But Hysteria in all its most aggravated moral forms, is distinguished from insanity, by the fact that the personal consciousness is never lost sight of. There is always a sort of alienation of the personality in cases of insanity, a forgetfulness of self, which never appears in hysterical cases. In these latter, on the contrary, there is the most remarkable and persistent prominence of the self-love. Egotism, especially in married females as opposed to their husbands, is the most prominent and the constant moral symptom of Hysteria. Such persons entertain their hearers with marvellous tales of the greatness and exploits of their past lives, and of the richness and abundance of their possessions, of the number of their friends and of the distinguished consideration they have always received in society in their former places of residence. Such marvellous accounts are uttered with an air of sincerity well calculated to deceive the honest listener; and such unbridled license of the imagination and total obliviousness in regard to the truth, which are vulgarly attributed to entire want of principle and the most inordinate vanity, are in reality due to that morbid condition of the female organism which is designated by the comprehensive term Hysteria; a condition which, it it were properly understood, would prove far less mischievous in society, and less frequently destroy the family tie.
The second part of our division of the symptoms of Hysteria, includes all those which have relation to the physical system. These physical symptoms may be again divided into the sensational and the convulsive. Among the former may be ranked all those various uneasy sensations which appear at different time in different parts of the body, as in the abdomen, in the pit of the stomach and in the throat, sensations which are not very positively painful, but which are for that reason perhaps, all the more distressingly annoying; and which in the most aggravated forms become developed into actual spasmodic contractions in those parts. These sensations do not appear to exert any direct influence upon the organic functions, still they are attended with disturbances of the appetite, indigestion and general languor and debility, which are no doubt the consequences of the nervous derangement. These sensations are innumerable, variable or fixed, and either constant or excited by the slightest influence and even by the least touch.
As there is a constant indecision, want of fixedness or persistence in the mental sphere, rendering the mind liable to be swayed by the slightest breath of external influence, so in the physical system there is a corresponding want of permanency in the animal spirits. The same mobility that appears in the mental and moral states, and in the affectional relations towards others, appears in a corresponding degree in all the bodily conditions. And as the merest fancy will often bring on a paroxysm of jealousy in hysterical women, so the slightest direct touch, or the reflex influence from ordinary functional action, may give rise to a long train of hysterical sensations, or even occasion the most determined convulsions. This remarkable sensitiveness of thee physical system to external impressions, and no less remarkably increased reflex excitability, form the chief characteristics of the first or sensational variety of the physical symptoms of Hysteria.
The convulsive symptoms of Hysteria begin in the hypogastric region and gradually pass up the abdomen like the ripple of a wave, through the chest to the larynx and pharynx. First comes on a strange sensation, as of pain, in the hypogastric and ovarian regions, followed by suffocative feelings in the pit of the stomach, and then by the globus hystericus, which is characteristic of the complete hysterical passion. These form the precursory symptoms of the true hysterical convulsions, and are analogous to the aura which precedes the accession of an epileptic attack. And from appearing at the first in this mild form of semi-spasmodic contractions, these attacks may momentarily or hourly increase in severity, till trismus, or lock-jaw, supervene. And as hysterical attack, in its successive forms of development, involves the different nervous branches and ganglionic centres, corresponding symptoms appear. Thus from the disturbance of the nerves of the pharynx, there results dysphagia, globus hystericus; from the larynx, an affection, with the most imminent danger of suffocation, not to be distinguished from croup, except that there is not false membrane and that Nux vomica, rather, than Aconite or Spongia, may prove curative; from the bronchia, dyspnoea and cough; from the heart, attacks of palpitation, irregular beating and sense of anxiety; from the stomach, hiccough, retching and vomiting; from the bladder, ischuria or dysuria. And finally, as the paroxysms extend through the voluntary and involuntary muscles, there are developed tonic and clonic spasms of every kind and degree of violence, from mere tremor or nervous quivering to the most convulsive movements and contortions. “The masticatory and histrionic muscles of the face take part; trismus, chattering of the teeth as in the rigor of fever, the sardonic laugh and a rolling of the eyeballs upwards occur. After a duration varying from ten minutes to several hours, the paroxysm often terminates suddenly with a flow of tears or a copious discharge of urine; but not unfrequently it passes off gradually. Romberg, Diseases of the Nervous System.
The globus hystericus, which has already been mentioned, merits a fuller description, since it forms of the most characteristic symptoms of the invasion of the hysterical paroxysm. It consists in an obscure sensation, as of a globular body, which gradually ascends from the pelvic cavity, or at least from the hypogastrium, to the throat, where it seems to be arrested, and to produce a most painful sense of constriction and suffocation. This causes a peculiar choking sensation, which may be attended with sobbing. It is not confined to women, but may sometimes appear in those of the opposite sex, especially in young persons about the age of puberty, whose naturally delicate and sensitive temperament is agitated in a particular manner. Globus hystericus may arise from mentally or morally caused interruption of the delicate currents of the nervous fluids; and may, particularly in males, be at once removed by such relief and repulsion of these feeling as will again permit the free and unrestrained flow of these most interior and subtle fluids, of which we know but little more as yet than their hypothetical existence.
The causes of Hysteria are as various as they are numerous. No doubt very many cases of this disorder, especially of the convulsive form and most obstinate kind, are originated and maintained by displacements, functional derangements or structural disorganizations of the uterus or other of the sexual system. But since in these instances the hysterical affections are but the consequence or attendant symptoms of other and primary disorders, we do not consider them in this place. They require to be studied in connection with all the accompanying and causative conditions. But in all cases in which hysterical symptoms appear as part of the tout ensemble of the disease, the remedies advised, in the present chapter for Hysteria itself, should be carefully compared; since these various nervous mental and moral states should always be covered by the medicine to be administered.
To hereditary predisposition we many assign then the first place among the causes of idiopathic hysteria. This may exist in the form of (otherwise) latent psora, which thus irritates the organic or sympathetic nervous system in its relation to the sexual system. And the connection of the hysterical affection with such constitutional psora may be traced in the eruptions known to have appeared in the parents, or which may have been temporarily manifested in the hysterical patient herself. “A predisposition to Hysteria is, no doubt, to be ascribed in many cases to congenital inheritance of physical conformation and temperament. The greater number of sufferers from this disease, observes M. Georget, have descended from parents, or have been members of families remarkable for their liability to diseases, in the several forms of hysteria, epilepsy, maniacal affections, hypochondriasis, nervous headaches, deafness, blindness, palsies, &c. ( Davis’ Obstetrics. P). And I remember to have been a remarkable instance of the most aggravated form of this disease in a young woman whose father was subject to epileptic attacks. This hereditary constitutional predisposition to Hysteria, is very greatly aggravated by the personal influence of the mother, if she still remain subject to similar affections. And just in proportion as such predisposition exists if greater or less degree, will the patient be more or less liable to have it developed by the ordinary provoking influences.
