HYSTERIA is a purely nervous affection, which may arise and continue without any functional or organic derangement of the female sexual system on which it is based; and which does not necessarily produce such derangement or disorganization. Hysteria bears the same general relation to the nervous apparatus of the reproductive system, that chlorosis does to that of nutrition; and has no more exclusive connection with the uterus or other particular sexual organ, than chlorosis has with the stomach or other particular digestive organ.
As a purely nervous affection not necessarily painful, Hysteria must be distinguished from irritable uterus on the one side, and from hysteralgia on the other. In irritable uterus, although there is neither disorganization, nor structural change, except perhaps that of displacement, which is the most frequent cause of the irritability itself, the uterus is excessively sensitive to pressure or even to the touch; which is not necessarily the case in Hysteria. In hysteralgia the pain, sometimes mild, lingering, worrying, and sometimes violent, severe and acute, is always positive and decided.
But in the location of the disease itself may be found another important distinction between Hysteria and the somewhat analogous forms of uterine disease with which it is so apt to be confounded. In irritable uterus and in hysteralgia, from whatever cause these disorders arise, their actual location, principal seat and ultimate development appear to be in the uterus itself. This, however is not the case with Hysteria. The uterus indeed has usually been considered the seat of Hysteria, hence the name; but the ovaries, as the head-centre of the sexual system, must now be regarded as the real fons et origo, the fountain head of all hysterical affections. ( It must not be forgotten that a corresponding irritation of the nervous system belonging to the sexual apparatus of the male, may sometimes occasion a similar hysterical condition in men.) Thus pressure upon the ovaries will invariably bring on hysterical attacks in persons predisposed or subject to the disorder. Hysterical extends its influence over the entire sexual apparatus; from its profound connection with the sympathetic system, may extend its influence to all the involuntary organs and by its final extension to the cerebro- spinal nervous system, may involve also all the voluntary muscles; but its original seat and constant source, must be found in the ovaries. Hysteria is as truly and as exclusively due to irritability of the ovaries, as irritable uterus and hysteralgia are to a similar condition of the uterus.
Hysteria again has been founds to co-exist with the most perfect performance of all the functions of the uterus and its dependent organs, such as menstruation, conception, utero-gestation, parturition and lactation, although this is perhaps true rather of the milder than of the severe forms of this disorder. Still as not necessarily disturbing the functions, still less involving the structure of the sexual organs, and as not being invariably painful, Hysteria establishes its claim to be regarded as a purely nervous affection, capable of being distinguished from irritable uterus and from hysteralgia, both of which are also nervous affections, although of quite another sort. This distinction will appear more strongly marked, when we come to notice the differences in the nervous systems principally involved. And this definition of Hysteria is still further strengthened by the well-known influence of imagination and sympathy in extending this disorder from one person to others; as in the hospitals, where many are simultaneously and sympathetically affected from seeing a single one attacked by hysterical convulsions. And it is still more fully confirmed by the powerful influence of fear in preventing and allaying such convulsion. In this respects, as well as in some others, Hysteria bars a very remarkable resemblance to epilepsy.
The neuralgic and the convulsive forms constitute two distinct varieties of Hysteria; but this distinction, although sufficiently well marked, is one of degree rather than of kind. In what is termed the neuralgic form of Hysteria, the symptoms “are merely manifestations of nervous susceptibility. While in thee convulsive form, they are more intense, permanent, regular and periodic. And the principal apparent distinction between this latter condition of periodic menstrual convulsions and that which presents in uterine epilepsy, is to be found in the loss of consciousness which manifests itself in the latter form of disease, but not in the former.
A corresponding distinction may be seen in the nervous centres involved in Hysteria. For in the milder, so-called neuralgic form of the disease, which yet may be of hereditary origin, thee ganglionic or sympathetic nervous system seems principally concerned. While in the severer or convulsive forms of Hysteria, the original, predisposing, hereditary influence is, by provoking causes, extended to a full development in the cerebro-spinal nervous centre. In this case then we find the discordant influence extending itself to the muscular apparatus; and in consequence we have occasional spasms, or regular and periodically recurring convulsions. And it will be observed that these spasms first appear in those parts of the body and muscular tissues, which are in immediate relation with thee abdominal, the coeliac and the thoracic ganglia.
From these remarks it may be concluded that Hysteria is a purely nervous affection; which, being to a great extent hereditary in its origin, finds its primary seat in the ganglionic or sympathetic nervous centre; which finds its secondary and ultimate development in the cerebro-spinal nervous system; which in this extended development occupies the motor rather than the sensory nerve filaments; and which thus finally results in spasmodic contractions rather than in poignant sensations. And here is to be found perhaps the last, most important and reliable distinction between Hysteria and hysteralgia. In their constitutional origin, in their primary ganglionic seat of development, and in the provoking causes of their extension to the cerebro-spinal sphere, they may show but little difference; but here they diverge, for where Hysteria seizes upon the motor filaments of thee nerves and so leads to convulsions, hysteralgia involves the sensory filaments and occasions the intense pain which characterizes this affection. This distinction is exactly the same as that between asthma and angina-pectoris, the former affecting the motor nerves, and the latter the sensory nerves of the chest; so that in asthma we have severe constriction, with little if any other pain, while in angina-pectoris we find the most poignant distress, but no constriction.
Hysteria thus becomes and affection principally (although not exclusively) of the female system, which, constitutional in its origin and so underlying the organic nervous system, is also capable of extending itself over thee entire nervous organisation, and of simulating almost every form of disease, with he single exception, perhaps, of acceleration of the circulation. For some of these states of hysterical excitement can hardly be distinguished from inflammatory fever, except by ascertaining that the distinguished form inflammatory fever, except by ascertaining that the rapidity of the pulse does not correspond with the other apparently febrile symptoms.
To attempt to enumerate all the legions of symptoms which may appear in hysterical cases, would be a hopeless task. Hence our description of this multiform affection must to confined to the statement of the more prominent symptoms only, and to a general division and classification of those which make up the principal forms of the disease.
And the first and most general division of the symptoms of Hysteria, will be into those which belong to the mental and moral sphere, and into those which are purely physical sensations. And in each of these two divisions there will be found the same variety and even diversity of conditions. Thus among the moral symptoms there may be great depression of spirits with involuntary tears, or equally great exaltation of spirits and meaningless laughter; in these cases the exaltation and the depression being alike incapable of being attributed to any apparent cause. There may be sudden changes and even frequent alternations from one extreme to the other; and always an uncertainty, and want of fixedness and even positive mobility of character. And these revulsions are not confined to the individual states of joy and sorrow in the persons affected, they extend also to their affections towards the members of their families and towards others. And in addition to those changes which arise from no perceptible cause, there is a remarkable susceptibility to impressions, many of which, although in reality of the most trifling nature, appear to exert a fixed and powerful influence. Other, no less remarkable changes, in feeling and in affection arise from purely imaginary causes. Thus in hysterical persons, it is not uncommon to see personal dislike unaccountably take the place of previous affection; and the most violent and furious paroxysms of jealousy arise from the influence of imaginary and baseless suppositions. As in the personal condition of the hysterical females, there may be alternations of gaiety and of gloom, of frolicksome levity and of melancholy seriousness, so in relations to others, and if married, to her husband especially, she will at one time be full of affection and devotion, while at others, sentiments of aversion and positive dislike obtain the entire sway. One day, she will express herself as the happiest of wives and assure her friends that her husband is as good as he can be; the next she pours into the gaping ears of all the gossips her peculiar condition gathers around her, long tales of suffering, neglect and abuse, and represents the man, who has the misfortune to be her husband, as the most detestable monster. This form of Hysteria is a real monomania, with lucid intervals, but which may become a fixed insanity, in relation to the married state, and so not only destroy domestic peace, harmony and affection, but even break up the family.
