Chapter 5

"Another wonderful instance of the same kind is that of Janet McLeod, published by Dr. McKenzie. She was at the time thirty-three years of age, unmarried, and from the age of fifteen had had various attacks of epilepsy, which had produced so rigid a lock-jaw that her mouth could rarely be forced open by any contrivance; she had lost very nearly the power of speech and deglutition, and with this all desire to eat or drink. Her lower limbs were contracted towards her body; she was entirely confined to her bed, and had periodical discharges of blood from the lungs, which were chiefly thrown out by the nostrils. During a few intervals of relaxation she was prevailed upon with great difficulty to put a few crumbs of bread comminuted in the hand, into her mouth, together with a little water sucked from her one hand, and, in one or two instances, a little gruel, but even in these attempts almost the whole was rejected. On two occasions also, after a total abstinence of many months, she made signs of wishing to drink some water, which was immediately procured for her. On the first trial the whole seemed to be returned from the mouth, but she was greatly refreshed in having it rubbed upon the throat. On the second occasion she drank off a pint at once, but could not be prevailed upon to drink any more, although her father had now fixed a wedge between her teeth. With these exceptions, however, she seemed to have passed upwards of four years without either liquids or solids of any kind, or even an appearance of swallowing; she lay for the most part like a log of wood, with a pulse scarcely perceptible for feebleness, but distinct and regular. Her countenance was clear and pretty fresh; her features neither disfigured nor sunk; her bosom round and prominent, and her limbs not emaciated. Dr. McKenzie watched her, with occasional visits, for eight or nine years, at the close of which period she seemed to be a little improved."

This account, like that given of Miss Fancher, tells us nothing definite in regard to the fasting abilities of the young woman. It simply, with the other, may be accepted as indicating that hysterical women are able to go for comparatively long periods without food, and that fact we already knew. It will be observed that it is stated that she "_seemed_" to go four years without food or drink.

In regard to Miss Fancher, the evidence is a little conflicting. First we have Dr. Speir reported as saying, in answer to a question as to her having lived fourteen years without food:

"'Yes, she became my patient in 1864. Her case is a most remarkable one.'

"'But has she eaten nothing during all these years?'

"'I can safely say she has not.'"

This in the _Herald_.

But about a month afterward we find the following conversation, reported as taking place between the same physician and another reporter, this time of the _Sun_:

"'Is it true that she has not partaken of food in all these thirteen years?'

"'No, I cannot say that she has not; I have not been constantly with her for thirteen years. She may have taken food in my absence.'"

In which opinion all physiologists will join.

As I have said, hysterical women certainly do exhibit a marked ability to go without both food and drink. I have had patients abstain from sometimes one, sometimes the other, and sometimes both, for periods varying from one day to eleven, and this without much, if any, suffering, for as soon as the suffering came they did not hesitate to signify their desire to break their voluntary fasts. Real suffering is a condition which the hysterical woman avoids with the most assiduous care.

FOOTNOTES:

[14] Curiosities of Medical Experience. London, 1837, Vol. I., page 269, article, _Abstinence_.

V.

THE PHYSIOLOGY AND PATHOLOGY OF INANITION.

The opinion that food and drink are necessary to life is so generally accepted by mankind, that few venture to dispute the dictum of Virchow relative to Louise Lateau, "Fraud or miracle." But although it is impossible so far as we know for individuals to continue to exist for months and years without the ingestion of nutriment into the system, it is undoubtedly true that under certain circumstances life can be prolonged for days and weeks without any food of any kind going into the organism.

The body is a machine constructed for the purpose of working. The kinds of work which the body of a man or woman does are many. Every act of perception or sensation, is an act of work; so is every thought, every emotion, every volition. The action of the heart or lungs in the circulation and respiration, the evolution of the animal heat, the various functions of secretion and excretion, digestion, motion, speech, etc., are all so many kinds of work. Now as regards work, it is well known that for its due performance force is required, and it is equally well known that for the development of force, matter that can be metamorphosed is necessary. The engine may be perfect, the water may be in the boiler, but unless there be force in the form of heat there will be no steam; and there will be no heat unless there be fuel in a state of combustion.

The human body differs from any other machine in the fact that it uses its fuel in great part indirectly; only in fact after it has been assimilated and converted into tissues of various kinds. Thus when a muscle contracts, it is the muscle itself which is consumed; when a thought is conceived it is the brain which provides the force; when an emotion is experienced, it is again the brain which is decomposed. The body, therefore, lives by the death of its own substance. It is true, some kinds of food such as alcohol, tea and coffee, and perhaps some others do not require to go farther than the blood to be burned, but these are mainly heat-producing, and not tissue-producing substances. But whether matter be consumed directly or indirectly, all bodily force results from its decomposition, and without this destruction of matter the body would be absolutely incapable of a single functional action of any kind whatever, and its temperature like that of the so-called cold-blooded animals would be that of the surrounding medium, the atmosphere.

The quantity of food required by the system varies like the demands of other machines in accordance with the amount of work which is to be performed. A plowman, other things being equal, consumes more than a watchmaker; just as a locomotive burns more fuel than the little engine that runs a sewing machine; the strong able-bodied active man, one who works his brains and muscles up to their full power, eats more than the weak, emaciated and inactive girl, who passes all her time in the recumbent position in bed; and the latter will, other things being equal, endure for a longer period entire abstinence from food. A little food with such a one goes a great way, the demands of the system are at their minimum, and hence a mouthful of bread, or a little tea and toast taken at long intervals, suffices for the supply of all, or a great portion of the waste of the body. With such a person there is not much intense thought, there is little or no muscular action, the pulsations of the heart do not require to be of much force, the respiration is feeble, digestion is at its lowest point, there are no great demands for animal heat, and in fact if the temperature of the atmosphere of the room in which such a person lies, be kept high, the function of calorification may be almost nothing. Still there must be some food taken. The body, can to a certain extent, be used up in supplying the force required for the several functions without the necessity for an immediate restoration of its tissues, but there is a limit to this, beyond which it is certain death to go.

Chossat[15] has determined this point very accurately by many experiments performed upon doves, pigeons, Guinea pigs, rabbits, etc. He found that as a mean result, death ensued when the body lost four-tenths of its original weight. For instance, a body weighing one hundred pounds, could endure the loss of forty pounds without death necessarily following. Five-tenths or one-half appeared to be the extreme loss of weight in inanition which the body could endure without death resulting.

In addition to the loss of weight the temperature fell rapidly, the action of the heart was lessened, the number and depth of the respirations was diminished, and the excretions gradually became smaller in amount.

Experiments such as those of Chossat on the lower animals, cannot of course be instituted on the human subject, nevertheless nature sometimes performs experiments for us which are not without valuable results; and accidents of various kinds, have also given us important data.

On the 19th of March, 1755, twenty-two persons living in the Alpine village of Bergemoletto, in Piedmont, were buried in their houses by an avalanche or whirlwind of snow. The space covered was about two hundred and seventy feet in length, sixty in breadth, and the snow was over forty-two feet in depth. Notwithstanding all the efforts made by the survivors it was impossible to extricate the buried persons till the 18th of April following. All were dead except three women, who, having found some hay, fed a goat with it, and thus obtained from this animal a pint of milk daily, on which they had managed to sustain life for a month.[16]

In Belgium in the year 1683, four colliers were confined in a coal pit for twenty-four days without anything to eat. On the twenty-fifth day they were taken out. In all that time they had lived on nothing but a little water, which flowed from the walls of the prison in which they were immured.[17]

A case is mentioned by Foderé[18] on the authority of M. Chaussier, in which some workmen were taken out alive after having been confined for fourteen days in a cold damp vault. When released at the end of the time mentioned, their pulses were slow and weak, their animal heat greatly reduced, and respiration barely perceptible. Foderé ascribes their long existence without either food or drink, to the fact that the atmosphere of the vault was exceedingly humid, and that the moisture was absorbed into their bodies, taking the place of water ingested into the stomach.

In another case reported by Dr. Straus,[19] a man sixty-five years of age, was extracted alive from a coal mine, in which he had been imprisoned for twenty-three days. During the first ten days he had a little dirty water, but for the last thirteen days nothing whatever. When taken out he was in a condition of great weakness and emaciation and died after three days, notwithstanding all efforts made to preserve his life.

Cases of prolonged abstinence often occur among the insane, who, under the influence of delusions, or in order to destroy their lives refuse all food. Dr. Willan relates the case of a young man, who, through delusions, refused all food but a little orange juice, and who lived for sixty days on this alone.

Of course such persons, if under the observation of a physician, could be fed forcibly, but through the ignorance of friends or relatives it not unfrequently happens that medical aid is not invoked in time, and serious symptoms, or even death itself, may result. The time at which this last termination ensues varies according to the kind of insanity with which the patient is affected. A general paralytic deprived of all food dies sooner than a healthy person. An insane person suffering from acute mania also resists inanition badly, but one the subject of melancholia often endures the total deprivation of aliment for a long time. Esquirol[20] cites the case of a melancholic who did not succumb till after eighteen days of complete abstinence, and Desbarreaux-Bernard another in which life was prolonged for sixty-one days, but in this case a little broth was taken once. Desportes[21] refers to the case of a woman subject to melancholia who continued to exist during two months of abstinence, during which she took nothing into the stomach but a little water.

It would be easy to go on and quote other instances occurring among prisoners, shipwrecked persons, those suffering from diseases which prevented food entering the stomach, others lost in deserts, forests, etc., in which life has been prolonged for considerable periods. Such cases are, however, quite exceptional. An interesting instance occurring under one of these heads may, however, be cited as an example.

M. Lépine[22] reports the case of a young girl nineteen years of age who swallowed a quantity of sulphuric acid. As a consequence a stricture of the œsophagus was produced. Three months after the act, liquids alone passed into the stomach; emaciation was extreme and the countenance pallid. Four months subsequently, that is, seven months after swallowing the acid, the obliteration of the œsophagus was complete, and nothing whatever could be swallowed. The patient lived for sixteen days after all food or drink was prevented reaching the stomach. During the last days of her starvation she complained only of thirst and not of hunger. The prostration was extreme and the temperature greatly lessened. A tendency to sleep was present, and there was a subdued delirium. On the last day of life there was more excitement; the conjunctivæ were red, the pulse thread-like, and the skin cold. It is not stated whether or not attempts were made to feed this patient by injections into the rectum of nutritious substances, or by the use of baths containing such matters in solution. It may, however, safely be taken for granted that efforts of these kinds were made, and if so, the unusually long period during which life was sustained is explained.

In all the cases in which life was extraordinarily prolonged there was either not a total deprivation of food and drink, or there was a state of muscular inaction present particularly favorable to retardation of the destructive changes in the body which abstinence produces. It may be asserted that in ordinary cases absolute deprivation of food and drink cannot be endured by a healthy adult longer than ten days, and death generally ensues before the end of the eighth day. It is said that women sustain abstinence better than men. Young persons and the aged certainly resist with less power than those of the middle period of life. Dante was aware of this fact when he made the children of Ugolino die before their father, the youngest first, the oldest last.

Even though there be a total deprivation of what may strictly be called food, some of the cases already cited show that if water be taken life is preserved for a much longer period than would otherwise be the case. Thus a negro woman, according to Dr. J. W. Francis,[23] believing herself to be bewitched, abstained from food for three weeks, but during this period took two small cups of water, to which a very little wine had been added.

In a case reported by Dr. McNaughton[24] a longer resistance was maintained.

"The subject of this case was a young man, aged twenty-seven, who for three years immediately preceding his death almost constantly kept his room, apparently engaged in meditation, a Bible his only companion. At the latter end of May, 1829, his appetite began to fail; he ate very little, and on the 2d of July he declined eating altogether. For the first six weeks of his fast he went regularly to the well, washed himself, and took a bowl full of water with him into the house. With this he occasionally washed his mouth and drank a little; the quantity taken during the twenty-four hours did not exceed a pint. On one occasion he went three days without taking water, but on the fourth morning he was observed to go to the well and drink copiously and greedily. For the first six weeks he walked out every day, and sometimes spent the greater part of the day in the woods. He retained his strength until a short time before his death. During the first three weeks he emaciated rapidly; afterwards he did not seem to waste so sensibly. Prof. Willoughby visited him a few days before he died. He found the skin very cold, the respiration feeble and slow, but otherwise natural; but the effluvia from the breath, and perhaps the skin, were extremely offensive. During the greater part of the latter week of his life the parents say there was a considerable discharge of foul reddish matter from the lungs. To this perhaps the offensive smell referred to may be chiefly attributed. The pulse was regular, but slow and feeble, and the arteries extremely contracted. The radial artery, for example, could be distinctly felt like a small, hard thread, communicating almost a wiry feel.

"The alvine evacuations were rare; it is believed that he passed several weeks without any, but the secretion of urine seemed more regular. He died after fasting fifty-three days. On dissection the stomach was found loose and flabby. The gall bladder was distended with a dark, muddy-looking bile. The mesentery, stomach and intestines were excessively thin and transparent. There was no fat in the omentum."

In cases of complete abstinence, the phenomena--to several of which attention has already been called--are very striking. The respiration becomes slow until just before death, when, as Chossat observes, there is often a quickening of the respiratory movements. The exhaled breath has a peculiarly sickening and fetid odor. The pulse loses in force and frequency.

The blood becomes reduced in quantity to such an extent sometimes that, as observed by Collard and Martigny,[25] incisions may be made in various parts of the bodies of animals suffering from inanition without there being any hæmorrhage.

The animal temperature falls, according to Chossat, 8° per day until the day of death, when it reaches 14°; and at the moment life departs, the loss suddenly becomes 30°.

All the secretions are diminished in quantity. This is especially shown as regards the saliva and urine. Even open sores cease to secrete pus.

At first there is pain, the seat of which is referred to the stomach, and which pain in the beginning, being simply a feeling of emptiness, rapidly assumes a gnawing or tearing character. But before long this fades away and it does not appear that in the middle and final stages of inanition there is any suffering which can be called a pain, or which can be fixed in any definite part of the body.

The mental faculties are profoundly affected. A high state of delirium supervenes, and there are often hallucinations. These sometimes relate to food, which appears to the sufferer to be spread out before him in the most seducing manner. All nobility of character disappears, and selfishness and brutality govern. Finally the delirium becomes low and muttering, the bodily weakness becomes excessive, walking, or even standing, is impossible, the sufferer loses all sensation, and death ensues.

But probably no part of the subject is of more interest than that which relates to the association of inanition with hysteria. As is well known by physicians, the existence of this latter condition enables many to bear partial, or even complete deprivation of food longer and with less apparent suffering than would be possible with individuals in good health.

That Miss Fancher is subject to hysteria is very evident from a consideration of the clinical history of her case, and hence it is to be expected that she can endure long fasts without much inconvenience. It is just possible that she might, by remaining quietly in bed in a state of partial or complete trance--a hysterical condition in which the waste of the tissues is greatly reduced--exist for a month without either food or drink, and therefore the proposition which I made to her friends contains no exacting condition. But when it is gravely said that "for a period of nearly fourteen years she has lived absolutely without food or nourishment of any kind," we are forced to declare, in the interest of science, that the statement is necessarily absolutely devoid of truth. Subsequent statements, as we have seen, modify this fourteen years' claim very materially, and really leave it in doubt whether there was any abstinence at all.

But I think it may safely be believed that Miss Fancher has indulged in frequent long fasts. Hysteria is very frequently marked, not only by the ability to endure lengthened periods of abstinence, but by the abolition of all desire for food, to such an extent that the sight or even idea of aliment of any kind excites loathing and disgust. M. Lasègue,[26] in a very interesting memoir, has discussed this part of the subject with great precision, and has shown that though such patients take very little food they do take some, and that eventually they experience all the symptoms of inanition. He has never seen death result from the abstinence, for as soon as the condition becomes decidedly unpleasant the patient resumes gradually her normal alimentation.

In a case recently under my care, a young lady twenty-three years of age became hysterical in consequence of domestic troubles, and losing all desire for food, took nothing daily but a single cup of chocolate. She persevered in this restricted diet for twenty-nine days, although during the last eight or ten she gave decided evidences of starvation. She became emaciated, her temperature fell, especially in the extremities, her breath was offensive, her menstruation ceased, and there was such a marked sense of discomfort that she began to crave food, not, as she said, because her appetite had returned, but because she was afraid she would die. Still she resisted till, on the thirtieth day, she begged for a little beef tea, and from that moment her appetite returned to her, and by the end of another week, she was eating her ordinary quantity and variety of food.

Now, in this case, though the amount of nutriment taken daily was small, it was of such a character as to be well able to sustain life. The half pint of chocolate contained milk and sugar, besides the highly nutritious chocolate, with its carbonaceous and nitrogenous matters, and yet a month was the extreme limit of endurance.

That a state of inanition exists in Miss Fancher is not to be doubted. The extreme emaciation, the reduced bodily temperature, the contracted stomach and intestines, the great bodily weakness, all show that she is not sufficiently nourished. In her case there is apparently not only an absence of appetite but a positive disgust for food; and another symptom often present in inanition--vomiting when nutriment is taken into the stomach--appears also to be a prominent feature. It is probable that there is likewise a notable diminution in the amount of urine excreted, as this is a common accompaniment of hysterical manifestations such as hers. In some instances the function appears to be almost entirely arrested, as was the fact in a case described by M. Charcot,[27] and in two which have come under my own observation.

There is nothing remarkable in the admitted fact that Miss Fancher eats very little. We have seen how existence can be kept up on greatly reduced quantities of food, and under circumstances such as those governing her case, for periods which would be impossible in healthy persons. No one yet under any conditions, whether of hysteria or trance or assumed miraculous interference, has, to the satisfaction of competent and disinterested investigators, lived even two months without the ingestion of any food whatever. As to going nearly fourteen years in a state of abstinence--a statement in her behalf which many persons believe to be true--I can only say that all the teachings of science and of experience are against the claim. No one who had the most superficial idea of what knowledge is and how facts can be proven, would for a moment accept such a preposterous story, no matter by whom asserted.