HYSTERIA, a morbid state of the nerv ous system in which the clinical manifestations present a wonderful variety of symptoms closely simulating some forms of organic disease. There is often increased physical irritability; the condition is frequently manifested by neu ralgic pains, hyperwsthesias, hallucinations and convulsive and paralytic phenomena. It may be regarded as a brain affection —a mild insanity.
Among the causes of hysteria heredity plays a most important part. There may be direct transmission of the hysterical temperament from parent to child or other nervous mani festations in the family and its branches, such as epilepsy, chorea, neuralgia, insanity, etc. It occurs more frequently in women, but it is much more common in men than is ordinarily believed; it occurs in boys and girls at a ten der age or about the time of puberty. Briquet found that one-eighth of his cases were in children under 10 years of age. Anything which lowers the general tone of the nervous system may give nse to it in predisposed per sons. Haemorrhages, severe illness, poor food, anaemia, overwork in uncongenial occupations, anxiety, fright, jealousy, disappointments, make a profound impression; so does an education which fosters and stimulates inherited insta bility. The enforced social restrictions of women, which they often inflict upon their young children, with lack of proper exercise for physical development and an artificial and premature education and habits heighten this predisposition. Accidents are a frequent cause of the first appearance of hysteria, as has been clearly pointed out by Charcot. The disease may, at times, occur in young girls who have witnessed attacks in others.
To understand the symptoms of hysteria, it must be borne in mind that there are two classes of phenomena. These have been termed the mental stigmata and the mental accidents. The stigmata are anmsthesias (loss of sensa tion), amnesias (forgetfulness), abulias (loss of will power), motor disturbances and modi fications of character. These are the cardinal symptom-groups that characterize the mental state of the hysteric. Any or all of the mental accidents may likewise be noted — suggestibility and subconscious acting, fixed ideas, ecstasy, automatism, convulsive movements, sleep-walk ing, deliriums, etc. The occurrence of these constitutes important corroborative evidences of hysteria and while not found in all hysterics, they may be very common symptoms.
Hysterical persons often complain of some of the symptoms found in neurasthenia — neu ralgic pains in various parts and hypermsthetic areas about the abdomen, chest or back, fre quently in the neighborhood of the ovary, mam mary gland, etc. There may be anaesthetic patches in various parts of the body or there may be complete loss of sensation on one side associated with anaesthesia of the mucous mem branes. The special senses on that side are involved — sight, taste and hearing.
There may be irritations of the bladder and urethra; pain in the joints, which may be mis taken for joint disease.
In some cases the senses are exceedingly acute. Persons notice odors imperceptible to others; are often made sick by odors which do not affect normal individuals; may have a liking for odors and substances disagreeable to others. Perverted sense is shown in an abnormal taste, in eating soap,. slate-pencils, etc. Hysterical manifestations in some are simply emotional exaggerations; they laugh and cry without cause. In serious attacks there are likely to be various hysterical manifestations. Occasion ally tactile sensibility is disturbed and the muscular sense may be abolished. The anms thesia may affect the mucous membranes of mouth, pharynx and nose, abolishing the re flexes of the parts. The secretions may be diminished or arrested.
Spasmodic convulsions and paralytic phe nomena may occur. The spasmodic attack may be rhythmic; may simulate the trembling of organic disease; may be confined to one mem ber or involve the entire half of the body; may be coarse, as in disseminated sclerosis, or a fine tremor, as in paralysis agitans, or the tremor may simulate the trembling of organic brain dis ease. It may occur in any muscle or group of muscles; may manifest itself as contracture, which may be intermittent or may last contin uously for months or years. Contracture may be confined to the strong muscle of the jaw and other muscles in their neighborhood, causing trismus. Spasms of the glottis may take place giving rise to severe difficulty in breathing; or of the pharynx, causing difficulty in swallowing. Globus hystericus is a constant symptom, but is not as frequent as it is often thought to be. Persistent and severe vomiting often occurs, but the nutrition rarely suffers materially from these attacks. Retention of urine is frequent, owing to spasm of the sphincter, and the catheter may have to be used for months.