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HYSTERIA

HYSTE'RIA (so called from the Greek word hystera, the womb) is a disease which stimulates so many other diseases, that it is not easy to describe it with the brevity which the limits of this work necessitate.

The hysterical fit or paroxysm—the most marked form or manifestation of the disorder—is almost, though not exclusively, confined to women, and chiefly to young women. In a severe case, the trunk and limbs are strongly convulsed; the patient struggles violently, retracting and extending her legs, and twist­ing her body with such force that the aid of three or four strong persons is often required to prevent a slight and apparently feeble girl from injuring herself or others. ' The head,' says Dr. Wat­son in his Lectures, ' is generally thrown backwards, and the throat projects; the face is flushed; the eyelids are closed and trem­ulous; the nostrils distended; the jaws often firmly shut; but there is no distortion of the countenance. If the hands are left at liberty, she will often strike her breast repeatedly and quickly, or carry her fingers to her throat, as if to remove some oppression there; or she will sometimes tear her hair, or rend her clothes, or attempt to bite those about her. After a short time, this violent agitation is calmed; but the patient lies panting, and trembling, and starting at the slightest noise or the gentlest touch; or some­times she remains motionless during the remission, with a fixed eye; till all at once the convulsive movements are renewed; and this alternation of spasm and quiet will go on for a space of time that varies considerably in different cases; and the whole attack frequently terminates in an explosion of tears, and sobs, and con­vulsive laughter.'

In another less frequent form of the affection, the patient sud­denly sinks down insensible and without convulsions : after remaining for some time in this state, with flushed cheeks, a turgid neck, and irregular breathing, she recovers consciousness, but remains for some time depressed, in spirits and fatigued.

During the attack, especially in the first variety, the patient complains of uneasiness in the abdomen, and of a sensation as if a ball was rolling about, and rising first to the region of the stomach, and then to the throat, where she feels as if were being choked. The abdomen is distended with wind, which moves with a loud rumbling sound along the intestinal canal, and is often dis­charged by eructation. Towards the close of the fit, but more commonly after it is over, a large quantity of pale limpid urine is discharged.

In many respects, this affection resembles Epilepsy (q, v.). Ac­cording to Dr. Marshall Hall, the most essential difference is this : that in hysteria, much as the larynx may be affected, is never closed; while in epilepsy, it is closed. Hence, in the former, we have heaving, sighing inspiration; and in the latter, violent, ineffectual efforts at expiration.

The hysterical fit varies in duration from a quarter of an hour or less to many hours.

The persons who suffer from hysteria are commonly young women in whom the process of menstruation is disordered, and who are either naturally feeble, or have been debilitated by dis­ease or want; and in patients of this kind, the hysteria, or the hysterical tendency, is apt to show itself in mimicking so faith­fully many of the most important diseases, that the physician has often great difficulty in determining the true nature of the case Among the disorders that may be thus simulated by hysteria are, inflammation of the peritoneum (or Peritonitis, q. v.), various forms of palsy, inflammation of the larynx (or Laryngitis, q, v.), inability to swallow (or Dysphagia), painful affection of the breast, disease of the hip and knee joints, and disease of the spine. Many of these cases of pseudo-disease come to a sudden favorable termination under some strong mental or moral emotions. Those who are old enough to recollect the morbid religious excitement that prevailed at the time when Irving and his followers believed in the 'unknown tongues,' can hardly fail to remember the re­markable, or, as many regarded it, the miraculous cure of a young paralytic lady, who was made to believe that if, on a certain day, she prayed for recovery with sufficient faith, her prayer would be answered, and she would recover at once. She did so, and her palsy instantly disappeared. This case, which was regarded by the believers in the movement as a direct answer to prayer, and as inaugurating a new era of miraculous cures, admits of easy and rational explanation by some psychologists. There are various instances on record where, in a similar way, an alarm of fire has instantly cured an hysterical paralysis that had lasted for years.

In the cases already noticed, the patient is not guilty of wil­fully deceiving the physician; but in other instances they an found to practice the most remarkable impositions, pretending by various frauds to be suffering from spitting of blood, from stone in the bladder, &c., or to be living without food of any kind.

Hysteria is a very troublesome affection to deal with, because it is very readily induced by example, or, as Dr. Watson terms it, is propagable by moral contagion. If, in a hospital ward or in a factory where many young women are congregated, one girl goes off in a fit, all the others who may happen to have a hysteri­cal tendency will probably follow her example. In such cases, a decided order that the next girl who is attacked shall be treated with the actual cautery, or even with the cold affusion, will often have a marvelous effect in checking the spread of the disorder.

During the fit, the treatment to be adopted is to prevent the patient from injuring herself, to loosen her dress, and to admit an abundance of fresh cool air; to dash cold water upon the face and chest; and, if she can swallow, to administer a couple of ounces of the asafœtida mixture, or a drachm of the ammoniated tincture of valerian in a wine-glass of water. After the paroxysm is over, the patient should have an active purge, and the bowels should be kept properly open by aloetic aperients; and the shower-bath, preparations of iron, and tonic treatment generally should be adopted, and all abnormal bodily and mental excite­ment, such as late parties in hot rooms, novel-reading, &c., care­fully avoided.

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