There are three periods in a complete hysterical attack:— 1. The preconvulsive period, in which the aura—mental, sensory, or ovarian— occurs.
2. The convulsive period, consisting of the tonic and the clonic spasms.
3. The post-convulsive period, of which the most striking feature is the delirium identical with the mental state which characterizes one or the other of the dif ferent varieties of hypnosis.
In the first period consciousness and memory are always preserved, and injury might occur during the second period may be prevented by precaution ary measures.
In the second period consciousness and memory are usually abolished, and the patient has no knowledge of the convul sions.
In the third period consciousness is usually preserved. He has knowledge of his movements, and yet when the attack is terminated he is ignorant of what he has said and done during this third stage.
Any one of the three periods may exist alone. A. Pitres (Revue Neurol., Sept. 15, '96).
[The following is rather typical of hysterical convulsions as I have observed them: Au hysterical female at 22 years, after presenting many of the prodromal symptoms for two or three days, com plained of a sudden choking sensation in the throat, which she said was rising and choking her. She fell, or, rather, sank, to the floor, without hurting her self. The whole body and limbs became rigid and she shook all over as one with a severe chill. The legs and feet were extended, the arms flexed at the elbows, and the fingers were firmly flexed over the thumbs. The pupils were slightly dilated, but equal in size and responded fairly well to light. The eyeballs were rolled in different directions under the closed lids, but on raising the upper lids the balls turned upward and inward. The face did not change in color percep tibly, although the breathing stopped for at least 30 or 40 seconds. At the end of about a minute clonic, convulsive movements began in the arms; the legs were flexed and extended at the knees and hips a number of times, and the head was turned from side to side in a rhythmical manner. During the period of clonic movements, which lasted about eight minutes, the pupils and color of the face remained normal and the tongue was not bitten. The patient did not soil her clothes nor froth at the mouth.
After the clonic, convulsive movements ceased the patient lay as if exhausted. A pin-prick was scarcely recognized, and consciousness seemed greatly blunted, but on pressing over the left ovary the convulsive movements recommenced, and these were followed this time by opis thotonos, rolling of the body from side to side, and various exaggerated move ments.
In watching this case the psychical character of the movements was well marked, and the movements seemed almost voluntary. They were different from the reflex, forcible, shock-like move ments of epilepsy. There was a rhythm in the movements which is never ob served in the convulsive stage of true epilepsy. J. T. ESKRIDGE.] There is, however, in many of the graver cases of epilepsy, especially in children and young adults, periods of maniacal excitement and hysteroid-like movements, which follow true epileptic convulsions. These may occur a few minutes, hours, or a day or so, after one or several epileptic fits. I have a case of epilepsy, in a girl 15 years old, under my care at present, in which maniacal outbreaks take place the first or second day after a series of convulsions. They have never followed a single convulsion in this patient.
There are many abortive and atypical types of an hysterical convulsion. A condition of ecstasy, somnambulism, catalepsy, trance, or lethargy may follow or even take the place of the convulsion. Charcot called attention to the fact that mental symptoms may take the place of the convulsive seizure. We may have no convulsion, but a condition of alternat ing consciousness, the abnormal state of consciousness apparently entirely replac ing the convulsive seizure. I have one such case under my care at present.
It is important to bear in mind that firm pressure over "hysterogenic zones," especially over the sensitive ovarian re gion (?), will bring on a convulsion or may arrest it if the pressure is made dur ing its progress. I have been able on two or three occasions to arrest an hys terical convulsion by forcibly pulling and flexing one of the great toes. Many of the stigmata of hysteria, such as an msthesia, contracture, and paralysis de velop or increase soon after hysterical convulsions.