Chapter III: Hysteria, with Cases

It may, perhaps, be necessary before relating cases which I have treated, suffering from hysteria, to state briefly what I understand by this term. The word Hysteria was doubtless originally used in the belief that it depended on excessive reflex action of the nerves of the uterus and ovaries, when these organs were excited by disease or other causes; but this view is a very limited one, for, as Dr. Handfield Jones says, “it does not appear that females suffering with irritable uterus are more hysterical, often not so much so, as those who have no such disorder.” There is, however, as I have already mentioned, in almost all hysterical patients, an exacerbation at the menstrual periods.

Dr. Copland’s opinion, that “increased reflex excitability of the nerves of the female generative organs is one principal causative condition of hysterical affections,” appears to me the correct one. Romberg also says, “from the time when hysteria has taken root, the reflex action preponderates throughout the organism, and renders the individual more dependent upon external stimuli.”

I have alluded in the last chapter to those patients who have no desire to get well. Such I am not considering; and although I believe that all the complaints of an hysterical patient are more or less exaggerated, my experience differs from that of Dr. Handfield Jones, who believes that such patients are not “_bonâ fide_ anxious to get well.” In his view he is supported by Dr. Prout, who considers that “the whole energies of the patient’s mind are bent on deception;” and by Dr. Watson, who says that “the deceptive appearances displayed in the bodily functions and feelings find their counterpart in the mental.” I am confident that I have met with many instances in which the nerve power has become so weakened that the patient, without having organic disease, really feels all the symptoms she describes, and is only too anxious to be cured. The cases I shall now narrate are a few of a large number that have come under my care, and I am not without hope that their relation may show that hysteria, instead of being a term of reproach, does truly represent a curable disease.

The following was the first case that came under my notice, after I had satisfied myself of the correctness of my views on the subject:—

CASE I. HYSTERIA—FIVE YEARS’ ILLNESS—OPERATION—CURE IN TWO MONTHS.

D. E., æt. 26, single; admitted into the London Surgical Home Oct. 12,
1859.

_History._—She had been a dressmaker in Yorkshire to all the best
families around, but for the last five years had been so ill as to
render her unable to do any work, and had been entirely supported by
her former customers. When in that neighbourhood, on a professional
visit to a lady, I was requested to see, amongst others, this poor
_ci-devant_ dressmaker. Her physiognomy at once told me the nature of
the case; she was much attenuated, having for a longtime been unable
to retain any food, always being sick, with great pain, immediately
after meals. She had constant acid eructations; was so weak as to be
at times unable to cross the room; complained of a burning, aching
pain, with great weakness at the lower part of the back. Her catamenia
were irregular, with much leucorrhœa; bowels generally costive. She
was very melancholy, and expressed a most earnest desire to be cured.
I advised her admission to the “Home,” and on October 15, I divided
the clitoris subcutaneously. This being my first operation, I did not
know the consequences of performing the operation in this manner. For
two days the hæmorrhage was profuse and uncontrollable. Sleep was
procured by opiates. I ordered ℥ij of olive oil to be rubbed into her
chest every night, with a view to nutrition of her attenuated frame. A
moderately generous diet was given, _but no stimulants_. She was quite
well in two months, and has never since had a day’s illness. She
resumed her occupation as a dressmaker, and recovered nearly all her
former customers. 1865.—I have heard almost yearly of this patient,
and lately had a letter from the lady to whom I previously referred,
saying that my patient is perfectly well and in robust health.

CASE II. TWO YEARS’ ILLNESS—OPERATION—CURES.

P. F., æt. 21, single; admitted into the London Surgical Home Jan. 7,
1861.

_History._—Attributes her illness to having strained herself two years
ago, when lifting a heavy saucepan from the fire. Has ever since that
time suffered great pain in the back and side, much worse when she
walks, but tolerably easy in the prone position. Catamenia very
irregular, both as to time and quantity. Great pain in defecation.
Bowels very constipated. Has been eleven weeks in a metropolitan
general hospital, and thirteen weeks in a special hospital for women,
from both of which she was discharged as having nothing the matter,
because she had no evident disease. She had, however, been treated for
uterine disease.

_On examination_, the uterus was found to be quite healthy; there was,
however, evidence of excitation of the pudic nerve.

Jan. 10. The clitoris completely excised.

Jan. 16. Is much better.

Jan. 31. Discharged from the Home, cured. Is quite well in her health,
having lost all aches and pains, and being able to defecate without
the slightest uneasiness.

CASE III. HYSTERIA—THIRTEEN YEARS’ ILLNESS—STERILITY—OPERATION—CURE, AND
SUBSEQUENTLY THREE PREGNANCIES.

S. S., æt. 33, married; admitted into the London Surgical Home
February 23, 1861.

_History._—Although married several years, has had no children. About
a year ago suffered from pain in the right side, which, however, being
treated was cured. In April last the pain returned in the back, and at
short intervals has recurred. At times the pain is so severe that she
is unable to walk. Has for thirteen years suffered from leucorrhœa,
globus hystericus, &c.; and has always had distaste for marital
intercourse.

_Examination_ confirming me in the diagnosis I had formed of this
case, I, on February 28, operated in the usual manner. Her recovery
was retarded by an attack of jaundice, but in May she was discharged
cured.

In July, 1862, this patient was seen quite well and ruddy, and had
long lost all her old symptoms. She had been once pregnant, but
miscarried at three months.

In July, 1865, she came to town with her youngest child. She was quite
well, and had never been ill since the operation.

_Remarks._—This was the first case of this nature under my care, in
which the patient, formerly sterile, became pregnant after removal of
the cause of her illness.

CASE IV. HYSTERIA, WITH SLEEPLESSNESS—SIX YEARS’ ILLNESS—OPERATION—CURE.

H. R., æt. 55, single; admitted into the London Surgical Home Nov. 18,
1861.

_History._—For six years has suffered from a feeling of fulness,
weight, and heat at the lower part of abdomen, with pain in the back,
and “bearing down.” At this time her menses had just ceased. Has not
slept well for three or four years. Wakes every hour. Is always
restless and fidgety. Frequent desire to micturate, with pain on doing
so, and often desire without power to void it. Bowels costive;
digestion indifferent.

She is a nervous, restless woman, with glistening and constantly
wandering eye—pupils dilated. Has suffered from peripheral irritation
for many years.

Nov. 21, 1861. Usual operation performed. A week later, slept well for
four hours, the first time for many years.

Dec. 1. Has lost the irritability of the bladder, and passes water
every four hours only; lost also the bearing-down pain; restless
excitement gone.

Dec. 7. Eats and sleeps well; is cheerful and grateful; leaves the
Home cured, having been in only three weeks.

In 1863 was perfectly well.

CASE V. FISSURE OF THE RECTUM, WITH HYSTERIA—OPERATION FOR THE
FORMER—RELIEF—SUBSEQUENT OPERATION FOR HYSTERIA—CURE.

Mrs. L., æt. 55; admitted into the London Surgical Home Dec. 9, 1861.

_History._—Is a widow. Has for many years suffered from all the
inconveniences of a fissure of the rectum, combined with bad
digestion, undue nervous excitability, and sleepless nights. Is very
anxious to be cured. It being thought that all these symptoms might be
due to a painful fissure of the rectum, the ordinary operation for
this affection was performed on December 12. The bowels were opened in
a few days without pain, and the fissure was healing well. Being,
however, still sleepless, excitable, and irritable, questions were
asked which showed that a further operation for removal of another
source of irritation was advisable; therefore, on December 24, I
performed my usual operation. The next night she slept well. She
became quiet and cheerful, and on January 6, 1862, she was discharged
quite well.

_Remarks._—This case is very interesting, as it shows that there may
exist at the same time more than one irritation exerting inhibitory
influence.

CASE VI. HYSTERIA, WITH EPILEPTIFORM ATTACKS IN CHILDHOOD—VARIOUS
AILMENTS FOR THIRTEEN YEARS—OPERATION—NO BENEFIT.

H. D., æt. 23 single; admitted into the London Surgical Home April,
1862.

_History._—When very young, until ten years of age, had frequent fits.
Improved in health till she was fourteen years of age, when she began
to suffer from abdominal enlargement. First menstruated at nineteen.
Is constantly sick after meals. Has been in nearly every hospital in
London. The patient is very hysterical, and is always _talking_
religion.

_On examination_ the abdomen was found very tympanitic. Under
chloroform this state quite subsided. Walls of abdomen fat and
muscular. Body generally well nourished. Evidence of continual
irritation of the pudic nerve.

April 3. Operation as usual.

For some time after the operation this patient was much better of the
sickness, and great interest was manifested by several visitors in her
case; she never, however, received permanent benefit, being a regular
impostor, and discovered on several occasions tying handkerchiefs,
&c., tightly round her waist to make her abdomen swell. She was
discharged as incurable.

_Remarks._—This case I have inserted as a warning. It is no fault of
the operation if it fail in such cases.

CASE VII. HYSTERIA—SEVERAL YEARS’ ILLNESS—OPERATION—CURE.

Miss M., æt. 42; admitted into the London Surgical Home April 13,
1862.

_History._—Has felt ailing for many years, but for the last two has
suffered pain in the uterine region, and, on pressure, over the
ovaries. This pain is accompanied by bearing down, and a sense of
distension. Suffers from considerable leucorrhœa. Menstruation
regular, and during the period the pain is absent. Bowels regular.
Sleep disturbed. Feels depressed, and is inclined to melancholia.

_On examination_ there was no congestion of uterus or enlargement of
ovaries, but there was evidence of peripheral irritation of the pudic
nerve.

April 17. Usual operation performed.

She rapidly improved; sleep and cheerfulness returned, and all pain
left her. She expressed herself as not having been so well for many
years.

May 13. Left the Home, having gained flesh and strength, and being
quite cured of all her bad symptoms.

_Remarks._—Interest attaches to this case, as instead of exacerbation,
there was diminution of the symptoms during menstruation.

CASE VIII. HYSTERIA—MANY YEARS’ ILLNESS—PHANTOM TUMOUR—OPERATION—CURE.

A. B., æt. 24; admitted into the London Surgical Home 16th July, 1862.

_History._—Is a single woman, and procures a living by dressmaking.
When younger, was a nurse-maid. Catamenia commenced before she was
thirteen, but she was not regular until she was nineteen, since which
the function has proceeded normally both in time and quantity. Has for
many years been ailing, and always had something the matter. Has
suffered from intense irritation in the genital region, especially in
the bladder, and she has constant pain in the back. For two years has
been treated at a dispensary for an abdominal tumour; during this
period she has taken much medicine, but without benefit.

_On examination_ the abdomen was found increased in size and
universally tympanitic. Under the influence of chloroform the swelling
entirely subsided.

July 17. Usual operation performed under the influence of chloroform.

Sept. 2. She was discharged quite cured, all her hysterical symptoms
having left her, and the tumour never having been seen since the day
of operation.

CASE IX. HYSTERIA—FIVE YEARS’
ILLNESS—STERILITY—OPERATION—CURE—PREGNANCY—TWO CHILDREN.

Mrs. O. came under my care in 1862. She had been ill ever since
marriage, five years previously; having distaste for the society of
her husband, always laid upon the sofa, and under medical treatment.
Evidence of peripheral excitement being manifest, I performed my usual
operation. She rapidly lost all the hysterical symptoms which had
previously existed; and in about a year came up to town to consult me
concerning a tumour, which greatly frightened her, as she feared it
was ovarian. I discovered that she was six months pregnant. She was
delivered at full time of a healthy child. In 1865 she again called on
me to show herself, not only in robust health, but pregnant for the
second time.

CASE X. HYSTERIA—IRRITATION OF RIGHT OVARY—MENORRHAGIA—NINE YEARS’
ILLNESS—OPERATION—CURE.

C. M. A., æt. 28, single; admitted into the London Surgical Home June
22, 1863.

_History._—Since the age of 19 has been more or less subject to
uterine flooding; for the first three years lost blood every day. Has
been five times in a metropolitan hospital; always better while there,
but as bad as ever as soon as she left. The bleeding is much worse at
each menstrual period. She passes large coagula; has constant pain in
the back, headache, and palpitation of the heart, and cannot sleep; is
dreadfully pale and anæmic.

_Examination_ showed great irritation over right ovary, and there was
evidence of long-continued peripheral irritation.

July 2. Usual operation.

July 7. Menstruation came on in a moderate flow.

July 10. Menstruation ceased; is much better, and there is sign of
returning colour in the face.

July 31. Has improved considerably, and had no return of the bleeding.
To be discharged cured.

CASE XI. HYSTERIA—MANY YEARS’ ILLNESS—OPERATION—CURE—MARRIAGE AND
PROGENY.

Emma K., æt. 22, single; admitted September 16, 1863, into the London
Surgical Home.

_History._—Commenced menstruating at 15 years of age, but owing to the
use of cold water during a period, the secretion was arrested for six
months; the function was then restored, and has ever since continued
normal. At 16 she suffered from piles, which occasioned very much
irritation and pain after each evacuation, aggravated by constipation
and by walking. Though regular as to time, there is always excessive
catamenial flow, and it lasts for eight days. Has been under long and
varied medical treatment, without benefit.

_Examination_ showed peripheral irritation, as evinced by the abnormal
condition of the external genitals.

Sept. 17, 1863. The usual operation performed.

Oct. 1. Progressing most favourably.

Oct. 22. Leaves quite cured.

1866. This lady married, and was delivered August, 1865, of a living
child. She is still quite well.

It will have been observed that one very prominent symptom in many of the foregoing cases is sleeplessness, or perhaps more properly, frequent wakefulness at nights, and constant restless movements in the day. These are the cases which, if left to go on, are very liable to terminate in insanity. The three following are instances in which the hysteria was verging on this state, and as they can hardly be classed under the head of insanity, I prefer narrating them here.

CASE XII. HYSTERIA—MENTAL ABERRATION, AND TENDENCY TO MELANCHOLIA—EIGHT
YEARS’ ILLNESS—OPERATION—CURE.

In December, 1861, a single lady consulted me, giving the following
history of her illness:—

Has not been well for seven or eight years; has felt languid, and not
so lively as formerly. For the last two years has menstruated every
three weeks, and the flow has lasted four or five days. There is
considerable white discharge from the vagina after each period,
lasting for a week. Great irritation about vulva, perinæum, and anus
before and during each menstrual period. For the last five or six
years had had occasional irresistible and unaccountable fits of
depression; thinks that it is her mind—if her mind were as strong as
her body she would be pretty well: her memory is good, but mind weak.
Has suffered from great pain at lower part of the back; says she
cannot rise from a chair without great difficulty, on account of a
feeling of stiffness in hips and trembling of the legs (this is
probably owing to a swelling of the hip-joint, as all the joints of
her fingers and ankles are swollen). Says she can sit quietly to
crochet or needlework, but cannot sit quietly to think, or compose her
mind to write a letter: has not written a letter properly for three
years. Has been subject to attacks of melancholy and weeping, without
any tangible cause, but which she cannot resist. Suffers from want of
sleep, and at night frequently lies awake four or five hours together.
Appetite good; bowels costive.

In appearance is fresh-coloured and plump, but she says she is thinner
than formerly; dark eyes; large dilated pupils.

_On examination_ there was evidence of great irritation about the
vulva, and constriction of the anus, with a very small fissure.

Dec. 21. I divided the fissure, and performed my usual operation.

Dec. 31. Very much improved; swelling of the joints much less.

Jan. 1. She sat up, and feels much better. Her spirits are improved;
has no pain in the joints; sleeps well. In another month she returned
home quite well, and has continued so to the present time.

CASE XIII. EXTREME HYSTERIA, VERGING ON INSANITY—FIVE YEARS’
ILLNESS—OPERATION—CURE.

Mrs. ——, æt. 32, married; admitted into the London Surgical Home
August 5, 1862.

_History._—Has been married twelve years, but has had no children nor
miscarriages. Has always enjoyed pretty good health until about five
years ago, when she began to suffer from leucorrhœa and great pain
during menstruation. Catamenia regular in time and quantity. Her
bladder is so irritable that sometimes she has to pass her water every
half-hour; the urine sometimes very much loaded. Suffers from headache
and giddiness in the morning. Says that for the last three years the
act of coition has been accomplished without the least pleasure, but
with pain. Bowels are opened regularly and without pain.

August 7. Having diagnosed the cause of the disease, the usual
operation was performed.

August 9. A severe attack of erysipelas came on, and she was very ill
for some days, but she made a good recovery.

A few days after the operation this patient was observed to be
occasionally very violent and unmanageable, and to have at these times
a wild maniacal look. On questioning her husband, it appeared that for
several years she had been subject to fits of violent excitement,
especially during the menstrual period, and that at such times “she
would fly at him and rend his skin, like a tigress.”

This patient made a good recovery; she remained quite well, and became
in every respect a good wife.

CASE XIV. EXTREME HYSTERIA—INCIPIENT INSANITY—OPERATION—CURE.

Mrs. R., æt. 42; admitted into the London Surgical Home Aug. 5, 1862.

_History._—Has been married, but has been a widow for twelve years. Is
companion to a lady. Never had any family. Has been ailing for some
years, but has not suffered severely until the last six months.
Suffers most from pain in the lower part of the abdomen, and from
constant burning and irritation about the vulva. During the last few
months has become very nervous and fidgety; never can remain quiet,
and says that lately she “has had a sort of lost feeling, particularly
when writing; being unable to compose her thoughts, or concentrate her
mental energies.” Has suffered from considerable irritability of the
bladder; and her urine is often full of thick deposit. Catamenia
regular in time and quantity. Cannot sleep.

_On examination_, is a very nervous woman, her eyes restless and never
quiet; constant twitchings of the limbs, and occasionally an
appearance almost of insanity about her expression. There is every
evidence of a long-continued inhibitory influence.

August 7. The usual operation performed.

August 8. Feels very comfortable. Slept better last night than for
some years.

August 9. Is improving wonderfully: the expression of countenance
completely changed.

Sept. 9. Left quite well. Has got fat, and has now a cheerful face and
manner. Says she feels a different being, and is quite astonished at
her own improvement. Has lost all her nervous twitchings and other
uncomfortable symptoms, and has now a comfortable night’s rest.