VISCERAL AND DISTURB ANCES.—In many cases of hysteria these symptoms become quite pronounced, and some of them may persist for a long time, and become troublesome, or even dangerous to life. The pharynx may become so irritable that deglutition is difficult or almost impossible on account of spasm of the pharyngeal muscles re sulting from the presence of food. Be sides the globes hystericus, spasm of the larynx may take place and greatly em barrass respiration.
Functional dysphagia occurs more fre quently in women than in men, but it is not uncommon in the latter. and may appear in children.
There may be pain. or a sense of con striction, or a feeling of a foreign body in the gullet often at about the cricoid cartilage, or even higher. The condition may be associated with glob us liystericns or other evidence of hysteria, or the dys phagia may be the only symptom. Where there is evident spasm of the gullet, this comes on in advance of the act of swal lowing. A. Coolidge (N. Y. Med. Jour., Aug. 28, '97).
Indigestion in some form is common in hysteria, but that form which inter ests us most in this connection is that in which the stomach and bowels become greatly distended with gas. Peristaltic movements of the bowels may be greatly lessened and in some cases apparently reversed. A section of the bowel may become greatly distended and form a phantom tumor of the abdomen.
Patient, male, aged 19 years, after a period of overwork, suffered so greatly from difficulty in breathing and palpi tation of the heart, that he was obliged to remain eight weeks in bed. Later the curious symptom developed that with each inspiration the stomach filled with air, emptying again on expiration. The chemical and motor conditions of the organ remained normal and there was no sign of pyloric stenosis. Herz (Med. News, Jan. I, '9S).
Constipation may be so troublesome that neither brisk purgatives nor ene mata have much effect. Vomiting often proves annoying and sometimes danger ous. It may occur almost immediately after the food is swallowed, apparently before it has reached the stomach (cesoph agismus). In some cases after the food
has lain in the stomach for some time considerable gastric pain and distress are complained of and the food is vom ited. In such cases, especially when the subject is a. young girl, as is often the case, the symptoms of gastric are closely simulated and may cause some apprehension. Pure hysterical vomiting is unattended by nausea, and the patient does not show signs of exhaustion from the act. It occurs fifteen minutes to an hoar or more after eating, and the whole contents of the stomach are apparently ejected; but probably this is rarely so, as the patient may show comparatively little emaciation, although vomiting may persist for weeks. The emesis may be purely mental, or it may be partially vol untary, for purposes best known to the patient. It is well known that malin gerers may become quite expert at vomit ing at will. It is sometimes difficult or almost impossible to determine how much the vomiting is due to psychical in fluence and how much to pure voluntary effort. In some instances the vomiting may be so persistent as to endanger the life of the patient by starvation, but this is extremely rare. Hysterical anorexia may be so great that the patient is un able to take sufficient food to maintain life. In those cases in which persistent refusal to take food is kept up for weeks or months and yet the patient does not greatly emaciate, it becomes evident that deception is being attempted.
Irregular and rapid heart-action is common in hysteria and is often a source of apprehension and distress to the pa tient. The pulse-rate may be 100 or 140 per minute, or even more. The patient often becomes faint on the slightest ex ertion, such as made in turning in bed or sitting up. Dyspncea and pseudo anginal attacks may occur from a little extra physical effort, or from emotion, especially fright.