PATHOLOGY.—Strictly speaking, hysteria cannot be regarded as having a morbid anatomy. In an often-quoted case of Charcot's,14 an old hystero-epileptic woman, affected for ten years with hysterical contracture of all the limbs, sclerosis of the lateral columns was found after death. On several occasions this woman experienced temporary remissions of the contracture, but after a last seizure it became permanent. This is one of the few reported cases showing organic lesion; and this was doubtless secondary or a complication. In a typical case of hystero-epilepsy at the Philadelphia Hospital, a report of which was made by Dr. J. Guiteras,15 the patient, a young woman, died subsequently while in my wards. Autopsy and microscopical examination revealed an irregularly diffused sclerosis, chiefly occupying the parieto-occipital region of both cerebral hemispheres. Undoubtedly, as suggested by Charcot, in some of the grave forms of hysteria either the brain or spinal cord is the seat of temporary modification, which in time may give place to permanent material changes. Old cases of chronic hysteria in all probability may develop a secondary degeneration of the cerebro-spinal nerve-tracts, or even degeneration of the nerve-centres themselves may possibly sometimes occur. Two cases now and for a long time under observation further indicate the truth of this position. One, which has been reported both by H. C. Wood16 and myself,17 is a case of hysterical rhythmical chorea in a young woman. Although the hysterical nature of her original trouble cannot be doubted, she now has contractures of all the extremities, which seem to have an organic basis. The other patient is a woman who has reached middle life; she has several times temporarily recovered from what was diagnosticated as hysterical paraplegia, in one instance the recovery lasting for months. Now, after more than four years, she has not recovered from her last relapse. Contractures, chiefly in the form of flexure, have developed, and she has every appearance of organic trouble, probably sclerosis or secondary degeneration of the lateral columns.
14 Leçons sur les Maladies du Système nerveux.
15 Philadelphia Medical Times, 1878-79, ix. 224-227.
16 Ibid., vol. xi. p. 321, Feb. 26, 1881.
17 Ibid., vol. xii. p. 97, Nov. 19, 1881.
Briquet18 reviews the various hypotheses which have been held as to the pathological anatomy of hysteria, giving a valuable summary of the autopsies upon supposed hysterical cases up to the time of the publication of his treatise in 1859. About the sixteenth century, Rislau, Diemerbroeck, and Th. Bonet sought to establish a relation between lesions of the genital organs met with in the bodies of hysterical women and the affection from which they suffered. About 1620, Ch. Lepois believed that he had established the existence of certain alterations of the brain in cases of hysteria. Hochstetter and Willis toward the beginning of the present century arrived at similar conclusions. That researches into the state of the genital organs have chiefly occupied those investigating hysteria is shown by the writings of Pujol, Broussais, Lovyer-Villermay, and, above all, by those of Piorry, Landouzy, Schutzenberger, and Duchesne-Duparc. Georget, Brachet, Girard, Gendrin, Bouillaud, Forget, and Lelut, about the fourth or fifth decades of the present century, made numerous autopsies on those dying when hysterical phenomena were in full activity, and concluded that the genital organs of these individuals revealed nothing in particular. This, in brief, is also the conclusion of Briquet. Jeanne d'Albret, the mother of Henry IV., who was all her life subject to hysterical headache, had her brain examined after death, but absolutely nothing was found. Vesalius made an autopsy with equally negative results on a woman who died from strangulation in an hysterical attack. Royer-Collard also found nothing in an old hysteric. Briquet believed—and I fully accord with this view—that in some of the cases of Ch. Lepois, Hochstetter, and Willis diseases such as chronic meningitis were present with the hysteria. He concludes that anatomy does not show anything positive as to the seat or nature of hysteria, except the suspicion of a certain degree of congestion in various parts of the brain.
18 Op. cit.
While, however, hysteria may not have a morbid anatomy, it, like every other disease, has, in a correct sense, a pathology.
The ancients saw only the uterus when regarding hysteria. Hippocrates described the hysterical paroxysm and its accompanying disorders under the name of strangulation of the uterus. The ancients generally supposed that the disease originated in the ascent of the uterus to the diaphragm and throat. They believed that this accommodating organ could wander at will throughout the body, doing all manner of mischief. Hippocrates asserted that it was the origin of six hundred evils and innumerable calamities.
According to Sydenham,19 the disorders which are termed “hysterical in women and hypochondriac in men arise from irregular motions of the animal spirits, whence they are hurried with violence and too copiously to a particular part, occasioning convulsions and pain when they exert their force upon parts of delicate sensation, and destroying the functions of the respective organs which they enter into, and of those also whence they came; both being highly injured by this unequal distribution, which quite perverts the economy of nature.” Speaking of the strangulation of the womb, or fits of the mother, he says: “In this case the spirits, being copiously collected in the lower belly and rushing with violence to the fauces, occasion convulsions in all the parts through which they pass, puffing up the belly like a ball.”