HYSTERIA. 



5S3 



would appear to be some unusual condition of all 

 the nerves of the body, productive, according to vari- 

 ous accidental circumstances, of the signs of disease 

 in the various parts which they supply, although 

 such diseases do not in reality exist. Medical 

 practitioners learn to recognize these spurious mala- 

 dies, which quite impose upon common observers. 

 A patient is thought to be suddenly and violently 

 attacked with inflammation of the brain, or of the 

 bowels, or of the lungs ; or, some previous disease 

 actually existing, certain symptoms are superadded, 

 which make the case unlike any that are ever 

 found in systematic descriptions ot disease. Even 

 in the course of a fever, a disease which seldom 

 fails to excite the practitioner's anxiety, he is liable 

 to be surprised, when the subjects of them are hy- 

 sterical by constitution, by such strange accidents 

 as but for that explanation would be either unin- 

 telligible or would mislead him into very erroneous 

 practice. The diagnosis, consequently, or detec- 

 tion of hysteria, in all its possible forms and com- 

 binations, is a very important study to the physi- 

 cian; and a thorough acquaintance with its mutable 

 character, and its property of mixing itself up with 

 other maladies, sometimes enables him to tranquil- 

 lize the fears which such odd combinations of dis- 

 order are well calculated to excite in the patient's 

 friends and relations. 



Among the many troublesome accompaniments 

 or parts of hysteria, may be mentioned a particularly 

 distressing cough, of a distinct and marked charac- 

 ter. All coughs derive some modification from 

 the cause in which they originate. The cough of 

 a common cold differs from the deep hollow cough 

 of consumption, and both are distinct from the 

 hoarse cough which generally attends or precedes 

 the measles. The cough or hooping-cough is dis- 

 tinct from all. But the cough of hysteria is not less 

 peculiar ; it is commonly loud, short, and repeated; 

 dry and hard, and shaking the whole frame; in- 

 duced and prolonged by all kinds of mental irrita- 

 tion, and quite refractory under common demulcent 

 and anodyne treatment. It is sometimes periodical, 

 and dependent on temporary causes ; but often 

 permanent, or at least not removed until by general 

 means the patient's health and strength undergo 

 great improvement. In some patients it puts on 

 the character of croup, and in others of asthma; 

 still, however, in most cases, only admitting of 

 abatement by means directed to the general im- 

 provement of the constitution. 



Imitating almost every disease, hysteria occasion- 

 ally puts on many of the signs of approaching 

 death. The pulse sinks until it can hardly be felt; 

 the hands and feet become cold ; the patient 

 breathes with difficulty, and feels convinced that 

 nothing can save her ; and these very distressing 

 symptoms and sensations may last for many hours ; 

 may return on many successive days, and yield at 

 last, leaving the patient quite well. Such things 

 happening to persons in the prime of life, their 

 blooming appearance some weeks after recovery is 

 often remarkably contrasted with the gloomy cir- 

 cumstances by which they were surrounded when 

 the attacks were at the worst. 



If the hypochondriacal patient feels a dread of 

 diseases merely on account of some depraved sen- 

 sations, we cannot wonder that the hysteric patient, 

 in whom many of the functions are often mani- 

 festly disturbed, should believe herself to be la- 

 bouring under incurable disorders. The action of 

 the heart, for instance, is very frequently irregular in 



hysterical patients ; the pulse intermits, and pecu- 

 liar sensations of oppression, or obstruction, or 

 temporary cessation or interruption of the heart's 

 action, are not uncommon. The distinction of 

 such cases from those in which the heart is actually 

 undergoing some change of structure is exceed- 

 ingly important ; especially where, as not unfre- 

 quently happens, the palpitation depends on debil- 

 ity, induced perhaps by a previous attack of fever 

 or other illness ; for in such weakened states the 

 symptoms of hysteria often manifest themselves, 

 and bloodletting and other measures, which in the 

 case of slow organic change might be requisite, 

 would, by still further increasing the debility, ex- 

 asperate the hysterical malady, and probably render 

 it inveterate. 



Divers troublesome symptoms incidental to fe- 

 males of delicate constitution, and often looked 

 upon as inexplicable, and consequently as affording 

 no clear indications of treatment, are discovered to 

 be truly hysterical in their nature, either from its 

 being found that less equivocal signs of hysteria 

 are occasionally exhibited by the patients liable to 

 them, or from the success which follows the ad- 

 ministration of what are called anti-hysteric reme' 

 dies. Among these symptoms are an occasional 

 loss of voice ; a difficulty of swallowing sometimes 

 so great as to create fears of an obstruction of the 

 gullet ; pain fixed to one particular spot, as in the 

 left side, or in the loins, or over one eye. These 

 affections are not unfrequently very obstinate, re- 

 sisting all kinds of treatment for months, or re- 

 turning after short intervals of relief, even for 

 years. When their dependence on a disordered 

 condition of the nerves is not suspected, the pa- 

 tients are, of course, needlessly subjected to va- 

 rious plans of treatment, founded on a belief in 

 the existence of local disorder. Extreme pain in 

 the course of the spine, with great tenderness and 

 a loss of power in one or in both of the lower ex- 

 tremities, a combination of symptoms sufficient 

 to excite apprehension, are all found, in some 

 cases, to depend on a morbid condition of the ner- 

 vous system, and to be parts of hysteria. All 

 these circumstances expose the hysterical patient 

 to the same deceptions which we have said that 

 unprincipled pretenders to medicine practise with so 

 much impunity on the hypochomlriacal. To assert 

 the existence of some serious local disease is to 

 gratify the patient by conforming to her own be- 

 lief, and to ensure her fullest confidence. To tell 

 her there is no local disease ; that her symptoms 

 depend upon her general state of health ; and that 

 relief is only to be expected from long persever- 

 ance in the use of medicine calculated to improve 

 it, and united with the sacrifice of some indolent 

 or luxurious habits ; is to preach a very unwelcome 

 doctrine, and often ensures the dismissal of the too- 

 faithful counsellor. 



The attacks of hysterical pain are sometimes so 

 sudden and so violent as, when affecting the head 

 or the bowels, to excite, even in the minds of the 

 practitioner, much doubt as to their possible origin 

 and tendency, and few parts of medical practice 

 call for a more careful comparison of all the attend- 

 ant symptoms. The absence of fever, the tran-' 

 quillity of the pulse, the complete intermissions of 

 pain occasionally occurring, and other symptoms 

 according to the particular case, can alone be guides 

 to practice, and, warily regarded, save the patient 

 from very unnecessary measures. 



In certain examples of hysteria, the paroxysm or 



