HYSTERIA. 



417 



act, such as yawning, laughing, crying, although the mental emotion 

 by which they are generally induced is not present. In this way fits 

 of spasmodic yawning, laughing, and weeping arise. Thus, spasmodic 

 expiratory movements, combined with spasmodic contraction of the 

 rima glottidis, and tension of the vocal cords, give rise to that obsti- 

 nate cough known as hysteric cough, and to its modifications, consist- 

 ing of barking and howling sounds. Spasmodic contraction of the 

 oesophagus, extending from below upward, gives the patient a feeling 

 as if a ball were rising from the epigastrium into the throat, a symp- 

 tom commonly called globus hystericus. Yery often hysterical per- 

 sons are troubled for a quarter of an hour, or even for hours at a time, 

 with eructations, which recur at short intervals, and during which a 

 quantity of inodorous air is belched up, usually with a loud sound. 

 If we watch the patient carefully, we can see, by the movements of her 

 mouth and throat, that she has previously swallowed this air. As 

 however, the majority of healthy persons are unaware of it, when they 

 swallow air in the movements of chewing and deglutition which they 

 make under the influence of violent nausea, I do not suppose that hys- 

 terical persons do it consciously and intentionally ; hence I have classed 

 this symptom among the disorders of motion. Just as anaesthesia and 

 hyperaesthesia of the sensory nerves may coexist, so in the motor sys- 

 tem hysterical convulsions may be accompanied by hysterical palsy. 

 Sometimes a single extremity alone is involved ; sometimes there is 

 hemiplegia. The fact, that the electric contractility is preserved in the 

 muscles of the palsied part, argues strongly against the peripheral 

 origin of this form of paralysis. If the peripheral nerves were diseased, 

 if they had lost their functional excitability, then electricity would be 

 just as powerless to excite them as the will is. Now, in hysteric 

 palsy, as every muscle which the patient is unable to contract volun- 

 tarily may be made to contract by application of the electrode to its 

 nerves, the palsy must be of central origin. Moreover, the rapid 

 changes which occur in hysterical palsy, especially the sudden way in 

 which it sometimes subsides, proves that its source is some slight and 

 easily-adjusted derangement of nutrition, and that it does not consist 

 hi serious structural change at the centre of volition, but, in some cases, 

 an excessive indecision and incapacity on the part of the patient tc 

 make up her mind to move the limb seem to be the reasons for the 

 palsy. I have no doubt that any one, as long as he is firmly persuaded 

 that he is unable to perform a certain act, is indeed incapable of gen 

 crating the necessary motor impulse. As the palsy in this class of cases 

 is due to a perverted mental impression, it should, properly speaking, 

 take rank among the psychical disturbances. Some time ago I saw a 

 patient suffering from a hemiplegia, which had lasted for months. The 



