It was, however, the genius of Charcot, and the influence of his able pupils, which finally secured the overthrow of the sexual theory of hysteria.  Charcot emphatically anathematized the visceral origin of hysteria; he declared that it is a psychic disorder, and to leave no loop-hole of escape for those who maintained a sexual causation he asserted that there are no varieties of hysteria, that the disease is one and indivisible.  Charcot recognized no primordial cause of hysteria beyond heredity, which here plays a more important part than in any other neuropathic condition.  Such heredity is either direct or more occasionally by transformation, any deviation of nutrition found in the ancestors (gout, diabetes, arthritis) being a possible cause of hysteria in the descendants.  “We do not know anything about the nature of hysteria,” Charcot wrote in 1892; “we must make it objective in order to recognize it.  The dominant idea for us in the etiology of hysteria is, in the widest sense, its hereditary predisposition.  The greater number of those suffering from this affection are simply born hysterisables, and on them the occasional causes act directly, either through autosuggestion or by causing derangement of general nutrition, and more particularly of the nutrition of the nervous system."[262] These views were ably and decisively stated in Gilles de la Tourette’s Traite de l’Hysterie, written under the inspiration of Charcot.

While Charcot’s doctrine was thus being affirmed and generally accepted, there were at the same time workers in these fields who, though they by no means ignored this doctrine of hysteria or even rejected it, were inclined to think that it was too absolutely stated.  Writing in the Dictionary of Psychological Medicine at the same time as Charcot, Donkin, while deprecating any exclusive emphasis on the sexual causation, pointed out the enormous part played by the emotions in the production of hysteria, and the great influence of puberty in women due to the greater extent of the sexual organs, and the consequently large area of central innervation involved, and thus rendered liable to fall into a state of unstable equilibrium.  Enforced abstinence from the gratification of any of the inherent and primitive desires, he pointed out, may be an adequate exciting cause.  Such a view as this indicated that to set aside the ancient doctrine of a physical sexual cause of hysteria was by no means to exclude a psychic sexual cause.  Ten years earlier Axenfeld and Huchard had pointed out that the reaction against the sexual origin of hysteria was becoming excessive, and they referred to the evidence brought forward by veterinary surgeons showing that unsatisfied sexual desire in animals may produce nervous symptoms very similar to hysteria.[263] The present writer, when in 1894 briefly discussing hysteria as an element in secondary sexual characterization, ventured to reflect the view, confirmed by his own observation, that there was a tendency to unduly minimize the sexual factor in hysteria, and further pointed out that the old error of a special connection between hysteria and the female sexual organs, probably arose from the fact that in woman the organic sexual sphere is larger than in man.[264]