HYSTERIA HYSTERICS. 343 



HYSTERIA HYSTERICS. 



A fit of hysterics may occur in a great variety of forms, but the following 

 may be regarded as the description of a bad attack. The patient has been 

 " put out," or " upset " about something. She begins talking vehemently and 

 unreasonably, and becomes greatly agitated. She laughs or cries, or perhaps 

 exhibits a combination of both. She is probably more or less aware of her 

 condition, and of the notice her conduct is attracting, and she may, perhaps, 

 apologise for or lament her weakness. Suddenly she loses all self-restraint, 

 and seems entirely to abandon herself to the intensity of her feelings. 

 She gives a cry or a scream, and falls down, throwing her arms about in a 

 disorderly manner. She makes a great noise, utters incoherent sentences, sobs 

 violently and repeatedly, and complains of her throat, her stomach, or breath. 

 After a time she seems faint, or exhausted, or "worn out," and then gradually 

 " comes to herself" again. These paroxysms vary greatly in different cases, 

 not only in their severity, and the symptoms they present, but also in their 

 duration. Sometimes it is " all over " in a minute or two, and the patient gets 

 "all right" again, but more commonly this condition continues more or less 

 for an hour or two, or, perhaps, the whole afternoon. After the paroxysm the 

 patient commonly voids a large quantity of pale limpid urine, looking almost 

 like water, and this is sometimes discharged during the fit. 



At first sight this may appear somewhat like the description of an epileptic 

 fit, but in reality very little difficulty is experienced in distinguishing -between 

 these two conditions. We have already pointed out the means of making the 

 diagnosis (see EPILEPSY). It will be seen that in hysteria the onset of the attack 

 is less sudden than in a real fit ; the patient gives some kind of warning, and 

 if you have had any experience of such matters, you will know pretty well 

 what is going to happen. A young lady in hysterics takes good care not to 

 fall unless there is some one by to catch her, or at all events to condole with her 

 after she has fallen, and she is, moreover, especially careful not to fall in an 

 ungraceful attitude, or to damage her clothes in falling. Of course there are 

 exceptions to this rule, for some people go into hysterics regardless of expense. 

 It will be noticed that an attack seldom comes on at night, or when the patient 

 is alone. Then, in hysteria, unconsciousness is seldom complete ; you may 

 think the patient is quite insensible, but if you are rash enough to make any 

 uncomplimentary remark, you will find that appearances are deceptive. In 

 an hysterical fit there is never that frightful distortion of the countenance that 

 one meets with in epilepsy. The pupils are quite natural, and are never dilated. 

 The eyelids may quiver, or the eyeballs may be turned upwards, but there is 

 no squinting, and the eyes never remain wide open with a ghastly stare. It 

 is obvious that the patient can see, for the eyes are often directed towards some 

 one standing near, and then rolled up again under the eyelids. The tongue 

 is not bitten, although there may be a great deal of spluttering, and foaming 

 at the mouth. The attack is often followed by exhaustion, but never by stupor. 



When the fit is more severe than we have described, it is, probably, not a 



