HYSTERIA IN CHILDREN 
CONTRASTED WITH MANIA; 
READ BEFORE 
The Association of Physicians of Asylums, at the 
Meeting held at Baltimore, May, 1873, 
BY 
HENRY LAN DOR, M. D., 
Physician to tha London Asylum, 
ONTARIO. 
FREE PRESS STEAM BOOK AN1) JOB PRINTING COMPANY. RICHMOND STREET, 
1873. HYSTERIA IN CHILDRE 
Contrasted with Mania, 
The case of hysteria I brought before the meeting of the 
Association at Madison last year, gave rise to some discussion 
on points not fully considered by me before it was related. 
No previous intention existed on my part of alluding to the 
case at the meeting. It was only told to fill a vacant hour. 
It excited more attention than I supposed it would. I was 
asked pointed and searching questions on the responsibility for 
crime of a patient suffering under the symptoms described; and 
how the disease could be said to differ from acute mania. 
With regard to responsibility for illegal acts committed 
whilst the disease exists, I imagine that responsibility would 
be determined on exactly the same principles as it is in cases of 
transitory disorder of the mind, or of continued impairment. 
Whatever disturbs the mind, whether fever, inflammation 
mania, or hysteria, must, according to its amount and symp- 
toms, more or less deprive the sufferer of responsibilty for acts 
done whilst so afflicted. Each case must be left to the con- 
sideration it merits, and no general rule can be universally 
applicable. This is the very point I wished to state emphati- 
cally in my paper on Insanity in relation to Law. 
Before deciding the differential symptoms of mania and 
hysteria, I think it will be advisable to say a few words on 
hysteria generally, and on the nature of reflex actions, and the 2 
HYSTERIA IN CHILDREN 
influence of the cerebral lobes over their manifestations. To 
use the words of my friend, the late Mr. Skey, of St. Bartholo- 
mew’s Hospital, " It may be asserted with truth, that every 
“ part of the body may become, under , provocation, the seat of 
“ an apparent disease that in reality does not exist. It assumes 
"all the attributes of reality with an exactness of imitation 
"which nothing short of accurate and careful diagnosis can 
" distinguish from real disease. To give an example of the 
“commonest kind: A knee joint has severe pain in it, which 
" is aggravated by any movement. The temperature may be 
“ raised, and you leech, blister, paint with iodine, and use other 
“ violent remedies all to no purpose, because it is the nervous, 
“ not the vascular system which is involved.” Sir Benjamin 
Brodie, a man of achte observation, who made diseased joints 
one of his especial studies, says, “ I do not hesitate to declare 
" that at least four-fifths of the female patients who are com- 
“ inonly supposed to labor under disease of the joints, 
“ labor under hysteria, and nothing else.” “What has become,” 
says Mr. Skey, “ of all those cases of diseased spine that were 
“ so common a few years since, in every watering place in Eng- 
“ land. Girls and men in Bath chairs, wheeled about every - 
“ where, strapped and ironed, and tortured with issues.” 
Hysteria only was the matter, and they are cured now by tonics, 
stimulants and exercise. If there is in any one constitutional 
weakness from bad or deficient blood, some nervous disease will 
most probably arise, neuralgia, gastrodynia, or most likely, hys- 
teria in the first instance, but after long continuance some more 
serious nervous disorder. If it simulates inflammation of some 
local structure, and should it unhappily be treated by depletion 
in any form, all the worse for the victim. Her or his case is by 
so much rendered problematical The mental conditions of 
these young people, possessing low vascular and muscular sys- 
tems, is one of great excitability long l#jfore paroxysms of 
hysteria occur. They are irritable, easily moved to tears or 
laughter, they play with excess of energy4 but are subject to 
fits of lassitude; and they are incapable of long continued CONTRASTED WITH MANIA. 
3 
effort. Hysterical persons are in a state of reduced vigor from 
a low condition of health of the nutritive system. The disease 
is more common in females than in males, because the nervous 
system of females is more excitable in the healthy state, and is 
rapidly increased in irritability when they become unhealthy. 
(See Skey and Dr. Carpenter). The phenomena of hysteria are 
reflex. There is no disease in those parts that appear affected, 
whether in the form of local pain, or in that of mental disorder. 
The pain is probably due to irritation of the spinal ganglia, the 
mental disorder to irritation of the cerebral lobes, and the 
observed phenomena are purely reflex. The irritation that 
excites the cerebrum, or the ganglia, may be in the intestines, 
the uterus, or elsewhere, or it may be general, in the reduced 
powers of the system or the depraved circulation. The acute- 
ness of the physician will have to determine these points. That 
quality which we term the “ will ” may be disordered, and 
frequently is in hysteria; and I take the will to be nothing 
more than the combined and concentrated action of our brains. 
It is judgment and action combined, and by constant and inces- 
sant practice, it arrives at nearly instantaneous decision. It is 
analagous to the sum of the educated moral faculties which we 
term conscience. It is like those conclusions of reflection, so 
rapid and accurate, and well combined, that we call the result 
sagacity. (See the lecture of Mons. Bernard, Professor of Phy- 
siology in the College of Prance,Revue des deux Mondes). Still 
the operation of the will is not immediate. The experiments, 
made in Germany, also stated in the essay of Mons. R. Radau 
bear on this subject. Thought (I condense his statements) 
never springs simultaneously under the influence of an external 
cause; an appreciable interval of time elapses, one or two 
tenths of a second, before an idea is aroused in consequence of 
an impression received by the brain. Impressions coming from 
without are not perceived at the very instant of their production. 
They travel along the nerves with a speed of from 60 to 90 feet 
in a second; equal to the speed of the hurricane, but very much 
less than that of a cannon ball. For instance, we are conscious 4 
HYSTERIA IN CHILDREN 
of an injury in the feet only after half a tenth of a second has 
elapsed. The commands of the will from the brain pass with 
no greater rapidity. Limbs do not instantaneously obey the 
motive thought. When a movement is provoked by a shock in 
any part of the body, the stimulus first travels to the brain, 
there a thought is developed ; the will sends out an order; the 
order is conveyed to the limb, which is bidden to act. All these 
three acts require three separate durations of time, of an appre- 
ciable duration for each. In the human body the time is a 
trifle. But suppose the subject of an injury is a whale of 90 
feet in length. A boat it in the rear, and the harpoon 
is driven in ; pain is sent to the brain (nearly 90 feet); a second 
is lost. The brain returns the order to the tail to strike the boat. 
A trifling amount of time is used by the brain in forming the 
will to send this order; but the order lias to travel from the 
head to the tail, and another second is lost. In two seconds 
the boat has backed astern and got out of reach. Thus the 
length of the animal is the chief cause of the impunity of 
whalers in such circumstances. Similar acts are measured by 
the chronoscope, and skilled observers like Dr. Jaeger and Dr. 
Hirsch have found that the brain requires ,2£ intervals to form 
its decisions between the arrival and departure of its informa- 
tion and its orders. These reflections and experiments show • 
that time is necessary to form conclusions and acts of will by 
the brain, and the brain is the organ from wliich the will 
emanates. 
I will next allude to some experiments of Mons. Onimus, 
on nervous control, with a view of showing how the presence 
of the cerebral lobes, or their absence, is associated or dis- 
associated with the actions of animals. If the cerebral lobes 
are removed in animals the movements which were possible 
before are not put an end to, they take on particular characters. 
They are more regular, because they are deprived of menial 
influence. The animal is a locomotive apparatus without res- 
traint. But their being no brain to originate will, the animal CONTRASTED WITH MANIA. 
5 
cannot start without help or excitement. The pigeon must be 
thrown into the air or it will not fly ; the frog must be put into 
the water, and started, or it cannot swim. The experimentor 
can determine such an act for the animal, limit it, arrest it, or 
give it any required direction. The movement, once given, will 
continue until some object interferes. The frog swims straight 
on until stopped by the edge of the water. The pigeon flies 
until it encounters something; so with the duck or goose in 
swimming. In fact, the animal is inert living matter, uncon- 
scious, and the creature of external excitements. Deprived of 
both lobes it is inert until excited. Deprived of one, like the 
duck with one pellet in its head, the movements are rotatory. 
I have related these facts of Mons. Onimus, to show experi- 
mentally how, when the cerebral lobes are removed, no excite- 
ment is originated by the animal. It must be subjected to 
external impulses, as a substitute for the will and the mind. I 
will nowT say a few words on the nature of the connection 
between the cerebral lobes, the spinal ganglia and the s actions 
of the individual in the natural, and in the excited state arising 
from disease. I cannot do this better than by condensing some 
of Dr. Carpenter’s ideas on the “ Unconscious Action of the 
Brain.” The act of breathing is a pure reflex action, and goes 
on when we are unconscious of exerting any effort. Most reflex 
actions are, to a certain extent, under the control of the will. 
Without this control, as to respiration, no long speech could be 
made, because we are able to regulate our breath so as to make 
it subservient to the act of speech, but only to a certain point. 
No long sentence can be uttered without pausing to breathe, 
but still we have control over the act of respiration for the 
purpose of speech. This is an illustration of the way mental 
operations may be independent of the will, yet be under its 
direction. 
These reflex actions of the spinal ganglia are instinctive 
actions. The tendency to them is horn with us. There are 
others to which we are trained, and we act through the process 6 
HYSTERIA IN CHILDREN 
of bodily education, as unconciously, methodically and regularly 
as in the more purely reflex actions. Take the act of walking. 
We all know that the child has to be taught this act, often with 
difficulty and time, yet when once acquired it is as automatic 
as the act of breathing. We start on a walk and our minds are 
occupied with earnest thought, and our legs continue their 
automatic movements without any conscious act of will. What 
stimulates the spinal ganglia ? The mere act of the foot touch- 
ing the ground conveys the stimulus to the spinal ganglia. Tho 
order is sent out to raise the foot and advance the limb for 
another movement, whilst the brain is occupied in operations 
of its own, and is unconscious of the action of the spinal 
ganglia. The great ganglia of the senses, seated at the base of 
the skull, also convey their orders to their respective nerves, in 
obedience to the commands of the grey matter of the cerebral 
surface sent by direct fibres to those ganglia. The great organ 
of thought, and its complete sum the will, sends its directions 
to its servants, and receives its impressions through those 
servants after an appreciable interval of time for its working. 
As these operations are carried on in tho healthy state, so are 
they in the diseased, and that control which the will has in 
part over natural reflex actions, it is the duty of the physician 
to encourage over hysterical reflex actions, and this persevering 
encouragement is the true method of cure of hysteria. 
Physiologists inform us of the wonderful energy and power 
of corpuscular aggregations of bioplasm (the living basis of 
structure;; how they enter into the formation of all animal 
material, and into that of cerebral structure amongst others; 
how their abnormal movements may give rise to disease and all 
its subsequent manifestations. It is therefore exceedingly 
possible that abnormal action of bioplasm in the grey matter of 
the brain causes the various forms of iusanity, according to 
the locality affected,and the nature of the departure from healthy 
action; mania in one form; dementia in another; idiocy in 
another. These derangements of bioplasm may be temporary, CONTRASTED WITH MANIA 
7 
lasting for but a short period, give place to healthy movements, 
and again become deranged, and so account for recurrent mania, 
and its intervals of soundness. In mania these changes in 
action of matter may take place, whilst in hysteria there may 
be no such changes, and the grey matter be only subject to irri- 
tation, from the deranged state of the circulation, its poverty of 
healthy material, or some alteration of its qualities. Or the 
hysteria may be caused by irritation of some other part of the 
ganglionic system, reflexly acting on the cerebrum. Whatever 
explanation is attempted, I think thu cerebral symptoms are due 
to reflex action in hysteria,but to altered bioplastic arrangements 
temporary or permanent in mania. No doubt, long continued 
irritation may pass into an alteration of structure, and in 
hysteria may pass into mania. 
Suppose we imagine an illustration of these ideas. In the 
case of a wound in the hand, the seat of pain is in the hand, 
but the recognition of pain is in the cerebral lobes, for if the 
nerves to the hand are severed, the pain is not recognized by 
the cerebrum. Now, suppose there is no injury in the hand, 
but that the origin of the same nerves in the spinal ganglia is 
irritated by disordered blood; then the pain is felt in the hand 
although no injury exists there, and the cerebral lobes recognize 
reflexly the irritation in the spinal ganglia. Why irritation 
should be confined for a time to one ganglia, I know not, except 
that it is so, and that apparently it changes to some other 
ganglia as often as the pain flits from one part to another. But 
then, I am equally unable to tell why the pain in acute 
rheumatism flits from joint to joint, although I know it does so. 
Suppose, however, that the irritation is general, as it was in 
this child, then the cerebral lobes are affected also, and symptoms 
of mental disturbance show themselves in addition to hysterical 
pains. This seems to me a fair statement of the facts and 
symptoms as they were seen in this child, and are seen in 
similar cases. Whether the theory is sound is another question. 
But theories are justifiable so long as they explain the pheno- 8 
HYSTERIA IN CHILDREN 
mena. When they cannot, they must be abandoned. Tim 
emission theory ol light explained all the known phenomena 
for 100 years. When it could do so no longer it had to be 
abandoned for the undulatory. This is an illustration of the 
use of theory. 
I take the case of the child, related by me at Madison, as 
one typical of hysteria in early youth, She was in poor hoalth, 
ill nourished, thin blood, weak, and she looked half starved. 
She would not move nor use her limbs ; she was always talking 
nonsense; always complaining of pain somewhere, which lasted 
longest when attention was called to the locality. She slept at 
night; she thought white colors, black, and black, white, for a 
long time. She ate well in quantity, but often not the food 
most nourishing for her. She would shriek when she saw the 
liand approaching the seat of her fancied pain, but when not 
observing the hand, any extent of pressure could be borne. She 
got well when her bodily health became sound, and has continued 
well up to this time. Where do these symptoms differ from 
mania ? First, in their evanescence. They are excessive whilst 
they last, but they change daily or oftener. They arc violent, 
but quickly soften down. She slept well nightly; maniacal 
sufferers do not. Hysterical patients thoroughly understand 
all that is said to them; maniacal do not. The former give 
some attention, more than they appear to do, to the physician’s 
words; maniacal rarely give any. In maniacal people the form 
of violence in words or acts is continuous, for the most jsirt 
whilst the attack lasts. In hysteria no one can tell whether 
the morrow will be like to-day, most probably not. l’ain, 
when felt in mania, is felt when the attention is directed to the 
part or not; the reverse is the case in hysteria. In hysteria, 
there is often obvious cause for the mental irritability, either in 
disease, or in altered function, or in irritating substances else- 
where than in the brain; mania exists without such obvious 
causes, although it often accompanies poor blood and feeble 
constitutions ; and hysteria may also exist without obvious CONTRASTED WITH MANIA. 
9 
cause, yet rarely. The action on the brain is irritation, not 
change, irritation so general as to disturb the sum of the action 
of the organ. The will is disturbed as well as the intelligence. 
I have been contrasting hysteria in children under puberty 
with mania in young people over puberty ; for although I have 
seen, in the last twelve years, a few cases of hysteria in children 
where the mind was involved, I have seen no cases of mania 
under puberty, nor earlier than 16 years of age. No doubt, in 
populous cities there are numerous cases of hysteria in children, 
which are not often found in small country towns where there 
are not the same unhealthy modes of life. 
I will now refer to some observations of Dr. Gray. He 
denies the distinctive differences of these two diseases, but in 
the cases he referred to, he took his examples from those who 
had been long suffering under their symptoms, which had 
gradually come on, and had developed by degrees into insanity. 
But, notwithstanding his denial of any distinctive differences, 
I find that he admits that there is hysteria without insanity, 
and therefore he must draw the line for himself. In the 240th 
page of the October Number of the Journal, 1872, he has drawn 
a very marked line. He there says, hysteria is “ a well marked 
“ nervous disorder, in which persons may by disease be deprived 
“ of the power of using the will over the muscular system, just 
“ as I believe the peculiar disease of the brain, which we call 
“ insanity, is one in which the ideas and acts are in the main 
“ beyond the reach of the will.” In this definition hysteria is 
confined to loss of will-power over the muscular system ; and 
mania to loss of will-power over ideas and acts. Acts are, I 
have always supposed, muscular, and therefore, the definition 
of mania includes that of hysteria. No wonder that, with this 
definition in his mind, Dr. Gray sees hysteria as a portion of 
insanity, and no wonder that, when he confines hysteria to loss 
of will-power over the muscular system, he does not recognize 
deranged or excited ideas as a part of hysteria. Being totally 
unable to accept either of these definitions, Dr. Gray and myself 10 
HYSTEEIA IN CHILDREN 
cannot agree on fundamentals, ami therefore, we are not likely 
to find the arguments derived from different premises satisfac- 
tory to each other. It is as unwise in writing, as it is in the 
witness-box, to define insanity, for there cau be no definition 
that will include all its phenomena. But in order to give Dr. 
Gray the liberty to criticise my definition, which he will not lie 
slow to avail himself of, I will hero state it. In my paper on 
“ Insanity in Relation to Law,” I gave J)r. Combe’s definition 
that “ It is a morbid action in one, or several, or the whole of 
“the organs of the brain, and functional derangement in one, 
“ several, or the whole of the mental actions those organs 
"subserve.” I will add to this that in insanity,whether temporary 
or permanent, this morbid action i9 temporary or permanent 
alteration in the arrangement of the bioplasm ; while in hysteria 
it is an irritation of the grey and ganglionic structure*, 
produced by causes in action in other parts of the frame. 
To arrive at this conclusion I have related the facts and 
experiments contained in this paper, but I am afraid I have 
failed to satisfy I am conscious I have inadequately 
stated my own convictions. I have given you no new matter. 
I have merely attempted to bring those points in the researches 
of others together to support the opinions I entertain. Hysteria 
seems to me as different from mania as gastrodynia is from 
inflammation, or colic from enteritis, and I think that the more 
you give your attention to this subject the more you will be 
satisfied that the two diseases are essentially distinct. The 
treatment I do not allude to. It was discussed last year, and 
may be easily inferred from the statements here made. 
I have no doubt that the views expressed concerning the 
relation of cerebral bioplasm to mind will again lay me open to 
theological accusers as a materialist, which I am not, in their 
sense of the word, but as I believe that intelligence is the 
creation of the brain, as blood is of the organs of digestion, I 
am, in a physiological sense. As to life, whenever and wherever 
life enters into matter, whether when it is first seen in the CONTRASTED WITH MANIA. 
11 
automatic movements of the blood corpuscles, or at some pre- 
ceding or subsequent stage, we come, sooner or later, to the one 
great cause of all things ; the will of the Creator. There is a 
period in all researches into living matter when we must be 
convinced that, without a Great Creator, living matter could 
never be. We are allowed to search as deeply as we are able 
into the mysteries that surround us, and the deeper our search 
extends, the more we must be convinced of an Almighty 
Power that has created all things, and provided for them in 
continued and harmonious action and renovation. 
HENRY LANDOR.