Oppenheim defines hysteria as “a psychosis, which does not express
itself by disorders of the intellect, but in defects of character and
emotional disturbances, whose real nature is hidden under an almost
unlimited and varied number of physical symptoms of disease.”
The affection is about equally divided between the two sexes. A
neurotic tendency, often inherited, is an important underlying factor.
This condition, when associated with lack of mental discipline, is very
apt to lead to the mental depression and outbreaks of hysteria. A large
number of cases are between the ages of puberty and twenty-five. After
forty-five the disorder is infrequent.
White, Osler’s System of Medicine, says: “The significance of
Freud’s theory is the tracing of every case to sexual traumata
during childhood. Sexual experiences differ, however, from ordinary
experiences—the latter have a tendency to fade out, while the idea
of the former grows with increasing sexual maturity. There results a
disproportionate capacity for increased reaction which takes place in
the subconscious. This is the cause of the mischief.” A distinction is
made between the sexual and the sensual.
Anders points out that lack of proper mental development, improper
hygienic surroundings and chronic toxemia are causes.
The =direct causes= of hysteria may be many, and include physical and
mental influence, or both. Traumatism of various regions of the body,
but especially of the spinal column, may excite hysteria. Some slight
lesion of the vertebra or rib may be all that is discoverable. A
correction of the same is occasionally all that is necessary to remove
the direct cause; still there is usually considerable disturbance
of the spinal tissues, especially slight curvatures and muscular
contractions. Prolonged emotional excitement, overwork, defective
education and many moral and mental influences are potent and frequent
causes. Masturbation or an adherent prepuce occasionally is the cause
of the affection in boys, or any excitation that produces exhaustion.
Disturbances of the sexual system in both sexes are responsible for
many cases. The menstrual period and the menopause are frequent periods
for the manifestation of the disease. The disease often affects
prostitutes. Disturbances of the digestive, nervous and circulatory
systems, and general diseases of an exhaustive kind are exciting causes
of hysteria. Dr. Still said that occasionally the colon is prolapsed
and crowded down upon the pelvic organs. Hazzard[122] is of the opinion
that “a majority of the cases show a depression of all the ribs,
narrowing the thorax and often causing enteroptosis.”
=Symptoms.=—The symptoms may be extremely varied, including any symptom
of the many nervous diseases. The =sensory symptoms= are numerous. The
most common is anesthesia, which may be found in certain parts of the
body, usually one side (the left) of the body. Geometrical areas that
bear no relation to the innervation is characteristic. The patient may
not know of the sensory derangements until discovered by the physician.
When there is =anesthesia= without other nervous symptoms, the case
is commonly hysterical. The most marked symptom is analgesia, where
the patient is insensible to painful impressions. A pin may be placed
deeply into the flesh, and not be felt by the patient. The anesthesia
may extend to the mucous surfaces, and even deeply down to the tissues
of the joints. Organic and tendon reflexes are not changed. There may
be other symptoms of disturbed sensation; as an absence of pressure,
temperature and muscular sensation.
=Hyperesthesia= may be present nearly as often as anesthesia.
Hyperesthetic areas may be found in various regions of the body,
but especially along the spinal column and in the ovarian region.
The “hysterical spinal irritability” is of special interest to the
osteopath. The spinal column may be affected as a whole, or in
segments, or confined to a single vertebra. Especially when a spinal
irritability is in segments, or confined to a single vertebra, are
local derangements of the spinal column apt to be found. Correction or
even =pressure= upon these areas will often relieve the patient. Severe
pain over the heart may simulate angina pectoris. =Globous hystericus=
is of quite common occurrence.
Charcot refers to the ovarian hyperesthesia as follows: “It is
indicated by pain in the lower part of the abdomen, usually felt on
one side, especially the left, but sometimes on both, and occupying
the extreme limits of the hyperesthetic region. It may be extremely
acute, the patient not tolerating the slightest touch; but in other
cases pressure is necessary to bring it out. The ovary may be felt to
be tumefied and enlarged. When the condition is unilateral, it may be
accompanied with hemianesthesia, paresis, or contracture on the same
side as the ovarialgia; if it is bilateral, these phenomena also become
bilateral. Pressure upon the ovary brings out certain sensations which
constitute the aura hysteria, but firm and systematic compression has
frequently a decisive effect upon the hysterical convulsive attack, the
intensity of which it can diminish, and even the cessation of which it
may sometimes determine, though it has no effect upon the permanent
symptoms of hysteria.”
The =special senses= may be disturbed, although these symptoms are
usually transient. There may be blindness; narrowing of the field of
vision, due to anesthesia of the periphery of the retina; loss of
hearing; loss of smell or loss of taste.
=Motor disorders= may be of different forms of paralysis, as
hemiplegia, paraplegia or monoplegia. In fact all forms of =paralysis=
may be found in hysterical patients. Osier says: “There is no type or
form of organic paralysis which may not be simulated in hysteria.” The
affected muscles do not atrophy. The paralysis is usually general, and
contractures are common. Local paralysis, as of the bladder, vocal
cords and other parts of the body, commonly occur.
=Contractures= and =spasms= may also occur. True epilepsy may even
be simulated by hysterical spasms, but on careful observation the
characteristic attack of epilepsy is found wanting. Firm pressure may
increase the severity of an attack as well as bring it on. The spasms
are of various parts of the body, as the diaphragm, bronchi, abdominal
muscles, bladder, etc.
Various =disturbances= of the =viscera= may occur. Of the digestive
tracts, the appetite may be disturbed or depraved. Diarrhea or
constipation may be present. Flatulency is a common symptom. The
respiratory tract may be another point of considerable disturbance
in many cases. Dyspnea, aphonia, hiccough, cough, and exaggerated
breathing, as when cold water is poured on one, are common
manifestations. Various =cardiac= vascular symptoms may be manifested,
especially a rapid heart. Various =vasomotor= derangements are common.
=Physical manifestations=, as amnesia, lack of will power and an
excitable nature—easily moved to laughter or tears—are frequent. The
moral tone may be lowered. Even delirium, catalepsy, ecstasy and
trance, may be mentioned among the psychical phenomena.
The =hysterogenous zones= are of more than passing interest to the
osteopath. Tyson writes as follows, in regard to the hysterogenous
zones: “These are hyperesthetic areas especially studied by Richet,
on which persistent pressure will sometimes excite a hysterical
attack. While the ovaries are favorite hysterogenous zones, the zones
may be in any part of the body; as for example, the sides of the
trunk. Such pressure may also cause an existing attack to subside.
Hysterical spasms may also be localized or limited to groups of
muscles.” Especially when zones along the spine and side of the trunk
are located, the attack of hysteria may be completely relieved by
correcting the localized deranged tissues.
=Convulsive seizures= are not uncommon and may follow various prodromal
symptoms. Some authors divide the symptoms of hysteria into convulsive
and non-convulsive forms.
These are part of the many manifestations that are presented by various
hysterical patients, and it is readily seen that an osteopath has to be
continually on his guard.
=Diagnosis.=—The diagnosis is generally quite easy. The characteristic
emotional symptoms, associated with any of the many other symptoms
which have no organic lesion, are characteristic of the disease. Care
has to be taken, though, in some cases where symptoms are presented
which have organic lesions. The history, the attack and neurotic
temperament, will largely decide the nature of the affection. After the
“outbreak” the patient often feels decidedly better.
=Prognosis.=—Death may occur from exhaustion, but such a termination
is rare. Recovery is the rule, although the duration may be long.
Recovery usually takes place rapidly, after the exciting cause has been
determined and removed.
=Treatment.=—First of all, the osteopath should have due appreciation
of the mental characteristics of the disease. Whatever is dominating
the patient mentally must be either changed or abolished. It is not
always necessary to be harsh and severe with the patient; but one
should be firm and unyielding. He can do a great deal by having
complete mental control of the hysterical patient.
A most careful examination should be made for an exciting cause,
and when found it should be removed. This naturally constitutes a
very important part of the treatment. A light general treatment is
commonly indicated. The general health, especially the bowels,
should be carefully attended to. The hygiene, exercise and amusement
of the patient should receive due consideration. One has to gain the
confidence of the patient, and then be firm but kind to him. Relative
to diet Yeo[123] says: “The diet should be simple, abundant, and
supplied regularly, and at not too long intervals as is frequently the
case in boarding schools. All strong stimulants are best avoided, and
the hysterical should not indulge in strong tea or coffee, or exciting
wines and liquors.”
The “rest cure” as introduced by Weir Mitchell, is applicable in
some cases. This method consists of plenty of food, especially milk,
absolute rest of the body and mind, massage and electricity with
isolation of the patient from friends and sympathetic relatives.
Doubtless a general osteopathic treatment would be much better than
massage. Yeo says that to the application of hypnotism and suggestion
“we look with little sympathy and less confidence.”
During the hysterical =convulsions=, the patient should be watched, but
extreme measures should not be practiced. There is little danger of
patients hurting themselves. Throwing cold water in the face, or a cold
bath may produce the necessary mental shock. Pressure over the ovary
as stated in hysterogenous zones, or some other zone of the body, or
pressure upon a large blood vessel, as a carotid, will oftentimes stop
an attack.