ORGANIC DISEASE IN GENERAL AND OF THE NERVOUS SYSTEM ESPECIALLY.
—As is well known, there may be an association of organic and functional dis ease at the same time, or a person who is predisposed to hysteria may develop or ganic disease, and this, in turn, may cause the manifestation of hysterical symptoms. We have then, as S. Weir Mitchell has so graphically expressed it,_ "the symptoms of real disease painted on an hysterical background." The fact that the seat of the organic lesion often determines the location and the char acter of the hysterical symptoms not in frequently misleads the physician, and may cause him to err in diagnosis if he is not on his guard. We often meet with tuberculosis and hysteria in the same subject. A catarrhal condition of the larynx may cause hysterical aphonia, dyspncea, or even spasm of the larynx. An inflamed joint in a person predis posed to hysteria may lead to the devel opment of hysterical symptoms, such as contracture and paralysis of the limb. It is not uncommon for a ease of tumor of the brain to present many of most pronounced symptoms of hysteria. I have at present a patient under my care who has been treated for a period of eighteen months for hysteria and alleged uterine and gastrointestinal disorders. She has been subjected to several oper ations by certain orificial surgeons. Be sides her hysterical symptoms, she has double-choked disk, blindness, intense headache, vomiting, cerebellar tituba tion, and paralysis of one side of the face. A careful examination, and the recogni tion of the symptoms of organic disease would have prevented the error in diag nosis and saved the patient unnecessary annoyance and pain, and her friends needless expense.
I have seen a few cases of tubercular meningitis in the adult in which the early symptoms were of an hysterical character.
while probably not a di rect exciting cause of hysteria, yet is capable, when the disease is present, of exaggerating the symptoms, and possibly may, in persons who are very nervous and hysterically inclined, be the influ ence sufficient for its development. Re peated medical examinations, while the physician makes from time to time dili gent inquiries for certain associated symptoms, soon lead hysterical subjects to assume the lacking phenomena in their own cases; so that what was at first a slight hysterical disturbance becomes in time fully-developed hysteria. I have observed the effect of suggestion on hos pital patients who were not at the time the subjects of examination, but intently watching the investigation of other pa tients in the same ward.
Pathology.—So far as we know, hys teria has no anatomical basis. In the absence of any demonstrable change in the central nervous system its pathology must remain theoretical and speculative. As the clinical phenomena of this dis ease are observed there seems to be a faulty interpretation or misinterpreta tion of afferent impressions, a morbidly-. emotional state, with disturbed will and reason; hence all the efferent impulses, both conscious and subconscious, are per verted or allowed to run at a tangent. The morbid process is probably a dis turbed condition of the cerebral cortex, affecting the neurons, their processes, and the protoplasmic material, giving rise to perverted function of the highest nerve-centres and leading secondarily to derangement of the normal or harmoni ous action of the lower centres and of the sympathetic nervous system.
Hysteria, in its local manifestations, is limited to psychical processes. Al though the disturbed centre is in the cerebral cortex, still all the manifesta tions of hysteria appear in all possible territories of the nervous system. The nature of the disturbance of the cerebral cortex may be one of three types: 1. There may be a deadening of the sensory excitability of the cerebral cortex result ing in symptoms of hypnsthesia, anaes thesia, hypalgesia, and analgesia; or a deadening of the cortical motor dis charge, resulting in paresis and paralysis. 2. There may be an intensification of the perception of the entering impulse mani fested by hyperalgesia and hyperces thesia; or an intensification of the energy of the motor discharge, resulting in spasms and convulsions, often reflex in character. 3. There may be confu sional interpretation of entering im pulses, manifested by symptoms of partesthesia; or confusion in the motor discharge of cortical cells, resulting in hysterical ataxia, and in such contract ures as are due to the imperfect dis tribution of motor impulses to groups of opposing muscles. Predisposing causes include heredity, age, sex, protracted and exhausting diseases, sexual disorders, and faulty home-training. Exciting causes are psychical and physical trauma, sug gestion, and various toxamias. C. L. Mix (N. Y. Med. Jour., Aug. 4, 1900).