Hysteria (Gr. womb), a disease characterized by great excitability of the nervous system, especially of the sensory ganglia, without necessary structural lesion, and manifested by disordered states of the emotional nature, with loss of the power of controlling the thoughts and feelings, by spasmodic symptoms, and occasionally by perversion or suspension of the intellectual faculties. It received its name from the idea that it is peculiar to the female sex, originating in some disturbance of the uterine functions; but, though by far the most common in females, and generally connected with disorder in the generative system, it may also occur in males; a common name for it is "the vapors." The nervous symptoms predominate, varying in character and intensity according to the temperament of the individual, the nature of the causes, and the persistence of the disease. In the beginning it generally manifests itself by an exaggeration of the ordinary signs of emotional excitement, such as smiles and tears, irrepressible laughter and convulsive sobs, brought on by trifling causes; the nervous excitability increases, until violent convulsions of an epileptic or tetanic character arise from slight stimuli, with coma, opisthotonos, trismus, paralysis, cramps, ending often in monomania or moral insanity.
The paroxysms are sometimes of frightful intensity, requiring the strength of several persons to restrain a delicate female and prevent self-injury; after an attack the patient may be exhausted and almost insensible, and in a state of double consciousness, or much agitated, laughing or crying at the strangest fancies; at times the person falls insensible, breathing at long intervals, recovering with a sense of fatigue and coldness, or with involuntary emission of limpid urine. In cases where the nervous symptoms are less prominent, there are pain and a sense of heat and fulness in the region of the uterus, constriction of the throat with difficulty and increased desire of swallowing, a feeling as if a ball were rolling from the abdomen up to the epigastrium and throat with a sensation of pressure and suffocation, flatulence and tympanitic distention, hurried respiration, palpitations, occasional cramps, and great depression or exaltation of spirits. An attack of hysteria may last for several hours, the violent symptoms recurring every few minutes, with intervals of partial rest; or it may consist of but a single paroxysm of 20 minutes or half an hour in duration. After the paroxysm has ceased, tolerable health may be enjoyed for some time, though the nervous excitability persists.
In cases of long duration, the intellect and memory become enfeebled, the strength fails, and hypochondriasis and various chronic irritations of the vital organs supervene. Hysteria is very irregular in its march; it is the most protean of diseases, simulating almost every morbid condition; its duration is variable, sometimes terminating in health after a few attacks without medical treatment, and at others lasting a lifetime in spite of the best directed efforts to arrest it; its most dangerous consequences are convulsions, spasmodic contractions, partial paralysis, epilepsy, and tendency to insanity. The predisposing causes of hysteria are the female sex and a hereditary or acquired nervous irritability; the exciting causes are vivid moral emotions, anything which excites the imagination, especially disappointed love, jealousy, and various excesses of body or mind; it is often brought on by the mere force of imitation; some irregular action of the sexual functions is found in nearly if not quite all cases between the ages of 15 and 50. There has been great diversity of opinion on the nature and seat of the disease; its cause has been located in the uterus, in the brain, in the spinal cord, and in the stomach and other abdominal organs.
Whatever be its origin, a disordered state of the emotional nature is an essential character of hysteria, and the control of the feelings rather than of muscular action is lessened or lost; it is partly a disease of the mind, from improper education or self-abandonment to the power of the emotions. The habitual indulgence of feelings of a painful character or of sexual tendency affects the nutrition of the nervous and genital systems, giving rise to the peculiar phenomena of this affection. Though hysteria may simulate the phenomena of epilepsy, tetanus, chorea, hydrophobia, and other nervous diseases presented to its imitative disposition, it is dependent on a state of much less abnormal character; there is generally no structural lesion, nor any serious disturbance of the nutritive functions, as is evident from the long duration of the disease, and the suddenness with which different forms pass into each other or disappear entirely; the strangeness of these combinations and sudden changes is sufficient to distinguish hysteria from the more grave diseases which it imitates.
According to Carpenter, this excitability of the nervous system, which is only an exaggeration of that characteristic of the female sex, is caused by some defect of nutrition, the particular phenomena arising either from some morbid condition of the blood acting upon the nervous centre most susceptible to its influence, or from irritation of the peripheral nerves; he believes a gouty diathesis is one of the most frequent sources of this imperfect nutrition. - The principles of treatment are threefold: 1, to improve the nutrition of the nervous system by bringing the blood up to its healthy standard by strengthening diet, hygienic means, and the judicious employment of tonics; 2, to remove all irregularities in the menstrual or other functions, when they are evident exciting causes; 3, to act upon the mind, by leading the patient to repress the first emotional excitement by the force of the will, and to direct the attention to a different class of objects, substituting a pleasant for a disagreeable train of thought.
The attack itself requires that the patient should be kept from injuring herself, and the removal of all constricting garments, fresh air, sprinkling with cold water, inspiration of ammonia or other strong or disagreeable odors, irritating the nostrils with a feather, and other similar domestic remedies. To prevent a return, tranquillity of mind and habits of self-control are the best remedies; any disappointment, whether in love, business, or other affairs of life, should if possible be removed by the realization of the hopes; if marriage be unadvisable, the tendency to hysteric attacks will often be removed by the change of air, scene, and habits resulting from a distant journey; and a similar course is useful to distract the attention from other consuming cares and passions.