HYSTERIA. 415 



for by the action of any corresponding irritant. Some patients are 

 never free from the sense of a certain taste or smell ; some complain 

 of roaring and buzzing in the ears, or of spots before their eyes. It 

 is very remarkable that, besides these phenomena, indicative of exalted 

 excitability, and of a morbid irritability of the sensory nerves, there 

 should also be an anaesthesia, involving a variable extent of the surface 

 of the body. It is doubtful whether this anaesthesia be attributable to 

 suspension of function of the peripheral nerves, or to an extinction of 

 irritability at the nerve centres. I consider it very hard to determine 

 whether an hysterical person really is suffering from anaesthesia, or 

 merely indulging the caprice .of not showing signs of pain when 

 pricked, pinched, or burnt in particular parts of the body. There is 

 not the least doubt that such notions are of daily occurrence among 

 hysterical patients. If they only knew what a puzzling and interest 

 ing subject this matter of anaesthesia is, the number of hysterical cases 

 of this kind, no doubt, would increase vastly. I have seen a patient 

 who did not move a muscle while two streaks were being burnt along 

 her back with a red-hot iron, and yet there was not the slightest 

 ground for believing that she had anaesthesia of the back. 



All the derangements of sensation hitherto described have de- 

 pended upon morbid irritability of the cutaneous nerves, and of the 

 nerves of special sense. Connected with these there is a series of per- 

 verted sensations in internal organs. While, under ordinary circum- 

 stances, we have either no perception at all (or, at most, a very ob- 

 scure one) of the condition of the internal viscera, as long as they are 

 in good order, and while, without laying our hand upon the heart, we 

 are unaware of its pulsation ; and while respiration goes on without 

 our consciousness of the necessity for such an act ; and while we have 

 no perception whatever of the ordinary state of our stomachs and 

 bowels, yet hysterical individuals have the greatest variety of com- 

 plaints to make as to the condition of their internal organs, and claim 

 to suffer the most extraordinary sensations. They nearly all complain 

 of palpitation of the heart many of them of pulsation of the vessels. 

 Upon examining the heart-beat and the pulse, we may easily satisfy 

 ourselves that such sensations are but subjective ones ; and that the 

 shock of the heart is not really increased, nor is the pulse full and 

 hard. It is the same with the shortness of breath. Sometimes the 

 patients breathe laboriously and quickly, complain of the utmost op- 

 pression ; but, after exclusion of the possible existence of any disease 

 of the air-passages or circulation, or of a morbid state of the blood or 

 nutrition, capable of accounting for such dyspnoea, we may assure our- 

 selves that it is purely a case of hyperaasthesia or of perverted sensa- 

 tion. Besides this, although their digestion may be excellent, nearly 



