Nouvelle Iconographie de La Salpêtrière
 L'histoire des neurosciences à La Pitié et à La Salpêtrière J Poirier
The history of neurosciences at La Pitié and La Salpêtrière J Poirier 
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12 février 2004
Journal of the History of the Neurosciences
2002; 11; 4; 392-401
Yawning ?
Francis Schiller (1909-2003)
Department of the History of Health Sciences
University of California, San Francisco


Depuis l'Antiquité, le bâillement n'a que fort peu intéressé tant les philosophes, les psychologues ou les physiologistes que les enseignants, les moralistes ou les médecins. Tous les êtres vivants des oiseaux à l'homme, depuis la vie intra-utérine à la mort ont été reconnus comme bâilleurs. Bien qu'il procure souvent un bien-être à celui qui bâille, il est de règle de chercher à le masquer. Hippocrate l'a noté dans sa liste des comportements naturels. Aristote y a consacré quelques mots. Boerhaave en a attribué l'origine au cerveau. Haller a noté ses rapports avec l'audition, la circulation et le sommeil des bébés. Darwin a mentionné son lien avec les émotions. Des auteurs plus contemporains lui ont attribué un rôle dans la respiration et l'odorat. En 1962, Ashley Montagu a essayé de corriger la faiblesse des connaissances de sa cause en proposant son déclenchement pas l'élévation du CO2 et notant ses effets sur la circulation artério-veineuse intracrânienne. Le bâillement a intéressé quelques neurologues qui ont remarqué son association avec l'épidémie d'encéphalites léthargiques apparue après l'épidémie de 'grippe espagnole' dans les années 20, l'existence de bâillements en salves, son association avec l'épilepsie et bien sûr l'hystérie. Un écrit de 40 pages, retrouvé à la cour de Frédéric Le Grand au XVIII°, l'évoque comme stimulant face à l'ennui, et argue de ce constat pour condamner l'oisiveté, sujet qui inspira également Blaise Pascal. ou William James. Dans la monde Hindou, bâiller en public demeure un blasphème....

Since antiquity yawning has attracted a moderate interest among philosophers, psychologists, physiologists, as well as educators, moralists and physicians. Organisms from birds to men and from the womb to the deathbed were found to be displaying it. While sometimes satisfying to the producer, its display is offensive to the lay observer. Hippocrates had it on his lists of useful 'natures.' Aristotle dropped a few words on the matter. Boerhaave elevated its function to the intellect of animals. Haller has commented on its relation to the acoustic system, blood-flow, and baby sleep. Darwin mentioned it in connection with emotional behavior. Some modern authors praised its beneficial effects on respiration and smell. In the 1962, Ashley Montagu tried to correct the contemporary failure to explain the behavior by the fact of raised CO2 and arterial compression. It also interested some neurologists, especially in its association with the encephalitis lethargica in the 1920s, with 'spasmodic yawning,' with epilepsy, not to speak of hysteria. As to boredom or its stimulus, a 40-page dissertation survives from the court of Frederick the Great of the 18th century condemning idleness, a subject that also inspired Blaise Pascal and William James. But in the Hindu world, public yawning was a religious offense...

INTRODUCTION Of all imaginable subject titles appealing to the attention of editors, readers or audiences, this may well be the most self-defeating. The very mention of a yawn is like an invitation to boredom, almost as powerful as its actual display in public or intimacy, on podium, stage or screen. "Yawning is so catching" wrote the great Scotsman neurologist Robert Whytt in 1751. "as frequently to go round a whole company" and again in 1764, referring to it in the pervasive context of reflex action: "There is still a more wonderful sympathy between the nervous systems of different persons" (Whytt. 1768). "Like a donkey urinates when he sees or hears another donkey do it, so also man yawns seeing someone else do it " according to Aristotle (Zirnara, 1580). More infectious. perhaps, than smiling, and in sharp contrast to the latter, it lacks the stamp of shared appreciation. Worse than a scornful smile, it is in fact socially unacceptable, in part for being so low on the evolutional scale of behavior, half way between a reflex and an expressive movement . (Barbizet, 1958; Provine, 1986). Man shares it not only with the primates and cetaceans, but with smaller brained animals such as dogs, cats and rats, possibly with genera evolutionary even lower. Turtles and birds have been caught in the act (Ack-ernian l990, Heusner 1946, Lehmannn 1979, Lewy 1921). Human yawning may be taken as a display of disrespect or criticism, impolite: this makes it an early item on the list of things for children to refrain from in public or at least to hide that gaping niouth with a shielding hand.
No such control pertains to babies. Angelo Mosso wrote in 1901 in his basic book on fatigue, "Babies yawn and stretch themselves even in the very first days of life" (Mosso. 1904). Even some fetuses have been observed to yawn when their intrauterine behavior was screened with ultrasound. In some instances, they begin to do it from the 11th postmenstrual week on: opening the mouth widely, then closing it quickly while retro-flexing the head and sometimes elevating an arm, (De Vries et al., 1982. 1986). On the other hand, when neonates (from 11 to 21 days old) have been noted to imitate some experimenters open mouths, tongue and lip protrusion, and even sequential finger movements, they have not been found to mutate yawning as such (Gardner & Howard, 1970; Meltzoff & Moore, 1977). The issue has remained controversial, however (Provine, 1989). For, "yawning though it may be a reflex becomes contagious only during the second year because before that stage the correspondence between the visual model and the child's own movements has not been grasped" (Piaget, 1951).
Most textbooks on physiology and psychology deal only briefly with this basic element in the repertoire of animal and human behavior (Lewy, 1921; Barbizet, 1959 Siegal, 1974; Askenasy, 1989). Its seeming unimportance may be the cause here. But in 1872. Darwin did devote a few lines to it as an "Expression of the Emotions in Man and Animals" (Darwin, 1955). Already in 1837, he is said to have given it as a paradigm.
PURPOSE What purpose lies in this grotesque display of a mouth opening to its maximal width, in association with a diaphragm contracting to an uncommon degree, expanding the lung for an excessive intake of air, aided by a spasmodic elevation of the pharynx blocking the custonnary gentle nasal airways? We are faced with a paradoxical combination linking an attempt to turn off the weariness of having to be awake, tied in with the presentation of an ugly offeinsive spectacle. Not to speak of stretching our skeletal muscles, closing our eyes to the point, occasionally, even of shedding tear or two. Albrecht von Haller's observation that we lose some of our hearing during the act was analyzed by an otologist in 1953: a wide opening of the Eustachian tube raises the air pressure in the middle ear (Laskiewicz, 1953). Boerhaave thought it raised brain power, ou the grounds of reports that lions and tigers yawn and stretch before the chase (Trautmann, 1901, p. 17).
In 1974, four letters to the editor appeared in The New England Journal of Medicine under the jolly heading "Why the Yawn" The first writer expressed a mixture of slight irritation, amusement and interest in the subject, because of a domestic experience. "Yawning remains a mystery" he started out. Nevertheless, as his wife had been yawning one day, her deep inspiration had allowed her to detect the odor of gas escaping from an extinguished pilot. Was yawning then protective, a danger signal or a protective mechanism enhancing the sense of smell (Siegal. 1974)? The first correspondent in the next issue agreed that it was protective by overcoming hypoventilation, as in postoperative alveolar collapse (Twiest, 1974). The second letter in this issue quoted Ashley Montagu who 12 years earlier had maintained that it was a form of behavior that has defied all attempts to explain it.Montagu's intent to correct this situation had been based on his concept of a 'critical consciousness': reduced by monotony often associated with raised CO, and compression of the external and internal carotid and the carotid bodies. . . . This state of normal active awareness and relatedness would be reactivated by a good yawn, with 'adaptive stretching of the jaw and other muscles' (Montagu. l962). Oxygen would reach the alveoli 'more directly the correspondent added, thanks to stretched bronchial muscles and stimulation of vagus nerve endings, putting off sleep' (Friedel. 1974). The last entry stressed, besides the salutary stretching of limbs, the contraction of the pterygoid muscles, venous plexuse and diaphragm. A contributing to increased venous return. But this writer too was still puzzled: why, was it 'catching' (Bhangoo, 1974)? Might we answer that the victims of the contagion must be predisposed by a touch of boredom they are already sharing, if only unconsciously?
PSYCHIATRIAC ASPECTS Primarily it was, like spasmodic sneezing, seen in the course of hysteria (Oppenheim, 1908; Lewy, 1921). But hysteria has largely lost any actuality since the first quarter of our century. Back in 1869, Brochin, keeping an open mind in his extensive encyclopedic article, devoted a few lines to hysterical yawning. It either introduces. he says, or terminates such attacks as it is also apt to precede epileptic seizures: here it represents "a useful warning." In hysteria, catalepsy and somnambulism yawning appears as 'la crise finale.' very frequent attacks may even constitute a disease sui generis. In girls with irregular menses, 'it seems hysterical to us' (Brochin, 1869).
From the vast supply of cases at the Salpêtrière late in the 19th century, Gilles de la Tourette was able to collect only six women presenting episodes of hysterical paroxysmal or protracted yawning. Their age ranged from 17 to 30 years. In one such case, Charcot himself counted eight yawns per minute, 480 per hour, 7200 in 15 hr - finally stopped by the patient falling asleep. Some of these cases also displayed coughing, choreatic movements, or clonic contractions merging into a convulsive seizure (Gilles de la Tourette, 1891-1895).
Meige and Feindel, in their classic monograph on tics ( 1902), also found it most common in hysteria. rarely also as the aura of an epileptic fit, but in its most intractable form in meningeal affections and in cerebral and cerebellar tumors (Translated by Kinnier Wilson in 1907 this anticipates his own statement to that effect quoted above.). Meige also quoted Saenger who, in 1900, recorded the case of a 29-year old nonhysterical woman who used to suffer from "apparently idiopathic... attacks of yawning and stiffness in the arms, followed by rapid contractions of the tongue lasting for about a minute... probably a species of tic" (Meige & Feindel, 1902).
On the other hand, boredom, which causes it, became a fashionable subject on the European continent covering over two centuries from the Enlightenment to Existentialism. A 40-page Dissertation sur l'Ennui, without any authorship given, was presented to the Académie des Sciences et Belles Lettres and published by G. J. Decker in Berlin in 1768. As French in those days was the official and social language at the Prussian court, it was presumably authored by one of its members close to King Frederick II, the Great, sponsored or possibly even authored in part by himself. A piece of propaganda, it concluded \vith an appeal to work: Work- made to relax us from our pleasures as pleasures are made to relax us from our work... This, Gentlemen, is the areat art to make oneself useful to society, the fatherland, to oneself... Duties... In these sparks of true genius you will recognize, Gentlemen, your AUGUST PROTECTOR. In Him every man recognizes a model.
At the outset, the thesis claimed that boredom has never been analyzed... although it has become a matter of fashion and good breeding (bon ton) (p. 3)... Yawning is just purely physical ennui (discomfort); if it sometimes accomparues psychological discomfort (ennui moral. this is the case rather accidentally than necessarily... (p. 5) It is not just inaction or indifference... It is the soul in spite of itself... (p. 16) [Amon- physical causes he mentions] slow digestion... nerves [concluding that it is] an impenetrable mystery... an incurable nervous disease... (pp. 19-21). The English have no word for it, their 'low spirit' is too weak, 'spleen' too strong.. .- (p. 27). [The OED indeed dates 'boredom' from 1852].
The author's conclusion, as we have seen, makes idleness the universal cause of ennui. He quotes La Rouchefoucault: -Work of the body delivers us from she suffering of the mind; this makes the poor happy" (p. 3 1 ). We are only 21 years away form the French revolution; the aristocratic aphorism îtself was then a century old.
In the preceding century, Blaise Pascal, that unique genius combining a fundamental mathematician and moralist, physicist and philosopher, highlighted our subject in his Pensées of 1670. He piled up the analogies:
Ennui. - Nothing is as unbearable to man as complete rest, without passion, without business, without diversion, without employment. This is when he feels his nothingness, his deprivation, his insufficiency, his dependency, his impotence, his emptiness. Forthwith and from the bottom of his soul he will bring up ennui, blackness, sadness, grief, resentment, despair (Pascal, see Béguin, 1953).
Going back to the early Christian era with Seneca in Rome, to St. John Chrysostomus, bishop and one-time hermit in the 14th century, to acedia of medieval monks, was taedium vitae. It pervaded the French literature in the 19th century from Chateaubriand to Baudelaire, Flaubert and Laforgue (Sagnes, 1969). And it culminated in JeanPaul Sartre's existentialist Nausea of 1938. This closely composed novel in autobiographical form contains a paragraph: I am bored, that is all. From time to time I yawn so widely that tears roll down my cheeks. It is a profound boredom. profound, the profound heart of existence (p. 157). And this other passage: The only real thing left in me is existence which feels it exists. I yawn, lengthily (Sartre, 1964, p. 170).
The Russian 19th century paradigrn of inertia is "the disease of Oblomovka," personified in Ivan Goncharov's famous fictional non-hero Oblomov. First published in 1858, the novel of that name contains such passages as:
'Presently it will be twelve o'clock. yet you are sprawling about on your back!'. . . 'l was just about to rise,' said Oblomov with a yawn. 'Yen have come too early in the morning,' suggested Oblomov with a yawn. As a matter of fact, he did read a page... . That done, he laid it down and yawned (Goncharov, 1858, pp. 49, 51, 59; See also pp. 138 & 241).
William James defined boredom as: Attentiveness to the passage of time itself The odiousness of the whole experience comes from insipidity, for stimulation is the indispensable requisite for pleasure in experience and the feeling of bare time is the least stimulating experience we can have.
Contributors to the psychiatric literature seem largely to have 'repressed' the subject of yawning. To boredom only a few references exist. In the James Strachey Standard Edition of Freud's work we find Breuer briefly referring to it, explaining 'these unpleasurable feelings' as an 'increase in normal intracerebral excitation' a 'surplus quantity of energy' (Freud, 1955). The paradoxical statement is based on the classical theory revived in the late 19th century concept of Beard's neurasthenia, using the analogy between the brain or mind with a machine having at its disposal, or producing, a given amount of 'energy.' For Breuer, a factor in the 'development of hysteria' was an 'intolerance of monotony and boredom.' As the nervous system 'at rest liberates an excess of excitation' (p. 240), that 'surplus' determines this 'incapacity to tolerate a monotonous life and boredom.' (Such reasoning would eliminate the parallel between boredom and fatigue.)
In a more recent psychoanalytical investigation, The Trauma of time, the author rates boredom 'a common complaint' He quotes Grotjahn (1942) calling it "an ego starvation" and Fliess (1961), finding in it a 'claustrophobic element'while Greenson (1953) detected "strong oral fixations." He also arees that 'oral or phallic problems are predisposing to boredom' (Schiffer, 1978). Another psychoanalytical inquiry associates boredom with depersonalization, calling lemptiness its extrerne form' to which 'narcissistic personalities are particularly susceptible.' Other terms used in this connection are helplessness, anger, depression, prohibited wishes and repressed sexual wishes (Hartocollis, 1983). Already, in the early 19th century "habitual" yawning was associated with people of low intelligence, with inactive minds and lacking in initiative, and who were described as lazy, soft. weak, indolent, timid, indifferent and melancholie, but also wily, crafty, defective and criminal (Lepelletier, quoted by Trautmann, 1901).
This brings us back to the oral aggressiveness of yawning. It finds a surprizing parallel in the experimental field, including the sexual aspect. Thus two Nigerian Patas monkeys, a male and female, produced what looked like yawning when they were exposed to mirrors, either fixed or hand held. They would also lick and chew them. The male displayed penile erection or masturbation at the same time. Yawning was repeated up to 23 times in rapid succession and would gradually diminish to a total of 67 yawns in 10 minutes as the mirror was losing its sense of novelty (Hall, 1962).
Since the 1960s, following a new impetus, a considerable amount of work bas been devoted to the biochemical provocation of yawing in animals (Provine, 1960). Again this was usually associated with penile erection, e.g., in rats. when potassium chloride was electrophoretically applied to their occipital cortices to trigger cortical spreading depression (Huston, 1971). The same reaction was obtained in rabbits after intraventricular infusion of ACTH (Bertolini et al. 1969, Baldwin et al. 1974), and after intraperitoneal injection of physostigmine and pilocarpine in infant rats (Urba-Holmgren et al. 1977; Goldberg, 1983). Oxytocin injected into the paraventricular nucleus of the hypothalamus, or the CA field of the hippocampus of rats had the same effect (Melis et al. 1983). Dopamine, activated by apomorphine has been another operative stimulus (Mogilnicka & Klimel l977, Yamada & Furakawa, 1980). This reaction has been blocked with narcoleptics (Gilbert. 1988). The cholinergic and dopaminergic effects also with bromocriptine, blocked by overdoses, keep being confirmed (Ushimaja et al. 1988).
Again clinicaliy, in humans, opiate withdrawal with naloxene has been shown to produce 'it' (Fleminc, 1979; Nemeth-Coslett & Griffiths. 1986). After combining naloxone with electroconvulsive therapy, yawning persisted for a full week (D'Mello et al. 1988). A thirty-year old woman taking Imipramine 150mg twice daily ended up yawning about twice daily for tive to fifteen minutes and gradually ceased doing it when the dose was reduced and finally discontinued (Goldberg, 1983).
Returning, finally, to the aspect of transmission, or echokinesia (Charcot's term, quoted by Meige, 1907) in a fairly recent letter to the Lancet - again one in a quartet on our subject the writer suggested that this may have a group cohesive function for animals that hunt in packs or protect themselves in herds (Weller, 1988). According to the French "One good yawner will create seven; even dogs watching their owners do it have been alleged to imitate them (Trautman. 1901, pp. 37,49).
Leonardo da Vinci - to emphasize some of the effects of painting over those of poetry - told this brief story: "An artist painted a picture that whoever saw it at once yawned, and went on doing so as long as he kept his eyes on the picture. which represented a person who was also yawning" (Richter, 1939). Whether or not such a daring picture was ever exhibited during the Renaissance, Leonardo illustrates here the preponderantly visual contagiousness of the habit. In a recent experiment, one quarter of the students made to read about it were also induced to yawning (Provine, 1986).
The author suggested that we are dealing here not with a 'true' (i.e.. intentional) imitation, but an act that 'only mimicks imitation' (Provine. 1989).
After noticin-g on a few occasions a person yawning on a streetcar shortly after having myself indulged in the act, and doubtine that the other person had observed me, I once asked such a coyawner whether in tact he had just seen me do it. By denying that he had confirmed my suspicion that there might be a remote possibility - hard to support on rational grounds that the germ of yawning could even be contagious by something like telepathy! It may be argued that boredom (or fatigue) is sornewhat endemic on vehicles of public transportation, hence merely coincidental.
A FEW ORIENTAL ASPECTS So much for the West. In the Hindu world, yawning is or was a religious offense. As an apology, you must snap your thumb and fingers together and pronounce the name of Raina. Not to do so would be a sin as great as murder. Another interpretation was that part of your soul may escape. Clap a hand before your mouth and say -Marayan - Good God! Analogous Islamic beliefs were expressed by Abu-Horeira who had the Prophet declare that while God loves a sneeze he hates a yawn. It is provoked by the devil who is mocking you. Worse than an offense to others, it is a curse on you (Saintyves, 1921).
POSTSCRIPT To end, however, in this negative vein may be unfair. For no matter which of the contradictory physiological explanations are to be accepted, and no matter how offensive the social aspects, a modicum of personal satisfaction cannot be denied to a good yawn.