Part 10

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 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 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 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, 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 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, 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, 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, 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.

The whole subject is one which is to be examined into and determined like any other matter, and yet, when a proposition is made to investigate by skilled observers the remarkable claim put forward, it is met with abuse and misrepresentation, as if these people thought that all they had to do was to make an assertion of a phenomenon which, according to what we know of nature, is absurd and impossible, to have it at once accepted by those who know, by painful experience, how doubtful all things are till they are proven, and how difficult it is to get satisfactory evidence of the most simple event in physiology or pathology. No one doubts the abstract possibility of a human being living without food, for, bearing in mind the discoveries that are constantly being made, nothing can be regarded as absolutely impossible outside the domain of mathematics. Two and two cannot make six, neither can two distinct bodies occupy the same space at the same time, nor the square of the hypothenuse be otherwise than equal to the sum of the squares of the other two sides of a right-angled triangle.

Our knowledge of natural science is, however, founded on experience. Looking at a bear, for instance, for the first time, and with no knowledge of its habits and capacities we would not be apt to believe that the animal could go into retirement at the beginning of winter and remain till spring in a condition of semi-existence and without food. But experience teaches us that the bear when it begins to hibernate is fat; that during hibernation it is in a perfectly quiescent state; that when it emerges into active life again it is emaciated, and that during the whole period of retirement it has taken nothing into its stomach. We then know by observing that all bears go through the same process, that it is a law of their organism to do so, and that their reduced functional actions are maintained by the consumption of the fat with which in the beginning their bodies were loaded. Even here, then, there is no exception to the law that there is no force without the decomposition of matter. Now, it is just possible that by some hitherto unknown or unrecognized condition of the system a man or woman may obtain the force necessary to carry on life for fourteen years without getting it through food taken into the stomach. But a possibility and a fact are two very different things, and the admitted possibility has not yet been shown to be a fact. It is easier--to use the argument of Hume--for the mind to accept the view that there is deception or error somewhere, than to believe that a woman, contrary to all human experience, should live fourteen years without food. Turtles, we know, will live for months while entirely deprived of nutriment. Many others of the cold-blooded animals will do the same thing. It is their nature to do so, and we have experience of the fact, but it is not the nature of women, so far as we know, and therefore we refuse to accept as true the stories which are told of their powers in this direction. And our knowledge is based not only on our daily experience of the wants of their systems and the examples of starvation which have come to our knowledge, but also upon the fact that in the many cases of alleged long abstinence from food that have been investigated, error or deception has been discovered. Therefore, when it is said that Miss Fancher lives without food, and has so done for fourteen years, we simply say, "give us the proofs." Of course the proofs are not given.

How far Miss Fancher is responsible for the assertions that have been made in regard to her long-continued abstinence I do not know. A tendency to deception is a notable phenomenon of hysteria, and if she has led those about her to accept the view that she has existed without food for years, the circumstance would be in no way remarkable. Other hysterical women have deceived in the same or in still more astonishing ways. Or it may be that the amount of food taken being very small, carelessness or want of exactness has led to the expression that she lived upon "absolutely nothing," just as we hear the words used every day by those who have little or no appetite, but who nevertheless do eat something. Again, a love for the marvellous is so deeply rooted in the average human mind that it willingly, and to a certain extent unconsciously, adds to any statement of a remarkable circumstance, till the latter grows, whilst being repeated, to fabulous dimensions.

But however this may be, whatever the explanation, it is quite certain that if Miss Fancher has lived fourteen years without food, or even fourteen months, or weeks, she is a unique psychological or pathological individual, whose case is worthy of all the consideration which can be given to it, not by superstitious or credulous or ignorant persons, but by those who, trained in the proper methods of scientific research, would know how to get the whole truth of her case, and nothing but the truth. It is to be regretted, therefore, that the proposition contained in the annexed letter (Appendix) was not accepted, and that we are forced to place Miss Fancher's case among the others which have proved to be fallacious, till such time as it may suit her and her friends to allow of such an examination.

FOOTNOTES:

Recherches expérimentales sur l'inanition. Paris, 1843, p. 20.