PATHOLOGY. 
316 
In nii thefe cafes we mud endeavour to difcover the 
Irritated nerves, and excite them to a new kind of ac¬ 
tion. In the laft variety, the infantile convulfion, we 
fhould look chiefly to the teeth and bowels. If any ir¬ 
ritation feems likely to exill about the former parts, they 
mull be freely lanced ; if about the latter, purgatives 
mull be given. If, on the other hand, pain and dizzinefs 
of the head be very fevere, leeches may be applied. The 
warm-bath is the firft thing to be had recourfe to when 
a child has a convulfion-fit ; and the attendants fhould 
be cautious not to forcibly open the clenched hands, or 
in any other way attempt- to counteract the mufcular 
motions, lince refinance merely increafes their ex¬ 
ertion. 
2. Syfpafia hyfteria, hyfterics : convulflve ftruggling, 
alternately remitting and exacerbating ; rumbling in 
the bowels; fenfe of fuffocation ; drowfinefs ; urine co¬ 
pious and limpid ; temper fickle. Two varieties. 
ci. H. atonica ; from debility of conftitution; without 
any evident proximate caufe. 
( 3 . H. irritata ; from Hidden emotion of the mind, or 
irritation of the Itomach or bowels. 
In tracing the nervous difeafes which grow out of dyf- 
peptic ailments, w'e have been very full and explicit on 
that form of hyfteria which has its origin in gaftric irri¬ 
tation, and efpecially that which is generally called the 
irregular forms of hyfteria. Hyfteria, as it arifes from 
uterine irritation, will now be difcufled ; and this for 
the purpofe of introducing the fymptoms of an hyfteric 
fit. The treatment will in no means deviate from that 
before laid down. The ftate of the uterine fyftem will 
be’of courfe looked to; but fo great is the fympathy be¬ 
tween the uterine and aflimilating organs, that irritation 
in the former generally impairs the functions of the latter; 
confequently the general plan of treatment cannot be 
different. 
The paroxyfm or fit of hyfteria is commonly preceded 
by a fenfe of laflitude, coldnefe of the feet, and a co¬ 
pious difcharge of pale limpid urine: often by pain in 
the head, loins, or Itomach ; which latter organ, as the 
fits commence, is fometimes affeCted with vomiting. 
The paroxyfms commonly begin by fome pain and ful- 
nefs felt in the left fide of the belly. From this a ball 
feems to move, with a grumbling noife, into the other 
parts of the belly ; and, making as it were various con¬ 
volutions there, feems to move into the itomach, and 
more diftinCtly itill rifes up to the top of the gullet, 
where it remains for fome time, and by its preflure upon 
the larynx gives a fenfe of fuffocation. There is occa- 
fionally much difficulty of breathing, and a palpitation 
of the heart at the onfet. By the time the difeafe has 
proceeded thus far, the patient is affeCted with a ftupor 
and infenfibility, while at the fame time the body is agi¬ 
tated with various convulfions : the trunk of the body 
is writhed to and fro, and the limbs are varioufly agi¬ 
tated ; commonly the convulflve motion of one arm and 
hand is that of beating with the clofed flit upon the 
breaft very violently and repeatedly. The whole of the 
belly, and particularly the navel, is often drawn ftrongly 
inwards ; fometimes there is a violent working, or alter¬ 
nate riling and falling, of the belly', attended with con- 
fiderable noife. The fphinCter ani, during the fit, is 
fometimes fo firmly conftriCted as not to admit a fmall 
clyfter-pipe ; and there is at the fame time an entire fup- 
preffion of urine. This ftate continues for fome time, 
with fome remiflions and renewals of the convulfive mo¬ 
tions; but they at length ceafe, leaving the patient in 
a ftupid and feemingly fleeping ftate. More or lefs fud- 
denly, and frequently with repeated fighing and fobbing, 
together with a murmuring noife in the belly, the pa¬ 
tient returns to the exercileof fenfe and motion, but ge¬ 
nerally without any recollection of the feveral circum- 
Itances that had taken place during the fit. 
Such fits are very liable to recur from time to time, 
and during the intervals the patients are fubjeCt to in¬ 
voluntary motions, to fits of laughing and crying, with 
fudden tranfitions from one to the other; while fome¬ 
times falfe perceptions and fome degree of delirium alfo 
occur, as well as all the various incongruities of the dif¬ 
eafe to which we alluded above. The preceding account 
is that of the molt common form of the hyjieric paroxyfm; 
but this is confiderably varied in different perfons, and 
even in the fame perfon at different times. It differs 
chiefly by having more or fewer of the circumftances 
above mentioned, by the greater or iefs degree of vio¬ 
lence of thefe, and by the different duration of the whole 
fit. See Cullen, Firft Lines, par. i 5x4. 
The hyfteric paroxyfm fcarcely refembles any other af- 
feCtion of the bod)', except occalionally the paroxyfm of 
epilepfy; but in epilepfy, the convulfive motions are ge¬ 
nerally much more violent, and the infenfibility more 
complete ; there is foaming at the mouth, and a ftate of 
coma, or profound fleep, follows the fit ; on the contra¬ 
ry, there is no globus rifing into the throat, no agitation 
of the abdomen, no fcreaming, laughing, or crying, nor 
any copious difcharge of limpid urine, as is common in 
the commencement of the hyfteric fit. 
For the relief of hyfteric fits, our means will vary ac¬ 
cording as the peculiar mobility of the nervous fyftem, 
on which the diforder chiefly depends, is connedted with 
a plethoric habit, and a purely fanguine temperament, 
or with an habit the reverfe of plethoric, in which a con- 
fiderable degree of debility, and a pale and phlegmatic 
temperament, prevail. If the patient be of a robuftand 
plethoric conftitution, blood-letting is the moft effedlual 
antifpafmodic that can be employed ; and, when the 
convulfions are fevere, or long continued, with a flufliijig 
or fulnefs of the vefiels of the face and external parts, it 
is the only antifpafmodic that can be adminiltered with 
fafety. At the fame time, the turgefcence and adtivity 
of the blood-veflels, and the confequent over-irritation 
of the nervous fyftem, may be diminilhed by the applica¬ 
tion of cold to the head and abdomen, or to the body in 
general. The ufe of naufeating emetics has alfo been 
recommended for this purpofe. Where the plethora is 
not fo confiderable as to warrant general blood-letting, 
cupping from the neck, or from any part in pain, may be 
fubftituted. 
But in thofe habits which exhibit no marks of plethora 
or of confiderable ftrength, evacuations of blood, fo far 
from being beneficial, are extremely detrimental, and 
are abfolutely enumerated among the caufes which in¬ 
duce the difeafe. In fuch conftitutions, the hyfteric pa¬ 
roxyfm is to be diminilhed or cut (hort by ftimulant and 
antifpafmodic medicines. Of thefe, opium, in its va¬ 
rious preparations, is one of the moft effectual; and its 
efficacy is confiderably aided by a combination with the 
more diffufible ftimulants, efpecially with aether and am¬ 
monia, or the volatile alkali. It is moft commonly not 
difficult to force the patient to fvvallow twenty or thirty 
drops of fulphuric aether and of tindture of opium, in 
any liquid, at the commencement or during the conti¬ 
nuance of the fit; and this is frequently followed by a 
fpeedy ceftation of the fpafmodic motions. Various other 
ftimulant medicines, efpecially thole of ftrong and pun¬ 
gent odour, may be adminiltered with good effect under 
the fame circumftances; fuch are the preparations of va¬ 
lerian, mulk, caftor, camphor, afia-fcetida, oil of amber, 
oleum animale, &c. At the fame time, any ftrong im- 
preffion made upon the nervous fyftem will frequently 
arreft the progrels of the paroxyfm ; as the application 
of any ftrong-fmelling fubftance to the noftrils, luch as 
burning feathers and volatile falts. The ltimulus of 
heat may likewife be reforted to for the relief of the pa¬ 
roxyfm, when it is obftinate; and it may be applied to 
the whole body, by means of the warm bath 5 or to the 
lower extremities, in the way of pediluvium. 
After the paroxyfm is over, the complaint requires a 
fteady regulation of the circulating and digeftive fyftem, 
of the mufcular motions, &c. in the manner before ad¬ 
verted 
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