Renaissance Philippe Pinel or J.-E.-D. Esquirol who, rather than wishing to see these mentally ill women tried and punished, pitied them and commiserated with their misery.^[89] Within the context of hysteria, Weyer was foremost a humanitarian who paved the way, however small, to improve the lot of these disturbed women. Even so, he had few, if any, clues into the nature of the phenomenon itself, much less into its natural history in the way that the eighteenth-century physicians were to construct these "case histories": the causes of these natural (i.e., conversion) symptoms; what these women have in common; and why these symptoms appear preeminently in women.

Weyer's humanitarianism is incontestable: his writing abounds in it as it does in close observation of hysterical symptoms. But detection is not tantamount to insight, and the process of medicalization, while admirable for its empiricism and humanitarianism, cannot be compared with the deep vision of the sort Thomas Sydenham demonstrated.

Weyer's contemporaries, however, fared no better. Timothy Bright, for example, an English physician trained in medicine at Trinity College, Cambridge, chased melancholy rather than hysteria, the two conditions then being closely allied. Bright's approach was partly physiological, partly psychological, mainly concerned—as the title of his treatise on melancholy says—with discovering the "reasons of the strange effects it [melancholie] worketh in our minds and bodies."^[90] Even so, Bright's main approach led him to explore "nourishmentes," or the transformation of food into "the melancholicke humour." As he says: "Whether good nourishmente breede melancholie by fault of the bodie turning it into melancholie, & whether such humour is founde in nourishmentes, or rather is made of them" (title of chap. 3). There was in the humoralist Bright no sense of demonic possession—melancholy was also medicalized in Bright's treatment—nor was there reference to a gender-based condition; rather Bright attributed the cause to an all-powerful soul wreaking havoc on the body's bile through these nourishments.

By contrast Jorden, a humoralist born two generations after Weyer, developed a uterine pathology exclusively based on the wandering womb and the bodily production of vapors. Jorden was summoned with three other doctors to testify in the case of Elizabeth Jackson, arraigned on a charge of bewitching the fourteen-year-old Mary Glover.^[91] This young girl began to suffer from "fittes. . . so fearfull, that all that were about her, supoosed that she would dye." She grew speechless and occasionally blind; her left side was anesthetized and paralyzed. These were the classic symptoms, recognized before Jorden compiled his narrative, but

was their source sorcery or illness? Magic or disease? Glover was diagnosed and then treated by leading doctors from the Royal College in London. When she failed to respond to their therapies, usually herbal concoctions and other chemical preparations, they pronounced, all too predictably, that something in the case was "beyond naturall" in her symptoms. Jorden demurred, finding for disease. When Justice Anderson—a notorious hammer of witches—overrode his evidence, Jorden felt compelled to defend his theory that Glover's symptoms constituted a disease (insensibility, choking sensations, difficulty in eating, convulsions, epileptic and periodical fits: conditions, he insisted, physicians alone were qualified to determine).

This defense became the substance of the already mentioned Briefe Discourse . Jorden named Glover's condition the "suffocation of the mother" (i.e., matrix or womb), more simply called the "mother," preferring this usage to the older medical term "hysterica passio."^[92] In seventeenth-century parlance these phrases became interchangeable with "hysteria," or its more common adjectival form, "hysterical." All referred back, medically and etymologically, to the womb, anatomy and language converging on the same part of the body that had been the source of hysteria from its inception. For Jorden, such conditions (not to be confused with symptoms) as the esophagian ball, respiratory and digestive blockages, panicky feelings of suffocation and constrictions, all pointed clearly to a uterine pathology. One can readily imagine how this approach shocked ecclesiastical authorities. Even Jorden's medical colleagues revolted against the theory of a uterine pathology as the sole source for the genesis of a medical condition. Harvey had not yet made his discoveries about the heart and the circulation of the blood; another generation would have to pass before Descartes infused anatomy and physiology with radical mechanism and materialism. Jorden's expectations about the reception of his medicalization of hysteria are unknown, but if he thought his radical medicalization would meet with receptive arms he was mistaken. In a religiously crazed world in which Galileo had recently been tried and others before him beheaded for heresy, it was not easy to claim that uterine debility was the single and sole cause of disturbances thought for so long to be the work of the devil.^[93]

Jorden recognized that his views in Briefe Discourse would be controversial, if not heretical, although his fundamental notion about disease itself, especially the idea that illness is always cured by its contrary (hot by cold, dry by wet, and so forth), was thoroughly traditional and commonplace. As he wrote in Briefe Discourse : "Diseases are cured by their contraries . . . and the more exact the contrarietie is; the more proper

is the remedy: as when they are equall in degree or in power."^[94] To establish his case for uterine debility as the major cause of hysteria, he drew heavily upon ancient authority, especially the Hippocratic and Galenic ideas with which he was familiar. Jorden did not subscribe to the notion, mentioned above as held by Plato and perhaps popular in ancient folk belief, of the womb as an "animal within the animal,"^[95] perhaps the somatic prototype of Freud's free-floating unconscious, the "mind within the mind." Instead he aired the idea, found in Hippocrates and discussed by Plato, of the wandering womb—the extraordinary belief that the uterus, when deprived of the health-giving moisture derived from sexual intercourse, would rise up into the hypochondrium (located between the stomach and the chest) in a quest for nourishment. Such predictable wandering, he believed, provoked painful sensations of oppression, constriction, and choking, sometimes leading to vomiting, forced breathing, and spasms.^[96]

It was a fanciful geography of hysteria, based only in part on Hippocratic tradition, medical reading, and a certain amount of erudition in the later classics, but there was more supposition than observation in its construction, even in those premicroscopic days when anatomy was not what it would be after the seventeenth-century microscopists and nineteenth-century cell theorists performed their experiments. Although Jorden did not intend it, his hypothesis of the wandering womb further fueled the fiction of female inadequacy, in which women were salvaged and restored by male complementarity—further because it had been circulated since ancient times and was now reinvigorated by Jorden. Nowhere is his fable more transparent than in the positive value placed on the healthful vaginal moisture that allegedly secured the womb and held it in place. But this fluid was provided only by the presence of the male seed—otherwise the cavity remained hollow and dry.^[97] The anatomy of this dry and unsafe condition had, as we have seen, been discussed throughout the Middle Ages. Consequently, all uterine mania and pathology derived from this unhinging and subsequent "wandering" of the womb. As long as it remained secure, so Jorden's theory went, the female retained her healthful balance: no amount of personal anguish or grief (Jorden's "affections of the mind") could dislodge her equilibrium, for hysteria was entirely a matter of the derangement of her vaginal cavity, and for precisely this reason Jorden and his contemporaries believed hysteria could never be a male disease. Although meat and drink, the humoralist Jorden believed, were "the Mother of most diseases, whatsoever the Father bee, for the constitution of the humours of our bodies is according to that which feedes us,"^[98]

the cause of this illness was a life-threatening dryness in the vaginal cavity. The health of the female, therefore, depended primarily on retaining a balanced vaginal moisture, best provided by male seed through sexual intercourse.

It was an extraordinary theory laden with mythic qualities, not least the notions of solitary wanderings and life-threatening peregrinations. What better way to portray female frailty than by using the organs of reproduction themselves—a notion the poets and playwrights of the time will repeat, metaphorize, and mythologize. Jorden's language, especially his vivid and dramatic images of solitary female journeys and his constant analogies of the role of gender in these dramatic wanderings (as in the mother and father of disease), confirms the degree to which his fiction of the "suffocation of the Mother" is gender-based.^[99] Constructed on the rock of female anatomic inadequacy (i.e., compared to the male), it suggests the idea that nature and perhaps even the deity had intended from the beginning to program, as it were, the female species for hysteria. Throughout the early modern period, Western medicine, especially medical theory rather than its applied therapies, was based on hypotheses generated in a dense jungle of verbiage, including abundant neologisms, which later proved to be more proximate to the fictions of the poets than to those of radical empiricists. Jorden's theory of the pathological "mother" was itself a metonymy loaded with cultural significance at the turn of the seventeenth century.^[100]

Furthermore, Jorden claimed that all uterine irregularities—menstrual blockage, amenorrhea, the retention of putrescent "seed," and assorted other "obstructions"—generated "vapours" that wafted through the body, inducing physical disorders in the extremities, the abdomen, and even the brain.^[101] For this there was no empirical evidence; even the alleged "vapours" would later prove to be imaginary. The vapors were said to wreak bodily havoc and induce pathological states that were facilitated by the symbiotic interactivity of the entire organic system. A power of "sympathy," Jorden reasoned, linked the womb to the rest of the body: to the head (then thought to be the seat not of the brain—that came later in the seventeenth century—but of the imagination);^[102] to the senses (which determined feelings); and finally to the "animal soul" that governed motion, thereby producing twitches, paroxysms, palsies, convulsive dancing, stretching, yawning, and other terrifying behaviors. Many accidents could trigger the condition, Jorden admitted, since "the perturbations of the minde are oftentimes to blame for this and many other diseases."^[103]

Veith, noting Jorden's inclusion of such "perturbations of the minde"

and his advocacy of therapeutic comfort, counsel, and support, extols the Elizabethan doctor for anticipating the conception of hysteria as a psychological malady.^[104] She commends him as well for "extraordinary perceptiveness" in recommending pharmacological prescriptions for hysteria, while claiming at the same time, and seemingly contradictorily, that "he was the first to advise anything resembling psychotherapy for hysteria." Some of Jorden's prescriptions were traditional herbs and natural medicines that seem inappropriate today but were common at the time. The originality of Jorden's analysis of hysteria lay in his grasp of the power of the mind over the body. For that reason he urged the physician to confirm the patient's fantasies, even when the doctor knows better. For example, Jorden recounted the successful treatment of the Countess of Mantua, who believed her acute lingering melancholy and hysteria resulted from her having been betwitched. Her physicians placed nails, needles, and feathers "into her close stoole when she tooke physicke, making her believe they came out of her bodie."^[105] Jorden also demonstrates his familiarity with Galen's remarks on hysteria. Recounting the case history of a male patient who believed he was impotent, Jorden reports that his physician prescribed "a foolish medicine out of Cleopatra , made with a crowes gall and oyle . . . whereupon he recovered his strength."^[106] Jorden lists many superstitious remedies that he believed could be effective because of the great power of the mind over the body to cure hysteria. Jorden epitomized it this way: "According to the saying of Avicen , that the confidence of the patient in the meanes used is oftentimes more available to cure diseases than all other remedies whatsoever."^[107] The confidence patients placed in these and other remedies—prayers, offerings, exotic rituals—nabled Jorden to feel confident in his own prescriptions.

Jorden's modernity was incontrovertible when compared to his contemporaries. Nevertheless, his remedies did not entail an essentially psychological approach. The main thing in his treatment was to "let the bodies bee kept upright, straight laced, and the belly & throat held downe with ones hand . . . apply evil smells to their nostrils, and sweet smells beneath . . . tie their legs hard with a garter for revulsion sake."^[108] In an anticipation of psychotherapy, he advised appeasing inflamed passions by "good counsell and perswasions: hatred and malice by religious instructions, feare by incouragements, love by inducing hatred, or by permitting them to enjoy their desires."^[109] Although Veith would like to establish Jorden's therapies as precursors to the modern treatments of hysteria, her interpretation is misleading and, what is more, overlooks its rather pedestrian medical traditionalism. Jorden's recognition of the role played by consciousness in the genesis of disease was neither new

nor properly psychogenic, as Veith claims. The Briefe Discourse was conventionally couched within the framework of the then current humoral medicine in its perception that all manners of disorders arose from a concurrence of certain physical complaints with the passions and senses. In this capacity there is nothing "psychogenic" about the theory of the "wandering womb" or the "suffocation of the Mother." Moreover, it is anachronistic to claim, as Veith does, that a staunch Galenic humoralist such as Jorden could have wished to advance either an exclusively somatic , or an essentially psychological , account of the "Mother": his concern was rather to establish a natural theory, based upon the integrated operations of the entire organism, so that "the unlearned and rash conceits of divers [persons who proportion] the bounds of nature unto their own capacities . . . might be thereby brought to better understanding and moderation." Not that he would, of course, preclude supernatural agency in principle:^[110]

I doe not deny but that God doth in these days worke extraordinarily, for the deliverance of his children, and for other endes best knowne unto himself; and that among other, there may be both possessions by the Devil, and obsessions and witchcraft, &c. and dispossession also through the Prayers and supplications of his servants, which is the onlely meanes left unto us for our reliefe in that case. But such examples being verie rare now adayes, I would in the feare of God advise men to be very circumspect in pronouncing of a possession: both because the impostures be many, and the effects of naturall diseases be strange to such as have not looked thoroughly into them.

Aiming to prove to the vulgar, "who are apt to make every thing a supernaturall work which they do not understand," that Mary Glover's "passio hysterica" was a mundane disorder, Jorden explained that each of the tell-tale symptoms of witchcraft could easily be proven by the expert physician to be naturally caused. This position differs from the one Shakespeare was to take in King Lear (see section VII). Shakespeare is less monolithically consistent than Jorden about fraud and natural genesis. "Consider a little," Jorden invited readers, "the signes which some doe shew of a supernaturall power in these examples":

One of their signes is insensibilitie, when they doe not feele, being pricked with a pin, or burnt with fire, &c. Is this so strange a spectacle, when in the Palsie, the falling sicknesse, Apoplexis, and diverse other diseases, it is dayly observed? And in these fits of the Mother it is so ordinarie as I never read any Author writing of this disease who doth not make mention thereof.^[111]

What Jorden proved in relation to anesthesias was applied to other symptoms, in addition to pointing out the connection between mind and body in hysteria:

There also you shall find convulsions, contractions, distortions, and such like to be ordinarie Symptoms in this disease. Another signe of a supernaturall power they make to be the due & orderly returning of the fits, when they keepe their just day and houre, which we call periods or circuits. This accident as it is common to diverse other chronicall diseases, as headaches, gowtes, Epilepsies, Tertians, Quartans &c. so it is often observed in this disease of the mother as is sufficiently proved in the 2nd Chapter. Another argument of theirs is the offence in eating, or drinking, as if the Divell ment to choake them therewith. But this Symptom is also ordinarie in uterin affects, as I shew in the sixt Chapter: and I have at this time a patient troubled in like manner. Another reason of theirs is, the coming of the fits upon the presence of some certaine person. The like I doe shew in the same Chapter, and the reasons of it, from the stirring of the affections of the mind.^[112]

The passage continues to emphasize that mind and body, working together, play a major role in hysteria. Like other passages, this one offers an abundance of signs, especially in the reference to the "affections of the mind," that Jorden primarily aimed to translate the "diabolical" into the natural, working within a familiar explanatory scheme that saw no reason to polarize or select between the organic and the mental. In this process he was simply an educated man of his times. When evaluating Jorden and Weyer, we can say that both physicians "medicalized" hysteria but, from our perspective, neither recognized the role played by the patient's cultural environment, especially as related to the lot of women. Both doctors were persuaded that hysteria arose from bodily ailments and somatically grounded emotional distresses; women were anatomically more pliant and imaginative than men and thus more suspectible to the condition, a disease of the reproductive organs. Yet neither considered the domestic and social stresses with which these female patients were unable to cope. Neither considered the kinship between the hysteric's "affections of the mind" and her emotions stirred in relation to the socioeconomic factors involved: a women's domestic situation, sexual status (and the double standard vis-á-vis that sexuality), her legal and economic misery, her persistent disappointments, the lack of hope in a hard life rarely abated by anything except death. It may be expecting too much for doctors of the sixteenth century to be social scientists, but it can also be said, on balance, that neither doctor seems to have had a glimmer of insight into hysteria in relation to class structure and social

stratification, of which there was then an abundance, even in their agrarrian European and English civilization.

According to the views of Weyer and Jorden and the many other Renaissance physicians who wrote about hysteria (i.e., the Swiss Aureolus Paracelsus, the French Paré, and Laurent Joubert, the chancellor of the University of Montpellier, among dozens of names now forgotten or unmentioned here),^[113] the female patient (to the degree that she was medicalized and removed from her mythic and diabolic status) was an integrated, organic hierarchy: a symbiosis of soma and psyche to be viewed apart from the social and economic reality in which she functioned. The Renaissance humanists had viewed her more totally: as a creature with a past and present history, with a future determined as much by cultural as biological forces. The great humanists—the Petrarchs, Erasmuses, and Mores—lived before Jorden, and those to whom Weyer's theories were available seem not to have incorporated the medicalization of hysteria into their system of thought. For the Renaissance humanists, the condition of hysteria still lingered in the twilight of a supernatural and diabolic world: a zone all the more perplexing to them inasmuch as medicine, as the Rabelais scholar Georges Lote has noted, was "the science of the sixteenth century, exercising great influence and inspiring confidence."^[114]

In addition, ideas about hysteria were then fermenting in a religious and intellectual milieu in which medicine was rapidly being revolutionized anyway. Learned and imaginative thinkers such as Rabelais, who had also been medically trained at Montpellier, probably absorbed more than we think about this process of medicalization.^[115] Rabelais himself comments ironically in Gargantua and Pantagruel (through the mouthpiece of the witty Dr. Rondibilis) on the womb as an "animal," parodying the Platonic tradition discussed above.^[116] But not even Rabelais, Mikhail Bakhtin has suggested in Rabelais and His World , with all his (Rabelais's) sophisticated medico-anatomical training, linked hysteria to the sociocultural position of women. The Dr. Rondibilis who wants to purvey his point about only women having a womb, and a womb that it is moreover just "an animal," is far more concerned with the gulf that lies between realism and literary representation than with any socioeconomic bases of female hysteria. (Rabelais and Shakespeare later classified women according to their virtue and modesty, their courage and beauty, but neither saw the correlation between health and wealth.) Rich women, whether virgins or widows, were given no dispensation when sunk in the depths of hysteria's abyss. There is no sense anywhere in Weyer and Jorden, for example, that the melancholy of the affluent differs from that

of other groups. Class-based hysteria enters the discussion later, at the end of the eighteenth century, as the symptoms of the affluent are said by doctors such as the Scottish Cheyne and James M. Adair and the French Joseph Lieutaud, to arise from different causes.^[117] In the period from approximately 1450 to 1700, the only distinction is bodily sign; as long as the sign is evident, all else proves irrelevant: so imbued with certainty is the semiology of the hysteric. By 1600 or 1650 medicalization became widely assimilated, as evidenced in the thought of a physician such as Thomas Fienus, especially the notion that hysterics are no longer witches to be detected, tried, and burned at the stake.^[118] In our twentieth-century, post-Freudian sense of female numbness viewed through the discourses of hysteria composed by Kristeva and Duras, this medicalization of hysteria caused a regression in woman's lot rather than advancement and brought little understanding of the plight of women that had lain at the heart of the condition in the first place. Once medicalized, hysteria became the deviant sport of Renaissance and Enlightenment doctors who justified any therapy in the name of calming female fits and faints. Viewed from the perspective of muting the more genuine causes in woman's lot, it was a short step from Dr. Jorden's therapies of foul smells, tight garters, and "crow's gall and oyle" to the clitoridectomies and ovariectomies of the nineteenth century. Women would have to wait for male physicians to liberate them—wait even after Freud and his colleagues arrived in Vienna.

VII

The conjunction of hysteria and modernity thus arises at the moment of its medicalization at the turn of the seventeenth century. Once hysteria became medicalized, its theory was not significantly revised except for the alteration of its somatic locations. Many decades were to pass before a majority of doctors became persuaded about the naturalness (as distinct from the demonization) of the condition. Here and there, as we shall see, there were some major discoveries of insight, for example Sydenham's, but the new hypothesis always leaned upon, and reflected, the prevailing medical theory of the day, hysteria being always a remarkably elusive disease.^[119] The larger matter about hysteria in the seventeenth century essentially entails the repetition of its medical diagnoses. After Weyer's and Jorden's medicalization, there was no significant insight into its nature until the advent of Willis and Sydenham. During that period (ca. 1600-1660), the voices of the nonmedically trained prove to offer as much insight as those of physicians and other caretak-

ers. If we want to understand seventeenth-century hysteria, we do well to consult the social history of women of all classes: a record revealing as much as the medical treatises that commonly crib from one another without having engaged in empirical research or brought forth anything new to the main argument.^[120]

The personal records of hysteric patients in that period—the non-medical voices we want to hear—are virtually nonexistent.^[121] It is not that the historian-archaeologist of hysteria has forgotten to listen to them but rather that the doctors in the seventeenth century did not record what their female patients said or did in any detail. For example, Richard Napier, an early Stuart parson-physician, compiled in a career spanning many decades casebooks of hysterical patients, but even here his voice speaks more forcefully than the patient's.^[122] Napier, as Michael MacDonald has demonstrated, habitually explained hysteria and all manner of melancholy states as proceeding from particular concatenations of bodily ailments and emotional distresses. Nor had Napier broken entirely free of the old supernaturalism or magic, occasionally linking hysteria to possession despite his clear awareness of its medicalization. By way of remedy, he prescribed "physick"—usually herbal purgatives, together with supportive advice and prayers. Missing from his compilations are comprehension of, or compassion for, the domestic travails of his female patients—the social conditions alluded to above. Class and rank figure nowhere. He discovered hysteria everywhere in the female world: all diagnosis and therapy originate, he believed, in the pathological body (the wandering womb) and in emotional grief (usually loss and depression); never was the distress seen as socially or economically determined.

Napier found no examples of hysteria among malingerers. Indeed, those pretending to be ill, to be hysterical, to escape poverty and duty by faking fits and starts are remarkably absent from the early seventeenth-century world: its medicine as well as its imaginative literature and art.^[123] The degree to which Napier anticipated the modern view is extraordinary. Compare Napier on malingerers to Dr. Alan Krohn, for example:

It should be stressed that hysterics are not faking, playing games, or simply seeking attention. . . . The hysteric is neither a malingerer nor a psychopath in that the sorts of parts he plays, feelings he experiences, and actions he undertakes have predominantly unconscious roots—he is usually not aware of trying to fool or deceive. When the hysteric uses cultural myths or lives out a cultural stereotype, he is usually not making a conscious choice of identity.

Moreover, in Napier's world there were two almost conflicting intellectual tendencies destined to keep women in biological chains: on the one hand, a persistent demonization of her as part witch, part animal, with a "wicked womb" (not so different from the one flaunted in Germaine Greer's The Female Eunuch^[124] ); on the other, a more humane view derived from the recent medicalization of her most emblematic disease (i.e., hysteria), which served to demystify her gender status.

The theological and religious consequences of these views were significant: even there, medicalization played a significant although clearly more osmotic role.^[125] Nevertheless, throughout the seventeenth century, women remained slaves, so to speak, of their biology, a fate similar to that which they experienced in antiquity; more time was needed to erase their image as voracious wombs paradoxically embodied in decrepit witches or insatiable pleasure-givers.^[126] Furthermore, the seventeenth-century conception connected the "spell" created by the older demonic frenzy to the "spell" of the menses, or menarche , rampaging furiously through the female body, causing violent paroxysm and anatomic upheaval. So long as woman was biologically mythologized, there was no hope of grounding her hysteria—her anxiety and panic, her twitches and epileptic convulsions—in a social fabric where she could be viewed as a rational being. The radical medicalization of hysteria, culminating in the eighteenth century, was well on its way by the time Jorden and his medical colleagues had died. By then, the representations of the female body had, as it were, been turned inside out; charted as ugly in anatomical drawings as well as idealized as beautiful on canvases and in literary texts, and within this paradoxical relationship covertly placed within the "ugly-beautiful" tradition in which the late Renaissance basked. But male fear of demonic female sexuality would not be quelled so quickly. Perhaps a word such as hystero-phobia should be coined to describe the male response to female sexuality in the period between the world of Harvey the anatomist and that of the radical Enlightenment physiologists, between the 1620s and the 1690s.^[127] In any case we will see that this male fear was no irrelevant obstacle on the road to the radical medicalization of hysteria.

These developments are clearly mirrored in thinkers as diverse as Shakespeare and Robert Burton, the scholar-author of the 1621 Anatomy of Melancholy . Burton, who had read Weyer, Jorden, and many other sources on hysteria, believed that fits of the "Mother" could be occasioned equally by body disease and by inordinate passions, appetites, and fancy, and similarly advised a dual package of pills and precepts. Burton gazed deeply into the class filiations of both melancholy and hysteria, believing that "hired servants" and "handmaidens"—no matter

what their age—were rarely afflicted. The "coarser" the woman, the less likelihood of her presenting with hysteria. Shakespeare, who may not have heard of either Weyer or Jorden, nevertheless responded acutely to "the Mother" as one of the important ideas of his time, metaphorizing it and even building it into the fabric of several of his plays. His sources are complex and deeply interfuse with the ideological dimensions of hysteria in the late sixteenth century and its troubled relation to magic and witchcraft. For example, there is no doubt that Shakespeare was familiar with Samuel Harsnett's antipapist pamphlet A Declaration of Egregious Popishe [sic] Impostures . . . Under the Pretence of Casting Out Devils (1603). Harsnett, a churchman with a checkered past by the time he wrote the Declaration early in life, had served on various commissions to inspect those who claimed to exorcise devils. He had heard vivid accounts of possessed women. From the time he was a student at Cambridge, he pondered the boundaries between fraudulent witchcraft and natural possession, especially in cases in which female hysteria was claimed to have manifested itself as a natural disease. His Declaration spoke loudly to his generation, especially to Shakespeare, who took the names of the spirits mentioned by Edgar in King Lear from it. Harsnett also recounts in the Declaration the case of a man afflicted with hysterica passio , a term he uses interchangeably with "the Mother," and he writes as if the case were an anomaly. But other Elizabethans had also commented on "the Mother," under different circumstances and in contexts other than political or medical ones, and had written about it both as natural illness and natural metaphor for female sexuality. A decade or so later the poet Drayton invoked "the Mother" as a simile for "a raging river" in his well-known Poly-Olbion (1612-1622)—no doubt a poetic trope for unbridled female sexuality—as well as considered it a genuine female malady:

As when we haplie see a sicklie woman fall
Into a fit of that which wee the Mother call,
When from the grieved wombe shee feeles the paine arise,
Breakes into grievous sighes, with intermixed cries,
Bereaved of her sense; and strugling still with those
That gainst her rising paine their utmost strength oppose,
Starts, tosses, tumbles, strikes, turnes, touses, spurnes and spraules,
Casting with furious lims her holders to the walles;
But that the horrid pangs torments the grieved so,
One well might muse from whence this suddaine strength should grow.^[128]

Thus by the turn of the seventeenth century the confluence of several streams of thought vis-à-vis hysteria had, so to speak, coagulated. M. E. Addyman considers Shakespeare's assimilation of the doctrine of hys-

teria to be sufficiently important to have warranted a book-length study.^[129] "It seemed to me," she claims, "that, while hysterica passio formed a potent symbol in Lear and offered a detailed vocabulary for certain effects, its role was limited; but of Leontes [in The Winter's Tale ] one could say that he was a hysteric, and the elucidating of that comment would reveal much of interest about the nature of the play."^[130] For Addyman, hysteria and its natural progression to insanity constitute the essence of Lear's disintegration. After Lear's mode of being and basis for authority have been irrevocably shaken, he inquires: "Who is it that can tell me who I am?" (I. iv. 250). When he no longer knows himself, he exclaims to the fool, "O fool, I shall go mad!" (II. iv. 289). After expressing his anguish over his rejection by his daughters and the sight of his servant in Regan's stocks, Lear cries out:

O, how this mother swells up toward my heart!
Hysterica passio, down, thou climbing sorrow,
Thy element's below!
(II. iv. 55-57)

Addyman's observation, which has eluded many Shakespeareans, is that Lear conceptualizes the horror of the disenfranchisement he is soon to experience in the very terms of—indeed in the very language of the newly medicalized condition. "Some new world," she writes, "some terrible knowledge which will not accommodate existing patterns of speech and habit, is about to be brought into being, and it is experienced in its first inner stirrings as 'this mother,' as 'hysterica passio .'"^[131] Why, we wonder, was hysteria, among all the various medical conditions then, perceived as capable of such drastic transformations, especially if figures as diverse as Shakespeare and Burton responded so forcefully to it?

The different uses of hysteria made by Shakespeare in Lear and The Winter's Tale do not diminish his creative response—on the contrary, they heighten it. A form of knowledge for the great tragic protagonist (Lear) becomes the basis for character and destiny in the later romantic one (Leontes). Hysteria signified to Shakespeare not simply a medical malady—for him it became more than a newly discovered disease recently emancipated from its demonic bondage. The transition from demonic profile to medical malady was indeed in the thick process of transition during the Elizabethan period. As Addyman observes, "Lear's hysterica passio is a form of knowledge: it is the mode and limitation of his awakening to the world which exists beyond his will"; for Leontes it represents more than anything "his maladjustment" itself, the essence of his dis-ease.^[132] It would be literal-minded, perhaps even obtuse, to in-

quire how Shakespeare conceived of a male hysteric in an era when the doctors had observed few.^[133] Narrative, especially great imaginative literature such as Shakespeare's plays, or (conversely) popular narrative, such as pamphlets and tracts, has always provided science and medicine with some of its best ideas; narrative brilliantly leaps to hypotheses doctors would not, perhaps could not, intellectually and imaginatively dare to make.^[134] The doctors saw the "mother" as feminine, but in the popular imagination it was something (however mysteriously) that could afflict men. It is unknown how Elizabethan medical authorities responded to Shakespeare's use of the term hysterica passio , and it may be that his usage in the plays was ignored. Still, the question about male hysteria in the Renaissance must be put in a medical context before it takes on significant meaning, and even more specifically must be addressed in relation to the category of hysteria raised at the beginning of this chapter.

Perhaps the point about Leontes, and presumably the larger point about hysteria in the Renaissance that Addyman wishes to make, is that Leontes's hysteria signifies the amalgam of disease and confusion—indeed, a diseased confusion—in which his child, adult, and sexual self coexist; it is not a narrowly conceived and almost clinical hysteria that Shakespeare embodies through the figure of Leontes (as it might have been in Jorden's treatment), but a metaphoric and symbolic hysteria. Similarly Robert Burton enlarged the domain of melancholy and brought it to the very foreground of his agenda, making it, as Devon Hodges has suggested, the basis for an anatomy and ontology of the cosmos.^[135] But if Burton's Anatomy of Melancholy demonstrates an almost uncontrollable impulse to dissect every form of knowledge as a symptom of the cultural transformation of his time, his larger signifier—melancholy—is hewn out of the stone of an even larger transformer: this category—melancholia and hysteria—reflecting the cultural shifts that to Burton virtually defy explanation. As in the plays, where hysteria—the hysterica passio —represents both the states of knowledge themselves and the psychological frames of mind of two of Shakespeare's most interesting figures, Burton uses the category hysteria to connect forms of knowledge that have been undergoing monumental conceptual shifts in his lifetime. Both responses, Burtonian and Shakespearean, demonstrate the magisterial significance of hysteria for the late Renaissance world: a meaning it could never have acquired had it not been for the medicalization of the one malady with secular and cultural overtones.^[136]

The question to be pondered then is why medicalization took the radical turn it did when it did , and throughout this chapter I have been suggesting that among the reasons (it was not the only reason) was the altering

status of women in the period from roughly 1600 to 1700 as social, economic, political, and even biological creatures. In brief, I am suggesting that doctors radically medicalize disease and become more positivistic in their approach to illness in times of unusual stress placed on one or both of the sexes.^[137] This principle may seem an arbitrary correlation between disease and gender. Eventually historical sociologists will bear it out, and a great deal of research into the history of the body, the sociology of medicine, and the history of gender will be required before we can understand how the principle developed in its crucial period in early modern Europe.^[138]

In the discipline of anatomy, then a rapidly changing body of knowledge, as well as in medical research and empirical speculation more generally, the view of women was being revised. Throughout much of the seventeenth century, medical research promulgated the traditional view of the female reproductive apparatus as an inferior, imperfect, almost inverted equivalent of the male.^[139] The notion that women were essentially and fundamentally different —radically other and strange—had not yet taken hold; they continued to be viewed as males manqué. It had long been known that female orgasm was unnecessary for conception and that menstruation occurred independent of erotic excitation, but these relationships had not yet been put into contexts that could change the old patriarchal views and create an independent biological niche for women. As Thomas Laqueur has emphasized, seventeenth-century medical theory commonly endorsed the classical view of the female reproductive system as inherently deficient, even deformed, a pathological inversion of the normative male.^[140] Menarche and puberty were cosmically ordained to upset body functioning, producing physical irregularities and pain that spawned further behavioral disruptions. Pregnancy and childbirth entailed seasons of sickness, sometimes leading to postpartum insanity. Menopausal women became moody and predatory. All such disturbances were clearly caused by a single aberration—by the seventeenth century the term womb was used metaphorically as well as literally. Men had no such ordained anatomy, no such predictable vulnerability, no such biological destiny.

Gender, however, was not the only factor governing the category then occupied by hysteria. Most physicians combined their learning in anatomy and physiology to religious, astrological, and astronomical beliefs in the diagnosis and treatment of these uterine syndromes. By the 1640s, a small library of medical literature conjoining these realms, natural and supernatural, had developed and was regularly producing books composed for an audience of doctors and their patients. John Sadler's The

Sicke Womans Private Looking-Glasse, wherein Methodically are handled all uterine affects, or diseases arising from the wombe; enabling Women to informe the Physician about the cause of their griefe is a fine specimen of the genre, and also interesting for its metaphors of hysteria and versions of linguistic representation.^[141] Sadler, a licensed physician, practiced humoral medicine in Norwich and specialized in female diseases. The fifteen chapters of his book aim to explain how virtually all female health and reproduction is governed by the health of the uterus and its motions: the rising, falling, and stasis of the womb washed into health by regular discharges and frequent pregnancy. Even so, Sadler devotes a whole chapter (13) to the question "whether devils can engender Monsters [of birth]," and despite his negative conclusion the fact remains that he was willing to spend so much time answering it. Sadler nowhere invokes the word "hysteria," but his references to the "weeping of the Wombe" (chap. 4), the "suffocation of the mother" (chap. 6), and "the hystericall passions" (p. 62) make evident that hysteria constitutes, of course, his true subject matter. His approach, common in the time, is semiotic: he searches for proximate "causes" and "signs" in an attempt to provide "prognosticks" and "cures," these necessary four components providing the physician with knowledge of the real state of the patient's womb. Once in possession of this knowledge, he prescribes from a wide variety of herbal remedies considered in conjunction with "the planet's influence" on the patient, as his astrological epigraph attests. His approach emphasizes that hysterical diseases arise primarily from the "suppression" or "overflowing" of the "menses"—from unnatural discharges—and this is why he starts his book with a discussion of unhealthy menstrual discharges, the single most common cause of hysteria.

"How many incurable diseases," inquired William Harvey, the famous discoverer of the circulation of the blood, "are brought about by unhealthy menstrual discharges?"^[142] The question was rhetorical, replicated dozens of times by Harvey's medical brethren. Like his peers, Harvey regarded women as slaves to their biology; the idea had already been generated in the great literature of the Renaissance, especially by Shakespeare and the dramatists. Gross female appetites, the "furor of the uterus" that was by now being called furor uterinus by the doctors,^[143] drove the entire sex, governing their words and deeds on earth, even necessitating a cosmic theology at whose center was an Edenic myth laying all culpability on Eve for mankind's irrevocable sin.^[144] No matter what women did with their biology, in the Christian myth they were destined to sin as a consequence of it. In matters anatomic and physiologic, there was—so to speak—no free will. This specific topic the late

Renaissance theologians debated almost ad nauseam .^[145] The church admonished its parishioners as well as serious students, as it had been cautioning for centuries, against the sins of the womb in less vivid anatomies, but secular opposition claimed that the retention of seed was equally, if also biologically, harmful. Jane Sharp, a male "quack doctor" in England who assumed a female pseudonym, advised lusty maidens to marry (and have sexual intercourse) or face the dire consequences of hysteria.^[146] Harvey, the anatomist, provided the empirical secular raison d'être: without gratification, overheated wombs would spark "mental aberrations, the delirium, the melancholy, the paroxysms of frenzy, as if the affected person were under the dominion of spells," this final phase revealing how a semantic sleight of hand could perpetuate witchcraft insinuations in secular contexts. In summary, male hegemonic culture was still affirming that women, especially in their rudimentary biologic sense, were not very different from men. But they were more mysterious, as the Romantic poets, especially Wordsworth, would continue to claim: mystery—the mystery of their dreams and desire rather than of their anatomies—is what distinguished them. Whether as witches or hysterics, whether in their normal state or pathologically demented as hysterics sometimes were, their imaginations were deemed to be of another order from men's. Yet the very notion of "women as mysterious" was a male construct. Oddly, it remains a fundamental concept of twentieth-century sexual theory, as when Jacques Lacan cryptically pronounces that

it can happen that women are too soulful in love, that is to say, that they soul for the soul. What on earth could this be other than the soul for which they soul in their partner, who is none the less homo right up to the hilt, from which they cannot escape? This can only bring them to the ultimate point . . . (ultimate not used gratuitously here) of hysteria, as it is called in Greek, or of acting the man, as I call it.

Historically speaking, not until the post-Cartesian world of the Enlightenment, and even later, did the notion of a resolute female difference mandating respect for its inalterability take a firm hold.

Harvey, forever the Aristotelian zoologist, explicitly drew the parallel between bitches in heat and hysterical women. In these pronouncements picturing the insatiable, ferocious, animal-like womb, he was closer to Plato and Euripides than he realized. A leader among those decrying the retention of seed, he warned that women who "continue too long unwedded, are seized with serious symptoms—hysterics, furor uterinus,

&c. or fall into a cachectic state, and distemperatures of various kinds."^[147] For "all animals, indeed, grow savage when in heat, and unless they are suffered to enjoy one another, become changed in disposition." Thus hysterical women direly needed medical attention, for "to such a height does the malady reach in some, that they are believed to be poisoned, or moonstruck, or possessed by a devil."

What, then, was to be done? Harvey advised prophylactic measures, above all "the influence of good nurture," with its power to "tranquilize the inordinate passions of the mind."^[148] But if this view represented a continuation and further medicalization of the effects of Jorden's "passions of the mind," it also embedded a theory of sex whose double standard is apparent from our perspective. Harvey's advising of prophylactic repression was, of course, restricted to women. In his own mind there was no contradiction because the raging womb—the furor uterinus —by definition reflected a female state of affairs. How else could it be? He did not see, nor did his medical brethren suspect, that men, like "all animals" also "grow savage when in heat." Or if he did see, men were exempt from the need for repression by virtue of a more protective anatomic apparatus that had been ordained, it seemed, by Nature. Here then was gender formation at the hands of the scientific elite of the day—the Harveys and his like—in tacit league to invoke biology to engrave the theory.^[149] The sexual repression of males and its deleterious consequences would not be understood until the nineteenth century, as we shall see in chapters 3 and 4, by Roy Porter and Elaine Showalter. Eventually it became evident, as they demonstrate, that repression itself was counterproductive, rendering the already hysterical only more hysterical. Nevertheless, seventeenth-century formulations, by construing hysteria according to the Greek model as primarily a gynecological disorder, activated the disease concept emplotted within a discourse of gender stigmatization. This is why hysteria the category and hysteria the medical discourse lie so proximate to the discourses of gender in this period of early modern history. Women were on trial, and male doctors sat on the right hand of the already male judges.

This might seem a clear invitation for the historian of hysteria to chuck medical theory altogether and instead invoke social history. After all, sickness did not always excuse the hysterical: in Shakespeare's and Harvey's time, hysteria was suspected to be the stigmata of vice, the wages of intemperance, even though no one put forth a lucid or persuasive theory explaining how this could be so. Two centuries later—in the mid-eighteenth and early nineteenth centuries—thinkers as diverse

as Adam Smith and Samuel Johnson, Jane Austen and Harriet Martineau, reported that the sick are commonly judged to be narcissistic egoists, extravagantly demanding of other people's time, patience, and resources.^[150] And who can forget the gloomy fate of the self-indulgent Emma Bovary, repaid in both life and death for her mortal sins? How then did hysteric sickness become the just reward of a defective personal morality and deformed female sexual apparatus? And what were the social or cultural determinants of this other conversion syndrome?

As men were largely exempt from the anatomic stigmata, their own morality was not held accountable. If the hysterical female became somatically ill through lack of self-control or personal discipline, it had to be explained why control and discipline were intrinsically different from that expected of the male. In other words, why was the raging erotic appetite of women different from its male counterpart?^[151] These questions were not answered in the seventeenth century—in many cases, not even raised. Furthermore, if we set the chronological dials to approximately 1600 or 1650, we observe little, if any, discussion of the social components. If sexual intercourse was the adjudged best remedy for hysteria, and marriage the guarantor for intercourse, is it not significant that in this period marriageable women greatly outnumbered eligible men?^[152] If marriage was closed to a certain segment of the female population, can it be that women concocted hysterical symptoms as an alibi to enhance their prospects for marriage? There were, it would seem, few better ways to ward off the often fatal "womb disease" than the acquisition of a marriage partner. Also, in that time (male) physicians were increasingly prescribing intercourse through marriage as a prescription to avoid hysteria.^[153] Such prescription was no doubt abetted by the very slow and incremental secularization of countries like England and other northern Protestant lands (the secularization was slower in the Catholic countries). But—we must ask—did the doctors perhaps have another agenda in recommending intercourse as the best remedy? And can hysteria have been a successful method for the otherwise erotically lost woman, so to speak, to mediate her anxiety and internal guilt? These are modern concepts, to be sure, but not without universal application, even in the period of early modern Europe. Finally, we must examine the roles played by class. These cannot be omitted either, for as early as the time of Boccaccio and Rabelais leisured ladies are said to be the most prone to erotic melancholy and hysteria; even if there is as yet no theory of class in relation to these illnesses, the idle and rich, the affluent and bored, remain the best candidates for affliction.

VIII

This gender asymmetry differentiated males entirely. They suffered crises and anxieties too, as both the medical and imaginative literature (plays, poetry) of the day demonstrate, but much less so in the romantic and erotic sphere. As the seventeenth century unfolded they were increasingly conceptualized and represented as public creatures: open, straightforward, rational, communicative, educated; working and functioning in public, in the broad light of day where their best virtues could be seen; and, as we have already suggested, mediating their romantic disappointments—which many obviously had—in the anger said to be almost preternatural to the male condition from time immemorial.^[154]

The imaginative literature of the seventeenth century—especially its plays and poetry—make it apparent that the gender gulf widened as the century progressed. Perhaps this is why marriage itself was transformed from a realistic, almost literalist, view to the more idealized one found in the Miltonic theogony. Difference of every kind was introduced into the speculative discourse of gender, buttressed often by medical and empirical observation, but also by religious and moral observations that discriminated among the kinds of friendship suitable to each sex. In Milton's epic, the sexes are already so far apart, so anatomically and biologically differentiated, that idealized female mystique and well-grounded male rationality become the twin pillars on which the great poet can construct his Christian myth.^[155] As the gender differences widened, the sexes found themselves increasingly categorized into stereotypes irreducibly female or male. No one cause can be assigned to these new arrangements, but their effects are miraculously captured in Jacobean and Restoration drama, especially in the roles of the rake, fop, madman, cuckold, unfaithful husband, as well as—on the other side—the virgin, widow, coquette, dreamer, foolish old duchess. Within these groupings and categorizations, appropriate diseases attached to each character type, as virgins and widows frequently found themselves cast as hysterics while clerics and students were depicted as melancholics.^[156] There was no deviation. When generalizing in this fashion, over large periods of time (half centuries rather than decades), it is tempting to grasp for the obvious trend without differentiating the subtleties. Nevertheless, if one compares the archetypal conceptions of women and men from roughly 1600 to 1700, large, even monumental, differences abound.^[157] If the rake is taken as a representative example in 1600 and then 1700, his transformed social identity makes the point, especially

within the contexts of the developing libertinism predicated on gender and sexuality.^[158] In the world of Ben Jonson and John Donne, for example, he is a marginal figure in the panoply of social types: libertine, wanton, promiscuous, pictured as ravingly heterosexual; by the time he reaches his maturity in the English Restoration, especially on the stage, he displays a newly acquired bisexual identity and stands in extreme contrast to those who promote the ideals of romantic marriage and the newly domesticated family.^[159] As Randolph Trumbach has written, "somewhere in this transition from one sexual system to another—from a system of two genders of male and female, to a system of three genders of man, woman, and sodomite—was . . . the growth of equality between men and women that was part of the modern European culture that was emerging in northwestern Europe around 1700 in all the structures of life."^[160] This equality probably signaled a transition from one anthropological sexual system to another; it did not diminish the gender differentiation on which so many theories of hysteria were then built.

Besides, the genuine underlying reasons for gender differentiation were as patently social and political as they were biological and anatomic. Political turmoil and eventual restoration of the rightful monarch, at least in England, resulted in a new sense of the nation, and with this fervid nationalism came new commerce, new professions, new military might, new wealth, and most apparent to the man or woman in the street, new urban sprawl. When Charles II returned from France in 1660, the greater London area had only about three hundred thousand people; by 1700, it had swelled to a city of six hundred seventy-five thousand, and by 1800, almost a million. With this growth a new set of social and professional relations developed and caused greater gender stress. Prostitution, female and male, arose as a profession for the first time in England, as did new and sometimes dangerous sexual liaisons between persons of different and same sexes.^[161] Crime, violence, squalor, and suffering caused by poverty all reached new levels, as the Newtons and Lockes at the close of the seventeenth century were creating their intellectual revolution. Socially speaking, the world of 1700 was a vastly different place from the England of the Elizabethans just a hundred years earlier, and nowhere was the difference more palpable than in the relation of the sexes.^[162]

Under the strain of the new stress, hysteria became for the first time in Western civilization—a male disease. Not surprisingly, it was a consequential moment for the history of both hysteria and gender. From this Restoration world two more radical breakthroughs in the theory of

hysteria will emerge, both by Sydenham: the first, that hysteria can "imitate any disease," and the second, the notion that it is "the commonest of all diseases."^[163] The question we must pursue is why the same generation—not merely the same physician—gives rise to both ideas, and we go a long way toward finding the answer if we isolate the new social roles of males in the Restoration. In both the Elizabethan and Restoration imagination, hysteria and melancholy were intrinsically linked. Throughout the seventeenth century they increasingly overlapped, especially when female patients were diagnosed as afflicted with the one as well as the other.^[164] The medical theory of both periods reveals an unusual coexistence extending beyond overlap and reciprocity; it often demonstrates confusion and chaos centered on the issues of gender (is hysteria a female malady and melancholy a male ?) and sex (does uterine anatomy predispose women to hysteria while male grief afflicts the intercostal cavity, causing melancholy and hypochondria?).^[165]

By the later period (the Restoration) men are being portrayed in a way altogether different than three generations earlier. The Restoration stage presented, of course, a theater experience very different from its Tudor-Stuart antecedent. More limited to the upper crust in its audience, it also controlled their responses more, and in this sense it can be compared with Richard Foreman's contemporary "Ontological-Hysteric Theatre," which attempts to exploit the hysterical syndrome by dramatizing naturalistic triangles of persons enmeshed in alienating situations. And the Restoration stage presented a more limited repertoire of characters—especially male rakes, fops, wits, wit-would-be's, as well as squires, gentlemen, statesmen, soldiers—often consumed in erotic adventures while drawn to the very brink of the old Burtonian melancholy by unrelenting male competition. At the same time this national stage remained coherent in its class structure and a faithful index of the collective erotic fantasy of the age, holding up the male victims of a predatory female eros forever in disguise. Why didn't the medical doctors recognize that in this dramatic representation lay one of the secrets of hysteria?—that it is as much a male as female condition, and therefore in no small degree socially rather than biologically constituted, as by now (i.e., after 1660) it was widely accepted that men did not have the defective female anatomic (i.e., reproductive) apparatus that had been the nemesis of women for centuries. This is the quintessence of the matter and gives us pause in the twentieth century as we wonder why this gender difference had not always been obvious. Not until the 1680s did these ideas and ideologies coalesce in the written discourses of the "En-

glish Hippocrates"—so-called for his genius in clinical observation and faithful recording of what he observed in his patients—Dr. Thomas Sydenham (1624-1689).

IX

Although well educated and possessing a first-class scientific mind, Sydenham seems an unlikely candidate for the imaginative leaps attributed to him. The son of landed gentry in Dorset in the West Country, he had been educated at Oxford, where he became acquainted with many of the prominent early members of the Royal Society. But the English Civil War soon drove him from Oxford's colleges to the battlefield, where he gained—in the words of his biographer—"his first introduction to manhood."^[166] As a young soldier he acquired some of the practical attitudes that would benefit him as a mature doctor. Later, in the 1670s, he built an urban medical practice in England second only to that of Thomas Willis, the famous "nerve doctor," in the prestige and political eminence of its patients. It is important that Sydenham's practice was located in London and that most of his patients were what we would call city dwellers, for in that era before the dawn of psychiatry and psychotherapy, the illustrious urban physician, such as Sydenham, could expect half the complaints of his patients to be nervous (their term) or psychological (our term).^[167]

Because Sydenham had suffered from the gout since his twenties, his own poor health required him to use his medical knowledge in the most practical way.^[168] It wasn't sufficient to be speculative and theoretical about medicine and its therapies when the doctor himself was a patient. Professionally, Sydenham's practice dealt with the diagnosis and treatment of regular, individual patients of stature, wealth, and fashion. He did not seek out the rich—they came to him.^[169] His compassion for the ill was such that he may have been the most sought-after physician in the realm. In brief, medicine was his life. When the brilliant young John Locke came to London with his new medical degree from Oxford, it was in Sydenham's clinic that he most hoped to begin his practice, and he did.^[170] Sydenham's reputation as an effective medical therapist had reached such a pinnacle by the 1680s that only the wealthy and powerful could afford his services, although he regularly ministered to the poor as well. In such patient-doctor encounters, demonological accusations were never taken seriously (these being more attractive to the lower classes than to his suave patients), thereby leaving the field open for new explorations of such mysterious afflictions as hysteria.

Sydenham, no medical historian or avid reader of medical classics, worked principally by observation. He believed that experimentation was successful only when several physicians made an identical diagnosis; otherwise, he concluded, the experiment was not even scientific. So much did he derive from his reading in Bacon, his medical education at Oxford, and his own intuition. By the time he gathered his thoughts about hysteria in the early 1680s he had read much Bacon (who did not pronounce on hysteria)—Sydenham's idol along with Cervantes—and had independently confirmed the earlier observations of Charles Lepois (the Italian physician also known as Carlo Piso, 1563-1633) that hysteria was not entirely an anatomic condition and, as a result, that males were just as susceptible as females.^[171] Lepois had rebelled against the earlier theorists of hysteria, and his comments demonstrated to what degree he disagreed with the medical establishment:

We believe we are correct in concluding that all the hysterical symptoms . . . have been attributed to the uterus, the stomach and other internal organs for the wrong reason. All [these symptoms] come from the head. It is this part which is affected not by sympathy but idiopathically and produces motions which make themselves felt throughout the entire body.^[172]

"The hysterical symptoms are almost all common to both men and women," Lepois wrote in the 1620s.^[173] But if Lepois looked to the brain, in the head, Sydenham felt no such constraint to search anatomically at all. Instead, he seemed to have been partially liberated from the pressure to specify a unique somatic seat for the disease. He wrote little and measured his words.^[174] What he wrote he penned laconically and empirically, without cynicism or malice toward his patients, addressing himself only to what he believed truly counted: clinical reality.

Veith has summarized the biographical and medical circumstances under which Sydenham wrote the Epistolary Dissertation . No reason exists to recount them here, for there is little to add, except to observe Sydenham's reason for accepting Dr. William Cole's invitation to set down on paper his thoughts "concerning the so-called hysterical diseases."^[175] Cole, a noted physician, had a large practice of his own in which he treated his own hysterical patients.^[176] Considering Sydenham one of the greatest living physicians, he asked the venerated doctor why hysteria had proved so elusive. Sydenham's answer in the Epistolary Dissertation was brief; coming from Sydenham it must have astonished many of his medical brethren. Whether through compassion or insight, he admitted how difficult hysteria was to cure. He empathetically reflected

that the pain suffered by hysterical patients was more severe than that in patients with other illnesses. He was the first in the medical establishment (after Lepois, mentioned above) to break from the uterine etiology; the first to degenderize hysteria by removing its erotic stigma altogether; the first also to claim that no single organ was responsible but a combination of "mental emotions" and "bodily derangements" working through the nerves and the then all-important animal spirits. In this last matter he differed radically from Lepois, who had thought the brain the somatic seat of hysteria.^[177]

In brief then, Sydenham arrived at radical conclusions:

1. He claimed that hysteria afflicted both men and women.

2. He considered hysteria the most common of all diseases.

3. He viewed hysteria as a function of civilization, that is, the richer and more civilized and influential the patient, the more likely he or she was to be afflicted.

A few years earlier, Willis had also concluded independently of Lepois that hysteria might be applicable to men, given its lodging—according to Willis—in the nervous stock, spanning the brain and the spinal cord.^[178] He derived this attitude from his theory of sympathy, which led him to reject inherited Hippocratic versions of hysteria. Willis's main argument was with the notion of a "wandering womb" as anatomically "suffocating" the rest of the body as it supposedly rampaged and choked other organs and deprived them of their rightful space. He also held objections to this view based on the normal and pathological dry-moist conditions in the body. Hysteria was an important concern to Willis from the beginning of his medical career. He challenged Nathaniel Highmore's etiology from "bad blood" in a huge treatise written in Latin and entitled Affectionum quae dicuntur & hypochondriacae pathologia . . . (1672), all as part of a larger campaign to give the brain a much greater role in the genesis of illness and to convert many conditions into diseases of the nervous system. The specific route for our condition, he believed, was that the uterus "radiated" (his word) hysteria through an infinity of neural pathways extending into every organ and tissue of the human corpus. Willis applied his notions of corporal sympathy to hysteria and then extended this route of nervous transmission to other female conditions, including chronic "head ache" (of the intense variety suffered by his contemporary, the brilliant and rich Lady Conway), coma, somnolency, epilepsy, vertigo, apoplexy, and generalized paroxysm (i.e., numbness), among many others. These and other conditions were owing, Willis thought, to nervous disorders he often termed "paralysis of

the nerves."^[179] But why omit men, Willis asked, unless the anatomy and physiology of the genders differ? However, Willis chose not to investigate the possibility, concentrating instead on his medical practice and treating the large number of female hysterics in his waiting rooms with a wide repertoire of drugs. The first of the great "nerve doctors" who flourished during the pan-European Enlightenment, Willis anticipated our current medical practice of prescribing drug-based therapies. Indeed, he would be at home today in our neuropsychiatric institutes where pharmacology reigns supreme and patients are drugged for almost every form of depression, anxiety, and pain.

However, Sydenham gazed more deeply into hysteria than Willis: if Willis discovered hysteria through theory, Sydenham came to it from practice. Like his predecessor, Sydenham intuitively demystified hysteria by rendering it an authentic medical affliction, neither diabolical nor fanciful but rational, empirical, mechanical, even mathematical, and, most crucially, calling it "an affliction of the mind" or, in our parlance, a psychological malady.^[180] The advancement in his thinking was part of a larger Restoration anatomic movement that had demystified the reproductive organs of the female body.^[181] Sydenham's psychologizing of hysteria was crucial. Yet he probed further than Willis: he stressed hysteria's imitative function—an altogether new idea—and noticed its protean potential to convert the original psychological distress into somatic reality. As Foucault intimates in his own work on hysteria in chapter 5 of Madness and Civilization , Sydenham was also more compassionate than Willis and penetrated further into the wasted lives of his female patients. Whether women merely elicited from Sydenham more compassion than men is unknown, and nothing in his writing offers a clue, but he was less suspicious than most of his medical colleagues that women's hysterical complaints were faked. By virtue of the silences in his Dissertation —revealing silences given his already Spartan style and avoidance of rhetoric—he apparently ruled out the possibility that these physical symptoms originated in the patient's attempt to deceive his or her physician, or, furthermore, that hysteria was an imaginary illness. In his view pain itself was a felt emotion, as real as fear, love, grief, and hate; he refused to contemplate the possibility that a woman presenting with demonstrable somatic pain was imagining or fabricating her anger or fear.^[182]

In matters of gender application, Sydenham claimed that the radical mood swings of women—spasms, swoonings, epilepsies, convulsions, sudden fits—were also known among men, especially, as he wrote, "among such male subjects as lead a sedentary or studious life, and grow pale over their books and papers."^[183] Caprice, in both women and men,

was the norm: violent laughter suddenly altered to profuse weeping, each succeeding the other in fits and starts. Nothing in the behavior of either gender, Sydenham thought, was grounded in reason, nor could actions be explained. Emotional instability was the hysteric's hallmark. But who were these "studious" types? Certainly not the farmers or rustics of eighteenth-century England or France, but the upper and leisured classes, many of whom had attached themselves to colleges, churches, and government posts. Implicit rather than explicit in Sydenham's male hysteria was a built-in class notion. The fact that "women are more subject than men," as Sydenham comments, has nothing to do with general anatomical differences or with female reproductive anatomy. Sydenham believed rather that the proclivity was an expression of the whole person , arising from a convergence of the mind and nerves mediated through the "animal spirits." These were subtle distinctions, especially the specific locations of anatomic difference. If hysteria was more prevalent and severe among women than men, it was because their anatomic nervous constitutions were weaker. These were important steps and linkages, especially the new significance attached to the mysterious animal spirits,^[184] and the relatively new idea that the bodily strength of the nervous constitution was gender bound and gender determined.^[185] By 1670 or 1680, not enough research on the nerves had been performed to justify such conclusions; what had been learned was speculative and theoretical; what is most interesting about Sydenham's position was that while he took a giant leap in the psychologizing of hysteria, he also laid out an agenda for "the weak and nervous feminine constitution" that would play a magisterial role in European hysteria for more than two centuries. The latter theory is, ideologically at least, a more controversial accomplishment and must be addressed now.^[186]

This analytic interpretation of Sydenham's three-part contribution is not meant to diminish it in any way. Surely Veith is right to praise him as "the great clinician" of hysteria and hail him for psychologizing it. Yet Veith has analyzed hysteria narrowly, considered apart from its philosophical, social, and ideological contexts—an opposite approach to that of Quentin Skinner (quoted in the epigraph to this chapter); Sydenham himself, narrowing his focus to the weak and nervous feminine constitution, further genderized the perplexing malady, as Freud would later do in fin-de-siècle Vienna. Even so, the term nervous constitution was no rhetorical flourish or linguistic elision for Sydenham, no metaphor or analogy to describe something sensed but improperly understood. To Sydenham and his colleagues it denoted the quintessence of the body's mechanical operations: the amalgam of its superlative, integrative net-

work.^[187] It was metaphoric, of course, to the degree that all language is, but in terms of representation the description was believed to be identical with the body's most essential anatomical network. The nervous system was, in short, the body's greatest miracle, without which neither sensation nor cognition could exist. Therefore, it is inappropriate to use the approaches of literary criticism to assume the concept represented merely a metonymy or metaphor for Willis, Sydenham, or the other anatomists and physicians in the aftermath of Descartes who began to make the nerves the basis of the new medical science.^[188]

Sydenham believed that "of all chronic diseases hysteria—unless I err is the commonest."^[189] By common he meant not simply prevalent then and in the past and presumably in Western and non-Western cultures, but constantly on the increase, and spreading , especially among the rich and the influential.^[190] Although Sydenham had treated cases of poor women, beggars, and vagrants who presented hysterical symptoms, he considered them exceptions. The "common" cases to which he refers existed among the leisured and idle: He wrote, "There is rarely one who is wholly free from them [hysterical complaints]—and females, it must be remembered, form one half of the adults of the world."^[191] He does not elaborate on this remark. Although he has much to say in the Dissertation about the proximate and direct causes, as well as the pathogenesis of hysteria, he does not explore one of his most brilliant insights about the social pervasiveness of hysteria. He sees hysteria as "the most common of all diseases" because afflictions of the mind now (i.e., in the seventeenth century) have assumed an importance they did not have previously. To generalize the matter to a principle: as life for the leisured and influential becomes more complex, society's maladies also alter. A hundred years ago, according to Sydenham's reasoning, hysteria may have been less prevalent, but by the end of the seventeenth century, in the complex urban milieu previously described, hysteria is on the rise and will continue to increase so long as the social milieu (its economic conditions, political institutions, class arrangements, etc.) grows increasingly complex. The observation entails no philosophy of history or philosophy of medicine, to be sure, but does demonstrate a profound insight into the relation of culture and disease.^[192]

Sydenham saw all this before the nineteenth-century growth of hysteria; indeed, he claims to have witnessed an explosion—an epidemic—during the English Restoration. Prophetic of things to come, he intuited that hysteria had persisted throughout the ages among both genders, although it had gone largely undiagnosed; within this context, he glimpsed the havoc wreaked on human lives by rapid socioeconomic

change and the new lack of personal repression. The libertinism and hedonism of the Restoration were unparalleled in previous generations. If Sydenham could somehow have been reborn into Freud's Vienna, he would neither have denied nor been amazed by hysteria's new prominence. He who had recognized that hysteria "is the commonest of all diseases" would not have been surprised by its explosion under the strain of even further gender arrangements in a nineteenth-century world in which interconnecting, almost organic, complexity created new stresses; where male individualism and selfhood were being threatened as they had not been before; and where women demanded rights (especially the vote) more vigorously than ever before. If the female nervous constitution was perceived to be weaker than the male in the English Restoration, it was deemed to be even weaker around 1900.^[193] This last matter—the historical development of the so-called weak feminine constitution—forms an integral part of the story of hysteria in the aftermath of Sydenham. Nothing in its nineteenth-century formulations can be understood without glimpsing how the genders became further differentiated according to this nervous system.

But Sydenham also detected something even more extraordinary about hysteria: its protean ability to transform itself and its symptoms. He wrote in 1681: "The frequency of hysteria is no less remarkable than the multiformity of the shapes which it puts on. Few of the maladies of miserable mortality are not imitated by it."^[194] It is an extraordinary insight. This suspected ability "to imitate" is what rendered hysteria, Sydenham thought, unique among maladies . No one had detected this remarkable and elusive capability before. It is as if Sydenham were asking, What is hysteria if it possesses this power of transformation? It is. not surprising that "whatever part of the body it attacks, it will create the proper symptom of that part. Hence, without skill and sagacity the physician will be deceived; so as to refer the symptoms to some essential disease of the part in question, and not to the effects of hysteria."^[195] Hysteria in Sydenham's construal was thus a singular malady. As in the recent profiles of such conditions as cancer or AIDS, the natural history of hysteria was such that it always brought with it another "history" personal to each patient:

Hence, as often as females consult me concerning such, or such bodily ailments as are difficult to be determined by the usual role for diagnosis, I never fail to carefully inquire whether they are not worse sufferers when trouble, low-spirits, or any mental perturbation takes hold of them. If so, I put down the symptoms for hysteria.^[196]

Our contemporary diagnostic practices may not differ so drastically as we think. Yet Sydenham's hysteria was a sickness born of emotional agitation and physical enfeeblement, one arising, for example, when "mental emotions" were superadded to "bodily derangements," such as "long fasting and over-free evacuations (whether from bleeding, purging, or emetics) which have been too much for the system to bear up against." And—more germane to protean transformation—its symptoms had been so extraordinarily protean because, rather as with volcanic eruptions, the disorder broke out in whichever bodily system was currently weakest.^[197] Long before Freud then, Sydenham was the first thinker to consider hysteria a disease of civilization , unlike most other maladies. Construing hysteria as "a farrago of disorderly and irregular phenomena," he saw the unreliability of much previous medical theory about the condition and commented: "If we except those who lead a hard and hardy life, then no persons are exempt from its tentacles." For him, hysteria was not a single disease but a broad range of medical conditions: a hodgepodge—a "farrago"—of changing symptoms, the premier emblem of the class of diseases, or conditions, that defied predictability: anomalous, sui generis , exempted from the regularity of all other diseases.

X

The succession of medical theory in the Restoration and eighteenth century was therefore relatively clear. In the progression from Willis and Sydenham to Cheyne and Bernard Mandeville—the satirist of The Fable of the Bees —and their successors later in the eighteenth century, it was Sydenham who took the largest strides. Willis made free use of the hysteria diagnosis in managing sick women, saw hysteria as a somatic disturbance, treated patients with drug-based therapeutics, and considered the probability that men could be afflicted too. Inasmuch as women of all ages and ranks could suffer from it, he prudently dismissed the notion of Dr. Nathaniel Highmore, his contemporary, that hysteria was due to bad blood.^[198] He doubted that it was owing to any specific uterine pathology and identified the central nervous system, spanning the brain and the spinal cord, as the true site. Being "chiefly and primarily convulsive," he argued, "hysteria flared on the brain, and the nervous stock being affected."^[199] The animal spirits were specially vulnerable: "The Passions commonly called Hysterical . . . arise most often [when] . . . the animal spirits, possessing the beginning of the Nerves within the head,

are infected with some Taint." So he, like Sydenham, concluded that hysteria could not, technically speaking, be solely a female complaint; he offered the weaker nervous constitution as the reason why women were worse afflicted.^[200] The obvious conclusion, although both Willis and Sydenham were too cautious to proffer it, was that men with clear symptoms of hysteria were effeminate.^[201]

These schematizations shifted the ground to the nervous system as the key through which to understand and interpret hysteria as a category as well as human illness, and the paradigmatic shift is important for Enlightenment medicine.^[202] But if hysteria, as both Sydenham and Willis claimed, was the Proteus of maladies—the elusive medical condition par excellence—then we should expect the medical theory of the period to view the nervous system as the key to practically all illness, not merely hysteria.

This it did. The best theory of the day did not, naturally, endow the nerves with the key to every disease, but once the mechanical philosophy had completed its work and the paradigmatic shift was absorbed (roughly by 1700), there were few if any diseases without nervous implications. Eventually this monolithic attribution would be seen for the foreshadowing of modern nervousness that it is. At the time, it was viewed as the only respectable medical course possible. Dealing with affluent clienteles, the highly influential Italian physician Georgio Baglivi and satirist Bernard Mandeville carved out comparable concepts of hysteria to encompass the protean ailments of the polite, whose sensibilities to pain were as extensive as their vocabularies, and who may have been adroit at manipulating the protective potential of sickness. Mandeville, a brilliant writer of prose, was sensitive to the languages of hysteria, especially their jumbled vocabularies and dense metaphors. He had commented profusely on the metaphoric kingdoms of "the animal spirits"—commenting pejoratively most of the time and demonstrating how little he believed that medical writers had followed the pious credos of the Royal Society espousing nullius in verba , loosely "nothing in the word." In his dialogic Treatise of the Hypochondriack and Hysterick Passions , Mandeville makes a character proclaim: "You Gentlemen of Learning make use of very comprehensive Expressions; the Word Hysterick must be of a prodigious Latitude, to signify so many different Evils," suggesting that a type of "madness" would arise from nomenclature itself, a form of illness every bit as real as the genuine "hysteric's affliction."

Drawing upon his extensive clinical experience, Baglivi demonstrated how patients commonly presented symptom clusters resistant to rigid disease categories, though responsive to the personal tact and guile of

the physician.^[203] Mandeville, for his part a profound social commentator as well as a sought-after medical practitioner, made much of the fashionable life-style pressures disposing women to hysteria while their husbands sank into hypochondriasis.^[204] Was there a determinant anatomico-physiological etiology for the disorder? Mandeville, like Sydenham, deflected the question, concentrating instead upon those behavioral facets—languor, low spirits, mood swings, depression, anxiety—integral to the presentation of the self in everyday sickness. Mandeville's substantial contribution to the theory of hysteria was revisionary more than anything else. He ridiculed the elaborate speculative models of mechanico-corporeal machinery floated by Willis, especially the idea that erratic mood shifts were literally due to "explosions" in the animal spirits, and derogated the highly analogical language Willis used to capture the iatromathematical motion of these nervous eruptions. Mandeville was less troubled by Willis's theory of sympathy than with his version of idiopathy : the idea that the "explosion" could convey its neuroanatomic effects throughout the body by sympathy. Idiopathy and "detonation" were Mandeville's unrelenting gripe, especially the unpredictable onset of the "detonations," not a theory of medical sympathy that had historically antedated Willis nor neurophysiological disagreement about the manner of conveyance through the nervous pathways. Furthermore, the metaphoric dangers of "detonation in the human body" struck the satiric Mandeville as comic, even hilarious. Anatomic detonations, nervous explosions, sudden eruptions: what reason did nature have for infusing the human microcosm called "the body" with these sudden "detonations," especially if they could "explode" at any moment and throw the organism into a paroxysm of hysterical illness?^[205]

Subsequent theorists of hysteria took up Mandeville's caveat, favoring the sympathetic transmission over the idiopathic. But by now—the eighteenth century—the neural transmission of hysteria had almost completely replaced the "bloody" and uterine, "explosions" or not. The old dualistic categories of spirit and body, rational and physical dimensions, were replaced by a more or less integral "nervous system" (however poorly defined and ill understood) transmitting all manner of "nervous disorders," of which hysteria was indubitably the supreme. As the discourse on hysteria made its way through the world of the Enlightenment, at least three of its most cherished beliefs were quashed. Set the dials roughly to the first quarter of the eighteenth century and hysteria is now a rampantly spreading malady that clearly afflicts both genders, women primarily because of their weaker nervous systems , and while stress and daily routine are crucial in its genesis, nothing is more

important than the state of the nerves and the animal spirits that govern them.

When Baglivi wrote in The Practice of Physick, reduc'd to the ancient Way of Observations, containing a just Parallel between the Wisdom of the Ancients and the Hypothesis's of Modern Physicians (1704) that "Women are more subject than Men to Diseases arising from the Passions of the Mind, and more violently affected with them, by Reason of the Timorousness and Weakness of their Sex," he meant weakness in the nerves . Baglivi was widely read throughout Europe, from north to south, from the avant-garde medical schools of Holland to those in Spain and Salerno. His theory of "Diseases arising from the Passions of the Mind" as diseases of gender took hold almost instantly. This eighteenth-century view represented a narrow conception of a disease that had puzzled doctors for long, even if men and women then invested in the ideologies of the animal spirits in ways now almost irretrievable. It was a narrow conception, and it demonstrates that the paradigmatic shift from a uterine to a nervous model for hysteria was the most significant shift the conception of hysteria experienced since its medicalization in the sixteenth century and until its genuine psychogenic formulation in the nineteenth.

XI

I hope I have explain'd the Nature and Causes of Nervous Distempers (which have hitherto been reckon'd Witchcraft, Enchantment, Sorcery and Possession, and have been the constant Resource of Ignorance) from Principles easy, natural and intelligible, deduc'd from the best and soundest Natural Philosophy.
—GEORGE CHEYNE, The English Malady

The paradigmatic shift is, of course, self-evident to the careful reader of these discourses, especially as former "hysterical" complaints now become monolithically "nervous." Sydenham died in 1689, almost at the moment that Newton's Principia (1687) was being interpreted and Locke's Essay Concerning Human Understanding (1690) printed, works providing evidence that paradigmatic shifts were then taking place in other fields as well as in medical theory.^[206] Within a generation, to be hysterical was to be nervous : the two became synonymous, the latter eventually a shorthand, a metonymy, almost a code word, for the broad class of hysterical and hypochondriacal illnesses. Another feature of the theory of hysteria (not merely the fact of its existence as a medical condition) affords a clue to this transformation into nervous illnesses: the sense that nervous disease permeates society. This pervasiveness had never been a primary dimension of the older theories of hysteria.^[207] For

generations, at least since the time of Weyer and Jorden, it had been thought that hysteria was present and could be found in segments here and there but that it was not omnipresent or pervasive in European society. Now, in the generation between the death of Sydenham and the succession of the Hanoverians (1689-1714), the pervasiveness of nervous disease became as entrenched as the mechanical revolution in science more widely.^[208] Was it for that reason, perhaps, that a large number of cases began to surface in the eighteenth century in comparison to previous periods? Even more puzzling, why should diagnoses of hysteria suddenly reach such epidemic proportions? Were there the cases to support the diagnoses, or were doctors on some type of crusade to hystericize (i.e., neuralize) medical illness and encourage the perception that disease was now fundamentally nervous?

The answers must be sought in the discourses themselves as well as in the views of women then and in social transformations then occurring. Today, we tend to think of the nineteenth century as the golden age of hysterical women in part because—we think—the eighteenth century refused to problematize the female sex^[209] —that is, to see women in all their biologic and social complexity. Yet authoritative social history reveals the opposite: for example, Sydenham's remarkable social construction of women and their chief disease. The degree to which an epoch problematizes women varies of course; it is perfectly true that all epochs problematize their women; nevertheless, in the period of the Enlightenment it was high. Throughout the Restoration and eighteenth century, at least in the British Isles and France, even the healthy woman was still seen as a walking womb. Several dozen rebels—the Bluestockings, the Aphra Behns and Charlotte Charkes, the Lady Mary Wortley Montagus and Madame de Staël's, and other sophisticates in the leading courts and capital cities of Europe—challenged this characterization, but they and their cohorts were unable to put a significant dent in the armor of that social world.^[210]

For some, spleen and vapors, often used interchangeably, were still proofs of demonic possession rather than somatic ailment; this is not surprising since witches were still being tried in the early eighteenth century (until the 1730s), even if not so vigorously as they had been previously.^[211] But for most, "the vapors" was the colloquial cousin of hysteria, as Dr. John Purcell, a self-professed "nerve doctor," insisted.^[212] Dr. John Radcliffe, for whom Oxford's Radcliffe camera is named, was dismissed from Queen Anne's service after telling Her Majesty that she suffered only from the vapors, thereby implying that hers was an imaginary and doubtful malady. This was nothing Her Majesty wished to

hear; the Queen wanted a diagnosis indicating real illness that could be treated with acceptable therapy, not some imaginary delusion, like "the vapors," for which her character could be impugned and to which no attention would be paid.^[213] We glimpse a different view in the poet Pope's treatment of Belinda when she descends into "The Cave of Spleen" in canto 4 of the famous mock-epic poem The Rape of the Lock (1714). Belinda's sudden hysterical seizure embodies the older connotation of the medical doctors, and becomes the sign of the unstable postpubescent and nubile nymph burdened with her essential uterine stigmata:^[214]

Safe past the Gnome  thro' this fantastic Band,
A branch of healing Spleenwort  in his hand.
Then thus addrest the Pow'r—Hail wayward Queen
Who rule the Sex from Fifty to Fifteen,
Parent of Vapours and of Female Wit,
Who give th' Hysteric  or  Poetic Fit ,
On various Tempers act by various ways,
Make some take Physick, others scribble Plays.
                      (lines 55-6o)^[215]

The poetry succeeds brilliantly here because of a sustained ambivalence between real and imaginary delusion: "Hysteric " and "Poetic " fits: that never-never land capturing genuine dementia versus imagined, even feigned, vapors. Pope thereby enables Belinda to enjoy a status unavailable in actual life had she been the historical, precocious, upper-class Arabella Fermor suffering from medically diagnosed hysteria.^[216] Unlike Belinda, real patients craved diagnoses that did not brand them as possessed or deluded by imaginary or pretended illnesses. They wanted to be told by their physicians and apothecaries that they were suffering from genuine nervous afflictions that had attacked specific parts of their nervous systems for which there existed pharmacological remedies and other tonic nostrums.^[217] Alternatively, in medical theory as distinct from the diagnostic and therapeutic spheres, nothing persuaded doctors and patients alike so well as numbers and mathematics. So long as the physician could quantify the malfunction of the diseased animal spirits and apply arithmetic and even Newtonian fluxions to the motions (i.e., the contractions and expansions) of the nervous system, both diagnosis and therapy seemed possible. Specialized "nerve doctors" were well served by iatromechanical training. For the rest, quantification and numbers had proceeded so far in the mechanical imagination of the day that nothing therapeutic succeeded so well as pills and potions designed to

normalize the mechanical motions of the animal spirits within the nerves that had caused the hysteria in the first place.

The path ahead for the theory of hysteria lay then in its iatromechanical applications, i.e., its mathematical charting.^[218] The followers of Sydenham, especially Baglivi and Mandeville, and of their counterparts Archibald Pitcairne (a Scot who became an important professor of medicine in Leyden and Edinburgh) and Herman Boerhaave in Holland,^[219] avowed a medical Newtonianism aspiring to establish the laws—static, dynamic, hydraulic—governing the mechanics of the organism and preferably couching their findings in these mathematical expressions. Anatomical attention to the body's solids would provide, they contended, surer foundations for medical laws than the traditional Galenic preoccupation with the humors and fluctuations of the fluids. Dr. George Cheyne in particular had nothing but scorn for talk of humors and those "fugitive fictions," the animal spirits.^[220] Mechanist physicians, treading lightly in Willis's footsteps, pointed to the experimentally demonstrable role of the nervous system—a sensory skeleton variously imagined as comprising nerves, fibers and spirits, strings, pipes, or cords—in mediating between brain and body, anatomy and activity. As I have described elsewhere, Cheyne and his medical peers in Enlightenment England launched an aggressively somaticizing drive to modernize medicine in a Newtonian mode. "Physic," Cheyne advised his brethren, must aspire to the condition of physics. The possibility of diseases, especially hysteria, springing primarily from the mind was discounted—no longer, in the main, because such disorders would be deemed diabolically insinuated, but because they would thereby be rendered empirically unintelligible. For the theory of hysteria this represented an invigorating somaticizing that totally undid Sydenham's cultural unraveling.^[221]

The Newtonian mechanics of cause and effect meant that no reflex, no disturbance of consciousness, no sensation or motor response, was to be admitted without presuming some prior organic disturbance communicated via the senses and the nerves. "Every change of the Mind," pronounced the enthusiastic Newtonian Dr. Nicholas Robinson in 1729, "indicates a change in the Bodily Organs,"^[222] a view Cheyne endorsed in The English Malady by adumbrating its workings in the intimate interplay between the digestive organs and healthy nerves' tonicity:

I never saw a person labour under severe, obstinate, and strong nervous complaints, but I always found at last, the stomach, guts, liver, spleen, mesentery [i.e., thick membranes enfolding internal organs], or some of

the great and necessary organs or glands of the belly were obstructed, knotted, schirrous, spoiled or perhaps all these together.^[223]

Cheyne subsumed hysteria—which in his fashionable medical practice covered a multitude of symptoms ranging "from Yawning and Stretching up to a mortal Fit of Apoplexy"—under the umbrella of nervous diseases, its being due to "a Relaxation and the Want of a sufficient Force and Elasticity in the Solids in general and the Nerves in particular."^[224] Cheyne's "nerves" thereby endorsed the Sydenham/Willis exoneration of the womb, relocating the distemper as the neighbor of the spleen and vapors, and closely situated next to melancholy. Time elapsed, however, before the educated public caught up with Cheyne's reforms, and even someone as knowledgeable of Cheyne's theory of hysteria as the novelist Samuel Richardson, Cheyne's great friend, conflated his version of hysteria with the vapors and spleen. In Richardson's last novel, Sir Charles Grandison (1753), the willowy heroine Clementina endures the three stages of "vapours" Cheyne described in The English Malady , proceeding from fits, fainting, lethargy, or restlessness to hallucinations, loss of memory, and despondency (Cheyne recommended bleeding and blistering at this stage), with a final decline toward consumption. To cure her, Sir Charles follows Cheyne, prescribing diet and medicine, exercise, diversion, and rest, and the story is considerably affected when Clementina's parents adopt unquestioningly Dr. Robert James's further recommendation that "in Virgins arrived at Maturity, and rendered mad by Love, Marriage is the most efficacious Remedy."^[225]

In the perceptions and practice of early Georgian medicine, these nervous complaints constituted a block of relatively nonspecific ailments and behavioral disorders. One need merely think of the letters and diaries of the period to see what resonance spleen and vapors emitted.^[226] They are even more frequently referred to in the poetry and drama of the period, where virtually no author is exempt. From the mad hack's attacks of spleen in Jonathan Swift's Tale of a Tub to Clarissa Harlowe's persistent bouts with vapors in the Richardson novel of that name, the nervous ailment exists as mundane reality as well as cliché and complex trope.^[227] Gender proves no discriminating factor, as men and women alike, and in almost equal numbers, fall prey to its sudden attacks. But diagnosed inaccurately, the same symptoms could denote lunacy, insanity, dementia: the same madness Swift's hack clearly suffers from in the Rabelaisian Tale of a Tub .^[228] To our way of thinking, the broad category melancholy would not seem to fit under this conception of hysteria. Yet it then did, one evidence of which is the consistent interchange of the

two words in even the most technical medical literature. Furthermore, the line between melancholy and madness was delicate and thus greatly feared. Melancholy, madness, hysteria, hypochondria, dementia, spleen, vapors, nerves: by 1720 or 1730 all were jumbled and confused with one another as they had never been before. Anne Finch, the Countess of Winchelsea and a poet much admired by Pope and Wordsworth, turned this confusion about the status of hysteria to her advantage in The Spleen: A Pindarique Ode by a Lady (1709). This is her most ambitious work: a phantasmagoria about life, death, and the nocturnal reverie world—all conceived and executed by pondering reality through the gaze of the splenetic poet.^[229]

The leading "nerve doctors"—the Mandevilles and Cheynes and their group of lesser epigoni—grounded these hysterical symptoms entirely in somatic origins: to make certain through tact and expertise that patients understood that virtually all hysterical complaints were worlds apart from gross lunacy. Thus Dr. Purcell, mentioned earlier as a fashionable nerve doctor, claimed that "the vapours"—a condition colloquially synonymous with hysteria—consisted entirely of an organic obstruction located "in the Stomach and Guts; whereof the Grumbling of the one and the Heaviness and uneasiness of the other generally preceding the Paroxysm, are no small Proofs."^[230] Noting that one of Hippocrates's noblest contributions to medicine lay in recognizing that epilepsy was not a divine affliction ("the sacred disease") but entirely natural, Purcell insisted that the vapors (what the French would call the "petit mal") were akin to epilepsy (the "grand mal"); indeed that "an epilepsie, is Vapours arriv'd to a more violent degree."

What had become of Sydenham's revolutionary insights—the social conditions, daily stresses, nocturnal excesses, wasting away of women in a patriarchal world, all of which he had believed were important in the genesis of hysteria? Where was the view that the new Enlightenment codes of politeness and refinement, and the encroachment of unwanted foreign customs on civilized English and French life (coffee, tea, chocolate, snuff, etc.) played a part in creating these hysterical complaints? In England and later in Western Europe they had gone underground, subservient to, or overwhelmed by, a scientific milieu bristling with vigorous Newtonianism.^[231] It is not easy to imagine that a wave of Newtonian-ism diverted the nerve doctors to such a preponderant degree despite theories such as Robinson's (note 231); nevertheless, the fact is that it did. Mental illness in our time has been construed so completely within the light of socioeconomic determinants, when it is not considered a genetic or hormonal disorder requiring chemical correction, that we find

it hard to imagine an approach to hysteria so monolithically iatromathematical as the Newtonian one of Cheyne's world. Yet for a generation at least, extending well beyond the second quarter of the eighteenth century, personal and social stress were discounted as uninteresting to the theories of hysteria, while the limelight fell on the application of the new "mathematical medicine" to existing cases.

Indeed, inquiry into the etiology of hysteria as a valid form of exploration regressed: all cases were deemed to result from deviant physiologies of the nervous system that could be understood only by Newtonian or other mechanical analyses. As the century evolved, it became clear that lunacy, insanity, and madness represented the great fears—the grand peur —of these early Georgians, not the chronic hysteria that doctors like Mandeville and Cheyne claimed they could always cure now that it was somaticized and released from its previous diabolical moorings. Lunacy was feared as the great hangman because even the best of the Newtonian doctors had no clue to its genesis and cure.^[232] In cases of hysteria there was at least hope for the patient. Its onset, as the doctors assuaged their patients, had not even been mi'lady's or his lordship's fault. Madness, on the other hand, represented an unequivocal failing in the popular imagination: a fatal lapse of the soul, a disjunction of mind and body; the stigma ne plus ultra ; in the brave new world of the Enlightenment it was a final, irrevocable state, usually ending in incarceration. It was not until late in the century that a new class of humane physicians—the Batties, Monros, Chiarugis, Crichtons, Pinels—demonstrated the same humanitarian attitude to madness that the Willises, Sydenhams, and Cheynes had for hysteria and other nervous disorders.^[233]

Medical science thus led early Enlightenment physicians to make a great play of the organic rootings of problematic disorders. But so too did bedside diplomacy. Confronted with indeterminate ailments, Cheyne, for example, pondered the problem of negotiating diagnoses acceptable to doctor and patient alike. In his remarkable autobiography and tantalizingly ambiguous self "case history," he claimed to empathize with these victims because he himself suffered from such disorders.^[234] Physicians were commonly put on the spot by "nervous cases," he noted, because such conditions were easily dismissed by the "vulgar" as marks of "peevishness," or, when ladies were afflicted, of "fantasticalness" or "coquetry."^[235] But his own somaticizing categories were pure music to his patients' ears, for they craved diagnoses that rendered their hysterical disorders real . The uninformed might suppose that hysteria, the spleen, and all that class of disorders were "nothing but the effect of Fancy, and a delusive Imagination": such a charge was ill-founded,

Cheyne assured them, because "the consequent Sufferings are without doubt real and unfeigned."^[236] Even so, finding le mot juste required tact. "Often when I have been consulted in a Case," Cheyne mused, "and found it to be what is commonly call'd Nervous, I have been in the utmost Difficulty, when desir'd to define or name the Distemper."^[237] His reason was the predictable desire not to offend, "for fear of affronting them or fixing a Reproach on a Family or Person." For, "if I said it was Vapours, hysterick or Hypochondriacal Disorders, they thought I call'd them Mad or Fantastical."

What precisely was the sociology and linguistics of this annotated disgust? Did the patients disown their hysteria and the similar maladies because they reflected a perverse life-style? Some moral or religious failing? Or was it that somehow centuries of uterine stigma could not be wiped away so quickly, not even by the reforms of Willis and Sydenham? Throughout his prolific medical writings, commenting on the recoil of his patients in the face of a diagnosis of nerves or spleen, even when he gave the complaints a somatic basis, Cheyne recognized the degree to which he would have to educate them. Sir Richard Blackmore, another fashionable "nerve doctor," experienced similar difficulties, to the point of admitting that his hysterical patients were often viewed as freaks suffering from "an imaginary and fantastick sickness of the Brain."^[238] The freaks thus became "Objects of Derision and Contempt," and naturally were "unwilling to own a Disease that will expose them to Dishonour and Reproach."

While Enlightenment doctors ignored what we would call the sociology of hysteria, they did accept the lack of gender distinctions. Black-more was as mechanical and Newtonian a physician as one could find in the early eighteenth century, certainly as "mechanical" as Robinson, his colleague, but he lost no opportunity to show that hysterical symptoms in women were identical to those in hypochondriacal men. Ridiculing uterine theories of hysteria as so much anatomical jibberish, Blackmore concluded, as Cheyne did, that "the Symptoms that disturb the Operations of the Mind and Imagination in hysterick Women"—by which he meant "Fluctuations of Judgment, and swift Turns in forming and reversing of Opinions and Resolutions, Inconstancy, Timidity, Absence of Mind, want of self-determining power, Inattention, Incogitancy, Diffidence, Suspicion, and an Aptness to take well-meant Things amiss"—"are the same with those in Hypochondriacal Men."^[239] The condition, he maintained, was common to both sexes, and the many names given to it—melancholy, spleen, vapors, hysteria, nerves, among dozens of others—all amounted to the same thing: a genuine malady with so-

matic pathology requiring a new understanding between doctor and patient. The sensitive physician demonstrated his expertise by ridiculing theories that these nervous complaints were the result of a diseased womb, and he recommended identical therapy for hysteric male and female patients.

To gain acceptance for the term hysteric and its symptoms, these physicians proposed to yoke them with more common organic illnesses, investing them with labels and copper-bottomed organic connotations, for example, by speaking of "hysterick colic" or "hysterick gout." The tendency persisted for sixty or seventy years at least. Thus one woman Cheyne treated had a "hysterick lowness," another "frequent hysterick fits"; eventually the word hysteric was so flattened and became so neutral in its connotations as to mean almost nothing at all. The physician thereby spared himself the accusation of merely trading in words—which he was consciously doing anyway in view of the number of conditions that had come under the umbrella of "nervous"—and imputations of shamming also were avoided. Robinson, already mentioned, insisted that such nervous disorders were not "imaginary Whims and Fancies, but real Affections of the Mind, arising from the real, mechanical Affections of Matter and Motion."^[240] His reason was that "neither the Fancy, nor Imagination, nor even Reason itself . . . can feign . . . a Disease that has no Foundation in Nature," a position that hurls down the gauntlet to Sigmund Freud.^[241] Organic agencies, such as stone, tumor, fistula, and so on, thus had to initiate the chain of reactions, no matter what the conversion process entailed: "The affected Nerves . . . must strike the Imagination with the Sense of Pain, before the Mind can conceive the Idea of Pain in that Part." Here then was the all-important role of the nerves in sensation, as well as all human pleasure and pain.

Cheyne, Blackmore, Robinson, and their contemporaries did not seek to deny the contribution of consciousness to the genesis of nervous disease nor reduce mind to body (Baglivi, so influential in southern Europe, went the other way, reducing all body to mind—a mind whose passions had been shaped exclusively by the state of the nerves). But their aspirations as "scientific" doctors treating "enlightened" patients (usually the elite of the population) disposed them to insist upon the priority of physical stimuli as part of their two-pronged strategy to win the confidence of their patients and the esteem of their medical peers. They relied on their academic-medical credentials to enforce this approach as being both objective and true. Credentials were, after all, one of the main factors in determining authority, popularity, and fashion-ability.^[242] The most sought-after doctors in London and Edinburgh,

Oxford and Cambridge, as well as at the spas and in the major cities of other countries, had been decorated, so to speak, for their academic achievements. If this approach rendered the species man—in a world increasingly explained by new theories about the sciences of man—l'homme machine , its philosophical materialism also had beneficial effects. Thus the establishment of nervous conditions as valid medical diseases helped to secure the credit of medicine itself in an era of rampant quacks and proliferating mountebanks, when doubts about its validity as a science were at an all-time high.^[243]

More locally, within the realm of medical theory, this state of affairs amounted to a neurological approach to hysteria, which Veith has claimed was "sterile" in a "controversial century."^[244] Oddly, it was the dominance of this neurological approach to hysteria and the triumph of the nerve doctors with their patients (physicians such as Cheyne) that led Veith to any Victorian or Darwinian notions about the evolution of medicine this disastrous conclusion. Countering her judgment, we might note (without adopting approach and returned to it the primacy of neurobiology.^[245] This may prove nothing in itself but at least demonstrates the or medical conditions) that late twentieth-century medicine has vindicated the neurological longevity of the neurological approach. Furthermore, the Enlightenment nerve doctors were immensely sympathetic to their patients. Even in an age, such as ours, when hysteria has become so politically and academically charged, this fact within the history of hysteria cannot be lightly dismissed. In the case histories detailed in the final section of The English Malady , Cheyne drew attention to the real woes of sufferers burdened with misery, depression, taedium vitae , ennui, hysteria, and melancholy—not least, to his own nervous misery.^[246] His patients, unlike Sydenham's, shared one common thread: they uniformly came from the ranks of the rich and the famous.

XII

Hysteria thus came of age in the openness of the Enlightenment, more specifically in the sunlight of the Newtonian Enlightenment. Virtually no important doctor in the first half of the eighteenth century placed the root of hysteria in the uterus, and this fact tells us as much about the patients of the epoch as its mostly male physicians. The modernization proved anatomically liberating, while also helping to discredit the theory based on the misogynistic sexual stigma of the voracious womb.^[247] The new emplacement of hysteria in the world of Cheyne and his "nerve doctor" colleagues moreover skirted vulgar reductionism. Its unmistak-

able language of the nerves—amounting to the heart of its linguistic discourse—pointed toward the mutual interplay of consciousness and body through the brain and the (often) still perplexing animal spirits as the primary nervous medium.^[248]

This new linguistic footing, which had been developing since the days of Willis and Mandeville, had profound cultural and gender-based implications: cultural because society itself was growing "nervous" in ways no one had anticipated, and gender-based as a consequence of this new nervous model of mankind mandating a weaker nervous constitution for women than men. The desexualization of hysteria was, of course, one part of a movement during the Enlightenment that demystified the entire body.^[249] This process included the reproductive organs and the newly privileged mind over matter, as in Hume's examples and (especially under the weight of Linnaean taxonomy) the rule of species over gender. With demystification also came the shedding of much of the shame of hysteria. Its sufferers at mid-century were now seen as the victims of an interestingly delicate nervous system buckling under the pressures of civilization, typically the thorn in the flesh of elites moving in flashy, fast-lane society.^[250] This was the essence of Cheyne's message in his best-selling book, The English Malady .

But the cultural reasons for this "delicate nervous constitution" were to remain hidden and elusive for some time. Its personal effects, especially for patients, were described ad infinitem; the other effects, the larger images of those living an affluent life, could be seen in the new image the emerging Georgians held of themselves. At home, in the bedroom, this might entail paralysis, fear of the dark, as well as dread of the incubus and succubus, as evidenced by sleepwalking and amnesia.^[251] (If the weekly and monthly magazines can be considered reliable, amnesia was more common than we might think.) These were the standard images of the somnambulant melancholic or insomniac hysteric in the caricatures of the time, as the accompanying plate demonstrates. More locally still, within the context of a now desexualized female hysteria, the suggestion was that coquetry verged on hysteria.^[252] To the vulgar, as Pope had suggested in The Rape of the Lock , hysteria might signify nothing more than coquetry itself. But these examples, medical and literary, signified something more deeply ingrained in the world of the Georgians than has been thought: namely, the nervous self-fashioning of Augustan society.

Stephen Greenblatt and others among the New Historicists have written about such self-fashioning in the Renaissance.^[253] Yet the latter period of the Enlightenment is even more revealing of the great personal ten-

[Full Size]

"Madwoman in Terror," ca. 1775, Mezzotint by W. Dickinson, after a 
painting by Robert Edge Pine. Engraving in the Wellcome Institute in 
London. The portrait illuminates the early female iconography of hysteria, 
in this instance a mad young woman of perhaps twenty or so whose wild 
hair is strung with straw, and whose eyeballs flash with terror and fear. 
A bandana is wrapped around her head; in fury she has torn the garment 
from her breast, which now lies bare. A feathery or animal garment clings 
loosely around her, and she is chained and roped, evidence that she poses 
a threat to others and is dangerous to herself. Window high up in the left 
corner makes clear that this is a cell for lunatics where she has been 
incarcerated.

sions it raised between the sexes in a milieu of increasing desexualization in which women continued to enjoy greater freedom and equality than they had before. The Augustan wits—the Addisons and Swifts, virtually all the Scriblerians—encouraged us to believe that logic, wit and intelligence—all part of the realm of the mind—were the sine qua nons of polite society then. But the tension between men and women revolved around more than matching wits, competing intellects, wit and wit-would-be, even in a "republic of letters" governed by an obsessive commitment to refinement and politeness, manners and etiquette. In addition, and most important, there was the unrelenting search for personal identity and self-fulfillment. This need is what the novel and drama of the period capture par excellence, and nothing reflects the mood of the epoch better than its great imaginative literature.^[254]

All these cults of sensibility—as I have called them elsewhere^[255] —demanded rising standards of behavioral achievement and necessarily called attention to their opposites: the realms of pathology and abnormality. This is why the medicine of the day, especially its theory based on bodily signs and symptoms, the semiology and pathology of illness, cannot be dismissed as so much esoterica.^[256] We have devoted two generations of study to the literary language of the Georgians; their ideas of body would well repay half that attention. The Lady Marys and Duchess of Portlands were hardly norms capable of emulation, yet in their bodily motions were codified the brilliant new urbanity of the age. Their sophisticated postures swirled round in rarefied atmospheres of courtliness and polite town society, abiding by a code of language and gesture in which the body was always required to be disciplined and drilled, coy and controlled; always mannered, as we see everywhere from the roles of dancing masters, acting teachers, tutors, governesses, and gymnasts of the age.^[257] Even so, new inner sensibilities had to find expression through refined and often subtly veiled bodily codes: one's bearing around the tea table, in the salon, at the assembly and pumproom, in town and country, at home and abroad, paradoxically revealing yet concealing at the same time, in actions, gestures, and movements that spoke louder than words.^[258]

This was the source of tension now superimposed on the gender pressures spawned in the Restoration under the weight of urban sprawl and new sociopolitical arrangements. In England at least, the gender rearrangements of the Restoration were elevated to exponential highs in the ages of Anne and the Georges. Isn't this a principal reason why the drama from Etherege and Congreve to Gay and Goldsmith assumes its particular trajectory vis-ÿ-vis the sexes and gender arrangements?

Urban sprawl, new forms of consumer consumption, gender rearrangements, interpersonal tensions, crime and violence, class mobility, the transfer of money and goods into a process of unprecedented consumption: the phrases appear to describe our vexed world. This was, however, the eighteenth century, consuming itself in newly found nationalism and wealth and basking in its accompanying leisure time, especially in food and drink.^[259] The lingua franca of such expression-repression-expression lay in the refined codes of nervousness: a new body language, ultraflexible, nuanced yet thoroughly poised within ambivalence. The essence of the code lay in these bodily gestures of recognition—whether blushing or weeping, fainting or swooning—which could act as sorting-out devices in times of doubt, certainly when love and marriage were involved. The comic drama from approximately 1730 onward demonstrates what heightened requirements the code placed on actors who tried to reflect it; our lack of recognition of the code itself results, in part, from the rarity with which any of these plays is now performed. Words were also tokens of recognition for the sensible and sensitive: sorting-out devices too. Under duress and at great expense, the language (of gestures and words) could be learned, but even among the rich and great, the smart and chic, it was acquired at the cost of great personal risk and self-doubt.

Risk lay everywhere in the new social arrangements represented—almost mimetically—in the proliferating idioms of nervous sensibility. The sheer number of the idioms then available has prevented us from seeing deeply (and some might say darkly) into the risks involved. Upon occasion we have even denied that the idioms existed. Readers today may well wonder: What cults of nervous sensibility? And why nervous ?^[260] Want of nerve , for example, betrayed a clear effeminacy, unacceptable in all classes from the highest rakes and fops to the lowest laborers. Paradoxically, want of nerves , exposed a rustic dullness, a latent tedium, a resulting boredom odious to the British for all sorts of reasons and feared among the highest ranking of both genders. Yet florid, volatile nervousness—in both men and women—betrayed excess and confusion: symptoms that could result in hysterical crisis. And hysteria, no matter what appellation it was given and no matter how culturally positive in the popular semiotics of that world, was a refuge of last resort. It was the cry of the person (usually female) unable to cope with the sharp cultural dislocations and social norms that had occurred in such a relatively short time. Within this taxonomy of disease, then, hysteria was the final limit beyond which no condition was more baffling, none capable of producing stranger somatic consequences. The semiotics of the nerves,

leading to understanding of hysteria, is therefore a way of knowing, and thereby decoding, the infirmity of excess, in much the same way that Foucault's hysteria is an understanding derived through comprehension of the female's inner spaces. And it was through this semiotics of the nerves that Foucault made the grandest claim of all: "It was in these diseases of the nerves and in those hysterias [of the period 1680-1780], which would soon provoke its irony, that psychiatry took its origin."^[261]

The quest was rather for a golden mean filtered by decorum—the same variegated decorum extolled by the age. But decorum had its snares too; it was easier to conceptualize or verbalize than to put into practice, as weepy heroine upon heroine lamented, usually to her detriment, in the fictions of the age. The snare was the retention of one's individuality within this bodily and verbal control. In practice, the act resembled treading on a tightrope, the walker forever balancing over the abyss. This was the beginning of a way of life—as Cheyne above all others in his age seems to have recognized—where the participants lived on the edge and in the fast lane. Richard Sennett, the American sociologist, has located the origins of modern individualism within this fast-paced eighteenth-century culture.^[262] More precisely, we might counterargue, individualism was created out of nervous tension and ambivalence over the self: the accommodation between the hyper-visible, narcissistic individual and a society that had craved it (i.e., the individualism), while at the same time demanding conformity to the civilizing process. This was the self-fashioning of the urbane Augustans, the codes on which the sexual politics of the new hysteria of the eighteenth century depended, and it would not have come about without the prior hypostases of the great nerve doctors—the Sydenhams and Willises, the Mandevilles and Cheynes—which resulted in the nervous codes that elevated sensibility to a new pinnacle.^[263]

Here then was a different route to the golden age of hysteria, a different dualism than the old Cartesian saw about mind and body. This Georgian self was less a divided Cartesian self—the now unisex woman or man riveted by conventional mind and body—than a creature part public, part private, often hidden behind a mask (sometimes a literal vizard) that curtailed self-expression as well as permitted it to flourish. Here, in this passionate sexual ambivalence, was the heart (one might as well claim the stomach and liver for the visceral effect it had on lives then) of the cults of nervous sensibility. It imbued Augustan and Georgian culture; eventually it made inroads in Holland, France, Italy, all Europe. And it left its mark on the best philosophers: the Voltaires and Hailers and Humes without whom an eighteenth-century "Enlight-

enment" is unthinkable.^[264] It energized the Diderots and Sternes, the Casanovas and Rousseaus, as well as the fictional Clarissas and Evelinas, the Tristram Shandys and other noted "gentlemen"—and gentlewomen—of feeling. How then could nervous sensibility have been born without a medical agenda that demystified the body and a subsequent Newtonian revolution that concretized its best hypotheses?^[265]

In the intellectual domain, this nervous tension surfaced as a Sphinxian riddle of psyche-soma affinities, and spurred, in part, the literally hundreds of works on mind and body we have heard about for so long.^[266] But in more familiar corners—at home and in church, in the theater and public garden, everywhere in polite society—it also appeared in subtle ways: in bodily motion, gait, affectation, gesture, even in the simple blush or tear, and in the most private thought that now could be read by another. Nervous tension was thus domesticized for the first time in modern history. Viewed from another perspective, it was also being mechanized for the first time, as manners themselves coagulated into an abstract code-language of mechanical philosophy: on the surface a loose application of Newtonian mechanics to the body's gait and gestures, but an application nevertheless.^[267]

The self-fashioning of nerves was thus significantly expanded: from mechanical philosophy it was medicalized, familiarized, domesticated, and eventually transformed into the métier of polite self-fashioning and even world-fashioning, in the sense that its code was eventually adopted as a universal sine qua non for those aspiring to succeed in the beau monde. The consequences for human sexuality and social intercourse were incalculable because passion and the imagination were implicated to such an extraordinary degree, as were the links between hysteria and the imagination. As soon as the imagination was aroused or disturbed, even in the most imperceptible way, somatic change was indicated. Of this sequence, the physicians had been certain from the mid-eighteenth century, if not earlier. "It appears almost incredible," Peter Shaw, His Majesty George II's Physician Extraordinary and the English champion of chemical applications in medicine, wrote in The Reflector: Representing Human Affairs, As They Are: and may be improved (1750, number 228), "what great Effects the Imagination has upon Patients." Later on the point was reiterated by William Heberden, another noted clinician in the tradition of Boerhaave whose life spanned nearly the whole of the eighteenth century and of whom Samuel Johnson said that he was "ultimus Romanorum , the last of our great physicians." Heberden was as much a product of this "nerve culture" as anyone else. After years of clinical experience he found that the indication of hysteria usually be-

gan "with some uneasiness of the stomach or bowels."^[268] He listed the symptoms: "Hypochondriac men and hysteric women suffer accidities, wind, choking, leading to giddiness, confusion, stupidity, inattention, forgetfulness, and irresolution." The symptoms were diverse, perhaps too diverse; a powerful and wild imagination lay at their base. But when Heberden pronounced on the root cause of hysteria, he could only say that the condition was fundamentally nervous , that is, fundamentally real or nonimaginary; in his words, "for I doubt not their arising from as real a cause as any other distemper."^[269]

Such nervous self-fashioning lay at the base of the social cults and linguistic idioms of Enlightenment sensibility, and were as influential as any other force in generating the theory of hysteria that we see reflected in the writings of the nerve doctors and their students.^[270] The process would not be reversible. The doctors did not impose their vision of society on their culture; it was life with its tensions that drew even the doctors into its orbit and caused their theories utterly to reflect this new society.

Just as important, nerves in the new culture precluded moral blame, because there could be no censure in a social, almost Zeitgeist , disease. Enlightenment swoons and their subsequent numbness in both women and men came from the act of buckling under the pressures of civilization, especially for the elite who moved within the fast lane of society. The new violence and the threat of its omnipresence enhanced the panic, as John Gay and the early novelists observed. Amelia's strange disorder is described by Captain Booth in Fielding's Amelia in terms that make clear the price she has paid for living in the new fast lane. Booth knows not what to call her "disease," but eventually lands on "the hysterics," which seems as accurate to him as any other appellations. Fielding's case history is not very different from the one Jane Austen will narrate with laser precision in Sense and Sensibility ; its Marianne Dashwood, with her swoons and sighs, is another "hysteric" whose case has not yet been discussed in the detail it deserves, meticulously recounted as it is in that novel from the first onset of fits and starts to the patient's near demise and eventual recovery. In all these cases, real and imagined, panic stemmed not merely from male violence but from a new type of female as well, and society's fears were substantiated almost daily by the culprits and vagabonds apprehended and brought into the courts of law.^[271] Life in the fast lane then, at least for the new urban rich, entailed high living, conspicuous consumption, reckless spending, more travel than previously (especially to the developing seaside resorts), late nights, and new gender arrangements, all combining to set off the beau monde from the other ranks of society. Neurological chaos in the body merely

mirrored the social disorder of the time. Though the comparison may not have struck the average aristocrat, these forms of disorder never stood apart, nor did the hysteria of its women and men.

But did a delicate nervous organization predispose one to the buckling under, or did the buckling under alter the body's nervous organization? The question is hard but cannot be overlooked or swept away. The approach to the answers taken by the nerve doctors was not, as Veith has suggested, sterile; they recognized the psychogenic burdens of their patients and the role played by mind and imagination, even though the doctors grounded virtually all their diseases in nervous structures. This monolithic attribution remains the difficult aspect of their "hysteria diagnosis" for us. Even so, the doctors often failed (almost always) to see the sociological roots of numbness and its radical enmeshment in language and its representations.^[272]

This is a revelatory indication of the degree to which the new nervous culture of the eighteenth century had made inroads into the philosophy, psychology, and medicine of the time. In brief, Cheyne and his colleagues scientized hysteria by radically neuralizing it. They did not invalidate consciousness in human life or reduce mind to body. Theirs was rather a crusade against duplicitous disease, campaigned for in the sunny light and quasi-blind optimism of high Enlightenment science. Not even hysteria could hide from them or prove elusive. If the Enlightenment nerve doctors came back today—heyne recidivus —they could not agree with our contemporary Dr. Alan Krohn about hysteria as "the elusive neurosis." To them, hysteria was fundamentally knowable: a neurology of solids, an iatromathematics of forces, a neural web of nerves, spirits, and fibers.

XIII

By the mid-eighteenth century, nerves seem to have run wild; the resulting hysteria was chronic among all those living in the fast lane and endemic, for different reasons, among the nation at large. Some women knew they had it, others did not: the inconsistency was less a defect of medical theory than the extreme fluidity of the diagnosis. For hysteria was not poured into a rigid mold by either the doctors or their patients. The diagnosis was usually made to fit the sufferer: a nonreductive expression of disorder. Linguistically speaking, hysteria profited from a new and very malleable vocabulary of the nerves as flexible and adjustable to the particular situation as the patient's symptoms themselves. In formal writing, by mid-century this vocabulary had been expressed

in new nervous discourses: of poets, novelists, critics, didactic writers, in narratives of all sorts. An aesthetic of "nervous style" began to emerge, endorsed by male writers, found suspect by female, which was unabashed in calling itself, after its patriarchal affinities, masculine, strong, taut—anything but feminine or epicene. And if style was then genderized to this degree, why should medicine not have been, especially the maladia summa hysteria—the genderized condition par excellence? Cheyne, above all, exploited this protean nervous idiom and procrustean vocabulary in his best-seller The English Malady , the real reason for its instant success. So too did his followers and disciples.

One of these, representative of these disciples in several ways, was Dr. James Makittrick Adair. Like Cheyne and William Cullen, Adair was also a Scot who had been deeply influenced by the Scottish Enlightenment. But Adair was also a Cheyne follower who saw what benefits could accrue to his career by worshiping, so to speak, within the "Temple of the English Malady." Adair had been taught in Edinburgh by Robert Whytt, the "philosophic doctor" who related "nervous sensibility" to every aspect of modern life, and he never forgot the great medical precept of his teacher, which resounded in the lecture theaters Adair attended: "The shapes of Proteus , or the colours of the chameleon , are not more numerous and inconstant, than the variations of the hypochondriac and hysteric diseases."

But it was Cheyne's thought that lay in the deepest regions of Adair's imagination throughout his professional medical career.^[273] Always acknowledging his teacher's famous essay of 1764-65 on nervous diseases (Whytt's Observations on the nature, causes, and cure of those disorders which have been commonly called nervous, hypochondriac, or hysteric, to which are prefixed some remarks on the sympathy of the nerves ), Adair served up explanations his readers wanted to hear about hysteria. He also provided them with a natural history of nerves in the linguistic and cultural domain:

Upwards of thirty years ago, a treatise on nervous diseases was published by my quondam learned and ingenious preceptor DR. WHYTT, professor of physick, at Edinburgh. Before the publication of this book, people of fashion had not the least idea that they had nerves; but a fashionable apothecary of my acquaintance, having cast his eye over the book, and having been often puzzled by the enquiries of his patients concerning the nature and causes of their complaints, derived from thence a hint, by which he readily cut the gordian knot—"Madam, you are nervous"; the solution was quite satisfactory, the term [nervous] became quite fashionable, and spleen, vapours, and hyp, were forgotten.^[274]

It is an extraordinary explanation, showing the continuity of eighteenth-century nervous self-fashioning. It not only casts light on the aftermath of Cheyne's career following his death in 1743 and on Whytt's much-discussed treatise of 1764 but resonates with class filiation. Adair saw how shrewd his medical brethren had been to classify as "nervous" those behavioral disorders free of determinate organic lesions: that is, vapors, spleen, hysteria, hypochondria, melancholy, and the dozens of subcategories spawned from these. Adair also recognized that naming and labeling played a large role in the hysteric's conceptualization. The Gordian knot was unraveled when words were deciphered. Likewise, in the previous generation, when Dr. Nicholas Robinson published a "Newtonian dissertation on hysteria" and wrote that every maiden had become so nervous that coining new words to describe its minute grades was necessary, he knew whereof he spoke. He himself compiled a whole vocabulary of remarkable neologisms that had been coined in his time: hypp, hyppos, hyppocons, markambles, moonpalls, strong fiacs, hockogrogles—all jocularly describing hysteria's grades of severity. Still, it was the great male poet, the dwarf of Twickenham, who used the vernacular of nerves to describe the living consequences of male hysteria. As he lay dying at fifty-five, Alexander Pope claimed to those gathered around him that he "had never been hyppish in his life." There was no need to gloss the phrase. Presumably all knew what he meant.

The very sturdy and nonhysterical Lady Mary, already mentioned, may have considered the "little poet of Twickenham" to be, like his fierce enemy Lord Hervey, a member of the "third sex." But even Lady Mary would have had to admit that Pope was essentially "male." How came it to pass that Pope, whose "long Disease, my Life" had paved the way for him to become more intimate with medical literature than he would otherwise have been, assumed male hysteria to be in the normal course of affairs?^[275] One can demonstrate, as I have tried, that as far back as the Elizabethan era, and probably earlier, males were assumed to be natural targets for "the mother," this despite their obviously not having the requisite anatomical apparatus. The progress of medical theory in the aftermath of Sydenham and outside the Cheyne-Adair circle also needs to be consulted if we are to understand how male hysteria shaped up in the eighteenth century.

For the fact is that virtually every serious medical author who wrote about hysteria after Sydenham's death in 1689, even the skeptics among the medical fraternity, included men among their lists of those naturally afflicted: in England, for example, these authors included some of the

best-known doctors of the age, including Nathaniel Highmore, Richard Blackmore, Bernard Mandeville (the physician-satirist), John Purcell, and Nicholas Robinson; in Scotland, Thomas Cupples, Lawrence Fraser, William Turner, and nearly the whole of the Edinburgh medical school; in Holland, the "Eurocentric" Boerhaave and his far-flung students, including Jan Esgers, C. van de Haghen, Lucas van Stevenick, as can be gleaned from dozens of medical dissertations written on hysteria at Leiden and Utrecht; in Denmark, Johannes Tode; in Switzerland and Bohemia, a certain number; in France, Jean Astruc, Nicholas Dellehe, J. C. Dupont, Pierre Pomme, and even the so-called father of psychiatry and transformer of therapies for the suffering insane, the great Philippe Pinel;^[276] in Germany, Gustavus Becker, C. G. Burghart, Georg Clasius, C. G. Gross, J. F. Isenflamm, Johann Christoph Stock; in Italy, A. Fracassini, P. Virard, G. V. Zeviani. These names suggest little if anything now, but in their time these figures constituted something of an international gallery of medical stars.^[277]

The treatment of males among the hysterically afflicted, and especially males of the upper classes, was a veritable industry in the eighteenth century. Whether the doctors were persuaded that males were clinically afflicted in the same way as women (sans "the mother" and the rest of the female reproductive apparatus) we may never know, and Mark Micale's biographical researches do not extend far enough back to offer a clue.^[278] Yet the medical literature from Sydenham forward speaks for itself and is unequivocal on the matter. Moreover, there seems to have been no major opponent to Sydenham's view about male hysteria to challenge his theory in the long course of the eighteenth century, neither in England nor elsewhere. Once the notion of male hysteria took root as a clinically observed phenomenon, which it had not done a hundred years earlier, its existence appears to have been guaranteed. The huge annals of eighteenth-century medical literature corroborate this position, and examples citing Sydenham as their fount are replete in the record. It is more difficult, however, to discover examples roughly contemporary with Sydenham, perhaps suggesting to what degree the notion of male hysteria had been absorbed into the medical imagination.^[279]

For example, consider the curious but still far from clear relationship between Thomas Guidott and John Maplet. Both were English physicians practicing in the Restoration and early eighteenth century in and around Bath. Guidott owed his entire Bath practice to Maplet, who helped him acquire it. After Guidott lost his practice in Bath through imprudence, libel, and squandering, he moved to London, remained loyal to his former patron, and continued to diagnose and treat his

(Maplet's) ailments until the end of his life.^[280] This would seem to be a case of professional patronage larded over with friendship, but it also had its profound medical side useful in these explorations of male hysteria. What survives are Guidott's accounts (not Maplet's), and considering Guidott's colorful character, his record may not be entirely reliable or complete. But it does provide enough information to comprehend what it was about Maplet's "male hysteria" that so attracted and excited Guidott, who wrote many years after Maplet's death:

[He] was of a tender, brittle Constitution, inclining to Feminine, clear Skin'd, and of a very fair Complexion, and though very temperate. . . yet inclinable to Hysterical Distempers, chiefly Gouts and Catarrhs, which would oftentimes confuse his Body, but not his Mind [mind and body construed as separate entities], which was then more at Liberty to expatiate, and give some Invitation to his Poetick Genius . . . to descant on the Tormentor, and transmit his Sorrow into a Scene of Mirth.^[281]

Multiple aspects of this analysis give us pause: Guidott's strange linking of hysteria to gout and catarrh and in other writings his subclassification of "hysterical gout"; his post-Cartesian version of the mind/body split; the assumption that creativity and hysteria ("Poetick Genius" and "the Tormentor") are cousins; above all, the presumption that in educated and intelligent males like Maplet "hysterical mania" is merely the outward sign (again a semiotics of the malady) of an almost "Feminine" nervous "Constitution." Here, in nervous anatomy and "Tender Constitution," lies the origin of temperamental sensitivity in men. Later, Guidott discusses Maplet's delicate nerves, metaphorically isolating them as "suspects" in this quasi-criminal hysterical disorder.^[282] "Suspects" in both the positive and pejorative dimension: positive in that they virtually breed sensitivity and creativity; negative in their pathological predisposing toward the condition. All this is what we would expect after unraveling and decoding the complex medical theory of the time.

Much less expected is Guidott's leap to friendship. He claims to be "attracted" to the nervous, brittle, delicate, tender, frail, white-skinned Maplet—not attracted sexually, certainly, nor primarily as a consequence of Maplet's professional generosity, although one would presumably be interested in the arm and leg of patronage, but attracted intellectually and humanly. Guidott's life is not sufficiently understood to hazard any guesses about his sexuality, but his case history of Maplet suggests the existence by approximately 1700 of a new Sydenhamian paradigm about male hysteria that yokes anatomy, physiology, and psychology to culture, gender formation, and society.^[283]

What better evidence could there be of gender basis in this account? Maplet is the "tender, nervous, brittle" male who has become afflicted and requires diagnosing and treating by Guidott; he is also the soft, creative, nervous male predisposed to hysteria and friendship. Guidott's language does not yet reveal the developed jungle of nerves and fibers that will flourish in Cheyne and Richardson, and later even more metaphorically and densely in the fictions of Sterne and the Scottish doctors. But it remains one of the earliest and most interesting accounts of male hysteria in English, certainly a prototype of sorts. Guidott himself was somewhat "poetically inspired," though he is not known to have been "hysterical." He had composed poetry at Oxford and wrote poetic satire when he quarreled with the London physicians.^[284] And he had matured in a world overrun with male enthusiasts of all sorts—the broad spectrum that permeates the great satires of the age, such as Swift's Tale of a Tub . Guidott's London, like that of Sydenham, his contemporary, displayed ranting enthusiasts on every corner, often said by the "doctors" to be male hysterics let loose on the Town. Though their numbers increased and decreased according to the luck of the time, decade by decade, their presence was commonly explained, as Swift had suggested in the Tale , in the language of the vapors and spleen, nerves and fibers, all their raving and madness attributable to "hysterical affections."

This was a motif—the connection between religious inspiration and male hysteria—that would extend throughout the course of the eighteenth century. As newly inspired sects became more visible, so too the varieties of their male hysterics, and in almost every case where documentation survives there lingers the implication of a "hysterical affection" of one or another variety. If epilepsies and convulsions were the signs of secular distraction, they also afflicted men crazed in groups by their religious enthusiasm; Philippe Hecquet, a French physician of the ancien régime, claimed in Le naturalisme des convulsions dans les maladies de l'épidémie convulsionnaire (1733) that convulsions among the mob were anatomically experienced no differently than among individuals.^[285] Charles Revillon, another French physician, supported this view in Recherches sur la cause des affections hypochrondriaques (Paris: Hérissant, 1786), explaining that sudden and unexpected catastrophic events trigger hysteria in the "mob's body" exactly as they do in the individual body. Historically there were—to browse through the century cursorily—the strolling French prophets, or Camizards, in the first two decades; the new alchemists and preachers of the mid-century; the melancholic visionary poets (the Grays, Smarts, Collinses, Cowpers), all of whom suffered some type of religious melancholy and were either incarcerated

in their colleges, like Gray, or in madhouses); to say nothing of the non-religious sects and the spate ranging from Hogarth's comic varieties to Dame Edith Sitwell's gallery of rogues.^[286] Male hysteria coursed down through the century. Whole books could be written about it, deriving much of their information from the pages of popular reviews like the Gentleman's Magazine , one of the most widely circulated outlets of the Enlightenment, British or non-British. For example, the November issue of 1734 recounts a story embellished by the twist of cross dressing. Both the husband and wife have been "hysterically affected," she more acutely than he. More familiar than she with the medical profession, the husband persuades a friend to impersonate a physician, who treats his hysterical wife by prescribing "the simple life." The wife is duped, follows her therapy, and recovers. More common cases reveal afflicted males, prescribed to by bona fide doctors, who do not recover quickly.

By 1775, Hugh Farmer, the dissenting minister who was the friend of Dr. Philip Doddridge and enemy of Joseph Priestley, persuaded his publishers that there was sufficient interest in contemporary male hysteria to resuscitate it in the oldest extant texts. Farmer did so himself in An Essay on the [male] Demoniacs of the New Testament , a work aimed to show how ancient the lineage of inspiration was.^[287] Farmer, like Christopher Smart and William Cowper, had himself been afflicted with a variety of religious melancholies that left him as debilitated as many chronic male hysterics. As a dissenting minister with a parish to look after and duties to attend to, Farmer was utterly uninterested in male license and liberty and, like Smart and Cowper, had maintained a queasy fear of women, especially older, sisterly women who forever rescued him and looked after him. The mindsets of all these figures lie far from the medical theory I discussed earlier, but not so far as to escape its effects. As I continue to suggest here, culture is a large mosaic whose individual pieces do fit together if the historian can only relate them. The English lyric poets, those of the ilk of William Collins and Smart, who were diagnosed male hysterics and melancholics, glimpsed the solipsism of their condition. All they discovered was an omniscient God whose powers of insight they could worship and emulate through their own visionary capabilities.^[288] More broadly though, the greater the resistance to hysteria among men (in that century there was a surfeit of resistance), the more it revealed about their male sexuality in an era growing increasingly patriarchal and fastidious about its sexual mores. All these conditions and individual cases, far-flung and disparate as they are, some more anecdotal than others, presaged the scenario for male hysterics in the nineteenth century.

Still, the preeminent matter of gender in cases more or less hysterical hardly vanished in the second half of the eighteenth century. Granting that both sexes could become afflicted, perhaps in equal degree, profound questions about hysteria's anatomical prefigurements lingered. This is not surprising after centuries in which the feminine gender base had been strengthened by men exorcising hysterical women in need of help. No one to my knowledge has ever attempted to compile a list of eighteenth-century cases by gender.^[289] If it were tried, even on a limited basis, it would be evident that women were said to have become afflicted in far greater numbers. The trend is even reflected in the lamp of imaginative literature. One and only one clearly delineated hysterical figure, for example, appears in Fielding's mock-epic novel Tom Jones : the young Nancy Miller, steeped in love sickness. Given the care with which Fielding is known to have constructed his symmetrical work of heroic proportions, the fact is not insignificant and can be demonstrated with similar results for other writers of the epoch. In Tobias Smollett there are many more: even the male hysteric Launcelot Greaves, a modern British version of Don Quixote, whose "nerves" become damaged from his circulation in a crime-ridden, dangerous environment. Smollett was morbidly fascinated with crime in an almost sociological way. He eventually concluded that it had perpetrated the most heinous attack against the society of his day and formed the bedrock on which chronic diseases like hysteria flourished.^[290]

Provided that medical and nonmedical discourses are gazed at in tandem, and without undue concern for validity in evidence, it becomes apparent that for most of the eighteenth century the nerves, not gender, were the burning issue for hysteria; that is, the nerves in their variegated anatomical, physiological, vivisectional, linguistic, ideologic, and even political senses. In the first published treatise on nymphomania, M. D. T. Bienville's curious work of 1775, there is no distinction whatever in regard to gender, no sense that the irritation or excitation of the genital area specifically is the cause of his new nymphomania.^[291] "Nymphomania," Bienville wrote, arises from "diseased imagination" taking root on the nervous stock, and it could afflict men as readily as women. Perhaps this occurred, in Bienville's view, because both genders had the potential for a "diseased imagination." It is an odd position to maintain, considering that his mind was formed in a world in which the close connection between sex and hysteria was taken for granted. Cases of "erotomania," a fierce and heightened form of erotic melancholy caused by love sickness, were regularly chronicled in the newspapers of the day. Erasmus Darwin, the poet and scientist, had mentioned one severe case

(James Hackman's shooting of Martha Ray), but others were also written up. In all of them, the nervous system had flared out of control as the result of passion. The nerves were the zone Bienville was trying to penetrate in his discourse; the healthy or unhealthy state of the nerves, as well as the anatomic condition of the genital area (morbid, tonic, flaccid, put to use or not, aroused), the determinants. Bienville, a French mechanist about whom surprisingly little is known, ultimately wanted little truck with an underlying mental malady.

Turn the page, so to speak, to more literary annals, and hysteria blends in with other conditions from which its commentators barely differentiate it. Hysteria, hypochondria, melancholy—all are nervous maladies of one grade or another. Sterne's eternally melancholic Tristram may have been, in just this sense, the greatest and most self-reflective male hypochondriac of all the fictional characters of the century. He calls his confessional book "a treatise writ against the spleen," and knows, as his opening paragraph makes plain, that his animal spirits and nervous fibers have been irrevocably mutilated, rendering him a type of male hysteric. This is why he (like so many male patients in the next century) must be "taken out of himself" as it were, through his own hobbies and the hobbyhorses of others. The nervous "tracks" on which "his little gentlemen" traveled during conception have been damaged. But a visit from Tristram to the great "nerve doctors"—the Cheynes, Cullens, and Adairs—would have proved futile: he might as well have sent his manuscript, which is as good a case history of a "male hysteric" as has ever been compiled. Yet Tristram himself might have been shocked to have been tendered this diagnosis. What Sydenham and his medical followers opined about male hysteria and gender at the end of the seventeenth century took decades to filter down to the ordinary person in any sophisticated way. Popular culture was indeed permeated with notions of hysteria, as I have been suggesting throughout this chapter, but Sydenham's views required decades to filter through to other doctors, let alone the lay public. A generation after Laurence Sterne's death in 1768, Edward Jenner, the Gloucestershire doctor and medical researcher into smallpox, was astonished to find himself a member of this filtered class. "In a female," Jenner wrote, "I should call it Hysterical—but in myself I know not what to call it, but by the old sweeping term nervous."^[292] The difference was extraordinarily significant for him.

One of hysteria's other paradoxes was that it was alleged both to afflict males and to safeguard them against it. This was a curious double take seemingly reserved for hysteria, although traces of the incongruity are also found in the theory of gout and consumption at the time. The dou-

ble bind rendered men safe and vulnerable at the same time. How are these theoretical "doubles" explained? Under what framing? If run through the gamut of possibilities, it is seen that gender and patriarchy, power and marginalization alone can explain the double status of hysteria. The nerves have merely been the convenient pawns of a grander landlord. For the professional medical world of the eighteenth century was still preponderantly—as it would be in the nineteenth century and much of our own—a male-centered universe.^[293] William Hogarth's male doctors, "consulting" as they often do in his prints, could not see to what degree they were monolithically set against the few females who appeared in them and were an indirect cause of the very hysterical suffering they claimed they sought to relieve. It is hardly surprising then that the theory of male hysteria between Sydenham and the Victorians revealed what it genuinely was by describing its Other, its Counter, its Double: female hysteria.

Hordes of male doctors, exclusively generating medical theory, now—for the first time—institutionalized female hysteria by claiming that men could be afflicted by it but in actuality rarely were. Whether in Scotland or the West Country, in France or Germany, the results of these gender debates were more or less identical, often derived from one another.^[294] The task then was to demonstrate precisely why women were more prone. But as the uterine debility hypothesis had been overthrown, the most persuasive mode was to argue from so-called incontrovertible universals: women's innate propensity to nervousness; their domestic situation in a private world conducive to hysterical excess; their insatiable sexual voracity granted from time immemorial—these as God-given, inevitable, unchangeable conditions. But all the while it was acknowledged that men were also prone, and proving theoretical consistency by occasionally diagnosing male hysterias and documenting them in the published literature.

Today, we understand the complexity of Enlightenment hysteria only if we are willing to view its paradoxes, its double binds, within large social and cultural contexts, and only if we are capable of conceding that medical theory then was consistent and internally logical so long as doctors were not asked to be held accountable for the cultural conditions in which hysteria flourished. The state of laboratory verifiability and clinical observation of patients in a condition such as hysteria was still small compared to other maladies. A hundred years later, in Freud's Vienna, there would still be debate about the objectivity of the clinician's gaze. What counted for more than objective gaze in the world of Whytt, Cullen, and Jenner was a view of "woman" that naturally—almost preternaturally—seemed to lend itself to the hysteria diagnosis.

XIV

It was not accidental then that treatises on madness began to appear in numbers at the historical moment that resistance set in to the monolithic theories of "the nerve doctors," especially their hysteria diagnosis. This overlap is a complex phenomenon involving theory and practice, as well as social conditions in Western European societies that were becoming more repressive of their poor classes after approximately the mid-eighteenth century. Given the degree to which nerves had earlier been held to account for everything pathological in body and mind the gamut from affections and passions to the wildest imagination—some doctors began to doubt whether this could be so. I refer, of course, to the well-known treatises by the Batties and Monros, the Perfects and Pargeters in the second half of the eighteenth century, who in varying degrees felt ambivalent about nervous diagnosis in relation to perceived lunacy and derangement; in brief, the company discussed by the late Richard Hunter and Ida Macalpine.^[295]

Their collective position permits us to understand how the rival theory of madness developed in relation to the hysteria diagnosis, as well as to comprehend to what degree the hysteria diagnosis had become a barometer of social conditions lorded over by notions of gender—surely a mental zone embracing more than a medical category. The spaces of confinement—madhouses public and private, the clinic, the hospital, prisons of one type or another, attics and closets—are as revealing here as the theory of madness itself. The line between so-called hysterics, female and male, and other types of lunatics was not finely drawn. Incarceration could be ordered for one type as easily as another. There were no specially ordained "hysteria hospitals" (although there were dedicated wards by late century such as the one in Edinburgh). Treatment and therapy for incarcerated hysterics were usually identical to that for other derangements. Furthermore, if the late eighteenth-century madhouse had not yet become the nineteenth-century nervous clinic, there were nevertheless structural similarities in both their methods of diagnosis and applied therapies. But there was one other difference between the diagnoses of madness and hysteria. Unlike the broad base of Enlightenment nervous conditions, madness was not then (in the age of William Battie and A. Monro) a stigma-free organic illness. It was closer to our polluted view of those afflicted with AIDS.^[296]

Stigma was nothing new. It had attached to diagnoses of derangement for centuries. What differentiated it now, in the medical realm of the late eighteenth century, was its new gender lines, often drawn with rank and social class as firmly in mind as any gender base. As Baglivi had pro-

nounced at the turn of the century: "Women are more subject than Men to Diseases arising from the Passions of the Mind."^[297] He and other physicians continued to stress that madness especially afflicted "poor women." Not so hysteria, a female condition said to afflict as many of the rich as the poor and perhaps more.^[298] Nor was madness gendered along the lines it would later be in the nineteenth century, in the decadent world of such subsequent "nerve doctors" as Charcot and Weir Mitchell, nor believed to imitate other diseases (Whytt's "Proteus and the chameleon"). Thus hysteria and madness drifted sharply apart in this dimension: the former deemed by medical professionals to be stigma-free, the latter tarnished by it. But in most other considerations the margins between madness and hysteria were irreparably blurred, and there was as much disagreement as agreement about which of the two diseases was more chronic and lingering. Nor was there much lucidity about, or significant differentiation of, somatic pain in relation to the two conditions. The patients' pain was often thought to be identical in both conditions, affirmed in either state to have been explicitly lodged in an organic site. So in these often contradictory conceptualizations of the late eighteenth century we are actually not far from the radical positivism of late nineteenth-century science and medicine.

One other contrast between lunacy and hysteria cannot be omitted before making the central point about their difference. This is the lunacy that did not announce its pathology through the explicitly acceptable language of organic nervous obstruction but which was said to be something else: hysteria masquerading as lunacy . Hysteria could present both ways—this was one of the features of its protean ability to imitate. And it may have been one reason the proprietors of Bedlam could open its doors to the public "to view the lunatics for a penny," without considering that they were inflicting pain upon patients. This "lunacy that was something else" leads us, moreover, to interrogate the rise of madness in the clear light of the hysteria diagnosis. Fortunately, the point is not so simple as a somatic (bodily) versus psychogenic (mental) hysteria.^[299]

A broad gaze over the eighteenth century buttressd by a cursory bibliographical column makes the point loud and plain. When Thomas Tryon, the neo-Pythagorean guru of health and diet, commented on lunacy in his 1703 Discourse of the Causes of Madness , he was persuaded that madness was still supernaturally induced through possession of devils and spirits, and he harbored no sense of a medicalized, let alone secularized, condition or category. Only one generation later Charles Perry, a licensed physician who traveled widely in the Orient and compiled massive treatises on the Levant, published a treatise On the Causes and

Nature of Madness (1723) claiming that lunacy was a mechanical defect in the nervous constitution, a position echoed for years to come in other works of "mechanical medicine," as in Giovanni Battista Morgagni's Seats and Causes of Diseases . . . (English version 1769). A few years later Andrew Wilson tried to refine the classification of all these conditions, but shortly thereafter William Rowley, another English physician who specialized in "female diseases," jumbled the categories together again in A treatise on female, nervous, hysterical, hypochondriacal, bilious, convulsive disease; apoplexy & palsy with thoughts on madness & suicide, etc .^[300] Rowley's classifications were weak, to say the least. Had he been a student at Edinburgh and listened to the lectures of Cullen and the other professors stressing the importance of classification in medicine, he would not have written as he did, but Rowley was a practitioner, not a theorist, and the intricacies of the female constitution and its maladies were beyond him.^[301] Not a year went by, it seems, without the appearance of some medical treatise aiming to distinguish among these conditions. Over these decades writing continued about the dangers of religious melancholy leading to madness and hysteria, as in John Langhorne's Letters on Religious Retirement, Melancholy, and Enthusiasm (London, 1762) or in the real-life cases of poets such as Christopher Smart, William Cowper, and (some would later say) William Blake.

Wordsworth performed something of a poetic amalgam of these traditions linking religion and hysteria, especially in the strange medical case of Susan Gale, the lonely mother whose intense passion he describes in "The Idiot Boy." Susan's "solitary imagination" lies at the base of her undiagnosed medical condition, just as the medicalized imagination did for so many hysterics examined by Wordsworth's contemporary physicians. Alan Bewell discussed the figure of Susan and "maternal passion" and claimed that the theory of hysteria plays a central role in the poetry of this great Romantic poet. "As a major figure in Wordsworth's mythology of origins," he wrote, "the lonely witch/hysteric provided him with a figural and empirical means for imagining in palpable terms the genesis of language and culture."^[302] These are large claims, but substantiated, I think, by the sweeping role the theory of hysteria played in the European Enlightenment.

But why, one asks, was there a need for a madness diagnosis in the first place if hysteria had been so broad and protean a category since the time of Sydenham that it could embrace most "mad" symptoms? This is the question that must be put if we are to make entry to the world of the nineteenth century, the milieu expounded in chapter 3, by Roy Porter. To restate the matter, where did hysteria and its rival, madness,

stand in relation to gender and the mind/body dilemma (considered separately and in tandem) if there was need for a new condition called madness in the eighteenth century?

There is no simple answer to this all-important question, in itself bound to provoke debate. On one hand, it may be argued that madness was not new in the eighteenth century, and yet even a cursory glance at its discursive representations from 1600 forward shows a sudden outburst of writing in this century. More crucially on the question about gender and the mind/body split, there is no clear-cut division in the late eighteenth century, as I have been stressing, between madness and the hysteria diagnosis. On the other hand—and the adversative is as weighty—the doctors and even their patients clearly have something in mind when they point to the condition of the one or the other. And many readers today will be struck by the fact that Battie's important discussion of madness never refers to hysteria or ever uses the word. No one can read these treatises on madness—by Battie, Monro, and their cohorts—and come away believing one has read a treatise on hysteria. At the same time, and equally paradoxically, the patients' symptoms often presented identically and were described in the same language for both conditions. These are the inconsistencies that must be faced if we are to move into the world of nineteenth-century "nervousness."

When the artist Joseph Farington recorded that his friend, Hone, had "been in a very nervous Hysterical state, the effect of anxiety of mind,"^[303] did he mean hysteria or madness? Across the channel, when French physician Pierre Pomme, who interested himself in few diseases more than nervous ones, published his treatise on "Hysterical Affections in Both Sexes,"^[304] did he mean hysteria or insanity or both? Pomme's boundaries are not drawn. Likewise for other medical writers of varying ranks and abilities. William Falconer's work on hysteria and madness was geared to strengthen the psychogenic bases of derangement by showing how fierce is "the Influence of the Passions upon Disorders of the Body."^[305] So too John Haygarth's treatise Of the Imagination, as a Cause and as a Cure of Disorders of the Body , written only a few years later.^[306] But at the same time Benjamin Faulkner, who owned and operated a private madhouse in Little Chelsea in London, complained that both hysteria and madness had "given birth to endless conjecture and perpetual error."^[307] He was doubtless right, and John Haslam, for two decades an official at Bethlehem, who wrote from long experience in the prison-houses of madness, found himself writing treatises on insanity without invoking hysteria.^[308] Paradoxically, it is as if the two conditions were

identical, yet oceans apart. The lists could be extended many times. Yet the matter is not lists but definition, categories, classification, and—from the patient's point of view—appropriate therapies for each condition.

What then was madness if it was taxonomically bred in the heyday of the hysteria diagnosis? From what need was it sprung? And what had the thousand-year-old hysteria ultimately become if it required the birth of a new malady—madness—to assuage its philosophical and practical defects? Foucault provided no answers in his classic works on madness, and the fault may not be his. Or is it that the late eighteenth-century doctors generating this welter of theory really believed they had discovered some intrinsic difference now lost to time? Can the crux be the massive amount—perhaps too massive—f extant evidence? Anyone can study these early treatises on madness—from Battie to Haslam; in France, from Pomme to Pinel—and explicate them page by page. It is more difficult to pronounce authoritatively on the silences of these discourses, such as the categorical lacuna discovered when William Battie's paradigmatic Treatise on Madness defines madness by refraining from glancing at the concept of hysteria. I am therefore suggesting that we need to study these works, both on hysteria and madness, for their silences as well as their revelations.

In conclusion, there is plenty of evidence to suggest that the Enlightenment nerve doctors conceptualized hysteria as light years away from lunacy, the latter normally conceptualized as a "diseased passion of the mind" often occurring without pathological nervous involvement and without a lingering and chronic madness. Lunacy, madness, insanity: the three are interchangeable terms in their conceptualization—but not so hysteria . Here then is the categorical imperative once again.^[309] For them, hysteria was not a malingering malefactor, but a curable condition of the body's nervous apparatus thrown into convulsion. Hysteria was thus not essentially the inflammation of the reproductive organs unduly excited, as it would again be in the nineteenth century with its retaliative clitoridectomies and antimasturbation techniques, but the nerves laboring under some extraordinary local distress, lesion, or fever.

Still, approximately by the turn of the nineteenth century hysteria was thought to be the more baffling of the two diseases—hysteria and madness—if also the less chronic condition, and now apparently losing ground to a more treatable "insanity." As Whytt had emphasized in Edinburgh a generation earlier with characteristic humility and wisdom, the body's nervous organization, following the laws of sympathy and sensibility, regulates all mind/body traffic. Even so, Whytt had to claim

(following Sydenham who had seen so profoundly into the mysteries of hysteria) that hysteria is entirely unpredictable whereas insanity was not.^[310]

But the discourses on madness, committed as they were to medical materialism, also built mystery into the essence of secularized modern man.^[311] Down through the eighteenth century the Enlightenment nerve doctors had constructed their theoretical edifices on the dualistic model they inherited from a post-Cartesian legacy; as well, they wrote in an intellectual milieu desperate to construct an infallible "science of man"—one as predictable for his or her frail states as strong states. Nevertheless, in generating their versions of hysteria, and then later of madness, they carved out space for man's mystery, enigma, anomaly. The endeavor demonstrated a philosophical tolerance that would serve the nineteenth century well. It also helped to legitimate anomalous, irrational, and enigmatic creatures of both genders as the victims of a medical condition still requiring medical research and authentic classification.

By the turn of the nineteenth century the male nerve doctors had palpably defeminized and dehumanized their female lunatics, often recording their case histories as if these mad patients were "unisex": conflating female and male discourse into a new version. Pinel, for all his well-deserved reforms in Paris, was the odd man out. "Ur-Enlightenment" and humanitarian figure that he was, he also displayed the most unusual versions of compassion and sympathy for his patients. But even Pinel could not resolve the definitional disputes on the boundaries of the two conditions, hysteria and madness, nor did he try.^[312] In the flow of theory, female lunacy was said to imitate male, a position as old as genesis itself, and just as female voices were recorded in the terms and tropes of the male, no different from the protean imitations hysteria had performed.

As hysteria had imitated virtually every other disease, according to Sydenham and Whytt, now, at the end of the eighteenth century, the case histories of women's derangement resembled those of men. It was an odd form of representation, no less baffling than all philosophical mimesis.^[313] But women not only lost their sexual identity, they even lost the voice—the expressive voice—presiding over their collective discourse. The reason and control of the "mad doctors" burned feminine unreason out of the medical annals of the late eighteenth century, so much did the doctors fear it. Instead, they replaced it with a logic and language of their own: a male grammar and syntax that prevailed up to the time of Josef Breuer and Freud. Our contemporary American feminists have enlightened us here—as Mary Jacobus and Juliet Mitchell

have so convincingly written—when cautioning that "women's writing can never be anything other than hysterical."^[314] We can almost reconstruct the position from the social vantage of the last two centuries by gleaning how inevitable it was that women would eventually retrieve the pathetic voices they had lost. No wonder that in our own time hysteria's "his-story" (history) has been transformed into "her-story": the retrieval of a grammar and syntax long suppressed as much as any set of diagnoses and therapies.

To return to the world of Enlightenment hysteria as it approached the turn of the century, not until William Cullen, near century's end, did the womb reappear, and then just momentarily, only to be discredited once again. Cullen's bizarre implication of the womb clung firmly to a somatic etiology, and in this sense it may be said to have had a temporary retarding effect. He not only invoked the hysterical womb but linked it to nervous conditions and the class he called "neuroses," claiming in First Lines of the Practice of Physic (1777), as had Sydenham and others before him, that hysteria was the most "protean of all diseases." "The many and various symptoms," he wrote, "which have been supposed to belong to a disease under this appellation, render it extremely difficult to give a general character or definition of it." But Cullen's explanation retains some of the mystery of hysteria in ways that had been lost on his less enlightened colleagues in Edinburgh and elsewhere. He gazed deeply into women; he understood their anatomies as well as neuroses (a word he virtually coined and made his own).^[315] He somehow gathered that the constant redefinition of hysteria's cause from the Renaissance to his own time was ultimately consistent with the socioeconomic developments he witnessed around him: in rank, class, and economic means. His version of hysteria was as sociological as Sydenham's, and it captured the age-old counterpoint of endorsing and rejecting the womb etiology that had been in vogue from the time of Hippocrates.

Au fond there is something unique to women and implicitly powerful, if destructively so, in the idea of the raging womb compared to the much tamer and vaguer notion that women have "inherently weak" nervous systems merely because of inferior "inner spaces."^[316] But even at that time, in the 1770s and 1780s, Cullen's strong paradigm about hysteria and neurosis took shape within the contexts of a developing rival theory of madness. Another chapter would be necessary to chart with clarity and precision its overlaps with hysteria. Yet rank and class never lurked very far behind these considerations of the role of gender in hysteria and madness. Now, in a European world that would soon be plunged into the night of chaos and political anarchy, both medicine and culture

conspired to rob the middle nouveau riche of its newest and most fashionable garb: nervous affliction. If the poor could be hysterical, as they were in Edinburgh, what was left for the "mad rich in London and Paris"? The pattern appeared to be global and local at once—as paradoxical in this sense as the gender-bound nature of the actual hysteria. Throughout Europe, nerves signified one thing preeminently: rank and class. What differed from place to place, locale to locale, were the forms of social control and patriarchal expression of the nerves. To these disparities, the medicine of the time was almost entirely oblivious and insensitive, and nothing proved it more than the prolific treatises on hysteria and madness. Meanwhile, the doctors churned out their vast collective annals of hysteria diagnoses, one of the largest in the medico-historical literature.

XV

In conclusion, I have been suggesting that the history of hysteria is essentially a social history. Even in the periods privileged here—the Renaissance and the Enlightenment—class structures were clearly falling apart in England by the 1760s (one thinks of the Middlesex riots, which were little more than the mass hysteria of the mob). Under this new class stress, gender and sex were further constrained, and slowly, very gradually, the onset of what would become, when full-grown and full-blown, Victorian prudery set in.^[317] But mass hysteria also needs to be considered within its sociopolitical contexts. For example, a case can be made that the onania crusades—the antimasturbation campaigns—of the eighteenth century manifested themselves in social forms that amounted to mass hysteria. The drive to blot out all masturbation as the road to insanity was in part a grass-roots movement; it was also abundantly discussed in the popular writings of Samuel Auguste Tissot, the prolific Swiss doctor who made "anti-masturbation" the centerpiece of his voluminous works, a chapter in social history that has now been retrieved by Roy Porter. The remarkable aspect of this sweeping manifestation of mass hysteria is the degree to which everyone then was persuaded of the evils of masturbation: hardly a voice in the long eighteenth century dared to cry out in favor of masturbation. A phenomenon merely "in the air" of a former culture (the Renaissance or the Enlightenment) may be difficult to retrieve, but it is not so when thousands of words have been expended on it, as was the case regarding onania. Regency and Victorian repression of sexuality, and other nineteenth-century versions on the Continent,

are unthinkable without the social upheaval created by the antimasturbation crusades extending over many decades in the eighteenth century.

The process created a new bourgeois repression of sexuality in late eighteenth-century England, and property, the law, consumer consumption, and finances all combined to make woman's lot worse than it had been in the Renaissance—not worse in any absolute sense but worse in relation to desire and expectation. But the role of shame and shaming in hysteria must also be considered. Those extraordinary nerve doctors from Willis to Cheyne, Whytt to Cullen, who found a clear organic substrate, safeguarded their patients against the charges that brought shame: the notion that they were poorhouse malingerers who had feigned these symptoms to improve their sad economic condition. By contrast, early eighteenth-century nerve doctors tended to indict cultural volatility as the culprit in hysteria and hypochondriasis. Luminous literati and salon sophisticates were victims of vertiginous life-styles said to enervate the nerves and sap their tonic strength. These nerves had not been originally defective at birth; they became so through high living under the new urban and suburban stress. By the late eighteenth century the poor had filtered up, and now they too were being victimized in this new recension of the disease. The effect of economic shoring, of aping the rich without the resources to do so, clearly had its nervous consequences. Long before Robert Carter wrote about workhouse hysterics from a psychogenic point of view that cast them in a bad light,^[318] others in late eighteenth century had developed a similar angle of explanation. In Scotland the hinge was social rank, as the poorer the woman, the more hysterical—and pathetic—her case was adjudged to be.

Ironically, what Cullen and his cohorts saw in Scotland and England, Mesmer did not see in France. Veith credited Mesmer as a hero within the history of hysteria for reasons that misinterpret his works and inflate his hypnotism. She hails Mesmer as of towering importance to the cracking of the hysteria code, on the grounds that his demonstration of the capacity of hypnosis to control the body through tapping unconscious mental networks ultimately bore fruit in psychogenic theories of Char-cot's France and Freud's Vienna.^[319]

Yet Mesmer never contended that the origins of his patient's hysterias were psychological, nor did he tout his own capacity to work cures through mental suggestion. He is not the harbinger of an internal millennium of the psyche, but of a poised nervous system vulnerable at every turn. Pace Veith, but this is as flawed an interpretation of Mesmer as is the notion that his contemporary, Emanuel Swedenborg, the ardent post-Newtonian mystic, was more mystic than scientist, which no reading

of his works can substantiate. Mesmer was as staunch in his Newtonian-ism as the British iatromechanists, forever maintaining that animal magnetism was a physically grounded, etherial fluid coursing through the cosmos, possessed of the capacity, when properly funneled through the afflicted, to relieve illness-causing obstructions.^[320]

When Louis XVI's investigating commission denied the reality of such a material substance, concluding that Mesmer actually performed his cures by the use of raw "imagination," such undercutting of his claims to a material substratum punctured his credentials and ruined his aspirations. Hysteria in the French Revolution is, of course, an immensely difficult subject because it blends so cunningly into other radically misogynistic behaviors, including the cataloging of egregious acts committed by women from the beginning of French history. It may be that such extreme antifeminism was itself a display of the mass hysteria on which I have commented at different points in this chapter, and that as the 1790s evolved, retrogression rather than progress occurred in this patriarchal society.^[321]

Even so, the long-term student of hysteria before, and beyond, Freud wants, of course, to compare this Mesmerian agenda with Freud's. A century later, it was the failure of hypnotism that initiated Freud's passage from an organic to a psychogenic etiology of hysteria. But there is no evidence that Mesmer, any more than Swedenborg, regarded his theories of nervous disorders and their therapies as grounded in anything other than Newtonian matter theory. So too the notorious Marquis de Sade, although under rather different ideological conditions and in different genres. The Sade whose women are told by their hedonistic instructors that "they are their anatomy"; the Sade whose first principle and holy gospel is not a latter-day Cartesian mind/body relation but a physics of pleasure and pain;^[322] this Sade also possesses a notion of hysteria that is much more organic than psychogenic.

The powerful idiom of the nerves receded very slowly in the nineteenth century, as did the organic basis of disease. This is one reason that, in England, Regency and even Victorian treatises on hysteria often resemble, or seem to be variations on the theme of, Enlightenment hysteria: an old malady with a familiar ring. The nineteenth-century neurasthenic patient—as Roy Porter and Elaine Showalter demonstrate in chapters 3 and 4—remains forever on the verge of nervous collapse, weakened by nervous debility, with atonic nerves, spirits, and fibers that require strengthening above all. Restore the eighteenth-century capitalizations and syntax, and one has not moved very far from the world of Mandeville and Monro, Cheyne and Cullen, Willis and Whytt. This

will not change until the psychogenic theory and etiology of hysteria overtake the organic in the late nineteenth century. And even then, the riddle of "the elusive disease" will continue to be, as it has been in our century, hysteria's inescapable organic resonances.

It is not my place in this chapter to poach in the groves of Charcot. But viewing Charcot in reverse anachronism—for example, from the perspectives of Sydenham and Mesmer—helps to expound what will be at high stake in the world of hysteria anatomized by Roy Porter and Elaine Showalter. Like Sydenham and Mesmer—even Swedenborg and Blake, to select more extreme examples—Charcot has been more misunderstood than understood in relation to hysteria. A spiritual brother of Sydenham, Charcot wanted hysteria to be the most universal of all diseases—but with this difference. Sydenham had observed it to be the most universal and protean, independent of his own ideological gain, but he had not wished it so; Charcot willed it because it legitimated his own scientificity, and no sense is made of his theory of hysteria without viewing it within the visual perspectives of the age and the broad contexts of his own life, as his biographers and best students have now shown.^[323]

The leap between Sydenham and Charcot is also maximal in other ways. The positivists among Charcot's circle rejected the old Aristotelian view of pain as an emotion. Current medical knowledge, since the late eighteenth century, had identified pain with organic lesions in, and constrictions of, the nervous system. Women who complained of chronic pain that could not be located in the nervous system ran the risk of finding themselves classified as hypochondriacs suffering from imaginary illnesses. What had presented itself to the Greeks as a fiery animal, an overheated, labile, voracious, and raging uterus, was now, in Charcot's world, diagnosed as a sexually diseased and morally debauched female imagination. The progress of the hysteria diagnosis from 1750 to 1850 had now been completed, and novelist Samuel Richardson's lighthearted precept about "every woman being a rake at heart"—put forward by Mrs. Sinclair's female debauches in Clarissa Harlowe —had come round full circle in Charcot: from the Greeks to the Victorians. Woman's generative organs had given her this capability, in the ancient world as well as the Victorian. Nowhere would this diseased female imagination—perceived to be cunning and artful as well as deceitful—present itself more grotesquely than in the hysterical females seen by Briquet, photographed by Charcot, and fictively imagined by novelists such as Dickens in Little Dorrit in the figure of Flora, the diminutive child-wife forever in a hysterical swoon.^[324]

Perhaps this is why—but in part only—the early nineteenth-century

novel is so heavily permeated with tyrannical husbands and child-wives on the verge of madness, only to be locked up in dingy attics by their husbands where they hallucinate, like Charlotte Perkins Gilman, imprisoned by her doctors and her yellow wallpaper. All point to a conception of hysteria whose most revelatory dimensions remain its basis in gender and social class power and control.

The complex story of the medical, scientific, ideological, political, and patriarchal way the nineteenth century crafted hysteria before Freud as an exclusive province of upper-class male physicians remains to be told.