Hysteresis

“ That hysteria plays a more important part in many demonstrations — physical, mental, and spiritual — than is generally supposed, will not be denied, at any rate, by medical men. Those indefinite distresses to which human nature, and especially female human nature, is more or less subjected, and which have borne at different times different names, such as the vapours, the spleen, the megrims, the nerves — and ennui should, perhaps, be added to the list — are nothing but varied forms of hysteria. ”

“ In hysteria the patient may be apparently unconscious; the body is normal to the touch, the pulse is full and regular, the color is natural, and if an attempt is made to raise the eyelid it will be met with resistance. Do not leave the patient alone, but do not disturb her until she recovers.
EPILEPSY.
The attack comes on very suddenly. The patient utters a sharp cry, and falls to the ground. The muscles are rigid, the eyes staring, and there may be frothing at the mouth. The muscles soon relax, and there are twitchings of the whole body. ”

“ It is convenient to group the very varied symptoms of hysteria into paroxysmal and chronic. The popular term “hysterics” is applied to an explosion of emotionalism, generally the result of mental excitement, on which convulsive fits may supervene. The characters of these vary, and may closely resemble epilepsy. The hysterical fit is generally preceded by an aura or warning. This sometimes takes the form of a sensation as of a lump in the throat (globus hystericus) . The patient may fall, but very rarely is injured in so doing. ”

“ I again repeat that this woman was not sick, that subsequent ab-reaction, despite all resemblance, is still not a hysterical process; one may ask why, after one nursing there results a hysteria and after another none. It cannot lie in personal predisposition, for the lady that I have in mind showed it very remarkably.
I now return to Miss Elisabeth v. R. While nursing her father there occurred for the first time an hysterical symptom in the form of a pain in a definite location on the right thigh. The mechanism of this symptom is fully explained on an analytical basis. ”

“ M. Janet’s subjects, whom he calls Léonie, Lucie, Rose, Marie, etc., were patients at the Havre Hospital, in charge of doctors who were His friends, and who allowed him to make observations on them to his heart’s content. One of the most constant symptoms in persons suffering from hysteric disease in its extreme forms consists in alterations of the natural sensibility of various parts and organs of the body. Usually the alteration is in the direction of defect, or anæsthesia. ”

“ We then deal with an injury produced by an etiology which continues to act chronically. We have to strengthen the capacity for resistance of the nervous system of our patient, and we must bear in mind that the existence of an hysterical symptom signifies a weakening of resistance of the nervous system, and represents a predisposing moment. From the mechanism of monosymptomatic hysteria we know that a new hysterical symptom generally originates as an addition to and as an analogy of one already in existence. The location once penetrated represents the weak spot which can be penetrated again. ”

“ Frequently some real disease is the starting-point of a train of hysterical disorders.
DURATION AND COURSE.—Hysteria is pre-eminently a chronic disease; in the majority of cases it lasts at least for years. Its symptoms may be prolonged in various ways. Sometimes one grave hysterical disorder, as hysterical paralysis, persists for years. In other cases one set of symptoms will be supplanted by others, and these by still others, and so on until the whole round of hysterical phenomena appears in succession. ”

“ Just as we may suffer a burn that is so superficial that we can hardly feel it, while there are other burns so deep and extended that they lead to death; just as there are light fevers and also fevers that are speedily mortal—so there are light hysteriæ, almost imperceptible, constituting a disposition of the organization rather than a disease, and besides them there are grave hysteriæ, so grave that they are confounded with insanity, with general paralysis, and with epilepsy. At the Salpêtrière, there are hardly any other hysterical cases than those of grave hysteria ”

“ Irritation or disease of the uterus or ovaries may result in hysteria, as may the bite of a dog, a tumor of the brain, a polypus in the nose, a phymosis, an irritated clitoris, a gastric ulcer, a stenosis of the larynx, a foreign body in the eye, a toe-nail ulcer, or a movable kidney.
Whatever tends to exhaust the nervous system will also cause hysteria, but only in those who have some inherited predisposition to the disorder. ”

“ Of course everything depends on the exact interpretation to be put on the word hysteria. As far as we are concerned, to consider a symptom of hysterical origin because it seems to be purely functional is sadly to misunderstand the question. The absence of what we call organic signs is a negative feature common to all neuroses, each of which, hysteria included, ought to have definitely fixed limits. ”

“ We frequently deal not with a single hysterical symptom but with a number of the same which are partially independent of one another and partially connected. We must not expect a single traumatic reminiscence whose nucleus is a single pathogenic idea, but we must be ready to assume a series of partial traumas and a concatenation of pathogenic streams of thought. The monosymptomatic traumatic hysteria is, as it were, an elementary organism, it is a single being in comparison to the complicated structure of a grave hysterical neurosis as is generally encountered. ”

“ Hysteria may appear at any age. It is common with children, especially during the five or six years preceding puberty. Of thirty-three cases under twelve years which came under Dr Still's notice, twenty-three were in children over eight years. Hysteria in women is most frequent between the ages of fifteen and thirty, and most frequently of all between fifteen and twenty. As a rule there is a tendency to cessation after the “change.” It frequently happens, however, that the disease is continued into an advanced period of life. ”

“ It is clearly demonstrated that the physical sexual organs are not the seat of hysteria. It does not, however, follow that even physical sexual desire, when repressed, is not a cause of hysteria. The opinion that it was so formed an essential part of the early doctrine of hysteria, and was embodied in the ancient maxim: "Nubat illa et morbus effugiet." The womb, it seemed to the ancients, was crying out for satisfaction, and when that was received the disease vanished. ”

“ The Great War has provided plenty of material for the study of hysteria, and French and German writers have dealt extensively with it. The paucity of English writings on the subject may indicate a smaller amount of material, but there has been sufficient considerably to increase our knowledge. The common form of hysteria is a mimicry of bodily disease; pains, paralyses, contractions and joint affections most often occur, though fits and trances are typical and there are few diseases which are not imitated. ”

“ If the disease be allowed for any length of time to run on, it might produce either organic—incurable—disease 1400of the heart, or consumption, or indigestion, or confirmed ill health.
383. At what period of life is a lady most prone to Hysterics, and what are the symptoms?
The time of life when hysterics occur is generally from the age of fifteen to fifty. Hysterics come on by paroxysms—hence they are called hysterical fits. A patient, just before an attack, is low spirited; crying without a cause; she is “nervous,” as it is called; she has flushings of the face ”

“ PROGNOSIS.—Hysteria may terminate (1) in permanent recovery; (2) in temporary recovery, with a tendency to relapse or to the establishment of hysterical symptoms of a different character; (3) in some other affection, as insanity, phthisis, or possibly sclerosis; (4) in death, but the death in such cases is usually not the direct result of hysteria, but of some accident. Death from intercurrent disorders may take place in hysteria. It is altogether doubtful, however, whether the affection which has been described as acute fatal hysteria should be placed in the hysterical category. ”

“ Now, there are various circumstances which favor modifications of psycho-biological relations, but which do not themselves directly cause them. Among those most frequently coming under professional recognition, hysteria may be instanced as a potent influence; but, in the light of the facts in my experience, it is incorrect to speak of the hysterical foot or the hysterical stomach or knee. We have the phenomena exhibited in both sexes, in children of tender years and in men and women in advanced life. ”

“ But then we have it from the patient's statement that at the time of nursing and the period following which I designated as the "first period" she had not suffered at all from the pains and weakness. To be sure, during the illness of her father she was once bedridden for a few days with pains in her legs, but it is doubtful whether this attack already belonged to the hysteria. A causal relation between these first pains and any psychic impressions could not be demonstrated by analysis; it is possible, even probable, that at that time we dealt with a common rheumatic muscular pain. ”

“ Deceptive remissions in hysterical symptoms often mislead the unwary practitioner. Cures are sometimes claimed where simply a change in the character of the phenomena has taken place. Without doubt, some cases of hysteria are curable; equally, without doubt, many cases are not permanently cured. It is a disease in which it is unsafe to claim a conquest too soon. In uncomplicated cases of hysteria the disorder often abates slowly but surely as age advances. As a rule, the longevity of hysterical patients is not much affected by the disorder. ”

“ Even though hysteria as a disease may be described as one and indivisible, there are yet to be found, among the ordinary and fairly healthy population, vague and diffused hysteroid symptoms which are dissipated in a healthy environment, or pass nearly unnoted, only to develop in a small proportion of cases, under the influence of a more pronounced heredity, or a severe physical or psychic lesion, into that definite morbid state which is properly called hysteria. ”

“ The effect of imitation in the production of hysteria has been known in all ages. Most of the epidemics and endemics of nervous disorders which have from time to time prevailed in various parts of the world have either been hysterical in character or have had in them a large element of hysteria. ”

“ It is well known that hysteria, chorea, and other allied nervous disorders are more likely to appear in the spring than at other seasons. This fact has been shown by various observers.
Hysteria may occur in any rank of life. It is not, as has been held by some, a disease of the luxurious classes. The American physician who has seen much of this disorder—and that means every physician of large practice—has met with hysterical cases in every walk of life. While this is true, however, hysteria of certain types is met with more frequently in certain social positions. ”

“ According to Bernutz, all the statistical data prove that hysteria in more than half the cases first manifests itself either just before or simultaneously with the commencement of menstruation. It seems also that at the time of puberty amenorrhoeic and dysmenorrhœic 102manifestations may give rise to the development of hysteria. In girls at this time of life, hysteria seldom takes the form of the great hystero-epileptic crisis, manifesting itself rather as nervous and moody states of mind, moral changes, weakness of will, in association with various forms of anæsthesia, spasm, and paralysis. ”

“ Some persons may be surprised to learn that hysterical patients are confined in the Salpêtrière, for it has not been usual to regard hysteria as a grave disease necessitating or justifying seclusion. It is not always so grave. The disease manifests itself in every degree. ”

“ During the night I felt impelled to get up and fetch them, and this morning I awoke with a round stone in each hand.
Hysteria takes strange forms. But who knows what is the real ground of hysteria? I used to think it was the special malady of the unmated woman; but, in later years, I have known many who had had a full share of the passional life, legitimate and otherwise, and yet still suffered from hysteria. ”

“ The second volume is devoted to the prognosis and treatment of nerve lesions.
The monograph of MM. Babinski and Froment on Hysteria or Pithiatism and Nervous Disorders of a Reflex Character next claims attention. In the first part the old conception of hysteria, especially as it was built up by Charcot, is set forth, and is followed by a description of the modern conception of hysteria due to Babinski, who has suggested the substitution of the term "Pithiatism," i. e. a state curable by persuasion, for the old name hysteria. ”

“ They consider in such a case that the life of the patient is not in danger and that a restoration to health will probably come about of itself. The differentiation of such an hysteria from a severe organic lesion is not always very easy. But we do not need to know how a differential diagnosis of this kind is made; you may be sure that the case of Breuer's patient was such that no skillful physician could fail to diagnose an hysteria. ”