(MSS.
Collection, National Library of Medicine,
Bethesda, Maryland, USA)
Hysteria at the Edinburgh
Infirmary
HYSTERIA
A lecture by James Gregory
delivered in 1788-1789
This disease under which we have had several
patients labouring is very disagreeable to the
practitioner especially in an hospital where
exercise, air and employment of mind are
precluded though they may be reckoned among its
most powerful remedies. For this reason I wish
to take in as few hysteric patients as possible
as I believe that more have been seized with
this disease in the hospital than have been
cured in it. I have known six seized with it in
one night. It generally happens that a temporary
relief is obtained by various remedies and as
soon as that happens I send them out.
Tho the disease is not dangerous, it ought
by no means to be passed over in silence as it
is frequently very severe and many of the
symptoms and forms it assumes are apt to deceive
the young practitioner. As to the definition and
description of it Dr. Cullen's are the best, but
you must not expect to find the combination he
finds in every case, for sometimes one symptom
appears and sometimes another. Whenever the
globus is present, I think the disease
characterized, tho its absence by no means
proves that hydrothorax is not present. I have
sometimes known the sole symptoms of the disease
to be a paralysis or loss of motion of every
muscle of the body for some minutes; sometimes
in the form of an intermittent.
The globus sometimes though rarely produces
vomiting when it answers at the stomach, when in
the throat it induces difficulty of deglutition:
dysphagia hysterica, sometimes of the speech and
at others asphyxia hysterica. The pulse is
sometimes immoderately frequent. I have counted
it at 180 and Dr. Whyte mentions having found it
220. Patients are at different times affected
with weeping, laughing. They sometimes fall down
motionless and at others have violent pains of
the bladder and kidneys, and it has sometimes on
this account been mistaken for calculous
complaints.
I had a woman in the clinical ward labouring
under hysteria who was affected with the most
astonishing cough I have ever observed,
continuing for two days without a second of
intermission, and the conclusions are sometimes
so astonishingly strong as to require the strait
waistcoat. I believe I never knew hysteria
produce an affection of the mind as epilepsy
does though I think the frantic state of the
mind may arrive at such a height as to produce
similar effects. It has been supposed that
hysteria may go to such a height as to promote
epilepsy though I do not know that such has ever
been the case. I had once a patient indeed in
whom the two diseases completely marked were
combined so that the patient would now perhaps
be seized with an hysteric paroxysm and in a
short time after with a fit of epilepsy. In the
fit the distinction between the two diseases is
rather difficult. The foaming is not always
present in epilepsy and sometimes though not
frequently accompanies hysteric paroxyms, but
during the intervals and at the coming on of the
disease it can readily be distinguished.
It has been a prevailing notion among
physicians that hysteria was somehow associated
with venereal appetite but though this may
sometimes, yet it is not always the case. It is
brought on by different passions as grief,
anger, fear, and many women who might be
supposed to make no scruple of owning it have on
being questioned denied it.
Once circumstance in hysteria is to be
particularly noticed, viz. that it depends on a
particular predisposition proceeding from a
certain mobility which is frequently connected
with Debility.
Baron [a patient) was not in this state,
and the mobility I mention by no means depends
upon it constantly - a peculiar concomitant
irritability is likewise present; hence females
are so subject to it. I would not, however,
confine it entirely to them, though the
instances of hysteric affections in the other
sex are very few and in those cases which have
been related I believe many mistakes have been
made. I never saw but one instance of the kind
myseL and that was in a young man who was
affected with globus and he was of a very
irritable habit, but I may safely say for one
man 10,000 women are affected with the
disease.
Hysteria does not depend upon a general
irritability on mobility alone, it seems in
general to proceed from a particular
irritability connected with the genital system.
The general irritability is greater in infancy
when no hysteria appears and it almost only
occurs from the age of puberty to the cessation
of the menses, and to this there are but few
exceptions. Y have seen women of 40 or 5O
atacked with it and I knew a lady who was much
affected with the disease in her younger days,
attacked with strongly marked hysterical
symptoms at the age of 66. It frequently attends
the sanguine temperament which is generally much
connected with irritability. There is a
remarkable connection too between it and the
period of menstruation. I knew a lady who was
affected with hysteria during the flowing of the
menses from causes which at another time could
produce no such effect, and it may be observed
that the period of menstruation is one of usual
and general irritability.
This peculiar irritability of the system
productive of the disease may arise from
innumerable causes, but the proximate cause may
remain unknown to us as long as the nature of
the nervous system sensations, and is so little
understood. It seems much connected with a
flaccidity of the simple solids and it is partly
by its effects on these, partly by its action on
the living principle that heat such as warm
rooms has such a tendency to produce it.
This irritability is likewise connected with
plethora as is shown by the temperament. It
frequently attacks by its arising from the
stoppage of evacuations and it is likewise
connected with debility especially of the bowels
and stomach, hence it accompanies dyspepsia.
Custom seems to have a strong effect in
resetting the disease as it has in asthma,
epilepsy, intermittents. The effects of
predisposition are in hysteria very
remarkable-certain circumstances and causes
which are indeed inevitable, often bring on the
paroxysms in the predisposed which, if applied
to 10,000 others not predisposed, would be
productive of no effect. Such are the passions,
external senses, sudden noise, certain smells
either fragrant or otherwise, particular objects
as cats or other mimais disagreeable sights
particularly those of mother person labouring
under the disease and it frequently first
commences that way.
The same tendency to imitate is observed in
many other instances as
yawning,
laughing, etc. As the muscles however employed
in these last actions are in general subservient
to the will, we can prevent the operation of
that remarkable tendency towards them and I am
sure much may be effected in that in hysteria.
It is a maxim I inculcate very strongly to my
patients, to use their utmost endeavours to
prevent the coming on of fits. I have often
known it succeed though my advice is by many not
well received.
In others their predisposition is so strong
that their endeavours are ineffectual. In some
there is a peculiar pleasure that attends the
coming on of the fit analogous I suppose to that
we experience in
yawning, and
that they really encourage them and bring them
on by reason of every possible effort, and in
cases like these I should suppose every remedy
must prove inefficacious. Fits are frequently
brought on by theatrical performances. This
happened in several instances during Mrs.
Siddon's performing at Edinburgh. I knew one
instance in Paris where death was the
consequence of a violent fit occasioned by the
representation of a tradgedy.
External heat is often likewise an exciting
cause; hence are hysteric fits so frequently
observed in crowded assemblies. Any great
stoppage of an evacuation, any disorder of the
stomach, renders the fits more violent. Hence it
has been known to be brought on by full living
and to come on constantly after a meal. I
believe hysteric fits will never come on without
some exciting cause; though our patients will
frequently deny it, but this is no proof against
it, for passions of the mind which they will not
own and circustanccs so trifling that they are
ashamed to acknowledge frequently induce it. I
knew one instance in the clinical ward of a
woman being seimd with a violent fit on being
deniedadrink of water. As to the proximate
cause, so little with respect toit is known that
it is by no means applicable to practice.
Our indications of cure are 1st, in the
intervals, to diminish extraordinary
irritability and stop or moderate the fits. The
first is answered by tonics such as the Peruvian
Cortex from 3-3,5 g 2-3 times a day. Steel, in
doses of 15 g or thereabouts, sometimes
conjoined with bitters asgentian, columba, etc.
Copper has been recommended. I have tried it in
many respects but doubt much as to its good
effects in hysteria. Exercice is of the greatest
benefits and I believe has sometimes produced
cures alone, and more especially when combined
with the occupation of the mind.
We are often obliged to compel our patients
to use it. I had an account of a lady who on the
slightest threatening of a fit was immediately
placed on horseback and obliged to ride pretty
hard; this always prevented the further progress
of the paroxysme and at length performed a cure.
From hence it will appear of what service it
must prove to undertake ajourney especially on
horseback for the cure of the disease.
With respect to moderating the fits, they
are never attended with danger; at least I never
saw them, so that we have generally nothing else
to do but to prevent the patients from hurting
themselves. The principal disadvantage that
arises from them is that habit they induce, and
to prevent this and stop the progress of the
fits many medicines have been proposed,
asfoetids to the nose, pedilùvium,
dipping the hands in cold or warm water, dashing
cold water on the face, and I have frequently
known attended with success draughts with
volatile alkali or ether, immediately before the
fit and frequently to prevent its formation. I
believe they possess more power then than at any
other time.
Opium has likewise been given with the same
intent by the mouth or by glyster, but they
generally loose their effects in a little time.
Camphor has been recommended and I have tried it
without much success. With respect to my
particular practice in these cases we had under
our care, I ordered the pediluviwn, the pi! abet
with a view to bring on the menses, though I
confess we ought to be cautious about
administrating them. For we are frequently
deceived by women with child who wishing to get
rid of their burden produce a miscarriage and
attribute many complaints to a cessation of the
menses which they are cunning enough to say,
happened many a month before.
How far this was the case with our patient I
shall not say - but supposing a real amenorrhoea
present,! know nothing so powerful in restoring
the menses as the aloctic pills from the great
irritability given the rectum. She was
remarkable hard to work as a scruple had no
effect. The anodyne castor, ara foetida. were
given without any benefit. At the period of the
menses, electricity and oil of Savin were
employed to which! believe the root owes its
virtues and I look upon lias the best mode of
exhibiting it, but lam far from placing much
trust in this or any other emniagogue. The only
remedy which seemed to have any effect was the
cold bath. Some of you saw the good effects of
the draughts of ether and the fetid julep.
