A tertian fever, with spasms and convulsions.

Hysteria, (from the womb, from which the disease was supposed to arise). Hysterics; an appellation of the midwives of Greece and Italy who practised medicine among women. It is one of those disorders that ranks among the nervous, and arises from a preternatural irritability, owing very frequently to some change in the uterine system. Dr. Cullen places it in the class neuroses and order spasmi; defining it a rumbling noise in the belly, with the sensation of a ball rolling in the abdomen, ascending to the stomach and fauces, and there producing a sense of strangulation, drowsiness, convulsions, profuse quantity of pale urine; the mind, though not spontaneously, fickle and mutable. The varieties arise from the remote causes; a retention, or too copious flow of the menses; leucorrhoea; obstruction of the viscera; a defect in the stomach; lasciviousness. The belly is often tumid, and the navel is drawn inward; a general shivering with coldness often attends; a frequent discharge of very pale or limpid urine; costiveness; anxiety; pain of the head, as if a nail was fixed in it; palpitation of the heart; a general tremor; an unequal and languid, or a quick fluttering pulse; coldness of the extremities; a pale countenance; convulsive twitchings, increasing to the most violent spasms; alternate laughing and crying, are the most common symptoms. When the fit goes off, though the patient seems ready to expire, and lies for many hours apparently dead, the whole of the disorder disappears, and, in some instances, a perfect health is apparently restored. Hoffman observes, that hysteric patients rarely die without the attack of an epilepsy or apoplexy; from both which, and from syncope, it should be distinguished. See Epilepsy and Apoplexy.

Girls, on the approach of the menses, and women who labour under a difficult menstruation, are subject to this disease, which often also attends pregnancy.

Every thing which weakens the constitution renders it more irritable. Among the causes of hysteria, therefore, may be mentioned excessive evacuations, particularly of the catamenia, late hours, depressing passions, continued anxiety, hope delayed, violent excitement, plethora, excess of drinking, etc. The causes of a fit are frequently surprise, apprehension, sudden grief, often indigestion; but the paroxysms occasionally recur without any obvious cause, particularly when occasioned by plethora, which, in a constitution where the balance of the circulation is nicely poised, often occasions convulsive paroxysms. See Convulsions.

During the fit, if the suffocation is violent, pungent acid spirits may be held under the nose, or rubbed round the temples, with moderate frictions about the praecordia, and on the feet. Stools may be procured by a clyster made of .an infusion of camomile flowers and common salt, or of two ounces of soap dissolved in a pint and a half of water, if the flatus forcing downwards will admit of their injection; feathers may be burnt under the nose, or cold water dashed in the face. A fit, however, seldom proves fatal; and our chief attention must be directed to the management of the patient in the interval, to prevent a return of the paroxysm. Avoiding the remote causes, whatever they may be, is indispensable; but when owing to plethora, this part of our conduct is involved in difficulties. Bleeding for a time may lessen, but will ultimately increase, plethora; and a sudden abstraction of tension, in any respect, will induce a fit. When stays were worn tight, a delicate woman would often experience an hysteric spasm on taking them off. The regulation of the diet, and of the alvine excretions, are the only practicable means of obviating plethora: but even this requires delicacy in the conduct, for suddenly abstracting the rich nourishment, to which some hysteric women are accustomed, will produce syncope; and in every case, even the more gradual diminution occasions languor. The same effects follow discharges by stool, if in excess; and in each we must proceed with caution, meeting the inconveniences so far as we can. Obviating the other remote causes requires no particular management.

Our first object in the intervals is to obviate flatulence, which, though a symptom, seems, in some instances, to be a remote cause. For this purpose the fetid gums are highly useful; but opium is a more powerful medicine in this view, and, though in many respects inconvenient, is often indispensable. Where the head is not particularly affected by opiates, or where its exhibition is not followed by sickness and faintness, the only inconvenience resulting from it is producing costiveness. The seeds of the henbane, as we have lately had occasion to mention, unite the advantages of opium without this effect. With opium sometimes camphor may be joined, to correct its bad consequences on the stomach and head; sometimes castor; but there are many habits in which opium, however managed, is injurious. The warmer stimulants act also as carminatives; particularly the aromatics, the bayberries, ether, some of the essential oils, and the animal oil of Dippel.

With a view to correct the constitutional defect tonics of every kind are employed, and particularly such medicines or combinations as are at the same time antispasmodic. The chief of the vegetable tonics is bark, which, alone, proves very generally injurious. With rhubarb and aromatics it is more useful, and with valerian often a very effectual remedy, though too unpleasant to be continued for a long time. The casca-rilla, as less astringent, is less injurious; and the bitters, with aromatics, are often valuable medicines in this complaint. The astringents, as the catechu and alum, are injurious.

Numerous tonics are derived from the mineral kingdom; but the remedy chiefly employed is the steel, and sometimes the zinc. Every preparation of iron has been given in this complaint with equal success, and perhaps there is no real foundation for a preference. The calcined and the vitriolated zinc have been sometimes useful. Copper and silver, in the forms of the cuprum ammoniacale and argentum nitratum, have been rather used as antispasmodics than as tonics, though they seem chiefly useful in the latter view. In general the mineral tonics, particularly the iron, are injurious, when any degree of inflammatory diathesis or plethora is present. See Hoffman and Wallis's Sydenham on the Hysterics; Cullen's First Lines, vol. iv.

Hysterico hypochondriacus morbus. Hysterico hypochondriac disease. Authors have usually contended that hysteria and hypochondriasis were the same diseases, differing in the sexes which they attacked; the former particularly affecting women, and the latter men. This, however, was the result of carelessness and inattention. The diseases are peculiarly distinct in every respect; but, like other congeneres, though distinct, they may be united in the same individual. Thus the hypochondriac, who always suffers 5 H from flatulence, may be occasionally attacked with true hysteric paroxysms; and the truly hysteric woman may have many of the symptoms of hypochondriasis. These combinations, however, are very rare, and would not have been noticed, but in respect to authors of credit, who have considered them as of more importance than they merit.

We mention this union also with another view. Dr. Wallis, in his publication on Disease and Health, thinks that he has discovered an hysterico hypochondriac disease, and the description he has introduced into the last edition of this dictionary. Nothing could show more clearly the want of discrimination which pervades every page of the former edition than the description of this supposed disease. It differs wholly from both; and is evidently a slow fever, from accumulations in the head, probably joined with acrimony in the fluids. The patient, he remarks, generally broods over some personal, but imaginary calamity. He does the same in nervous fever, in syphilis, and a variety of other diseases: they are not, therefore, to be reduced to hysteria, hypochondriasis, .or a combination of both.

In this complaint this author found warm stimulants, a generous diet, with topical discharges from the head, the most useful remedies. They probably would be so, but the complaint is not on this account either of those which are the present objects of our attention.

Hysteria cataleptica. A farther investigation of the subject of catalepsy has led us to consider it, with some late respectable authors, as connected with hysteria, or hypochondriasis. It was necessary to point out these connections, though they do not greatly invalidate the former suppositions. The principle still remains of the connection of clonic and tonic spasms; and the disease still depends on a peculiar mobility and irritability of the nervous system. See Jebb on Paralysis of the lower Extremities; Edinburgh Medical and Surgical Journal, vol. i.; Swedish Memoirs, 1778; Pe-tetin Electricite Animale, p. 140.