Pergamum, 2nd cent. A.D. (Galen, On Prognosis 6. Tr. A J. Brock. G)
A rare case history of elegant deductive analysis; that the causes of hysteria are primarily psychological was not rediscovered until the twentieth century.[1]
I was called in to see a woman who was stated to be sleepless at night and to lie tossing about from one position to another. Finding she had no fever, I made a detailed inquiry into everything that had happened to her, especially considering such factors as we know to cause insomnia. But she either answered little or nothing at all, as if to show that it was useless to question her. Finally, she turned away, hiding herself completely by throwing the bedclothes over her whole body, and laying her head on another small pillow, as if desiring sleep.
After leaving I came to the conclusion that she was suffering from one of two things: either from a melancholy dependent on black bile, or else trouble about something she was unwilling to confess. I therefore deferred till the next day a closer investigation of this. Further, on first arriving, I was told by her attendant maid that she could not at present be seen; and on returning a second time, I was told the same again. So I went yet a third time, but the attendant asked me to go away, as she did not want her mistress disturbed. Having learned, however, that when I left she had washed and taken food in her customary manner, I came back the next day and in a private conversation with the maid on one subject and another I found out exactly what was worrying the patient. And this I discovered by chance.
After I had diagnosed that there was no bodily trouble, and that the woman was suffering from some mental uneasiness, it happened that, at the very time I was examining her, this was confirmed. Somebody came from the theatre and said he had seen Pylades dancing. Then both her expression and the colour of her face changed. Seeing this, I applied my hand to her wrist, and noticed that her pulse had suddenly become extremely irregular. This kind of pulse indicates that the mind is disturbed; thus it occurs also in people who are disputing over any subject. So on the next day I said to one of my followers that, when I paid my visit to the woman, he was to come a little later and announce to me, ‘Morphus is dancing today.’ When he said this, I found that the pulse was unaffected. Similarly also on the next day, when I had an announcement made about the third member of the troupe, the pulse remained unchanged as before. On the fourth evening I kept very careful watch when it was announced that Pylades was dancing, and I noticed that the pulse was very much disturbed. Thus I found out that the woman was in love with Pylades, and by very careful watch on the succeeding days my discovery was confirmed.
Similarly too I diagnosed the case of a slave who administered the household of another wealthy man, and who sickened in the same way. He was concerned about having to give an account of his expenses, in which he knew that there was a considerable sum wanting; the thought of this kept him awake, and he grew thin with anxiety. I first told his master that there was nothing physically wrong with the old man, and advised an investigation to be made as to whether he feared his master was about to ask an account of the sums he had entrusted to him and for this reason was worried, knowing that a considerable amount would be found wanting. The master told me I had made a good suggestion, so in order to make the diagnosis certain I advised him to do as follows: he was to tell the slave to give him back all the money he had in hand, lest, in the event of his sudden death, it should be lost, owing to the administration passing into the hands of some other servant whom he did not know: for there would be no use asking for an account from such a one. And when the master said this to him, he felt sure he would not be questioned. So he ceased to worry, and by the third day had regained his natural physical condition.
Now what was it that escaped the notice of previous physicians when examining the aforesaid woman and the aforesaid slave? For such discoveries are made by common inductions if one has even the smallest acquaintance with medical science. I suppose it is because they have no clear conception of how the body tends to be affected by mental conditions. Possibly also they do not know that the pulse is altered by quarrels and alarms which suddenly disturb the mind.
Notes:
1. On the history of this ‘disease’, see especially Veith 1965 and Simon 1978.