HYSTERIA. — Gr., the womb.
Definition.—Hysteria is supposed to be a functional psychoneurosis due to a morbid condition of the cerebral, spinal, and sympathetic nerve-apparatus, but apparently involving primarily the cerebral cortex, and is characterized by mental, motor, sensory, vasomotor, and visceral disorders.
Varieties.—A sharp distinction must be made between hysterical manifesta tions and the disease known as hysteria. The fact is that all human beings and many of the lower animals may at some time, under peculiarly-trying circum stances, exhibit some of the manifesta tions commonly observed in hysterical subjects. A failure to draw a line of de markation between hysteria and the acci dental manifestation of the symptoms of the disease accounts for much of the dif ferences of opinion in regard to the fre quency of the morbid process. Some authors, and not a few neurological spe cialists, seem to regard hysteria as a com paratively frequent disease. My experi ence has taught me that the more care fully one studies his cases and the more patiently and thoroughly he examines into each symptom and analyzes it, the Iess frequently he meets with genuine cases of hysteria. A person sustains an organic lesion of some portion of the body, and during the progress of the dis ease manifests many hysterical symp toms, but after recovery from the organic disease there are no more hysterical symptoms. This is not hysteria, but the symptoms of it are the epiphenomena which have been added to the symptoms of the organic lesion. I have come to limit hysteria to those persons who, hav ing a predisposition to the disease, de velop its symptoms. Such a predisposi tion is more commonly inherited, but it may be acquired. For hysteria to be come a disease the symptoms must be more or less continuous, usually remit tent in character and frequently attended by paroxysms. Excluding all those cases in which hysterical manifestations are but the epiphenomena of other morbid processes, I have found true hysteria very infrequent in the adult and still less common during childhood.
Symptoms and Diagnosis.—Multiplic ity and variability characterize the symp toms of hysteria. There is not an organ of the body the functions of which may not be deranged in this disease. The symptoms may be as numerous as those that may arise from the perverted func tions of every organ of the body. Fort unately no one case presents even the majority of the symptoms of hysteria. There are, however, certain classes of symptoms which characterize the dis ease, both during the paroxysmal and interparoxysmal stages, although only one or many of these are present.
Hysterical children often only mani fest the mildest symptoms of the disease, unless subjected to some severe physical or psychical influence. They may re main emotional, oversensitive, depressed, show lack of the ordinary self-control, and yet manifest no distinctive stigmata of the disease for years. Indeed, the dis ease may never become developed in them, but by proper education and fort unate circumstances they seem to over come, to a great extent, their natural tendencies to become hysterical. Many adults go through life burdened by the psychical soil of hysteria, but never de velop the disease in a typical manner because they have never been subjected to causes sufficiently strong to overcome their power of resistance.
For convenience of study the symp toms of hysteria may be divided into two classes: (1) the interparoxysmal, which are more or less continuous and consti tute the stigmata of the disease; and (2) the paroxysmal. The interparoxysmal symptoms may be studied under the fol lowing headings: Psychical. sensory, motor, and vasomotor.