68 PROCEEDINGS OF THE CANADIAN INSTITUTE. 



of spinal action." He further remarks that the physiologist may 

 produce the same condition in three ways : (1) by exaggerating the 

 excitability of the spinal system by irritation of the centripetal 

 nerves; 2) by exaggerating directly the action of the cord itself; 

 and (3) by suppressing the functions of the brain. 



These three conditions have each their pathological analogies, and 

 they contain in themselves the totality of the pathogenic conditions 

 of hysteria. Whatever has been the causation of this malady* 

 he further says, we have always these two fundamental elements 

 united, viz. : (1) the weakening of cerebral action, especially that 

 of the will, and (2) the exaggeration of the automatic or spinal 

 action (hyperkinesie spinale). 



Thus we see that in these hysterical patients we have emotional 

 subjects who are readily impressed by whatever may affect the 

 sympathetic system, in other words, who are ruled too frequently by 

 the emotions and too seldom by the will, — or as M. Jaccoud so well 

 expresses it : " There is at least temporarily present a cerebral 

 paresis." Now physiologically what does this mean 1 It must mean, 

 if we adhere rigidly to the belief that the more or less complete 

 abeyance of functional activity in a part is necessarily dependent 

 upon a corresponding temporary absence of force-producing materials 

 in the part, and, so far as we know, this means arterialized blood. 

 For instance, pallor is an anaemia of the capillaries of the skin ; 

 while we have, unfortunately, too many examples showing that the 

 functional activity of an arm or leg depends directly upon its nutri- 

 tion. Moreover, our best authors give among the causes of hysteria, 

 loss of blood, prolonged lactation, &c. The first of these shows 

 that other than purely female disorders may be causes of this malady, 

 i. e., hysteria may occur in delicate and impressionable males as well 

 as in females. 



In claiming the anaemia theory as explaining these states I am 

 perfectly well aware that there are some authorities, notably Brown. 

 Sequard, who are opposed to it as being in many cases a sufficient 

 explanation of either hysteria or epilepsy. I find in notes taken from 

 his lectures on the peripheral irritation of nerves, that his explana- 

 tion of these pathological conditions is not on the supposition of any 

 slow or sudden unequal distribution of blood to the brain, but that 

 he considers the attacks essentially due to reflex action from peri- 

 pheral sensations creating impressions upon the brain centres. Then 



