M. J.‘SC’OTT 
ON 
HYSTEJRIA. 
Hysteria is evea still less susceptible of classification in any particular 
category of nervous diseases than are epilepsy and eclampsia. In this pro- 
tean malady derangement of the sensory motor and psychical functions is 
nearly always combined with disorder of the circulatory and nutritive sys- 
tem. Sometimes one set of symptoms predominates, sometimes another, and 
there is often an exalted excitability in one part of the nervous system, 
expressed in the form of hypersesthesia, or spasms, and which is complicated 
with interrupted irritability of some other region, evinced by anaesthesia and 
paralysis. We cannot as yet give a satisfactory answer to the question as 
to the existence of actual, although impalpable, material alteration in the 
nervous elements, to which the various forms of nervous derangement char- 
acteristic of hysteria are ascribable. For instance, although most patients 
are extremely susceptible to external irritability of the peripheral nerves, as 
to an over-excitability of those portions of the brain whence consciousness 
of the impression is derived. The former supposition is contradicted by 
the wide spread character of the hyperassthesia, as well as by the simul- 
taneous derangement of the physical functions; the latter by the intensity 
of the reflex action by which hyperaesthesia is accompanied. The 
latter condition is only ascribable to increased irritability in the spinal 
ganglia. Hence, the most plausible theory of the origin of hysteria is that to 
which Hasse adheres, namely: “ That the affection springs from a nutritive 
derangement of the general nervous system, both central and peripheral.” 
The facts that hysteria is observed almost exclusively and principally in 
females between the age of puberty and that of the extinction of the sexual 
function, and that, in a great number of cases, hysteria is accompanied by 
a morbid condition of the sexual organs, have given rise to the supposition 
that hysteria is a disorder of the general nervous system, originating in the nerves of the organs of generation. This theory, although somewhat too 
narrow, is true in a large number of eases. We have come to the conclu- 
sion, from the various phenomena described previously, that disease is 
not infrequently transmitted from the nerves, which it immediately affects 
to other nerves and to central organs; and, by analogy, wc may infer that a 
morbid state of the nerves of the sexual apparatus may extend to those of 
the rest of the body, as well as to the central organs. The mild derange- 
ments of innervation, the hyperaesthesia, the augmented reflex irritability, 
and the physical disorder which shows itself in some women during the 
period of menstruation, would seem to depend upon a process of this nature, 
and, as it were, from a physiological analogue to the pathological state 
of the sexual organs, which exists iu hysteria, arise in this manner. If a 
uterine infarction should develop after an abortion or a severe labor in a 
woman who has previously been healthy, and should this be accompanied by 
a well-marked hysteria; should the hysteria continue as long as the uterine 
disease lasts, and should it disappear as soon as we succeed in discussing the 
infarction, it would be manifest that to the uterus alone were due the mani- 
fold nervous derangements which we call hysteria. All diseases of the 
womb and ovaries do not exert an equal influence in producing this disease. 
Besides the infarctions, it is more especially the. ulcerations of the os uteri 
and the flexions of the womb which induce hysterical symptoms, while in 
cases of malignant growths and destructive affections, hysteria is much less 
common. Of the ovarian diseases the dermoid cysts of moderate size cause 
hysteria much oftener than do the very large sacs resulting from cystoid 
growths. In some cases irritation of the genitals, arising from excessive 
coitus, or imperfectly effected coitus, from Onanism, or from simple sexual 
excitement, has an influence upon the nervous system similar to that of the 
textural lesions of the sexual apparatus, above mentioned. But it would be 
both narrow and frivolous, and indicative of a most imperfect comprehension 
of the nature of woman, to ascribe all cases of hysteria, whose source would 
not be traced, to structural change of the genitals, to over-excited sexual 
appetite, or to its unnatural gratification. I certainly am no op 
indeed rather incline in the other direction, but I cannot believe that all 
hysterical widows, and old maids who become hysterical, without exhibiting 
any structural disease of their genital apparatus, suffer from suppressed 
sexual passion, or gratify it in ah illegitimate manner. 
Indeed, every day we have the opportunity of observing that mental emo- 
tion has an influence upon the excitability of the vaso-motor and nutritive 
nerves; that it causes the cheeks to redden or grow pale, muscles of the 
skin to contract or relax, the tears or saliva to flow. If all these various 
disturbances of innervation can arise from transitory physical impressions, 
it is easy to imagine that permanent nervous derangement, with disease of texture of the nervous system, may develop under the influence of the 
permanent mental emotions which beset a woman who finds all the hopes 
y( her life disappointed, who believes that she has foiled in her vocation, and 
who, under the depression consequent upon such feelings, is unable feto divert 
her thoughts into other channels. I admit the manner in which the contin- 
uous action of the physical impressions modifies the nutrition of the general 
nervous system, and thus leads to hysteria, is obscure; but it cannot be 
maintained that our insight into the mode in which disease of the genital 
nerves extends to other portions of the nervous system is any more clear. 
The state of mind which leads to hysteria depends not only upon external 
accidents upon .the individual. A fate which may befall one person without 
producing any apparent affect, may be the source of the deepest and most 
lasting depression in another. I heartily agree with Hasse, that, though 
hysteria is often seen in women wedded to impotent :T>en, yet it originates 
quite frequently in the sombre .feeling and miserable consciousness of a 
wasted life, which result when social claims of married life are not duly 
respected, or when the sentimental anticipations and fantastic ideals of a 
foolish girl are not realized. 
The nutritive derangement of the nervous system, from which hysteria 
arises, may also be induced by improper nourishment. We have sufficient 
proof of this fact in the frequent occurrence of this complaiut in cases of 
chlorosis and impoverishment of the blood unaccompanied by any disease 
of the sexual organs, by sensual excitement or Onanism and wdiere it 
cannot be traced, in the remotest degree to the physical impression above 
alluded to. 
There is a great variety as to the degrees of predisposition to hysteria. 
All the women with uterine infarction, or uterine flexion, or who have 
ulceration of the os uteri, are not necessarily hysterical, nor are all the old 
maids who believe their lives to have been thrown away, nor all the 
chlorotic girls. On the other baud, I have no hesitation in asserting that a 
tendency, either congential or acquired, plays a much more important role 
in inducing this affection than all other causes mentioned hitherto. The 
truth of this assertion is easy of proof. If we examine large numbers of 
women we find moderate degrees of uterine infarction, slight flexions of the 
uterus and erosions of the os to be so very common that the number of 
hysterical women would be equal to that of the non-hysterical ones, if 
affections like these alone sufficed to occasion hysteria, without the 
co-existence of a decided predisposition to such disease. It rarely begins 
to manifest itself before the twelfth or fifteenth year of life and very 
seldom appears in old age. It frequently outlasts the period of child- 
bearing and continues, in a moderate degree, during the climacteric years. 
The tendency to it is often congenital. Although a patient may have descended from a hysterical mother, and that mother also from hysterical 
parents, this alone is no absolute proof of the existence of such hereditary 
tendency, as it may have proceeded from injudicious training, which has. 
likewise propagated itself in the family for generations. 
SYMPTOMS AND COURSE. 
Owing to the complicated nature of the symptoms of hysteria, and to the 
varied character of its course, it is impossible to give a brief and compre- 
hensive description of this disease. Hence we depart from our usual 
practice in describing hysteria and instead of drawing a picture of the 
affection itself I shall give a classified discussion of its symptoms. 
Derangement of sensibility is a very common sympton, and is scarcely 
ever absent in any case of hysteria. “General nervousness, ” as the laity 
call it, is the first symptom of this class to which we shall refer. It often 
exists for years uncomplicated by any other form of the disease. This 
nervousness is sometimes evinced by an unusual acuteness of the senses. 
Some patients are able, by touch alone, to perceive the most trifling 
difference of weight and temperature, and thus to distinguish objects from 
one another, with their eyes shut, which healthy persons could not have 
distinguished. It is easy to understand that a faculty of this kind seems 
very wonderful to the masses, and that it often is made use of for purposes 
of imposture. In similar manner some patients have the sense of smell 
developed to a degree usually found afonV They are able to 
distinguish persons and things in the most remarkable manner, merely by 
their olfactory sense; or they may be able to hear and to recognize the step 
of a person who is still far off. Similar acuteness of the sense of taste has 
also been reported. Fortunately, however, hysterical hypersesthesia rarely 
takes the form of abnormal acuteness of the senses, or else the number of 
clairvoyants would be still greater than it is. Far more frequently the 
hypermsthesia of hysteria shows itself in the annoyance produced by a very 
slight degree of stimulation of the nerves of special sense. While, in a 
healthy person, it requires a very loud sound, a very strong smell, a very 
bitter or acid substance, or a very bright light, to produce an unpleasant 
effect upon the senses, hysterical persons complain if we elevate our voice 
a little in speaking, and beg us to talk in a whisper. They will often 
banish all flowers from their rooms because they cannot endure the odor of 
them; or will reject food if it contains the slightest particle of spice. To 
some hysterical persons bright daylight is quite intolerable, so that they 
constantly keep their eyes closed; to others a red color is unendurable, and 
no one must approach them without first putting off any red ribbon or 
article of clothing they may be wearing. This great sensitiveness to 
comparatively slight stimulus is often associated with idiosyncrasies. Certain forms of irritation, which from their quality rather than from their 
ntensity, are repulsive to healthy subjects, afford a sense of gratification to 
persons, and conversely stimulant, which are pleasant to a well 
person, often offend the senses of one who is hysterical. It is notorious 
that many hysterical people love the smell of burnt feathers, and take 
asafoetida without repugnance, while the odor of hyacinths, violets and 
other most agreeable perfumes is insupportable to them. Besides these 
signs of morbid irritability, there are other states of excitement of the 
sensory nerves which must be regarded as of a different character. In the 
first place there are neuralgias, especially prosopalgia, migraine, masto- 
dynia and ischias, all of which are of common occurrence in hysteria. 
Closely related to these there is a form of pain which is also very common 
and which is generally confined to one which is .known by name ofslaves’ 
hystericus. Besides this there is the almost never failing tenderness to 
pressure-on the back, and finally, those very peculiar hysterical affections of the 
joints (Arthrojiatliia Hysterica) which consists in pain in the articulation, 
often of such exquisite severity and so obstinate a duration as to be liable 
to be mistaken for grave inflammation. Morbid excitement of the nerves 
of special sense may also occur which cannot be accounted for by the 
action of any corresponding irritant. Some patients are never free from 
the sense of a certain taste or smell; some complain of roaring and buzzing 
in the ears, or of spots before their eyes. It is very remarkable that, 
besides these phenomena, indicative of exalted excitability, and of a morbid 
irritability of the sensory nerves, there should also be an anaesthesia 
involving a variable extent of the surface of the body. It is doubtful 
whether this anaesthesia be attributable to suspension of function of the 
peripheral nerves, or to an extinction of irritability at the nerve centres. 
All the derangements of sensation, hitherto described, have depended 
upon morbid irritability of the cutaneous nerves and of the nerves of spe- 
cial sense. Connected with these there is a series of perverted sensations 
in the internal organs. While, in ordinary circumstances, we have either no 
perception at all (or at most a very obscure one) of the condition of the 
internal viscera, as long as they are ir. good order, and while, without laying 
the hand upon the part, we are unaware of its pulsations; and while respir- 
ation goes on without our consciousness ,? !hc necessity for such an act; 
and while we have no perception whatever of the ordinary state of our 
stomachs and bowels, yet hysterical individuals have the greatest variety of 
complaints to make as to the condition of their internal organs, and claim to 
suffer the most extraordinary sensations. They nearly all complain of pal- 
pitation of thefoart—many of them of pulsation of the vessels. 
Upon examining the heart-beat and the pulse, we easily satisfy ourselves that such sensations are but subjective ones, and that the shock of the heart H 
is not really increased, nor is the pulse full and hard. It is the same with 
shortness of breath. Sometimes the patient breathes laboriously • 
quickly, complains of the utmost oppression; but, after the exclusion of the 
possible existence of any disease of the air passages or circulation, or of a 
morbid state of the blood capable of accounting for such dyspnoea, we may 
assure ourselves that it is purely a case of liypersesthesia or of perverted 
sensation. 
Besides this, although their digestion may be excellent, nearly all hyster- 
ical patients complain of a sense of pressure and fullness in the region of 
the stomach, or else of cardialgia, and, independent of the colic which 
sometimes troubles them, give most extraordinary accounts of the sensations 
which they feel in their abdomens. 
Under this head also come the thirst often observed in hysterical persons 
and the frequently-recurring desire to empty the bladder, although it is not 
full. Perverted sensations in the sexual organs are much more rare than 
might be supposed, more so, indeed, than has been represented by many 
authorities. The derangements of the motor functions observed in hys- 
teria are scarcely less numerous and varied than those of sensations. Their 
most common form is that of hysterical convulsions. There is no doubt but 
that morbid excitement of the motor nerves, which gives rise to hysterical 
spasm, proceeds from the spinal marrow and medulla oblongata. One of 
their characteristic signs is, that they never cause loss of consciousness. It 
is usually supposed that hysterical convulsions are of reflex origin, so that 
the spinal cord can only transmit the impression conveyed to it from the 
sensory nerves to the motor nerves. As the convulsion frequently springs 
from impressions produced upon the sensory nerves, or the nerves of special 
sense, it seems probable that this theory is the correct one. Hence, in cases 
where the convulsions seem to occur spontaneously, we must suppose that 
the cause has eluded our observation. In some cases hysterical fits consist 
in a mere twitching of one or more of the limbs, especially of the arms. 
They often recur at short intervals, for a while, whenever the temper of 
the patient is excited, and whenever stimuli even of moderate strength 
act upon the nerves of sensation or those of special sense. In 
other cases the spasms extend more or less over the entire body. 
They occur in violent paroxysms, and many almost assume the 
appearance of tetanic spasms, and still oftener of epileptic convul- 
sions. The patient often foams at the mouth, her thumbs are 
clinched in the palms of the hands—the only sign by which the attack may 
be distinguished from an epileptic one, being loss of consciousness. Very 
often spasm involves the group of muscles which operate in producing some 
complex act, such as yawning, crying, although the mental emotion which they are generally induced is not present. Thus spasmodic 
expiratory movements, combined with spasmodic contraction of the rima 
glottidis and tension of the vocal cords give rise to that obstinate cough 
nown as hysteric cough and to its modifications consisting of barking and 
wling sounds. Spasmodic contraction of the oesophagus, extending from 
ow upward, gives the patient a feeling as if a ball were rising from the 
into the throat, a symptom commonly called globus hystericus. 
Among the derangements of the vaso-motor and nutritive nervous system 
the most striking is the uneven and fluctuating state of the circula- 
tion in peripheral regions. Most patients constantly have cold hands and 
feet, while, without apparent cause, the natural color of the face gives place 
to a glowing redness, often accompanied by a disagreeable burning sensation. 
It is uncertain whether the secretions of saliva and that of the juices of 
the stomach and intestines are also modified by spasmodic contraction or 
paralytic dilation of the vessels of those organs; on the other hand, it 
undoubtedly is through derangement of innervation that the determination 
of blood to the kidneys arises, which causes the profuse secretion of urine 
of a limpid appearance, and is often described as hysterical urine— 
urina spastica. 
It is very difficult to furnish a brief and comprehensive description of 
the physical derangements observed in hysteria. In the first place, at 
outset of affection, we are struck by the rapid fluctuation which takes place 
in the spirits of the patient, and by the sudden transition from the most 
unbounded gaiety to the profoundest gloom. 
These symptoms are in part ascribed to the psychical hypersesthesia 
described above, and in part to physical hypersesthesia, by which it is 
accompanied. As mental impressions produce an unusual influence upon 
the temper of the patient, so too, suggestions which would produce no 
apparent effect upon the spirits of a healthy person produce a sense of 
annoyance or of repugnance in an hysterical one, although more rarely the 
sensation is one of gratification and pleasure. While the affection is still 
recent it is almost always possible, by adroitly conducting the conversation 
in the course of a few minutes, to make the patient laugh and weep 
alternately. There is much variety as to the course, duration and results 
of hysteria. In most instances the disease comes on gradually. At first 
the only symptoms are those of bodily and mental hyperacstliesia and their 
consequences, and it is not until afterward that the convulsions and other 
symptoms of greater or less violence show themselves. Sometimes they 
never appear. In rare instances the complaint begins with an attack of 
hysterics running an acute course, the other symptoms not making their 
appearance until afterward. At the menstrual period and immediately 
prior to it, the disease is almost always aggravated; sometimes, indeed, there never are any fits, excepting at this period. There is no fixed ri 
to the sensations of hysteria. It may continue for years with varying 
intensity, although during the climacteric years, it nearly always becomes 
milder. Recovery is not uncommon, the physician’s art having many 
triumph over hysteria to celebrate. There are plenty of cases, it is tr 
vvhich are never cured, and indeed, which do not even improve. 
Sometimes the malady runs into epilepsy or insanity. Death 
hysteria, however, is rare. There are only a few scattered cases on recmu 
in which death has occurred during violent convulsions, probably owing to 
embarrassment of respiration. 
Treatment is best, I would say on general principles, aperient tonics, &c. 
St. Louis, February 1, 1870.