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CHAP. XIII.

ÓF THE HYSTERIA, OR THE HYSTERIC DISEASE.

1514. THE many and various symptoms which have been supposed to belong to a disease under this appellation, render it extremely difficult to give a general character or definition of it. It is, however, proper in all cases to attempt some general idea; and therefore, by taking the most common form, and that concurrence of symptoms by which it is principally distinguished, I have formed a character in my system of Methodical Nosology, and shall here endeavour to illustrate it by giving a more full history of the phenomena.

1515. The disease attacks in paroxysms or fits. These commonly begin by some pain and fulness felt in the left side of the belly. From this a ball seems to move with a grumbling noise into the other parts of the belly; and, making as it were various convolutions there, seems to move into the stomach; and more distinctly still rises up to the top of the gullet, where it remains for some time, and by its pressure upon the larynx gives a sense of suffocation. By the time that the disease has proceeded thus far, the patient is affected with a tupor and insensibility, while at the same time the

body is agitated with various convulsions. The trunk of the body is wreathed to and fro, and the limbs are variously agitated; commonly the convulsive motion of one arm and hand, is that of beating with the closed fist upon the breast very violently and repeatedly. This state continues for some time, and has during that time some remis sions and renewals of the convulsive motions; but they at length cease, leaving the patient in a stupid and seemingly sleeping state. More or less sud, denly, and frequently with repeated sighing and sobbing, together with a murmuring noise in the belly, the patient returns to the exercise of sense and motion, but generally without any recollection of the several circumstances that had taken place during the fit.

1516. This is the form of what is called an hysteric paroxysm, and is the most common form; but its paroxysms are considerably varied in different persons, and even in the same person at different times. It differs, by having more or fewer of the circumstances above mentioned; by these circumstances being more or less violent; and by the different duration of the whole fit.

Before the fit, there is sometimes a sudden and unusually large flow of limpid urine. At the coming on of the fit, the stomach is sometimes affected with vomiting, the lungs with considerable difficulty of breathing, and the heart with palpitations. During the fit, the whole of the belly,

and particularly the navel, is drawn strongly in wards; the sphincter ani is sometimes so firmly constricted as not to admit a small glyster pipe, and there is at the same time an entire suppression of urine. Such fits are, from time to time, ready to recur; and, during the intervals, the patients are liable to involuntary motions, to fits of laughing and crying, with sudden transitions from the one to the other; while sometimes false imagina, tions, and some degree of delirium, also occur.

1517. These affections have been supposed pe culiar to the female sex; and indeed they most commonly appear in females: but they sometimes, though rarely, attack also the male sex; never, however, that I have observed in the same exquisite degree.

In the female fex, the disease occurs especially from the age of puberty to that of thirty-five years; and though it does sometimes, yet very seldom appears before the former or after the latter of these periods.

At all ages, the time at which it most readily occurs is that of the menstrual period.

The disease more especially affects the females of the most exquisitely sanguine and plethoric habits; and frequently affects those of the most ro bust and masculine constitutions.

It affects the barren more than the breeding women, and therefore frequently young widows. It occurs especially in those females who are li

able to the Nymphomania; and the Nosologists have properly enough marked one of the varieties of the disease by this title of Hysteria Libidinosa.

In the persons liable to the fits of this disease, it is readily excited by the passions of the mind, and by every considerable emotion, especially those brought on by surprise.

The persons liable to this disease acquire often such a degree of sensibility, as to be strongly af fected by every impression that comes upon them by surprise.

1518. In this history, there appears to be a concurrence of symptoms and circumstances properly marking a very particular disease, which I think may be distinguished from all others. It seems to me to have been improperly considered by physicians as the same with some other diseases, and particularly with hypochondriasis. The two diseases may have some symptoms in common, but for the most part are considerably different.

Spasmodic affections occur in both diseases; but neither so frequently, nor to so great a degree, in hypochondriasis as in hysteria.

Persons liable to hysteria are sometimes affected at the same time with dyspepsia. They are often, however, entirely free from it; but I believe this never happens to persons affected with hypochondriasis.

These different circumstances mark some difference in the two diseases; but they are still more certainly distinguished by the temperament they attack, and by the time of life at which they appear to be most exquisitely formed.

It has been generally supposed, that the two diseases differ only in respect of their appearing in different sexes. But this is not well founded; for although the hysteria appears most commonly in females, the male sex is not absolutely free from it, as I have observed above; and although the hypochondriasis may be most frequent in men, the instances of it in the female sex are very

common.

1519. From all these considerations, it must, I think, appear, that the hysteria may be very well, and properly distinguished from hypochondriasis.

Further, it seems to me to have been with great impropriety, that almost every degree of the irregular motions of the nervous system has been referred to the one or other of these two diseases. Both are marked by a peculiarity of temperament as well as by certain symptoms commonly accompanying that; but some of these, and many others usually marked by the name of nervous symptoms, may, from various causes, arise in temperaments different from that which is peculiar to hysteria or hypochondriasis, and without being joined with the peculiar symptoms of either the one or the other disease;

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