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Microhistories of
Technology
Making the World
Mikael Hård
Palgrave Studies in the History
of Science and Technology

Series Editors
James Rodger Fleming
Colby College
Waterville, ME, USA

Roger D. Launius
Auburn, AL, USA
Designed to bridge the gap between the history of science and the history
of technology, this series publishes the best new work by promising and
accomplished authors in both areas. In particular, it offers historical per-
spectives on issues of current and ongoing concern, provides international
and global perspectives on scientific issues, and encourages productive
communication between historians and practicing scientists.
 Mikael Hård

Microhistories
of Technology
Making the World
Mikael Hård
Institute of History
Technical University of Darmstadt
Darmstadt, Germany

ISSN 2730-972X     ISSN 2730-9738 (electronic)

Palgrave Studies in the History of Science and Technology
ISBN 978-3-031-22812-4    ISBN 978-3-031-22813-1 (eBook)
https://doi.org/10.1007/978-3-031-22813-1

© The Editor(s) (if applicable) and The Author(s) 2023. This book is an open access
publication.
Open Access This book is licensed under the terms of the Creative Commons Attribution
4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits
use, sharing, adaptation, distribution and reproduction in any medium or format, as long as
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 Preface

As a young doctoral student in the 1980s, I was convinced that the history
of the nineteenth and twentieth centuries could best be understood via
concepts like industrialization, urbanization, and rationalization. The
research sources I used for my PhD dissertation included engineering for-
mulae and technical drawings. And there was no doubt in my mind that
Sigfried Giedion had summarized modern history in the three-word title
of his most famous book: Mechanization Takes Command. Only later did
it dawn on me that history is much more complex, and frequently contra-
dictory. In time, I understood that the past cannot be reduced to one-­
dimensional processes such as mechanization.
When, two decades later, my focus shifted from Europe to other parts
of the word, I began working with another one-dimensional concept: glo-
balization. In standard historical narratives, globalization has been por-
trayed as an unstoppable force that flattens all obstacles in its path; modern
technology is usually seen as globalization’s constant companion. For
example, in the second half of the nineteenth century, steamships, tele-
graph lines, and Gatling guns are said to have paved the way for colonial-
ism, one of the defining phenomena of that time in history. Another
example: During the second half of the twentieth century, shipping con-
tainers and computer networks purportedly pushed the world further in
the direction of globalization.
Increasingly uneasy with such overarching, macrohistorical interpreta-
tions, I asked myself if a microhistorical approach might help us see the
world from a new angle. What if we were to tell stories from “below”

v
vi Preface

rather than from “above”—focusing on ordinary people and their experi-

ences rather than anonymous structures? After all, peoples in Asia, Africa,
and Latin America have created their own forms of material culture and
used imported technologies in different ways. An even more exciting pros-
pect: Could research on the Global South help to transcend received
notions of history? Could this investigation contribute to new paradigms
in the field of history of technology—beyond simplistic notions like tech-
nology “diffusion” and “transfer”? These are the questions which guided
me when conceptualizing this book.
To view Western technology as an invincible juggernaut is to leave no
room for local initiatives and culturally specific technologies. It is time to
question assumptions about ever-increasing global uniformity. After all,
the world displays wildly divergent technologies. Rather than seeking uni-
versal solutions—let alone pushing for them—we need to acknowledge
the varied technologies made by human beings across the world. As a
historian leading an international team of researchers in a project called
Global-HoT (A Global History of Technology, 1850–2000), my contri-
bution to this endeavor is to uncover and recount representative microhis-
tories—rather than to perform macroanalyses. In this book, we have
gathered stories of how people in various corners of the world challenged
the production techniques and products brought by globalization.
Exercising their autonomy and freedom, creative people from all walks of
life selectively modified, adopted, or rejected modern machines, tools, and
gadgets. The spread of so-called modern technologies did not erase arti-
sanal production methods and traditional tools. Often, the new and the
old coexisted. Cultural encounters between the Global North and the
Global South have given rise to countless innovative solutions, many of
which have gone unnarrated.
By emphasizing the richness of material cultures beyond Europe and
North America, the team and I illustrate that Western societies do not
have a monopoly on novelty. And by bringing to light the technologies of
skillful people around the globe, we show how inventive individuals and
groups have shaped their lives and their communities. Each chapter in this
volume demonstrates how tenacious people have used traditional, “home-
made,” and hybrid technologies, maintaining autonomy in a world of cor-
porate systems and global networks.
The global history of technology cannot be reduced to tracing the
transfer of technologies “from the West to the rest.” On the contrary, we
need to embrace the complex reality that local tools and methods have
survived despite the onslaught of globalizing forces. In many cases, to
 Preface  vii

meet their needs, indigenous populations creatively combined local tools

and methods with modern ones. By redefining “technological develop-
ment” to include the daily practice of people in various cultural settings, I
hope to more fully inform readers of the history of human ingenuity.
The title of this book, Microhistories of Technology, is deliberate in its
plurality and in its reference to being a collection of singular stories. These
microhistories were crafted with the aim of unraveling the peculiarities of
each regional technological landscape; at the center of each story are the
specific knowledge and skills inherent in each local material culture. For
example, inhabitants in Northern India employ various technologies,
which may be called indigenous or imported, Western or Eastern, modern
or traditional. Within this range of possibilities, the combination of solu-
tions each group uses is place- and time-specific; in every case, the user’s
world is singular.
I chose the subtitle of this book to suggest its connection with
Consumers, Tinkerers, Rebels: The People Who Shaped Europe, a book I
coauthored with Ruth Oldenziel and published in 2013—as part of the
Palgrave Macmillan book series Making Europe: Technology and
Transformations, 1850–2000. In contrast to that book and my earlier
works, this volume focuses on the interactions of individuals and groups
with technology in the Global South, as well as in Central and East Asia. I
highlight the practices, struggles, and aspirations of peoples in Africa, Asia,
and Latin America. I also apprise readers of the many myths and prejudices
typically associated with imperial powers, globalizing forces, and develop-
ment policies. In doing so, I hope to expand on the new body of literature
that examines technology’s complex and nuanced role in the modern
world. My goal—and indeed the goal of the Global-HoT team—is to
inspire readers to rethink the relationship between Western and non-­
Western material culture.
It has been a pleasure to write this book, and it has been a privilege to
discuss its findings with colleagues from so many parts of the world. I have
enjoyed the opportunity to craft narratives that bring to the fore previ-
ously unknown artisans and marginalized individuals. Some of the actors
in this book are local technicians and craftspeople who learned to adapt
“foreign” technologies to their own—and their communities’—needs.
Others are villagers and “slum” dwellers who singlehandedly made prod-
ucts to sell locally. Still others are people who made their own products in
an effort to retain their freedom of choice in a world increasingly domi-
nated by commercial consumer goods. Although local and “micro,” these
people’s stories deserve to be told.
 Acknowledgments

This book is the outcome of a collective effort. That said, the cover of this
book cites my name as the sole author. Indeed, I wrote all the chapters,
and I take full responsibility for any and all mistakes in the text. However,
the material herewith is based on research that I and other scholars con-
ducted within the framework of the research project “A Global History of
Technology, 1850–2000” (Global-HoT). This five-year undertaking
began in 2017, and it has been generously funded by the European
Research Council as a part of the Research and Innovation Program
Horizon 2020 of the European Union (ERC Advanced Grant No. 742631).
This research grant has also paid for language editing and open-access
publishing. My writing has also benefited from intense interaction with
fellows of the PhD program “Urban Infrastructures in Transition: The
Case of African Cities,” which was financed by the Hans Böckler
Foundation from 2014 to 2019 (Promotionskolleg PK039). In addition, it
would not have been possible to carry out the foundational work for the
book if I and my colleagues had not received dedicated support from the
Technical University of Darmstadt (TU Darmstadt), a public institution
of the German State of Hesse. I acknowledge the central-administration
staff members of TU Darmstadt, the university library, and my long-time
secretary, Iris Ohlrogge. Simon Bihr helped me and the rest of the ERC
team to solve all kinds of IT-related problems.
Indeed, it would be presumptuous for anyone to claim to singlehand-
edly write a truly global history of technology; close collaboration with
researchers from various continents is a requirement. Members of the

ix
x Acknowledgments

research clusters mentioned above contributed empirical material, their

language skills, and their competence in communicating cultural phenom-
ena. These collaborations have yielded scanned archival material from dis-
tant archives and extensive references to secondary literature. The material
in this book has also benefitted enormously from critical and creative semi-
nar discussions that took place under the auspices of the European
Research Council project and the Böckler program. This exchange and
these discussions have taught me to constantly question—and correct—
my own perspective, my worldview, and my implicit prejudices.
I have conducted primary research in archives and libraries in the
United Kingdom, India, and East Africa; my colleagues have carried out
primary research in many European countries, South America, East and
West Africa, and various parts of Asia. Twelve of the eighteen members of
the research team grew up in countries outside Europe and are fluent
in local languages, which include Kiswahili, Uzbek, Korean, Bengali, and
Arabic. Most of the researchers have been PhD students or postdocs at
TU Darmstadt; others have been associated with Global-HoT on a con-
tractual basis or as assistant researchers.
In terms of the researchers who have contributed to this book, I thank
Alejandra Osorio Tarazona, who provided me with literature and sources
for the chapter on cooking in South America. Some of the cookbooks
quoted in that chapter come from her personal collection. In addition,
Alejandra explained the intricacies of various cooking techniques as well as
particular Peruvian and Argentine recipes and ingredients. Alejandra also
helped me to better understand the specifics of South American material
culture.
Youngju Lee has been another invaluable contributor to this book.
Without Youngju’s assistance, it would have been impossible for me to
recount the history of menstruation techniques in South Korea. Youngju
was also kind enough to give me access to interviews she had conducted
with women in South Korea. Our discussions broadened my knowledge of
East Asian history in general—and modern Korean history in particular.
For the chapter on precolonial and colonial West Africa, I benefited
enormously from groundwork carried out by David Drengk. David’s
scanned primary sources, books, and articles enabled me to comprehend a
part of the world I have not experienced in person. Our conceptual discus-
sions were crucial to this book; it was David who convinced me to employ
the concept of the “technological landscape” in interpreting the West
African environment.
 Acknowledgments  xi

Mai Lin Tjoa-Bonatz did a wonderful job of researching information

for the first two chapters of this book. A specialist in Indonesian history,
Mai Lin unearthed archival material on both gold production and mis-
sionary stations. The process of co-authoring two articles with Mai Lin
contributed greatly to my cultural understanding of the region and the
activities of various groups—Batak headmen, Chinese goldminers, and
Christian missionaries among them.
The microhistory of construction work and daily life in Central Asian
cities would not have come about without the help of scholars Mariya
Petrova and Jonas van der Straeten. Mariya and Jonas carried out the
interviews on which much of the chapter is based; these scholars also pro-
vided most of the source material. Mariya’s language skills and cultural
knowledge proved essential during the revision process of the chapter.
The chapter on electricity provision in East Africa was very much
inspired by the work of Jonas van der Straeten and Emanuel Lukio
Mchome. Both scholars also gave me invaluable—often quite critical—
feedback. In addition, Jonas, along with Markus Schertler, provided me
with relevant archival material. Markus was one of the ERC program’s
associate members, although his research was financed by the Deutsche
Forschungsgemeinschaft (DFG). Frank Edward helped with access and
support during my research in Dar es Salaam, Tanzania.
Animesh Chatterjee and Aloy Buragohain generously provided their
comments and suggestions on the chapter on sugar production in India.
Jethron Ayumbah Akallah did the same for the chapter on Nairobi’s so-­
called slum areas. At an early stage of the book project, Jethron assisted
me in the relevant archives and libraries in Kenya. I am thankful for
Animesh, Aloy, and Jethron’s willingness to discuss the concepts of “flex-
ible settlement” and “appropriate technology,” which I adopted in two of
the book’s chapters.
Finally, I must mention additional people who have supported and
inspired me in the process of writing this book. Jochen Monstadt was
instrumental in piquing my interest in technological change in non-­
European settings. It was Jochen who secured the funding for the afore-
mentioned PhD program on African cities; he also brought in fellowships
for African PhDs from the German Academic Exchange Service (DAAD).
Without this financial support, I would not have had the opportunity to
work with Jethron, Frank, and Emanuel.
xii ACKNOWLEDGMENTS

In addition, Arne Kaijser, Lisa Friedman, Shorouk El Hariry, Dennis

Yazici, Markus Böck, and Wei Wu contributed their comments and ideas;
their feedback helped me to refine theories, optimize analyses, and improve
my arguments. In particular, Lisa’s critical and constructive remarks forced
me to rethink my own standpoints and modify my narratives.

Thank you all!

 Book Abstract

In most standard historical narratives, globalization is portrayed as an

unstoppable force that flattens all obstacles in its path. Modern technol-
ogy, too, is seen as inexorable: in the nineteenth century, steamships, tele-
graph lines, and Gatling guns are said to have paved the way for colonialism.
Later, shipping containers and computer networks purportedly pulled the
planet deeper into a maelstrom of capitalism.
Microhistories of Technology: Making the World tells the alternative
story of how people in Africa, Asia, and Latin America challenged glo-
balization, from its products to its production techniques. Creative indi-
viduals selectively adopted or rejected modern gadgets, tools, and
machines. For example, carpenters in Sumatra during the nineteenth
century ignored the wood saws imported by missionaries—choosing to
chop down trees with their arch-bladed adzes. Similarly, people in colo-
nial India disregarded competition from capitalist-run sugar plantations,
producing their own muscovado for local consumers. And, in Soviet
times, inhabitants of Samarkand, Uzbekistan, shunned the new prefabri-
cated, concrete residential buildings, preferring to remain in their exist-
ing mud-brick houses.
Through the lens of diversity, this book presents a multifarious global
history of technology and material culture. The microhistories in this vol-
ume show that the spread of modern technologies did not erase artisanal
tools and production methods. Rather, the new and the old often co-
existed fruitfully—as when South American home cooks adopted both
pre-Hispanic grinding stones and modern electric stoves. The outcome of

xiii
xiv Book Abstract

cultural encounters between old and new has been countless innovative
solutions, many of which have gone unnarrated in the history of technology.
By bringing to light the material culture of ordinary people around the
world, Microhistories of Technology shows how inventive individuals and
groups have shaped their own lives. Each chapter demonstrates how the
tenacious use of traditional, homemade, and hybrid technologies has
helped people to maintain autonomy in a “globalized” world.
 Praise for Microhistories of Technology

“Ideal for teaching, Hård’s eight vivid and illuminating microhistories of “honing
local techniques in a global world” will captivate readers, challenging them to
think afresh about how globalization works on the ground. Bringing fresh
insights into everyday technological choices through the lens of material culture,
this fascinating book will tempt readers to further explorations in the history of
technology.”
—Professor Francesca Bray, University of Edinburgh

“Among the efforts to understand globalisation and to write global histories in new
and diverse perspectives, this work will stand out for its critical engagement with the
question of technology and many presumed directionalities and inevitabilities
thereof. It is bound to provoke varied responses and to inspire fresh researches on
less explored localities and dimensions—perhaps with even less positing of Europe
as the polestar.”
—Professor John Bosco Lourdusamy, Indian Institute of Technology Madras

“Granitic ideas of Western technology and experts conquering the world come here
to a lethal end. Instead, a complex mosaic of micro and local universes of silent,
unnamed, and creative contributors to technological landscapes emerges. The book
is a feast of ordinary people in the “Global South,” making the world through ordi-
nary actions and technologies. The impressive variety of unusual sources highlights
historical cases rarely addressed by scholarship.”
—Professor Stefania Gallini, Universidad Nacional de Colombia
 Contents

1 Introduction:
 Honing Local Techniques in
a Globalized World  1

Part I Nineteenth-Century Ways of Life  13

2 Building
 Missionary Stations in Southeast Asia: Nias
Islanders Deploy Adzes 15

3 Communicating
 and Trading in West Africa: Talking
Drums and Pack Animals 43

4 Withstanding
 Globalization in Northern India: Farmers
Make Sugar for Local Consumption 71

Part II Twentieth-Century Improvisations  99

5 Accessing
 Electricity in East Africa: Dar es Salaam
Dwellers Pursue Power101

6 Creating
 “Creole” Cuisine in Latin America: Home
Cooks Reinvent Batánes129

xvii
xviii Contents

Part III Postwar Innovations 157

7 Earning
 a Living in Urban Africa: Maintaining the
“Native Beer” Economy159

8 Confronting
 Menstruation in East Asia: Koreans Create
Self-made Solutions189

9 Doing
 It Yourself in Central Asia: Uzbeks Build Adobe
Houses219

10 Conclusion: Challenging Globalizing Technologies249

Bibliography259

Index281
 About the Author

Mikael Hård studied in Uppsala and Gothenburg in Sweden and at

Princeton University, NJ, before receiving his PhD in the history of sci-
ence and ideas from Gothenburg University, Sweden, in 1988.
Between 1988 and 1994, Mikael worked at Gothenburg University
and the Berlin Social Science Center (WZB); he also spent 1 year as a
research fellow at the Swedish Collegium for Advanced Study (SCAS) in
Uppsala. In 1994, Mikael became professor of history of technology at the
Norwegian University of Science and Technology (NTNU), and 4 years
later he moved on to the Technical University of Darmstadt (TU
Darmstadt), Germany, to occupy a professorship with the same
denomination.
As a professor at TU Darmstadt, Mikael directed two PhD programs,
financed by the DFG, and was an active member of “Tensions of Europe,”
an international network of historians of technology. In 2017 he received
a 5-year grant from the European Research Council (ERC) for a project
on which this book is largely based—“A Global History of Technology,
1850–2000” (ERC AdG 743126).
Mikael has published widely in high-ranking scientific journals and with
academic presses. Among his publications are:
–– Consumers, Tinkerers, Rebels: The People Who Shaped Europe (Palgrave
Macmillan, 2013), written with Ruth Oldenziel
–– Urban Machinery: Inside Modern European Cities (MIT Press,
2008), co-edited with Thomas J. Misa

xix
xx About the Author

–– Hubris and Hybrids: A Cultural History of Technology and Science

(Routledge, 2005), written with Andrew Jamison
–– The Intellectual Appropriation of Technology: Discourses on Modernity,
1900–1939 (MIT Press, 1998), co-edited with Andrew Jamison
 CHAPTER 1

Introduction: Honing Local Techniques

in a Globalized World

One morning we hiked toward the mystical mountain of wealth and happi-
ness. (According to Dayak legend, a god’s son slayed his brother here, and
his tears and brain transformed into numerous gold nuggets.) […] Here,
the Dayak do not only wash the river sand; they also carry out the important
work [of gold] extraction in mines and galleries dug through hard rock
containing primary deposits. Particularly astonishing and interesting is the
fact that the Indigenous do this without any Chinese or European manager.
We are witnessing the gold mines of Gunung Mas, probably the only one of
its kind in the Malay archipelago.1 […]

With great skill, they follow the gold veins impressively far down, break the
rock (it should be noted in passing that they employ mallets and chisels of
German origin and work in the light of German storm lanterns); transport
it in panniers on their backs or along self-made winches to the surface;
pound; sift; and wash it; melt it in small, earthen vessels into bars; fashion
portions of it into artful jewelry and coveted golden teeth; and sell the rest

1
Helbig, Karl, “Gold bei den Dajaks,” Ostasiatische Rundschau 19 (15/16), 1938:
386–390; here: 387. All translations from German into English have been done by the author.

© The Author(s) 2023 1

M. Hård, Microhistories of Technology, Palgrave Studies in the
History of Science and Technology,
https://doi.org/10.1007/978-3-031-22813-1_1
Another random document with
no related content on Scribd:
Another patient aged twenty-seven had whooping cough, which
lasted six weeks, and was followed by severe pain in the back. For
this she consulted various physicians, being treated for Pott's
disease and spinal irritation. She, however, continued to grow worse,
and every jar and twist gave severe pain. At this time she had lost
much flesh, had pain in her back and elsewhere, and was subject to
numerous and violent spasms. When first seen by the physician who
consulted me she was complaining of pains in her legs, hips, and left
shoulder, which she considered rheumatic, and with pain in the
abdomen. Examination of the back with the patient on her side
showed a slight prominence over the position of the first or second
lumbar vertebra. The spot was painful on pressure, and had been so
ever since the attack of whooping cough three years before. A tap on
the sole of either foot made her complain of severe pain in the back.
The same result followed pressure on the head. The patient was
unable to stand or walk, but occasionally sat up for a short time,
although suffering all the time. There was no muscular rigidity. The
limbs and body were quite thin, but, so far as could be detected, she
had no loss of motor or sensory power. At times, when the pains
were worse, the arms would be flexed involuntarily, and she stated
that once the spine was drawn back and a little sideways. The pain
in the hips was augmented by pressure. During the application of a
plaster bandage she had a sort of fit and fainted, and the application
was suspended. She soon recovered consciousness, but refused to
allow the completion of the dressing. I diagnosticated the affection as
largely hysterical, and a few months later received word that the
patient was on her feet and well.

Kemper109 relates the case of a lady who eventually died of sarcoma

of the vertebræ, the specimens having been examined by J. H. C.
Simes of Philadelphia and myself. She was supposed at first and for
some time to be a case of hysteria with spinal irritation. In the case
of a distinguished naval officer, who died of malignant vertebral
disease after great suffering a short time since, this same mistake
was made during the early stages of the disease: his case was
pronounced to be one of neurasthenia, hysteria, etc. before its true
nature was finally discovered. The absence of muscular rigidity in the
back and extremities is the strongest point against vertebral disease
in these cases.
109 Journal of Nervous and Mental Diseases, vol. xii., No. 1, January, 1885.

In hysterical hemianæsthesia, ovarian hyperæsthesia, hystero-

epileptic seizures, ischuria, and other well-known hysterical
symptoms have usually been observed. The anæsthesia in
hysterical cases is most commonly on the left side of the body, but it
may happen to be so located in an organic case, so that this point is
only one of slight value.

Some older observers, as Briquet, who is quoted and criticised by

Charcot, believed that hemianæsthesia from encephalic lesions
differed from hysterical hemianæsthesia by the fact that in the former
case the skin of the face did not participate in the insensibility, or that
when it existed it never occupied the same side as the insensibility of
the limbs. Recently-reported cases have disproved the accuracy of
this supposed diagnostic mark. In his lectures, delivered ten years
ago, Charcot observed that up to that period anæsthesia of general
sensibility alone appeared to have been observed as a consecutive
on an alteration of the cerebral hemispheres, so that obtunding of
the special senses would remain as a distinctive characteristic of
hysterical hemianæsthesia. He, however, expected that cases of
cerebral organic origin would be reported of complete
hemianæsthesia, with derangements of the special senses, such as
is presented in hysteria. His anticipations have been fulfilled. In the
nervous wards of the Philadelphia Hospital is now a typical case of
organic hemianæsthesia in which the special senses are partially
involved.

Paralysis and contractures, if present, are apt to be accompanied in

cases of organic hemianæsthesia, after time has elapsed, by marked
nutritive changes, by wasting of muscle, and even of skin and bone.
This is not the case in hysteria.

The subsequent history of these two conditions is different. The

hysterical patient will often recover and relapse, or under proper
treatment may entirely recover; while all the treatment that can be
given in a case of organic hemianæsthesia will produce no decided
improvement, for there is a lesion in the brain which will remain for
ever. Hemianopsia, so far as I know, has not been observed in
hysterical hemianæsthesia.

In the monograph of Shaffer, with reference to both true and false

knee-joint affections certain conclusions are drawn which I will give
somewhat condensed:

Chronic synovitis produces very few if any subjective symptoms;

hysterical imitation presents a long train of both subjective and
objective symptoms and signs, the former in excess. Chronic ostitis
may be diagnosticated if muscular spasm cannot be overcome by
persistent effort; when the spasm does not vary night nor day; when
it is not affected by the ordinary doses of opium or chloral; when
reaction of the muscles to the faradic current is much reduced; when
a local and uniform rise of temperature over the affected articulation
is present; when purely involuntary neural symptoms, such as
muscular spasm, pain, and a cry of distress, are present. Hysterical
knee-joint is present, according to this author, when the muscular
rigidity or contracture is variable, and can be overcome by mildly
persistent efforts while the patient's mind is diverted, or which yields
to natural sleep, or which wholly disappears under the usual doses
of opium or chloral; when the faradic response is normal; when rise
of temperature is absent or a reduced temperature is present over
the joint; when variable and inconstant, emotional, and semi-
voluntary manifestations are present.

To recognize the neuromimesis of hip disease Shaffer gives the

following points: The limp is variable and suggests fatigue; it is much
better after rest; it almost invariably follows the pain. Pain of a
hyperæsthetic character is usually the first symptom, and it is found
most generally in the immediate region of the joint. “In place of an
apprehensive state in response to the tests applied will be found a
series of symptoms which are erratic and inconstant. A condition of
muscular rigidity often exists, but, unlike a true muscular spasm, it
can in most cases be overcome in the manner before stated. A very
perceptible degree of atrophy may exist—such, however, as would
arise from inertia only. A normal electrical contractility exists in all the
muscles of the thigh.”

In the neuromimesis of chronic spondylitis or hysterical spine the

pain is generally superficial, and is almost always located over or
near the spinous processes; it is sometimes transient, and frequently
changes its location from time to time; a normal degree of mobility of
the spinal column under properly directed manipulation is preserved;
the nocturnal cry and apprehensive expression of Pott's disease are
wanting.

With reference to the hysterical lateral curvature, Shaffer, quoting

Paget, says “ether or chloroform will help. You can straighten the
mimic contracture when the muscles cannot act; you cannot so
straighten a real curvature.”

In the diagnosis of local hysterical affections one point emphasized

by Skey is well worthy of consideration; and that is that local forms of
hysteria are often not seen because they are not looked for. “If,” says
he, “you will so focus your mental vision and endeavor to distinguish
the minute texture of your cases, and look into and not at them, you
will acknowledge the truth of the description, and you will adopt a
sound principle of treatment that meets disease face to face with a
direct instead of an oblique force.” According to Paget, the means for
diagnosis in these cases to be sought—(1) in what may be regarded
as the predisposition, the general condition of the nervous system,
on which, as in a predisposing constitution, the nervous mimicry of
disease is founded; (2) in the events by which, as by exciting
causes, the mimicry may be evoked and localized; (3) in the local
symptoms in each case.

Local symptoms as a means of diagnosis can sometimes be made

use of in general hysteria. A case may present symptoms of either
the gravest form of organic nervous disease or the gravest form of
hysteria, and be for a time in doubt, when suddenly some special
local manifestation appears which cannot be other than hysterical,
and which clinches the diagnosis. In a case with profound
anæsthesia, with paraplegia and marked contractures, with recurring
spasms of frightful character, the sudden appearance of aphonia and
apsithyria at once cleared all remaining doubt. Herbert Page
mentions the case of a man who suffered from marked paraplegia
and extreme emotional disturbance after a railway collision, who,
nine months after the accident, had an attack of aphonia brought on
suddenly by hearing of the death of a friend. He eventually
recovered.

To detect hysterical or simulated blindness the methods described by

Harlan are those adopted in my own practice. When the blindness is
in both eyes, optical tests cannot be applied. Harlan suggests
etherization.110 In a case of deception, conscious or unconscious, he
says, “as the effect of the anæsthetic passed off the patient would
probably recover the power of vision before his consciousness was
sufficiently restored to enable him to resume the deception.”
Hutchinson cured a case of deaf-dumbness by means of
etherization. For simulated monocular blindness Graefe's prism-test
may be used: “If a prism held before the eye in which sight is
admitted causes double vision, or when its axis is held horizontally a
corrective squint, vision with both eyes is rendered certain.” It should
be borne in mind that the failure to produce double images is not
positive proof of monocular blindness, for it is possible that the
person may see with either eye separately, but not enjoy binocular
vision, as in a case of squint, however slight. Instead of using a
prism while the patient is reading with both eyes at an ordinary
distance, say of fourteen or sixteen inches, on some pretext slip a
glass of high focus in front of the eye said to be sound. If the reading
is continued without change, of course the amaurosis is not real.
Other tests have been recommended, but these can usually be
made available.
110 Loc. cit.

The diagnosis of hysterical, simulated, or mimetic deafness is more

difficult than that of blindness. When the deafness is bilateral, the
difficulty is greater than when unilateral. The method by etherization
just referred to might be tried. Politzer in his work on diseases of the
ear111 makes the following suggestions: Whether the patient can be
wakened out of sleep by a moderately loud call seems to be the
surest experiment. But, as in total deafness motor reflexes may be
elicited by the concussion of loud sounds, care must be taken not to
go too near the person concerned and not to call too loudly. The
practical objection to this procedure in civil practice would seem to
be that we are not often about when our patients are asleep. In
unilateral deafness L. Müller's method is to use two tubes, through
which words are spoken in both ears at the same time. When
unilateral deafness is really present the patient will only repeat what
has been spoken in the healthy ear, while when there is simulation
he becomes confused, and will repeat the words spoken into the
seemingly deaf ear also. To avoid mistakes in using this method, a
low voice must be employed.
111 A Textbook of the Diseases of the Ear and Adjacent Organs, by Adam Politzer,
translated and edited by James Patterson Cassells, M.D., M. R. C. S. Eng., Philada.,
1883.

Mistakes in diagnosis where hysteria is in question are frequently

due to that association with it of serious organic disease of the
nervous system of which I have already spoken at length under
Complications. This is a fact which has not been overlooked by
authors and teachers, but one on which sufficient stress has not yet
been laid, and one which is not always kept in mind by the
practitioner. Bramwell says: “Cases are every now and again met
with in which serious organic disease (myelitis and poliomyelitis,
anterior, acute, for example) is said to be hysterical. Mistakes of this
description are often due to the fact that serious organic disease is
frequently associated with the general symptoms and signs of
hysteria; it is, in fact, essential to remember that all cases of
paraplegia occurring in hysterical patients are not necessarily
functional—i.e. hysterical; the presence of hysteria or a history of
hysterical fits is only corroborative evidence, and the (positive)
diagnosis of hysterical paraplegia should never be given unless the
observer has, after the most careful examination, failed to detect the
signs and symptoms of organic disease.”

PROGNOSIS.—Hysteria may terminate (1) in permanent recovery; (2)

in temporary recovery, with a tendency to relapse or to the
establishment of hysterical symptoms of a different character; (3) in
some other affection, as insanity, phthisis, or possibly sclerosis; (4) in
death, but the death in such cases is usually not the direct result of
hysteria, but of some accident. Death from intercurrent disorders
may take place in hysteria. It is altogether doubtful, however,
whether the affection which has been described as acute fatal
hysteria should be placed in the hysterical category. In the cases
reported the symptom-picture would in almost every instance seem
to indicate the probability of the hysteria having been simply a
complication of other disorders, such as epilepsy, eclampsia, and
acute mania.

As a rule, hysterical patients will not starve themselves. They may

refuse to take food in the presence of others, or may say they will not
eat at all; but they will in some cases at the same time get food on
the sly or hire their nurses or attendants to procure it for them. In
treating such cases a little watchfulness will soon enable the
physician to determine what is best to be done. By discovering them
in the act of taking food future deception can sometimes be
prevented. Hysterical patients do sometimes, however, persistently
refuse food. These cases may starve to death if let alone; and it is
important that the physician should promptly resort to some form of
forcible feeding before the nutrition of the patient has reached too
low an ebb. I have seen at least two cases of hysteria or hysterical
insanity in which patients were practically allowed to starve
themselves to death, but an occurrence of this kind is very rare.
Feeding by means of a stomach-tube, or, what is still better, by a
nasal tube, as is now so frequently practised among the insane,
should be employed. Nourishment should be administered
systematically in any way possible until the patient is willing to take
food in the ordinary way. In purposive cases some methods of
forcible feeding may prove of decided advantage. Its unpleasantness
will sometimes cause swallowing power to be regained.

Wunderlich112 has recorded the case of a servant-girl, aged nineteen,

who, after a succession of epileptiform fits, fell into a collapse and
died in two days. Other cases have been recorded by Meyer. Fagge
also speaks of the more chronic forms of hysteria proving fatal by
marasmus. He refers to two cases reported by Wilks, both of which
were diagnosticated as hysterical, and both of which died. Sir
William Gull describes a complaint which he terms anorexia nervosa
vel hysterica. It is attended with extreme wasting; pulse, respiration,
and temperature are low. The patients were usually between the
ages of sixteen and twenty-three: some died; others recovered under
full feeding and great care. In many of the reported fatal cases
careful inquiry must be made as to this question of hysteria being
simply a complication.
112 Quoted in The Principles and Practice of Medicine, by the late Charles Hilton
Fagge, M.D., F. R. C. P., etc., vol. i. 1886, p. 736.

Are not hysterical attacks sometimes fatal? With reference to one of

my cases this view was urged by the physician in attendance.
Gowers113 on this point says: “As a rule to which exceptions are
infinitely rare, hysterical attacks, however severe and alarming in
aspect, are devoid of danger. The attacks of laryngeal spasm
present the greatest apparent risk to life.” He refers to the paroxysms
of dyspnœa presented by a hemiplegic girl as really alarming in
appearance, even to those familiar with them. He refers also to a
case of Raynaud's114 in which the laryngeal and pharyngeal spasm
coexisted with trismus, and the patient died in a terrible paroxysm of
dyspnœa. The patient presented various other hysterical
manifestations, and a precisely similar attack had occurred
previously and passed away, but she had in the interval become
addicted to the hypodermic injection of morphia, and Raynaud
suggested that it might have been the effect of this on the nerve-
centres that caused the fatal termination. Such cases have been
described in France as the hydrophobic form of hysteria.
 113 Epilepsy and Other Chronic Convulsive Diseases, by W. R. Gowers, M.D.,
London. 1881.

114 L'Union médical, March 15, 1881.

Patients may die in hysterical as in epileptic attacks from causes not

directly connected with the disease. One of these sources of danger
mentioned by Gowers is the tendency to fall on the face sometimes
met with in the post-epileptic state. He records an example of death
from this cause. He also details a case of running hysteria or
hystero-epilepsy, in which, after a series of fits lasting about four
hours, the child died, possibly from some intercurrent accident.

TREATMENT.—Grasset,115 speaking of the treatment of hysteria, says

that means of treating the paroxysm, of removing the anæsthesia, of
combating single symptoms, are perhaps to be found in abundance,
but the groundwork of the disease, the neurosis or morbid state, is
not attacked. Here he indicates a new and fruitful path. In his own
summing up, however, he can only say that the hysterical diathesis
offers fundamental grounds for the exhibition of arsenic, silver,
chloride of gold, and mineral waters!
115 Brain, January, 1884.

No doubt can exist that the prophylactic and hygienic treatment of

hysteria is of paramount importance. To education—using the term
education in a broad sense—before and above all, the most
important place must be given. It is sometimes better to remove
children from their home surroundings. Hysterical mothers develop
hysterical children through association and imitation. I can scarcely,
however, agree with Dujardin-Beaumetz that it is always a good plan
to place a girl in a boarding-school far from the city. It depends on
the school. A well-regulated institution may be a great blessing in
this direction; one badly-managed may become a hotbed of hysteria.

Recently I made some investigations into the working of the public-

school system of Philadelphia, particularly with reference to the
question of overwork and sanitation.116 I had special opportunities
during the investigations to study the influences of different methods
of education, owing to the fact that the public-school system of
Philadelphia is just now in a transition period. This system is in a
state of hopeful confusion—hopeful, because I believe that out of its
present condition will come eventually a great boon to Philadelphia.
At one end of the system, in the primary and the secondary schools,
a graded method of instruction has been introduced. The grammar
and the high schools are working on an ungraded or differently
graded method. I found still prevailing, particularly in certain of the
grammar schools for girls, although not to the same extent as a few
years since, methods of cramming and stuffing calculated above all
to produce hysteria and allied disorders in those predisposed to
them.
116 The results of these investigations were given in a lecture which was delivered in
the Girls' Normal School of Philadelphia before the Teachers' Institute of Philadelphia,
Dec. 11, 1885.

Education should be so arranged as to develop the brain by a

natural process—not from within outward; not from the centre to the
periphery; not from above downward; but as the nervous system
itself develops in its evolution from a lower to a higher order of
animals, from the simple to the more complex and more elaborate.
Any system of education is wrong, and is calculated to weaken and
worry an impressionable nervous system, which attempts to overturn
or change this order of the progress of a true development of the
brain. To develop the nervous system as it should be developed—
slowly, naturally, and evenly—it must also be fed, rested, and
properly exercised.

In those primary schools in which the graded method was best

carried out this process of helping natural development was pursued,
and the result was seen in contented faces, healthy bodies, and
cheerful workers. In future the result will be found in less chorea,
hysteria, and insanity.

To prevent the development of hysteria, parents and physicians

should direct every effort. The family physician who discovers a child
to be neurotic, and who from his knowledge of parents, ancestors,
and collateral relatives knows that a predisposition to hysteria or
some other neurosis is likely to be present, should exercise all the
moral influence which he possesses to have a healthy, robust
training provided. It is not within the scope of an article of this kind to
describe in great detail in what such education should consist.
Reynolds is correct when he says that “self-control should be
developed, the bodily health should be most carefully regarded, and
some motive or purpose should be supplied which may give force,
persistence, unity, and success to the endeavors of the patient.” In
children who have a tendency to the development of hysteria the
inclinations should not always or altogether be regarded in choosing
a method or pursuing a plan of education. It is not always to what
such a child takes that its mind should be constantly directed; but, on
the contrary, it is often well to educate it away from its inclination.
“The worst thing that can be done is that which makes the patient
know and feel that she is thought to be peculiar. Sometimes such
treatment is gratifying to her, and she likes it—it is easy and it seems
kind to give it—but it is radically wrong.”

In providing for the bodily health of hysterical children it should be

seen that exercise should be taken regularly and in the open air, but
over-fatigue should be avoided; that ample and pleasant recreation
should be provided; that study should be systematic and disciplinary,
but at the same time varied and interesting, and subservient to some
useful purpose; that the various functions of secretion, excretion,
menstruation should be regulated.

The importance of sufficient sleep to children who are predisposed to

hysteria or any other form of nervous or mental disorder can scarcely
be over-estimated. The following, according to J. Crichton Browne,117
is the average duration of sleep required at different ages: 4 years of
age, 12 hours; 7 years of age, 11 hours; 9 years of age, 10½ hours;
14 years of age, 10 hours; 17 years of age, 9½ hours; 21 years of
age, 9 hours; 28 years of age, 8 hours. To carefully provide that
children shall obtain this amount of sleep will do much to strengthen
the nervous system and subdue or eradicate hysterical tendencies.
Gymnastics, horseback riding, walking, swimming, and similar
exercises all have their advantages in preventing hysterical
tendencies.
117 Education and the Nervous System, reprinted from The Book of Health by
permission of Messrs. Cassell & Co., Limited.

Herz118 has some instructive and useful recommendations with

reference to the treatment of hysteria in children. It is first and most
important to rehabilitate the weakened organism, and especially the
central nervous system, by various dietetic, hygienic, and medicinal
measures. It is important next to tranquillize physical and mental
excitement. This can sometimes be done by disregard of the
affection, by neglect, or by removal or threatened removal of the
child from its surroundings. Such treatment should of course be
employed with great discretion. Anæmia and chlorosis, often present
in the youthful victims of hysteria, should be thoroughly treated. Care
should be taken to learn whether children of either sex practise
masturbation, which, Jacobi and others insist, frequently plays an
important part in the production of hysteria. Proper measures should
be taken to prevent this practice. The genital organs should receive
examination and treatment if this is deemed at all necessary. On the
other hand, care should be taken not to direct the attention of
children unnecessarily to those organs when they are entirely
innocent of such habits. Painting the vagina twice daily with a 10 per
cent. solution of hydrochlorate cocaine has been found useful in
subduing the hyper-irritation of the sexual organs in girls accustomed
to practise masturbation. Herz, with Henoch, prefers the hydrate of
chloral to all other medicines, although he regards morphine as
almost equally valuable, in the treatment of hysteria in children.
Personally, I prefer the bromides to either morphia or chloral. Small
doses of iron and arsenic continued systematically for a long period
will be found useful. Politzer of Vienna regards the hydrobromate
and bihydrobromate of iron as two valuable preparations in the
hysteria of children, and exhibits them in doses of four to seven
grains three to four times daily.
 118 Wien. Med. Wochen., No. 46, Nov. 14, 1885.

Hysteria once developed, it is the moral treatment which often really

cures. The basis of this method of cure is to rouse the will. It is
essential to establish faith in the mind of the patient. She must be
made to feel not only that she can be helped, but that she will be.
Every legitimate means also should be taken to impress the patient
with the idea that her case is fully understood. If malingering or
partial malingering enters into the problem, the patient will then feel
that she has been detected, and will conclude that she had better get
out of her dilemma as gracefully as possible. Where simulation does
not enter faith is an important nerve-stimulant and tonic; it unchains
the will.

Many physicians have extraordinary ideas about hysteria, and

because of these adopt remarkable and sometimes outrageous
methods of treatment. They find a woman with hysterical symptoms,
and forthwith conclude she is nothing but a fraud. They are much
inclined to assert their opinions, not infrequently to the patient
herself, and, if not directly to her, in her hearing to other patients or
to friends, relatives, nurses, or physicians. They threaten, denounce,
and punish—the latter especially in hospitals. In general practice
their course is modified usually by the wholesome restraint which the
financial and other extra-hospital relations of patient and physician
enforce.

Although hysterical patients often do simulate and are guilty of fraud,

it should never be forgotten that some hysterical manifestations may
be for the time being beyond the control of patients. Even for some
of the frauds which are practised the individuals are scarcely
responsible, because of the weakness of their moral nature and their
lack of will-power. Moral treatment in the form of reckless harshness
becomes immoral treatment. The liability to mistake in diagnosis,
and the frequent association of organic disease with hysterical
symptoms, should make the physician careful and conservative. It is
also of the highest importance often that the doctor should not show
his hand. The fact that an occasional cure, which is usually
temporary, is effected by denunciation, and even cruelty, is not a
good argument against the stand taken here.

Harsh measures should only be adopted after due consideration and

by a well-digested method. A good plan sometimes is, after carefully
examining the patient, to place her on some simple, medicinal, and
perhaps electrical treatment, taking care quietly to prophesy a
speedy cure. If this does not work, in a few days other severe or
more positive measures may be used, perhaps blistering or strong
electrical currents. Later, but in rare cases only, after giving the
patient a chance to arouse herself by letting her know what she may
expect, painful electrical currents, the hot iron, the cold bath, or
similar measures may be used. Such treatment, however, should
never be used as a punishment.

The method of cure by neglect can sometimes be resorted to with

advantage. The ever-practical Wilks mentions the case of a school-
teacher with hemianalgesia, hemianæsthesia, and an array of other
hysterical symptoms who had gone through all manner of treatment,
and at the end of seven months was no better. The doctor simply left
her alone. He ordered her no drugs, and regularly passed by her
bed. In three weeks he found her sitting up. She talked a little and
had some feeling in her right side. She was now encouraged, and
made rapid progress to recovery. Neglect had aroused her dormant
powers. It must be said that a treatment of this kind can be carried
out with far more prospects of success in a general hospital than in a
private institution or at the home of a patient. It is a method of
treatment which may fail or succeed according to the tact and
intelligence of the physician.

I cannot overlook here the consideration of the subject of the so-

called faith cure and mind cure. One difference between the faith
cure as claimed and practised by its advocates, and by those who
uphold it from a scientific standpoint, is simply that the latter do not
refer the results obtained to any supernatural or spiritual agency. I
would not advise the establishment of prayer-meetings for the relief
of hysteria, but would suggest that the power of faith be exercised to
its fullest extent in a legitimate way.

A young lady is sick, and for two years is seen by all the leading
doctors in London; a clergyman is asked in and prays over her, and
she gets up and walks. The doctors all join in and say the case was
one of hysteria—that there was nothing the matter with her. Then,
says Wilks, “Why was the girl subjected to local treatment and doses
of physic for years? Why did not the doctors do what the parson
did?”

Tuke119 devotes a chapter to psychotherapeutics, which every

physician who is called upon to treat hysteria should read. He
attempts to reduce the therapeutic use of mental influence to a
practical, working basis. I will formulate from Tuke and my own
experience certain propositions as to the employment of
psychological measures: (1) It is often important and always
justifiable to inspire confidence and hope in hysterical patients by
promising cures when it is possible to achieve cures. (2) A physician
may sometimes properly avail himself of his influence over the
emotions of the patient in the treatment of hysterical patients, but
always with great caution and discretion. (3) Every effort should be
made to excite hysterical patients to exert the will. (4) In some
hysterical cases it is advisable to systematically direct the attention
to a particular region of the body, arousing at the same time the
expectation of a certain result. (5) Combined mental and physical
procedures may sometimes be employed. (6) Hypnotism may be
used in a very few cases.
119 Influence of the Mind upon the Body.

The importance of employing mental impression is thoroughly

exemplified, if nothing else is accomplished, by a study of such a
craze as the so-called mind cure. Not a few people of supposed
sense and cultivation have pinned their faith to this latest Boston
hobby. A glance at the published writings of the apostles of the mind
cure will show at once to the critical mind that all in it of value is
dependent upon the effects of mental impression upon certain
peculiar natures, some of them being of a kind which afford us not a
few of our cases of hysteria. W. F. Evans has published several
works upon the subject. From one of these120 I have sought, but not
altogether successfully, to obtain some ideas as to the basis of the
mind-cure treatment. It is claimed that the object is to construct a
theoretical and practical system of phrenopathy, or mental cure, on
the basis of the idealistic philosophy of Berkeley, Fichte, Schelling,
and Hegel. The fundamental doctrine of those who believe in the
mental cure is, that to think and to exist are one and the same, and
that every disease is a translation into a bodily expression of a fixed
idea of mind. If by any therapeutic device the morbid idea can be
removed, the cure of the malady is assured. When the patient is
passive, and consequently impressible, he is made to fix his
thoughts with expectant attention upon the effect to be produced.
The physician thinks to the same effect, wills it, and believes and
imagines that it is being done; the mental action to the patient,
sympathizing with that of the physician, is precipitated upon the
body, and becomes a silent, transforming, sanitive energy. It must
be, says Evans, “a malady more than ordinarily obstinate that is
neither relieved nor cured by it.”
120 The Divine Law of Cure.

Hysteria cannot be cured by drugs alone, and yet a practitioner of

medicine would find it extremely difficult to manage some cases
without using drugs. Drugs themselves, used properly, may have a
moral or mental as well as a physical influence. Among those which
have been most used from before the days of Sydenham to the
present time, chiefly for their supposed or real antispasmodic virtues,
are galbanum, asafœtida, valerian, castor and musk, opium, and
hyoscyamus. The value of asafœtida, valerian, castor, and musk is
chiefly of a temporary character. If these drugs are used at all, they
should be used in full doses frequently repeated. Sumbul, a drug of
the same class comparatively little used, is with me a favorite. It can
be used in the form of tincture or fluid extract, from twenty minims to
half a drachm of the latter or one to two drachms of the former. It
certainly has in many cases a remarkably calmative effect.
Opium and its preparations, so strongly recommended by some, and
especially the Germans, should not be used except in rare cases.
Occasionally in a case with sleeplessness or great excitement it may
be absolutely indispensable to resort to it in combination with some
other hypnotic or sedative. The danger, however, in other cases of
forming the opium habit should not be overlooked. According to
Dujardin-Beaumetz, it is mainly useful in the asthenic forms of
hysteria.

Of all drugs, the metallic tonics are to be preferred in the continuous

treatment of hysteria. Iron, although not called for in a large
percentage of cases, will sometimes prove of great service in the
weak and anæmic hysterics. Chalybeates are first among the drugs
mentioned by Sydenham. Steel was his favorite. The subcarbonate
or reduced iron, or the tincture of the chloride, is to be preferred to
the more fanciful and elegant preparations with which the drug-
market is now flooded. Dialyzed iron and the mallate of iron,
however, are known to be reliable preparations, and can be resorted
to with advantage. They should be given in large doses. Zinc salts,
particularly the oxide, phosphide, and valerianate; the nitrate or
oxide of silver, the ammonio-sulphate of copper, ferri-ferrocyanide or
Prussian blue,—all have a certain amount of real value in giving tone
to the nervous system in hysterical cases.

To Niemeyer we owe the use of chloride of sodium and gold in the

treatment of hysteria. He refers to the fact that Martini of Biberach
regarded this article as an efficient remedy against the various
diseases of the womb and ovaries. He believed that the
improvement effected upon Martini's patient was probably due to the
fact that this, like other metallic remedies, was an active nervine. He
prescribed the chloride of gold and sodium in the form of a pill in the
dose of one-eighth of a grain. Of these pills he at first ordered one to
be taken an hour after dinner, and another an hour after supper.
Later, he ordered two to be taken at these hours, and gradually the
dose was increased up to eight pills daily. I frequently use this salt
after the method of Niemeyer.
The treatment of hysteria which Mitchell has done so much to make
popular, that by seclusion, rest, massage, and electricity, is of value
in a large number of cases of grave hysteria; but the proper selection
of cases for this treatment is all important. Playfair121 says correctly
that if this method of treatment is indiscriminately employed, failure
and disappointment are certain to result. The most satisfactory
results are to be had in the thoroughly broken-down and bed-ridden
cases. “The worse the case is,” he says, “the more easy and certain
is the cure; and the only disappointments I have had have been in
dubious, half-and-half cases.”
121 The Systematic Treatment of Nerve-Prostration and Hysteria, by W. S. Playfair,
M.D., F. R. C. P., 1883.

Mitchell122 gives a succinct, practical description of the process of

massage: “An hour,” he says, “is chosen midway between two
meals, and, the patient lying in bed, the manipulator starts at the
feet, and gently but firmly pinches up the skin, rolling it lightly
between his fingers, and going carefully over the whole foot; then the
toes are bent and moved about in every direction; and next, with the
thumbs and fingers, the little muscles of the foot are kneaded and
pinched more largely, and the interosseous groups worked at with
the finger-tips between the bones. At last the whole tissues of the
foot are seized with both hands and somewhat firmly rolled about.
Next, the ankles are dealt with in the same fashion, all the crevices
between the articulating bones being sought out and kneaded, while
the joint is put in every possible position. The leg is next treated—
first by surface pinching and then by deeper grasping of the areolar
tissue, and last by industrious and deeper pinching of the large
muscular masses, which for this purpose are put in a position of the
utmost relaxation. The grasp of the muscles is momentary, and for
the large muscles of the calf and thigh both hands act, the one
contracting as the other loosens its grip. In treating the firm muscles
in front of the leg the fingers are made to roll the muscles under the
cushions of the finger-tips. At brief intervals the manipulator seizes
the limb in both hands and lightly runs the grasp upward, so as to
favor the flow of venous blood-currents, and then returns to the
kneading of the muscles. The same process is carried on in every
part of the body, and especial care is given to the muscles of the
loins and spine, while usually the face is not touched. The belly is
first treated by pinching the skin, then by deeply grasping and rolling
the muscular walls in the hands, and at last the whole belly is
kneaded with the heel of the hand in a succession of rapid, deep
movements, passing around in the direction of the colon.”
122 “Fat and Blood,” etc.

Massage should often be combined with the Swedish movement

cure. In the movement cure one object is to call out the suppressed
will of the patient. This is very applicable to cases of hysteria. The
cure of cases of this kind is often delayed by using massage alone,
which is absolutely passive. These movements are sometimes
spoken of as active and passive, or as single and duplicated. Active
movements are those more or less under the control of the individual
making or taking part in them, and they are performed under the
advice or direction, and sometimes with the assistance, of another.
They proceed from within; they are willed. Passive movements come
from without; they are performed on the patient and independently of
her will. She is subjected to pushings and pullings, to flexions and
extensions, to swingings and rotations, which she can neither help
nor hinder. The same movement may be active or passive according
to circumstances. A person's biceps may be exercised through the
will, against the will, or with reference to the will.

A single movement is one in which only a single individual is

engaged; speaking medically, single movements are those executed
by the patient under the direction of the physician or attendant; they
are, of course, active. Duplicated active movements require more
than one for their performance. In these the element of resistance
plays an important part. The operator with carefully-considered
exertion performs a movement which the patient is enjoined to resist,
or the latter undertakes a certain motion or series of motions which
the former, with measured force, resists. Still, tact and experience
are here of great value, in order that both direct effort and resistance
should be carefully regulated and properly modified to suit all the
requirements of the case. By changing the position of the patient or
the manner of operating on her from time to time any muscles or
groups of muscles may be brought into play. It is wonderful with what
ease even some of the smallest muscles can be exercised by an
expert manipulator.

The duplicated active movements are those which should be most

frequently performed or attempted in connection with massage in
hysterical patients. The very substance of this treatment is to call out
that which is wanting in hysteria—will-power. It is a coaxing,
insinuating treatment, and one which will enable the operator to gain
control of the patient in spite of herself. As the patient exerts her
power the operator should yield and allow the part to be moved.

Much of the value of massage and Swedish movements, in hysteria

as in other disorders, is self-evident. Acceleration of circulation,
increase of temperature, direct and reflex stimulation of nervous and
muscular action, the promotion of absorption by pressure,—these
and other results are readily understood. “The mode in which these
gymnastic proceedings exert an influence,” says Erb,123 “consists, no
doubt, in occasioning frequently-repeated voluntary excitations of the
nerves and muscles, so that the act of conduction to the muscles is
gradually rendered more facile, and ultimately the nutrition of the
nerves and muscles is augmented.”
123 Ziemssen's Cyclopædia.

The objects to be attained by the use of electricity are nearly the

same as from massage and duplicated active movements: in the first
place, to improve the circulation and the condition of the muscles;
and in the second place, to make the patient use the muscles. The
faradic battery should be employed in these cases, and the patient
should be in a relaxed condition, preferably in bed. A method of
electrical treatment introduced some years ago by Beard and
Rockwell is known as general faradization. This is sometimes used
in the office of the physician. In this method the patient is placed in a
chair with his feet on a large plate covered with chamois-skin; the