HYSTERIA, a term applied to a disordered condition of the nervous system, the anatomical seat and nature of which are unknown to medical science, but of which the symptoms consist in well-marked and very varied disturbances of nerve function. By the ancients and by modern physicians down to the time of Sydenham. its symptoms were supposed to be due to disturbances of the uterus (_____ [Greek], whence the name), but it is now universally recognized that they are dependent on a variety of causes with which that organ has no necessary connexion. The causes of hysteria may be divided into the predisposing, such as hereditary predisposition to nervous degeneration, sex, age, occupation, and national idiosyncracy; and the immediate, such as mental and physical exhaustion, fright, and other emotional influences, pregnancy, the puerperal condition, diseases of the uterus and its appendages, and the depressing influence of injury or general disease. Each and all of these causes may act and react in any given case; in fact, it is nearly always impossible to assign a particular cause in a particular instance. Perhaps, taken over all, hereditary predisposition to nerve-instability may be asserted as the most prolific cause. It is often noticed in families in which this instability exists that hysteria presents itself to a greater or less extent in a considerable number of its members as the sole indication of the diathesis. As regards age the condition is apt to appear at the evolutional periods of life -- puberty, pregnancy, and the climacteric -- without any further assignable cause except that first spoken of. It is very frequent in girls between the ages of twelve and fifteen, and in women on the cessation of the menstrual flow. It is much more common in the female than the male, -- in the proportion of 20 to 1, -- which circumstance points to the important influence of the uterus in causation, but definitely places hysteria in the category of nervous diseases. It has been asserted that certain races are more liable to the disease than others-that for instance the Latins and the Slavs are more prone to it than other inhabitants of Europe. This, however, is doubtful ; in the more excitable races we find on the whole a greater tendency to hysterical excitement, in those whose national characteristic is calm and impassionateness a tendency to hysterical depression; and it is probable that the greater prominence of the symptoms in the former may have masked the more subtle yet not less important manifestations of the disease presented in the latter. Occupation, or be it rather said want of occupation, is a prolific cause. Tln. is noticeable in all classes of society: in the higher the idle luxurius woman concentrates herself upon herself, and the frivolity of her existence helps to aggravate the evil which may be innate in her constitution ; in the lower classes the disease is not so prevalent except among women who live a vicious and excited life. The experience of prison authorities shows not only that women of the criminal classes are individually liable to the hysterical paroxysm, but that it is very apt to assume an epidemic form amongst them. There is no proof that any particular legitimate occupation tends to its development. The depressing effects of almost any disease may be directly productive of hysteria, more especially those accompanied by pain and loss of sleep. There can be little doubt, however, that disease of the uterus and its appendages has a greater tendency towards its production than disease of any other system. At the same time, hysteria seems to follow more frequently on the less severe than on the graver forms of uterine complaints.
In point of duration hysteria may be transient or chronic. In the first phase it consists of an explosion of emotionalism, generally the result of mental excitement, to which the popular term "hysterics" is applied. Such attacks are generally preceded and accompanied by a sensation of a lump in th throat (the "globus hystericus"), a flow of limpid urine, violent outbursts of alternate laughter and weeping, and sometimes even convulsion. In the chronic condition we find an extraordinary complexity of symptoms, both physical and mental. These are continuous, constituting the "status hystericus," and paroxysmal. The physical symptoms are extremely diverse: there may be a pseudo-paralysis, the patient lying palsied wholly or partially, or there may be rigidity of one or more limbs, in either case the symptom persisting for weeks or months or even years ; there may be flushing or pallor of the face, an increase or decrease of temperature. Perversions of sensation are frequent symptoms ; these consist in complaint of pain, generally of a local character --, a common instance is the sensation of a nail being driven through the vertex of the head ("clavus hystericus"), or of increased sensibility of particular parts. On the other hand loss of sensation may be complained of, or, as occasionally happens, hyperaesthesia and anaesthesia may be stated by an individual to exist in different parts of the body. The region of the spine is a very frequent seat of hysterical pain. Pain, more especially when referred to a joint, is apt to be accompanied by swelling. Both the motor and the sensory symptoms are in every instance out of all proportion to any assignable cause, and for the most part disappear suddenly, leaving the patient in perfect health. It is to such cases that the wonderful cures effected by quacks and charlatans may be referred. The mental symptoms have not the same tendency to pass away suddenly. They may be spoken of as interparoxysmal and paroxysmal. The chief characteristics of the former are extreme emotionalism combined with a curious obstructiveness, a desire to be an object of importance, and a constant craving for sympathy. This is sought to be procured at an immense sacrifice of personal comfort, and to this may be referred a very large proportion of the motor and sensory symptoms above spoken of. The paroxysmal condition does not materially differ from the transient hysteric attack, except that convulsion is more common and more violent. The special senses of taste, sight, and hearing may be affected, sometimes temporarily obliterated. Hysteria may pass into absolute insanity.
Treatment consists in attention to the general health, and to such special symptoms as may arise, notably those connected with the function of menstruation. The submission of the patient to the best moral influences is of no mean importance. But it may be admitted that the results are generally unsatisfactory so far as medication is concerned, as the cure is usually spontaneous or dependent on some sudden mental influence.
See Ziemssens Cyclopedia of the Practice of Medicine, vol. xiv.; Reynoldss System of Medicine, vol. ii. (J. B. T.)
The above article was written by Sir John Batty Tuke, M.D., D.Sc., M.P.; Medical Superintendent, Saughton Hall Asylum, Edinburgh; Member of General Medical Council of Registration and Education; Medical Superintendent of Fife and Kinross Asylum, 1865-73; author of Morrison Lectures, Insanity of Over-exertionof the Brain.