PAROXYSMAL SYMPTOMS.—The con vulsion is the most prominent symptom of hysteria, and, while it does not occur in the majority of cases of this disease, it is the one symptom first thought of by many, especially among the laity, when the term hysteria is mentioned. The hysterical convulsion of the classical type, first described by Charcot, and fur ther elaborated and illustrated by his industrious pupil, Richer, is of very in frequent occurrence in this country. Here the paroxysms assume numerous atypical and abortive types. There are great similarities and dissimilarities be tween the hysterical and the epileptic convulsion. Prodromal symptoms are often absent, or if present are not recog nizable in epilepsy. In hysteria they almost invariably occur, and are usually so pronounced as to be observed not only by the physician, but by the patient and attendant. They often begin several days before the convulsion takes place in pronounced cases of hysteria. In the lighter forms of this disease, especially in those eases in which the paroxysm is caused by temporary physical exhaustion or emotional shock, the prodromal period does not extend over more than a few hours at most, and frequently it is appa rently limited to a few minutes. After the exhaustion and excitement caused by attendance upon a ball, in which the patient has danced until the early morn- , ing hours, the emotional disturbance fol lowing a lover's quarrel, a sharp disagree ment with an intimate friend, or the receipt of sad news, the subject becomes excessively nervous, impatient, irritable, and breaks out into fits of apparently causeless laughter or crying. The emo tional disturbance and loss of self-con trol increase, and soon an hysterical con vulsion, immediately preceded by an aura, supervenes.
In the majority of cases of hysteria the prodromal symptoms extend over a period of two or three days. The psy chical phenomena are the more promi nent. The mood of the patient changes; she is depressed, peevish, irritable, nerv ous, and unable to pursue her ordinary routine duties. She often becomes less sociable, keeps to herself, seems to be absorbed in her own thoughts, and may show evidences of being suspicious or the subject of hallucinations or delu sions. Personal habits change; from
being neat and tidy, she neglects her person and her dress. In some instances there is great increase of motor activity and there may be maniacal tendencies; in others, the patient is mute, broods, and becomes melancholic. The appetite is capricious, lessened, or lost; the tongue is coated, the digestion poor, there may be nausea and vomiting, and the bowels are often constipated. Sometimes deg lutition is difficult on account of spas modic action of the throat-muscles, and in some cases there may be spasm of the cesophagus or of the larynx. The stig mata of hysteria, especially relating to the sensory and motor phenomena, may develop or increase at this time.
The convulsion is immediately pre ceded by an aura, most commonly from the ovary; next from the throat, the globes; from the head, the clams; or from any "hysterogenic zone." In the child the paroxysm may consist of a maniacal outbreak, with hallucinations or delusions; it may take the form of violent motional disturbance, inappro priately termed chorea major, attended with delirium and a tendency to break furniture; or it may be an epileptoid convulsion.
Hysteria may be present in very young children. The simplest form shows itself by exhibitions of anger without sufficient cause and crying. A more accentuated form manifests itself by the child stif fening out its limbs, the face becoming violet and turgescent, with trembling of the whole body. Chamnier (Med. Press and Circular, Dec. 9, '91).
It is rare even in adults in this coun try to have the classical convulsion di vided more or less distinctly into four stages. The first stage is known as epi leptoid; the second, the period of grand movements; the third, period of passion ate attitudes; the fourth, the period of delirium. In the hysterical convulsions that I have witnessed the first and second periods have been fairly well marked, but the third stages has been entirely absent, and only occasionally has the fourth period been present.