The third portrait is also one of which most medical men have seen examples. A young girl, in whom the menses have only just appeared, or have even not yet commenced, begins, without obvious reason, to take to sentimental notions, or to adopt an exaggerated “goodiness.” She is the pet of the worthy village clergyman and his kind-hearted wife, who soon perceive that she is “delicate”; she is a martyr to headaches, and to pains in the back and other parts, which come and go with extraordinary rapidity. Gradually there grows up a legend in the neighbourhood to the effect that “that sweet Mary Jones has a diseased spine” and sure enough, Mary Jones takes gradually more and more to her bed, and at last lies there continually, “quite paralysed in her legs, you know.” Perhaps she may never get further than this stage, being luckily dragged out of it by some shrewd and energetic doctor. But if left to her own devices she rarely stops at Paraplegia. The next stage is whispering, or total loss of voice, and then comes inability to swallow. The story of the “fasting girl” is well known; and it is probable that there is more or less of conscious deception in all these cases of hysteric dysphagia, where the refusal of food is apparently complete, for such patients are by that time nearly always accomplished liars. At any rate, this is certain, that the whole train of symptoms are often rapidly curable by moral influences skilfully applied, and simple tonic remedies.
Take yet another picture. A poor married woman has had children with great rapidity, and is therefore trying to avoid a fresh pregnancy by suckling her last baby, though it is eighteen months old. She is anaemic and haggard; she complains of almost constant sore pain over the top of the head; she complains also with especial bitterness of pains at particular points in the trunk, chiefly in the spine, in the right hypochondrium, and beneath the left breast. The voice is whispering or absent, and there is also nearly always hysterical globulus.
Hysteria and Inflammatory Disease : Sometimes a medical man may for a moment experience difficulty in deciding whether a patient be suffering from Hysteria, or from an acute inflammatory disease; but he is able by the use of the thermometer to determine the point. The temperature of patients in acute inflammation is invariably raised; but the temperature of hysterical persons is always natural (98* Fahr.). Further, the state of the pulse, the character of the pains, and the general condition of the nutritive processes, furnish additional proofs of the real character of the disease. The ideal nature of hysterical sufferings may be further proved by diverting the patient’s attention from the part complained of; then, firm pressure on the part; or the sharp movement of a joint, may be borne without complaint, whereas the slightest touch was immediately before said to be “agonising in the extreme.”
Hysteria and Epilepsy : In Hysteria there is absent the suddenness of seizure, the complete loss of consciousness, the dilated pupils, the bitten tongue, and the total disregard of injury of person or clothes that mark Epilepsy. There is much sobbing and crying, much exhaustion, but no perfect stupor in Hysteria, nor is an attack followed by profound sleep.
If the epiglottis be touched with the finger, and prove insensible, the case is hysterical* (*See Quain’s Dictionary of Medicines, article “Hysteria,” by Dr. Buzzard. A French physician is said to have thus tested twenty thousand cases.
Hysterical Fit – A paroxysmal form of Hysteria may be caused by some transitory occurrence, as a real or imaginary grievance. The patient is talking in an agitated manner; she is laughing or crying, or both; then she bursts out into an immoderate fit of one or the other; the Globus hystericus begins to form and to rise, and as soon as it reaches the throat, the patient screams or makes an incoherent noise, appears to lose all voluntary power and consciousness, and falls to the ground. On closely watching a case, however, it will be noticed that there is not absolute loss of consciousness; the patient contrives to all so as not to injure herself or her dress; an attack does not occur when she is asleep or alone; the countenance is not distorted as in Epilepsy; the eyelids may quiver and the eyes be turned up, but the eyes are not wide open, nor the pupils dilated, as in Epilepsy, and the patient may be observed to see and look, and to have her paroxysms at longer intervals if she observes the medical attendant conversing on the other subjects. The breathing may be noisy and irregular, but there is no such absolute arrest of breathing as to cause Asphyxia; the fit continues for an indefinite period, followed by apparent exhaustion, but not by real stupor.
The Hysterical Expression – An easily flushed face; the features rapidly respond to the mental emotions; the upper lip is deep and prominently full. The eyeballs are large, and the sclerotic (white-of-the-eye) of a transparent sky-blue; the pupils is much dilate, giving a general dark hue to naturally light eye, and the conjunctiva is smooth and bright from tears on every emotion. The eyelids are large, full towards the outer angle, giving a drooping, appealing expression to the face (the “sweet expression of ladies). Of these several hysterical marks, the puffiness of the eyelids and the dilatation of the pupils are the most constant – indeed, are seldom absent and seldom deceive (Chambers).
MEDICINAL TREATMENT –
1. During the paroxysms – Belladonna, Chamomilla, Moschus
2. Between the paroxysms – Aconite, Asa., Aur-M., Belladonna, Calc-C., Causticum, Chamomilla, Cim., Cocc., Coffea, Hyoscyamus, Ignatia, Kali-Br., Mosch., Nux V., Platina, Pulsatilla, Sepia, Staphysagria, Valer.
LEADING INDICATIONS FOR THE PRINCIPAL REMEDIES –
Asafoetida – Hysteria from inertia or irritability of the biliary system, with burning dryness of the throat; cutting, crampy pains, or distentions of the abdomen; nausea and inclination to vomit; constipation or diarrhoea, with frequent urging; high- coloured strong-smelling urine; sensation as of a ball rising in the throat; premature, painful menstruation; uterine excitement; depressed, fitful spirits.
Aurum – Hysteria with excessive menstrual discharge, congestive headache, melancholy etc.
Belladonna – In the congestive form; also during the fit when the face is red and turgid, and the veins of the neck swollen, with other symptoms of determination of blood to the head.
Calcarea Carb. – When the Hysteria approaches to Epilepsy, too frequent and profuse menstruation, nausea, fainting and spasms on swallowing.
Causticum – Loss of voice, pains in the neck or abdomen; profuse flow of urine; dejection.
Cimicifuga – Hysteria associated with uterine disturbance, mental restless irritability, and despondency; pain in the left side and under the breast; sinking at the stomach.
Cocculus – Hysteria with menstrual colic, irritability, dejection, and copious discharge of pale urine.
Coffea – Hysteria with sleeplessness, the mental faculties being incessantly active. According to Dr. Ludlam it is especially adapted to the affections of elderly ladies.
Ignatia – Hysteric convulsions with the sensation of a ball in the throat, suffocative constrictive sensation, and difficult swallowing; heightened exhausted impressionability of the whole of the nervous system, with frequent changes from high spirits to dejection; Hysteria from disappointment, mortification, or any intense mental excitement.
Moschus – Hysterical attacks with fainting; small, fluttering pulse; coldness of the surface. Like Camphor, it is especially useful during a paroxysm, and often cuts it, short. It is of less service between the attacks.
Nux vomica – Hysteria with constipation, bitter or acrid eructations, flatulence, hiccough, distention and pain in the stomach, headache, giddiness, faintness, etc. After a few days Sulphur may be substituted.
Platina – Hysteria with depression of spirits; anxiety, irritability, and nervous weakness, especially if associated with uterine congestion; early, excessive, or too prolonged menstruation; sexual excitement.
Pulsatilla – Hysteria with suppressed period or uterine disorders, especially when the Pulsatilla temperament corresponds. It may be followed by Sabina or Silicea.
Sepia – In persons of a sad, desponding disposition; spasms in the throat; profuse, clear, watery urine; great emotion, tendency, to cry, and prostration; Neuralgia, particularly ovarian.
ACCESSORY TREATMENT – 1. During the Fit – After the patient’s clothes are loosened, and an abundant supply of fresh air is secured, an attempt may be made to arrest the hysteric convulsions by a method suggested by Dr. Hare – viz., that of forcibly preventing the patient from breathing for a certain time, by holding the mouth and nose. The effect of such constraint is to make the patient, when allowed to do so, “draw a long breath,” this vigorous inspiration being usually followed by a relaxation of all spasms, and a disappearance of the fit. Prolonged attacks are notably benefited by this plan of treatment; in brief ones there is neither time nor need for it. Dashing cold water on the face and neck, or pouring water out of a large vessel from a height directly over the mouth and nose of the patient, so as to stop her breathing and force her to open her mouth, often succeeds. “A calm manner,” says Dr. Reynolds, “the absence of all appearance of alarm and of either scolding or distressing sympathy – all of which things the apparently unconscious patient patient observes much more accurately than do her frightened friends, – will sometimes bring a fit to a speedy end.”
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."