Hysteria, when it appears in its unmixed form, and is not the forerunner of Epilepsy, or symptomatic of any other disease, is seldom attended with danger, al though it may be difficult to remove. Our indications are to prevent or cut short the paroxysm, and to ob viate its return. The first is accomplished by any sthl den impression upon the mind or the organs of sense. The general directions for this purpose it is almost possible to lay down, as so much depends upon the peculiar circumstances of the case, both with respect to the bodily and mental constitution of the patient. A fit has been prevented by suddenly dashing cold water over the patient, by antispasmndics, carminatives, or stimulants, and by various means which only operate through the medium of the imagination. In order to prevent the return of the fit, we endeavour to restore the due balance between the powers of the system, by increasing strength while we diminish action. This is accomplished principally by tonics of various kinds, ve getable and metallic, of which, perhaps, the most ef ficacious is cinchona, combined %%id] some preparation of iron. Among the auxiliary means, we may mention bodily exercise, the cold bath, 4bstinence in diet, early rising, and such other means as are generally allowed to invigorate the system, while, during the whole course of the disease, we are to he especially careful to pre serve a vet y open state of the bowels.
This is a peculiar kind of convulsion, which princi pally affects the extremities, and generally the arm and leg of one side more than the other. It consists in a loss of voluntary power over the parts, so that the pa tient is unable to move them in the required direction, while they are subject to a vatiety of spontaneous mo tions, which he has it not in his power to restrain. Other parts of the body, especially the lace, are sub ject to involuntary twitchings ; and, when the disease is violent and has been of long standing, the speech be comes affected, and at length a degree of fatuity super venes.
Chorea makes its first appearance almost exclusively in young persons, for three or four years previously to the period of puberty ; but if it be not removed by proper remedies, it will continue, in a certain degree, for a long period, or even during the remainder of life. The patients are generally of a delicate habit of body, and such as have not enjoyed a sufficiency of nourish ment, fresh air, or bodily exercise. It occasionally oc curs in paroxysms, or, at least, is more violent at some times than at others ; but generally its progress is gra dual, first exhibiting itself in certain gestures or mo tions of the limbs, which seem rather objects of ridicule than of medical treatment. Sometimes the first symp tom that is noticed is a dragging of the leg in walking, similar to what we obseve in slight paralysis. Along with the more appropriate symptoms we generally find, that the digestive organs are deranged, and espe cially that the bowels are torpid. The disease, in some cases, appears to be sympathetic of a local irritation, such as that from teeth or from worms ; but, generally, we do not observe any local exciting cause to which it can be referred. It is said to be disposed to disappear spon taneously at the age of puberty, but we doubt the cor rectness of this observation.
The cure of Chorea has been attempted by various means that are very opposite to each other. By some authors depletion is recommended, while, by others, tonics and stimulants are prescribed ; and in each case the remedies are directed generally with little regard to the nature of the individual cases, or the difference which may exist between them. This apparent incon sistency, perhaps, depends partly upon the nature of the complaint, which, like sonic others of the Neuroses, may arise from causes that are almost diametrically op posite to each other, and yet may exhibit nearly the same symptoms. The plan el treatment which we shall recommend is, that the state of the bowels be always the first object of attention; that brisk cathartics be administered, consisting of calomel combined with a drastic purgative, until the evacuations arc of the natu• ntl quantity and quality. II' the appetite be defective,
we should then administer stomachics; and if the sys tem exhibit marks of general weakness, we may em ploy tonics and stimulants. We believe that less ad vantage' will be obtained front the use of opium and other sedatives, than the nature and the symptoms of the disease might lead us to expect ; nor do we apprehend that much will be gained by the tribe of antispasmo dics. The application of blisters to the origin of the nerves which supply the affected part, especially to the different regions of the spine, has been found a useful practice ; mercury given so as to effect the system, has been strongly recommended by some writers, and like wise electricity ; but we do not feel much confidence in either of these remedies. We need scarcely remark, that it is extremely important in all cases of Chorea to examine the state of the teeth, and to remove every probable cause of irritation which may seem to be de rived from this source.
By Tetanus, in its most extensive sense, we mean a rigid contraction of any muscle or set of muscles ; but it is usually applied to a general condition of the system, where all the muscles of the body, and espe cially those of the trunk, neck, and jaws, are in a per manently contracted state, so as to render the patient almost incapable of motion, speech, and deglutition, while the most acute pain is experienced in all the af fected parts, and particularly about the pit of the sto mach and over the abdomen. The disease is some times principally confined to the jaws and the neigh bouring parts, when it is styled Trismus or locked jaw. It usually commences with a degree of stiffness in the back of the neck, with some difficulty in opening the mouth ; to this succeeds the rigidity of the muscles of the trunk, where it is often so violent as to bend the body into tile form of an arch, and it finally extends to the extremities. The disease is aggravated by pa roxysms, which are generally, but riot always brought on by some voluntary exertion, as by changing the posture, or by swallowing, when the contractions be come much more forcible, and the pains more acute, until the patient is carried off in one of these acces sions, exhausted as it were by his excessive exertions, and worn out by the violence of his sufferings. The exciting causes of the disease are of two kinds ; the most frequent in this climate is a certain species of mechanical injury, not productive of much pain, but exciting a specific irritation, which, from some cause, affects the nerves so as to induce the disease. Wounds of a nerve are perhaps the most frequent cause, but laceration of a tendon is also said to excite it ; and it is often observed to follow gunshot wounds or surgical operations, in which large bones have been divided ; in these cases it is generally supposed that a loose splinter of bone has been left in the wound, that a nerve has been torn, or perhaps included in a liga ture. The other class of the exciting causes of Tetanus is even more obscure ; it occurs principally in hot cli mates, and generally originates from those circum stances that are supposed suddenly to check the cuta neous perspiration, where the body is exposed to damp and cold after great heat ; of these one of the most frequent occasional causes is sleeping on the moist ground, after violent exercise under a tropical sun. It does not appear that the symptoms of the disease in these two varieties are materially different, although arising from such different causes; but those of the latter kind, which are termed idiopathic, are, for the most part, less violent than such as arise from wounds or other mechanical injuries. Although fever is not an essential symptom of the disease, yet, after it has subsisted for some time, the pulse becomes accelerated and the temperature increased ; and it has been sup posed that the best means which we possess of form ing a prognosis is derived from the state of the pulse, especially with respect to its velocity.