This section is from the book "Smith's Family Physician", by William Henry Smith. See also: Natural Physician's Healing Therapies: Proven Remedies that Medical Doctors Don't Know.
Hysteria has characters peculiar to itself; but it is apt also to assume the form, and mimic the symptoms, of various other diseases of a much graver nature.
The hysterical paroxysm is almost, though not exclusively confined to women. It occurs under a great variety of forms, but they may all be reduced, for convenience of description, to two. The first of these has a general resemblance to an Epileptic fit. The trunk and limbs of the patient are agitated with strong convulsive movements; she struggles violently, like a person contending; rises into a sitting posture, and then throws herself back again; forcibly retracts and extends her leg, while her body is twisted from side to side: and so powerful are these muscular contortions that it is often as much as three or four strong persons can do to restrain a slight girl, and prevent her from injuring herself or others. The head is generally thrown backwards, and the throat projects; the face is flushed; the eyelids are closed and tremulous; the nostrils distended; the jaws often firmly shut; but there is no distortion of the countenance; the cheeks are at rest, unless when, as often happens, the patient is uttering screams and lamentations. If the hands are left at liberty, she will often strike her breast repeatedly and quickly, or carry her fingers to her throat, as if to remove some oppression there; or, she will sometimes tear her hair, or rend her clothes, or attempt to bite those about her. With all this, her breathing is deep, labouring, irregular; and the heart palpitates. After a short time this violent agitation is calmed; but the patient lies panting and trembling, and starting at the slightest noise or gentlest touch; or, sometimes she remains motionless during the remissions, with a fixed eye; till all at once the convulsive movements are renewed; and this alternation of spasm and quiet will go on for a space of time that varies considerably in different cases; and the whole attack frequently terminates in an explosion of tears and sobs, and convulsive laughter.
There is a variety of this form of hysterical paroxysm, in which the patient suddenly sinks down insensible,and without convulsions with slow and interrupted breathing, a turgid neck, and flushed cheeks; and she recovers from that condition, depressed in spirits, fatigued, and crying.
In the other of the two forms of this malady, the patient experiences a sense of uneasiness in some part of the abdomen, frequently towards the left flank; a ball appears to roll about, and to rise first to the situation of the stomach, and then to the throat, where the patient feels a choking sensation; the action of swallowing is frequently repeated; the abdomen becomes distended with wind, loud rumblings and sudden eructations take place; there is much palpitation of the heart; the patient is sad and sorrowful, and prone to shed tears.
After the paroxysms, these patients commonly void a large quantity of limpid, pale urine, looking almost like water; and this is sometimes expelled during the fit.
Sir Thomas Watson says: "It is of great importance to distinguish between Hysteria and Epilepsy. It is a dreadful announcement to have to make to a father or a mother that their child is epileptic, whereas Hysteria, though it is sufficiently distressing, is attended, in nine hundred and ninety-nine cases in a thousand, with no ultimate peril, either to mind or body.
In the Epileptic fit there is an entire loss of consciousness. The patient, on emerging from the paroxysm, recollects nothing of what has been going on during its continuance. It is not so in the Hysterical fit. The loss of consciousness is very seldom complete: and it never occurs at the outset of the attack. The. patient often is able to repeat, (though she may not always choose to confess it), what has been said by the by-standers during the period when she seemed insensible. This is a point of distinction well worth remembering, for more reasons than one. It not only helps the diagnosis when the fact comes out; but it suggests certain cautions to ourselves. We must take care not to say anything by the bedside of a hysterical patient which we do not wish her to hear; and we may take advantage of her apparent unconsciousness, and pretend to believe in it, and speak of certain modes of treatment which she will not much approve of, but the very mention of which may serve to bring her out of the fit.
In the epileptic paroxysm the face is usually livid; and foam which is frothy with air, or red with blood, escapes from the patient's mouth. These are symptoms which we do not see in the fits of Hysteria. The convulsive movements, even, offer some characteristic shades of distinction. In Epilepsy they are commonly more marked on one side of the body than on the other, and less irregular: the same movements are rapidly repeated: there is a strangling rattle in the breathing: while in Hysteria the forcible flexion and extension of the limbs, and the contortions of the trunk are more sudden, and, as it were, capricious; the respiration is deep, sighing, mixed with cries and sobs, and often with laughter. But, perhaps, the convulsive motions differ most in the face. The epileptic expression is usually frightful: the eyelids half open, the eyeballs rolling, the mouth drawn to one side, the teeth grinding, the gums exposed by the retraction of the lips, the tongue protruded and bleeding, the complexion leaden; while in Hysteria the cheeks are red, but at rest; the eyelids are closed and trembling; if you raise the upper one, you will see the eye fixed, perhaps, but it is bright, and very different from that of the Epileptic, which, if it be not rolling, is dull, projecting, and the pupil usually dilated.
The hysterical seizure may be over in a quarter of an hour, or in less time than that; or it may last many hours, or even several days. •
The hysterical seizure is almost peculiar to women: and it seldom occurs to them except during that period of their lives in which the menstrual function of the womb is, or ought to be, in activity.