Definition

This is a condition of perverted mentality. Perverted ideas control the patient, and produce more or less morbid derangement of the different organs of the body.

Etiology

This is an affection common to women. The definition should be strictly confined to an affection peculiar to women; for it probably is largely associated with irritation of the ovaries and womb. Improper early training is to blame for creating such a nervous affection. There is always a lack of moral responsibility and self-control in such cases. Such women are strictly controlled by their impulses and emotions. It may be that fear will have possession of them; it may be anxiety or jealousy.

An unhappy love affair is quite enough to start a run of morbid processes that will ruin the life of such a woman. Many nulliparous married women, who have no domestic responsibilities, have no discipline and are not poised, and they give way to all kinds of worries. Masturbation and sexual excesses are exciting causes in a certain percentage of these cases, and eventually break them down physically. Earlier symptoms are those of indigestion. Those who are autotoxemic will look pale, showing anemia.

Pathology

The disease is looked upon as purely functional, with no organic lesions. Unfortunately many of these cases go through the surgical "plants" of our country and in the course of three or four operations come out minus all the organs that they can spare--not because the organs are pathologic, but because the women are willing to have something done for them, and surgeons too often allow their patients to do the diagnosing. Besides, each case operated upon swells their statistics of successful operations.

Symptoms

Really hysterical women will present symptoms that may be mistaken for serious functional or organic derangement. A physician who has a strong personality or a fad can change the location of the diseases of hysterical women at pleasure. If they have more trouble in the region of the apex beat of the heart than the physician is willing for them to complain of, he may discover a disease in some other part of the body--possibly a sensitive ovary. The patient, as soon as told, will put her mind upon the ovary and forget the derangement she had in the chest; and from that time on she will complain of her ovary until the physician strategically discovers she has some other disease that is more important. This may seem ridiculous, but it is true; and it is easy to see how surgical maniacs may be caught in the meshes of a hysterical woman and be induced to perform a lot of unnecessary operations. Stratagems may be used to induce these patients to think health, but it requires time and patience.

Convulsions

These are mild, and usually occur after some disappointment, irritation, or feeling of anger. The patient will laugh and cry at the same time, and assume a condition resembling coma. Many simulate death. A really hysterical woman can cause a great deal of disturbance, in working up sympathy in the home, or even in the neighborhood, by making people believe that she is in a dangerous condition. Such patients will often complain of a lump in the throat. This is called "globus hystericus." After a severe spell they will throw themselves into a convulsion, but it lacks a very great deal in having the true ring. Anyone who has watched epilepsy will see the lack of genuineness in the hysterical convulsion. Loss of voice is frequent. Some cases will complain of stiffness of the joints; others will complain of paralysis of the lower extremities. I remember seeing one patient who was paralyzed for three years, having to be helped from her bed to her chair in the morning and then back to her bed in the evening. It took only about three or four weeks of discipline to cure her. Physicians should always be on their guard in believing symptoms that are represented to them by nervous women as being genuine. A woman may be absolutely honest, but the physician will not be honest if he allows a patient of this type to fool him into harsh medication; and certainly it is criminal to allow such cases to inveigle the physician into a surgical operation.

Loss of the special senses--taste, smell, and hearing--is common with these patients, There is also visual derangement--loss of perception of colors.

Many will complain of spasms of the pharynx. There will be vomiting, loss of appetite, depraved appetite, gastric pain, flatulency, diarrhea, and also constipation.

There may be rapid breathing, asthmatic breathing, dry cough, and a spurious type of hemorrhage from the lungs. The blood is of a pale-red color, and comes from the mouth and pharynx. Many will suck their gums for the purpose of starting a little blood. If there is anything a hysterical patient loves more than another, it is to excite, the sympathy of those about her. If she should ever work as hard for health as she does to procure sympathy, she could evolve ideal health. She looks upon a failure to convince her physician of the genuineness of her sickness as a calamity,

There are often irritable heart, rapid pulse, pain in the region of the heart, hot flashes, cold chills, and hemorrhages in the skin. The hemorrhages are usually, if not always, fraudulent.

These patients always complain of smarting urinating and retention of urine. They have urine of low specific gr avity. Some of them are troubled with incontinence.

Bladder and urethral irritations are common, and frequent urination is a marked symptom, I have known of a case where the woman had the habit of pushing small pebbles into her bladder, for the purpose of eliciting sympathy and enjoying the excitement of an operation for their removal.

These cases in many instances are moral perverts. They exaggerate everything; but unfortunately they fool themselves the same as they do others. Many have been known to indulge in self-injuries by way of swallowing needles; sucking blood and then vomiting it; inflicting serious injuries to their bodies, and not allowing the sores to get well by picking them and irritating them continually. Sometimes this condition takes on a criminal aspect, such as setting fire to houses, stealing, etc. Kleptomania is a form of hysteria--or perhaps I would better say that all kleptomaniacs are hysterics.

Diagnosis

The symptoms cannot be mistaken by a physician. Of course, these cases are liable to lead laymen and inexperienced physicians astray.

Treatment

The treatment must be psychological. Of course, everything must be done to correct indigestion, constipation, etc. All perverted conditions of the system must be righted.

The patient must be taught to live correctly--correct eating, correct bathing, and exercise; and then the physician who is unable to control the patient, leading her into a better state of mind and giving her poise and self-will, has no business to assume the responsibility of her case.