GENERAL RECAPITULATION, PATHOLOGICAL APPLICATIONS. 845 



pose that the convulsive action depends rather upon some state of the blood 

 which alters its relation to the nervous tissue as its exciting fluid, than upon 

 any such change in the nutritive supply which it affords as would induce a 

 more permanent disorder in the system. Taking all the phenomena, however, 

 into account, there seems much reason to think that a general excitability of 

 the nervous system, such as is only an exaggeration of that which is character- 

 istic of the female sex, is induced by some defect of Nutrition, comparatively 

 permanent in its nature ; whilst the particular forms of perverted action are 

 determined either by some toxic agent in the blood, slight variations in which 

 may give it a selective power for one part or another of the Nervous Centres, or 

 by irritation of the peripheral nerves. Among the sources of imperfect nutri- 

 tion, leading to undue excitability of the nervous system, and thus acting as a 

 " predisposing cause," it seems probable that a gouty diathesis is one of the 

 most frequent j 1 whilst among the exciting causes, some irregular action of the 

 sexual apparatus is among the most common, though it would not be correct to 

 affirm, that disorder of the nutritive or secretory functions of the sexual system 

 is essential to the production of the hysteric condition. The influence of Emo- 

 tional states upon this condition is among the most remarkable features in the 

 history of the disorder. There can be little doubt that habitual indulgence of 

 the feelings, especially when these are of a painful kind, has a direct tendency to 

 affect the nutrition of the nervous system ; but when these feelings have special 

 reference to sexual subjects, they will exert a powerful indirect influence, by 

 fixing the mind on the genital system, and thereby modifying its condition 

 (CHAP, xviii.). In either of these modes, the habitual emotional state acts as 

 a " predisposing cause ;" but we constantly observe that, when the hysteric 

 diathesis is established, any particular access of emotional excitement, even 

 though it be of a pleasurable nature, induces the hysteric paroxysm ; and it is 

 by making a powerful effort to restrain the feelings that the Will, if the patient 

 can be led to exert it, has so much control over the hysterical tendency. It 

 is generally, however, a part of the complaint, that the Will cannot be effectually 

 exerted; and this either on account of the vehemence of the Emotional dis- 

 turbance, or through an absolute impairment of voluntary power; the state of 

 mind then approximating closely to some forms of Insanity. It is in such cir- 

 cumstances that the influence of powerful motives, adapted to work upon the 

 Will through the feelings, may be brought to bear most effectually in checking 

 the paroxysm ; thus it is well known that when the sight of an " hysteric fit" 

 in one individual tends to induce it in another, a determined threat of severe 

 treatment is the most certain means of keeping it off. Hence the treatment of 

 Hysteria may be considered as requiring three classes of remedial means ; 

 those, namely, which operate by improving the general state of nutrition of the 

 Nervous System and by diminishing its excitability, these for the most part 

 acting through the blood, and being directed to the increase of its nutritive com- 

 ponents and to the elimination of any morbid matter which it may be suspected 

 to contain; those which operate by removing the exciting causes of the 



tinned to be occasionally accompanied by severe cramps, and sometimes by general con- 

 vulsion, coma, &c. This was not altogether corrected, although improved by marriage ; 

 and any emotional excitement of an unpleasant kind was sure to produce an additional 

 aggravation. The state of the os uteri was then examined; and as it was found to be un- 

 duly contracted, cautious dilatation by sponge-tents was practised. This had the best 

 results ; the dysmenorrhoea soon abated; pregnancy supervened, and after a miscarriage 

 (which seemed traceable to emotional excitement, coinciding with the monthly nisus) a 

 second pregnancy, which went on to the full term ; and no return of the spasmodic attacks 

 has since occurred. It is worthy of note that in this case there was an hereditary predis- 

 position to Gout, which seemed once to manifest itself in a peculiar affection of the tis- 

 sues about the wrist-joint, of a character rather gouty than rheumatic. 

 1 See Dr. Laycock "On the Nervous Diseases of Women," pp. 161 et seq. 



