The different phenomena presented by the symptoms of hypnotism may either exist separately or occur associated in a certain order. Charcot and his pupils have observed that in hysterical subjects these symptoms tend to fall into three distinct groups. We think it well to give here a summary of Charcot's nosographic essay.*
"Attempt to make a nosographic distinction of the different nervous states known under the name of Hypnotism.
"The numerous and varied phenomena which are observed in hypnotic subjects do not occur in one and the same nervous state. In reality, hypnotism clinically represents a natural group, including a series of nervous states, differing from each other, and each distinguished by peculiar symptoms. We ought, therefore, to follow the example of nosographists in endeavouring to make a clear definition of these different nervous states, accord-
ing to their generic characters, before entering on the closer study of the phenomena presented by each of them. It is owing to not having begun by defining the special state of the subject under observation that observers so often misunderstand and contradict one another without sufficient cause.
"These different states which, taken as a whole, include all the symptoms of hypnotism, may be referred to three fundamental types: 1st, the cataleptic state; 2nd, the lethargic state; and 3rd, the state of artificial somnambulism. Each of these states, including moreover a certain number of secondary forms, and leaving room for mixed states, may be displayed suddenly, originally, and separately. They may also, in the course of a single observation, and in one subject, be produced in succession, in varying order, at the will of the observer, by the employment of certain methods. In this latter case, the different states mentioned above may be said to represent the phases or periods of a single process.
“Setting aside the variations, the imperfect forms, and the mixed states, we do not propose in this account to do more than indicate briefly the general features of these three fundamental states, which may be said to dominate the complex history of the symptoms of hypnotism.
"1. The Cataleptic State. — This may be produced: (a) primarily, under the influence of an intense and unexpected noise, of a bright light presented to the gaze, or, again, in some subjects, by the more or less prolonged fixing of the eyes on a given object; (6) consecutively to the lethargic state, when the eyes, which up to that moment had been closed, are exposed to the light by raising the eyelids. The subject thus rendered cataleptic
is motionless and, as it were, fascinated. The eyes are open, the gaze is fixed, the eyelids do not quiver, the tears soon gather and flow down the cheeks. Often there is anaesthesia of the conjunctiva, and even of the cornea. The limbs and all parts of the body may retain the position in which they are placed for a considerable period, even when the attitude is one which it is difficult to maintain. The limbs appear to be extremely light when raised or displaced, and there is no flexibilitas cerea, nor yet what is termed the stiffness of a lay figure. The tendon reflex disappears. Neuro-muscular hyperexcitability is absent. There is complete insensibility to pain, but some senses retain their activity, at any rate in part — the muscular sense, and those of sight and hearing. This continuance of sensorial activity often enables the experimenter to influence the cataleptic subject in various ways, and to develop in him by means of suggestion automatic impulses, and also to produce hallucinations. When this is the case, the fixed attitudes artificially impressed on the limbs, or, in a more general way, on different parts of the body, give place to more or less complex movements, perfectly co-ordinated and in agreement with the nature of the hallucinations and of the impulses which have been produced. If left to himself, the subject soon falls back into the state in which he was placed at the moment when he was influenced by the suggestion.
"2. The Lethargic State. — This is displayed: (a) primarily, under the influence of a fixed gaze at some object placed within a certain distance of the eyes; (b) in succession to the cataleptic state, simply by closing the eyelids, or by leading the subject into a perfectly dark place.
"At the moment when he falls into the lethargic state, the subject often emits a peculiar sound from the larynx, and at the same time a little foam gathers on the lips. He then becomes flaccid, as if plunged in deep sleep; there is complete insensibility to pain in the skin, and in the mucous membrane in proximity with it. The organs of the senses sometimes, however, retain a certain amount of activity; but the various attempts which may be made to affect the subject by means of suggestion or intimidation are generally fruitless. The limbs are relaxed, flaccid, and pendent, and when raised they fall back again as soon as they are left to themselves. The pupils are, on the other hand, contracted, the eyes are closed or half-closed, and an almost incessant quivering of the eyelids may usually be observed. There is an exaggeration of the tendon reflex; neuro-muscular hyperexcitability is always present, although it varies in intensity. It may be general, extending to all the muscles of the animal system, the face, the trunk, and the limbs; and it may also be partial, only present, for instance, in the upper limbs, and not in the face. This phenomenon is displayed when mechanical excitement is applied to a nerve-trunk by means of pressure with a rod or quill; this causes the muscles supplied by this nerve to contract.
"The muscles themselves may be directly excited in the same way; somewhat intense and prolonged excitement of the muscles of the limbs, trunk, and neck produces contracture of the muscles in question; on the face, however, the contractions are transitory, and do not become established in a state of permanent contracture. Contracture may also be produced in the limbs by means
of repeated percussion of the tendons. These contractures, whether produced by excitement of the nerves or muscles, or by percussion of the tendons, are rapidly relaxed by exciting the antagonist muscles. As it has been already said, the cataleptic state can be instantaneously developed in a subject plunged in lethargy, if while in a light room the upper eyelids are raised so as to expose the eyes.
“3. The State of Artificial Somnambulism. — This state may, in some subjects, be immediately produced by fixity of gaze, and also in other ways which it is not now necessary to enumerate. It may be produced at will in subjects who have first been thrown into a state of lethargy or catalepsy, by exerting a simple pressure on the scalp, or by a slight friction. This state seems to correspond with what has been termed the magnetic sleep.
"It is difficult to analyze the very complex phenomena which are presented under this form. In the researches made at the Salpêtrière, many of them have been provisionally set aside. The chief aim has been to define, as far as possible, the characteristics which distinguish somnambulism from the lethargic and cataleptic states, and to demonstrate the relations which exist between it and the two latter states.
“The eyes are closed or half-closed; the eyelids generally quiver; when left to himself the subject seems to be asleep, but even in this case the limbs are not in such a pronounced state of relaxation as when we have to do with lethargy. Neuro-museular hyperexcitability, as it has been defined above, does not exist; in other words, excitement of the nerves or of the muscles them-
selves, and percussion of the tendons, do not produce contracture. On the other hand, various methods, among others, passing the hand lightly and repeatedly over the surface of a limb (mesmeric passes), or, again, breathing gently on the skin, cause the limb to become rigid, but in a way which differs from the contracture due to muscular hyperexcitability, since it cannot, like the latter, be relaxed by mechanical excitement of the antagonist muscles; it also differs from cataleptic immobility in the resistance encountered in the region of the joints, when the attempt is made to give a change of attitude to the stiffened limb. To distinguish this state from cataleptic immobility, strictly so called, it is proposed to distinguish the rigidity peculiar to the somnambulist state by the name of catalepsoid rigidity; it might also be called pseudo-cataleptic.
“The skin is insensible to pain, but this is combined with hypersesthesia of some forms of cutaneous sensibility, of the muscular sense, and of the special senses of sight, hearing, and smell. It is generally easy, by the employment of commands or suggestion, to induce the subject to perform very complex automatic actions. We may then observe what is strictly called artificial somnambulism.
“In the case of a subject in a state of somnambulism, a slight pressure on the cornea, made by applying the fingers to the eyelids, will change that state into a lethargy accompanied by neuro-muscular hyperexcitability; if, on the other hand, the eyes are kept open in a light room by raising their lids, the cataleptic state is not produced."
We ought to add that this description is made from
nature, and that the Salpêtrière nearly always furnishes patients in whom it is easy to observe these three states, with all their characteristics. In order to observe these states in a new subject, the conditions laid down by the Salpêtrière school must be observed. These two conditions have been already noted by us: (1) The experiment must be tried on the same kind of subject, that is, on one aflFected by epileptic hysteria; (2) the same mode of operation must be used, that is, by the simplest processes — by fixity of gaze, pressure on the scalp, the electric spark, etc. Any change effected in one of these two conditions alters the experiment and consequently modifies its results.
It must be admitted that even in the case of subjects affected by epileptic hysteria, results differing from those of Charcot will be obtained if the patients are subjected to a different modus operandi; if, in other words, they do not receive the same hypnotic education.
We have often been struck by this fact in the course of our researches, and it has appeared the more significant to us, since our experiments have been made on subjects resembling those who served to establish the theory of the three states. We give some examples. It is not, as might be supposed, a necessary symptom of catalepsy that the eyes should be open. We have observed that if hemi-catalepsy and hemi-lethargy are produced, and these hemi-states are then transferred, half of the body becomes cataleptic, although the eye belonging to that half remains shut. Catalepsy with closed eyes may, therefore, exist in profound hypnotism. So, again, it is possible to throw the same subjects into a deep lethargy, in which no trace of neuro-muscular hyperexcitability remains.
We have ascertained that when a magnet is brought near to the arm of a subject in a natural sleep, or to the scalp of a subject in the, lethargic state, a new state is produced which has nothing in common with the lethargy described above except the relaxed state of the muscles; mechanical excitement of the nerves, muscles, and tendons, and pressure on the hypnogenic or hysterogenic zones, produce absolutely no effect. No change occurs when the eyes are forced open, the breathing is imperceptible, and there is complete insensibility; it is, in fact, the image of death. Pitres * had the opportunity of observing a case of equally profound lethargy in a patient who was subject to spontaneous attacks of sleep. When one of these attacks came on while he was in a lethargy accompanied by hyperexcitability, this phase of hypnosis became more profound, and all muscular reaction disappeared. Finally, as we have already remarked, neuromuscular hyperexcitability is not a symptom peculiar to lethargy; in cases of profound hypnotism, contractures may be produced in the waking state, corresponding in all respects to those of lethargy.
These facts only prove that the general symptoms of profound hypnotism may be incomplete or modified, and this is also the case with all other morbid symptoms.
The number of states or periods may also vary in the case of each subject. Speaking generally, there are three states — lethargy, catalepsy, and somnambulism; but this number is not fixed. Dumontpallier and his pupils demonstrated some time ago, and any one may verify the fact for himself, that there are transitional stages between each of these periods, really mixed states, which
* Des Zones hypnogènes, p. 65.
the experimenter may make permanent by the employment of appropriate means. In this way from six to nine new states may be created, or even a greater number. It is probable that the invention of new experimental processes, subjecting hypnotic patients to fresh modes of excitement, would lead to the production of entirely new manifestations, differing from those which have been described up to this time. In fact, hypnosis is not a spontaneous neurosis, but an experimental nervous state, of which the symptoms may vary with the processes which give rise to it, while, however, still falling within the limits of the general physiology of the nervous system.
We should misunderstand Charcot's description if we regard it as a systematic work. The only object of the description was to represent hypnosis in all its forms and details. It must not be forgotten that at the time it was made, he wished to establish the real existence of a certain number of hypnotic phenomena, and to demonstrate the existence of an experimental nervous state by such strongly marked characters as to be obvious to every one. Charcot selected subjects in whom these characters were displayed in an exaggerated form which left no room for doubt. This method was perfectly successful, since even those who were unwilling to accept profound hypnotism, were led to study its less developed forms.
The theory of the three states, therefore, only includes one part of the truth, but it is a part which opened the way to all the researches subsequently made upon the question, and even now profound hypnotism is the only state in which we find such objective characters
as to limit the field of discussion. It is the object of the Salpêtrière school, not so much to give a definitive description, as to show that hypnotism may be studied in accordance with the most improved processes of clinical science and experimental physiology, and that the science can only be constituted by means of the characters determined by this mode of study. As long as patients affected by acute hysteria exist, most of the results obtained by the Salpêtrière school may be verified.
The history of profound hypnotism serves as an invaluable guide in threading our way through the confused mass of observations which are not included in this form of neurosis.