6. HYSTERIA. Sydenham, Stahl, Van Swieten, Sprengel, and Frank regard hysteria and hypochondria as substantially the same disease. The two maladies unquestionably bear a very close resemblance to each other in many respects; as, for example, the almost infinite variety and similarity of the symptoms which they present, and the proneness of the subjects of both diseases to exaggerate trivial or even imaginary ailments into disorders of magnitude. But there are marks of distinction between them equally important, which refute conclusively the opinion respecting their identity. Pure hypochondria almost invariably occurs in individuals of a lymphatic and bilious temperament. Their dispositions are generally gloomy and morose, and ever inclining to "look at the dark side." Hope, confidence, cheerfulness, enter but sparingly into their dispositions; they are not addicted to "building castles in the air;" never behold anything bright, agreeable or desirable in the future; but looking with distrust and aversion upon mankind, and obstinately fixing their thoughts upon some dreadful impending calamity, which they are sure will overtake them, sooner or later; they either drag out a miserable existence, suffering mentally almost every evil, or terminate their woes by suicide. Hysteria, on the other hand, usually occurs in females of a nervous, or nervous-sanguine temperament, with cheerful, lively and ardent dispositions, vivid imaginations, and highly impressible organizations. Hypochondria is uniform and continuous in its course, and presents but slight variations from day to day. Hysteria occurs in paroxysms, with intervals of greater or less duration, of passable bodily health and spirits. Hypochrondria is always connected with disorder of the stomach and liver; hysteria is owing to an irritation or erethism of the whole nervous system. Writers have always regarded the seat of hysteria as in the uterine and sexual organs, because it has usually been associated with derangement of the functions of these organs. It occurs after the period of puberty, in females of a nervous, or nervous-sanguine temperament, with strong sexual propensities, and is accompanied with deranged menstruation, dysuria, sexual excitement, or pains in the pelvic region. Yet the malady seems evidently to be of a purely nervous character, consisting of an erethism of the whole nervous system and capable of being brought into active operation by any exciting cause which may operate upon the economy, like deranged menstruation, the depressing emotions, fright, terror, mortification, dread, chagrin, disappointed love, undue excitement of the sexual organs, &c. This peculiarly irritable condition of the nervous system may exist for an indefinite length of time, without any actual development of proper hysteric symptoms, provided the above-named exciting causes do not operate. DIAGNOSIS. Sometimes the first symptoms of hysteria are flatulency pains, or distressing sensations in the stomach, bowels, chest, head and back; faintness, vertigo, bitter taste, eructations, dysuria, anxiety, depression of spirits, difficulty of. breathing, sense of suffocation from something like a ball rising in the throat, (or globus hystericus,) ringing in the ears, delirium, or loss of consciousness. Symptoms of this kind take place in individuals of a feeble and purely nervous temperament, and the delirium and loss of consciousness appear to take the place of convulsions. In others, of a nervous-sanguine temperament, with robust constitutions, the convulsive paroxysms come on by slight twitchings of the muscles of the mouth and eyes, with wild expression, eyes rolled up, convulsive laughing, crying, or sobbing, constant attempts to pull out the hair, to strike the breast or some other part, or to bite; difficult or laborious respiration, succeeded in a short time by the most violent convulsions. In other instances the paroxysms are preceded by a croupy cough, or colic pains, or pains in the head, chest, back or pelvis. In some cases the paroxysms take place suddenly, without any warning symptoms, and the patient may suffer a series of dreadful convulsions, with only brief intervals of consciousness, for many hours, and then be restored speedily to all her mental and bodily faculties. It would be useless to attempt a detail of all the phenomena which may occur in hysteria, and we shall, in conclusion, only observe, that the peculiar condition of the nervous system upon which the disease is dependent and the convulsive paroxysms to which this morbid state gives rise, should command our principal attention in the treatment of the malady. CAUSES. The predisposing causes are: a delicate, nervous temperament, too much confinement in close and heated apartments, the frequent perusal of exciting works of fiction, attendance upon theatrical exhibitions, tight-lacing, want of exercise, premature tasking of the mind to the neglect of the body, habitual indulgence in lascivious thoughts, nervousness, luxurious living. Amongst the exciting causes may be mentioned: violent mental im. ressions of any kind, whether produced by the sight of disagreeable bjects, or the smell of disagreeable odors, or the hearing of sudden noises, discordant sounds, or by terror, fright, anger, rage, grief, chagrin, mortification, and disappointed love or ambition. Hamilton supposes the presence of irritation and indigestible substances in the intestines is a common exciting cause of hysteria. Other exciting cases are: sudden suppression of the menstrual discharge, too profuse evacuations, uterine irritation, and leuchorrhoea. Hysteria has long been regarded as dependent on spinal irritation. From the extent of the spinal cord and its connection from one extremity of the trunk to the other, and its connection with the cerebral nerves, it must exercise an extensive influence on the phenomena presented by various diseases too often overlooked. The publication of Teale on Hysteria, drew public attention to the subject, and lessened the excessive medication and depletion which was then going on. A case mainly caused by that treatment is thus given: A lady aged twenty-six, had been bled and otherwise reduced, for inflammation of the lungs. She was then seen to be suffering from debility, with occasional peculiar lassitude, which compelled her to go to bed, where she spent most of her time; pulse natural, tongue clean, appetite good, bowels and skin natural. But occasionally there came on tightness across the chest, difficulty of breathing, which after a short time disappeared. The physician prescribed tonics for the "debility;" but ten days passed without improvement; at a loss what to do, he examined the spine, and found three dorsal vertebræ quite tender, and pressure upon them caused stricture of the chest. External irritation over the seat of tenderness was the only treatment thought of, and in that case it produced such amelioration of the suffering that the lady, comparing it with the result of other treatment, was grateful. It was formerly common to attempt to cure acute neuralgic attacks in hysterical females by bleeding; if there was some temporary palliation of the pain, the physician was satisfied; when the pain returned he repeated the bleeding. TREATMENT. For the cure of hysteria, arising from a torpid state of the bowels, and an accumulation of undigested fæcal matter, and attended with putrid or sour taste, bitter or acid eructations, flatulency, fullness, distention and pain in the epigastrium, constipation, nausea, weakness, languor, faintness, headache, giddiness, confusion of ideas, strong tendency to convulsions, Nux-vomica and Sulphur are the proper remedies. When the attacks appear to have been excited by derangement of the uterine functions, the most suitable remedies will be Pulsatilla, Sabina, and Silicea. If the exciting cause has been terror, fright, anger, disappointment, mortification, or any violent, mental excitement, Ignatia, Hyoscyamus, Aurum, Belladonna, Coffea, will each cover most of the symptoms. Administration.-The remedies should be administered at the third dilution, during the paroxysm, by placing a drop upon the tongue at short intervals, or by smelling; but during the intervals, a drop once in twelve hours, until the desired impression is produced. Pulsatilla.-Case by Dr. Cramoisy. A girl aged eight years, of healthy family. At the age of two years, was aroused from sleep by convulsive movement of the head, subsiding in a few moments, and re newed on again falling asleep. As she grew older, the spasms continued to recur, she learning to facilitate the lateral movements of the head, by holding it in her two hands, each spasm lasting three or four hours. At the end of five years she was affected by a barking cough, which would continue from five to ten hours incessantly. The child being conscious of its coming and of its disappearance. After this had lasted three days, Dr. Cramoisy found the case to be a neurosis of the larynx, constituting a symptom of hysteria, the cough simulating the bark of a dog. There was pain in the head and eyes, with photophobia and dilatation of the pupils. Bell., Ignatia, Cuprum, were tried without result. Pulsatilla 6°, was then given, two drops in a tumbler of water, a table-spoonful every four hours. The spasms ceased after the third dose, and the cure was rapid and complete. Hyoscyamus.—The symptoms taken collectively, as witnessed by , many authors, present a picture of hysteria of considerable severity. Accordingly, we find in J. A. P. Gessner, Störck, and in the Act. Nat. Cur. (IV., obs. 8,) that a case of hysteria, which bore great resemblance to Hyoscyamus, was cured by the use of this plant. According to J. H. Lange, nutmeg has been found efficacious in hysterical fainting fits. The sole natural cause of this phenomenon, is homoeopathic, and can be attributed to no other circumstance, but that the nutmeg, when given in strong doses to a person in health, produces, as stated by J. Schmid and Cullen, suspension of the senses and general insensibility. Cuprum.-Chorea and Hysteria, are convulsive diseases. In two cases, already referred to, the breathing was impeded --an indication of its homoeopathicity to spasmodic asthma. From the commencement of the action of the poison, pain in the stomach and colic were present in the majority of cases, and might induce us to select this medicine in a case of cramp of the stomach; we should feel further justified in having recourse to this remedy, because cramps in different parts of the body, frequently result from long-continued use of small doses of the cupreous compounds. Caulophyllin.*-Spasmodic pain in the uterus, stomach, bowels, &c.; tendency to spasmodic forms of hysteria; threatened abortion. Its action in small doses is primarily on the uterine motor nerves, thus controlling spasmodic action of the uterus; it also affects the motor nerves generally. Secondarily, it acts upon the nerves of sensation, causing neuralgic and rheumatic pains. Its effects on the motor nerves of the uterus, are considered equal to those of Secale, though in other respects there is little resemblance Leontice Thalictroides, Caulophyllum, False Cohosh. * between these agents. Caulophyllin is said to be capable of causing abortion; but that it will also prevent it when threatened, if the ovum be not already detached. It is used in rheumatism, dropsy, epilepsy, hysteria, cramps, amenorrhoea, dysmenorrhoea, chorea, leucorrhoea, hysteritis, hiccough, to hasten delivery, and to relieve after pains. In atonic conditions of the uterus; passive hæmorrhages, and prolapsus uteri. In five grain doses it is said to excite uterine contraction more decidedly than Ergot. 7. EPILEPSY. Epilepsy.-The name is derived from Enhaμßávw, to invade, attack, oppress. It was described by Hippocrates by the title of Morbus Sacer, though he rejected the idea of demoniacal possession. It was most fully described by Aretæus. Epilepsy has been known from the most ancient times. It was common in the day of Hippocrates, who described it; and at the present day it is estimated that in every one thousand persons six are epileptic. Symptoms. The patient, when in apparently perfect health, is affected with a slight flush of the face, then a scream more unearthly and horrible than any sound uttered by human creature. The whole body becomes convulsed; he falls forwards, if sitting, if standing, generally the same way. Sometimes there is a slight warning. The jaws are fixed, the tongue being frequently caught between them on their sudden closure, and severely bitten; expression of suffering is agonizing. There is bloody, frothy saliva issuing from the mouth; head drawn upon the chest, the body curved forward; thighs flexed, hands violently clenched. One side generally more affected than the other; the same side always the worst; countenance livid and distorted. The carotid arteries are distended and beat violently. The seminal fluid generally ejected during the paroxysm by the convulsive action of the ejaculator muscles. Gradually the muscles relax; the eyes open, they are blood-shot, turned upward with a ghastly expression of death; the breathing slow, gasping, stertorous, as if approaching death. In a few minutes the countenance becomes natural, breathing gradually less stertorous; and now, if undisturbed, he will fall into a deep and tranquil sleep; he wakes after half an hour or more, wholly unconscious of what has occurred, or of the fearful ordeal he has passed through. In some cases he opens his eyes and looks about him a few minutes after the attack, as if nothing had happened. Generally there is coma. If the fits succeed each other rapidly in considerable number the coma may last for days or a week, and is sometimes succeeded by VOL IL-38. |