844 OF THE FUNCTIONS OF THE NERVOUS SYSTEM. 



by removal of the injured part ; and powerful sedative remedies alone possess 

 any influence in restraining the paroxysms. The Cerebral apparatus is entirely 

 unaffected in this disorder ; but the nerves of deglutition are usually those first 

 influenced by it ; those of respiration, however, being soon affected, as also 

 those of the trunk in general. The condition termed Hydrophobia is nearly 

 allied to that of traumatic Tetanus, differing chiefly in the mode in which the 

 cranio-spinal axis is affected. The irritable state of the nervous centres obvi- 

 ously results from the introduction of a poison into the blood ; and here the 

 early removal of the wounded part is very, desirable as a means of prevention ; 

 although, when the poison has once begun to operate on the centres, it is of no 

 use. The muscles of respiration and deglutition are, as in Tetanus, those spas- 

 modically affected in the first instance ; but there is this curious difference in 

 the mode in which they are excited to action that, whilst in Tetanus the 

 stimulus operates through the Spinal Cord (either centrally, or by being con- 

 veyed from the periphery), in Hydrophobia it is often transmitted from the 

 ganglia of Special Sense, or even from the Cerebrum; so that the sight or 

 sound of fluids, or even the idea of them, occasions equally with their contact, 

 or with that of a current of air the most distressing convulsions. Many 

 forms of that protean malady, Hysteria, are attended with a similar irritability 

 of the Nervous Centres; but there is this remarkable difference in the two 

 cases, that the morbid phenomena of Hysteria, whilst they often simulate those 

 of Chorea, Tetanus, Hydrophobia, Epilepsy, &c., are evidently dependent upon 

 a state of the system of a much less abnormal character. The absence of any 

 structural lesion, and even of any serious impairment of the nutrition, of the 

 parts of the Nervous System which are the sources of the actions in question, 

 is proved by the length of time during which the severest forms of them may 

 exist without permanently serious consequences, and by the suddenness with 

 which the several forms of them give place one to another, or pass off alto- 

 gether. The strange combinations, moreover, which they occasionally present, 

 remarkably distinguish them from the more settled forms of the diseases which 

 they simulate. 1 The clinical history of Hysteria, then, would lead us to sup- 



1 Thus, the Author has known an obstinate case of Hysteric disorder, in which at one 

 period attacks of the most complete Opisthotonos coexisted with perfect Coma; at another 

 period, the Coma recurred alone ; then again, there was Trismus, lasting for five conse- 

 cutive days, without any other spasmodic action or loss of sensibility ; this sometimes 

 alternated with fits of Yawning, in which the jaw was held open for half an hour together; 

 at another period, the convulsions had more of the Epileptic character, the face being dis- 

 torted, and the limbs agitated, concurrently with a state of Coma, but without laryn- 

 gismus ; with this alternated fits of Laryngismus, without insensibility, and occurring 

 during the expiratory movement ; whilst during the whole of this succession, there was 

 Paralysis of the extensor muscles of both lower extremities, with paroxysms of the most 

 violent and prolonged Cramp in one of them. (See g 325, note.) The mental phenomena 

 were almost equally strange ; for a state of almost Maniacal excitement often came on sud- 

 denly, and ceased no less abruptly ; and every form of double consciousness, from simple 

 sleep-waking to an alternation of two very similar states of mental existence, presented 

 itself during one long period of the disorder. It is worth noting that in this case the 

 exciting cause of the disorder lay in the disappointment of affections long cherished in 

 secret ; but the nutrition of the nervous system had been previously impaired by anxiety 

 and excessive mental exertion. The first access of the disorder was kept off by the influ- 

 ence of a very determined will ; but when the malady had fully developed itself, it resisted 

 every kind of treatment for four years. The catamenial discharge remained very scanty 

 during the whole of that time, and was sometimes absent altogether ; and the recurrence 

 of the period was almost invariably marked by an aggravation of the spasmodic attacks, 

 and frequently by pains resembling those of the first stage of labor. A slow and almost 

 imperceptible improvement was taking place, when circumstances occurred, which gave a 

 new turn to the feelings ; a fresh attachment was formed, which was happily reciprocated; 

 and from that time the cure rapidly advanced, the convulsive and paraplegic affections 

 being speedily recovered from, and nothing being left but dysmeiiorrhoea, which still con- 



