The relation of hysteria to certain morbid constitutional states has long been recognized, particularly its connection with the tubercular diathesis. This has been shown by numerous observers, especially among the French. The most valuable recent contribution is that of Grasset,33 who believes that a direct connection can be traced between the tubercular diathesis and hysteria. When the relations of hysteria to the scrofulous and tubercular diathesis are spoken of by him, it is not meant that hysterical subjects have tubercles in the lungs, but that these diatheses are found in various generations, and that among some subjects of the hereditary series the constitutional states manifest themselves as hysteria. It is not the evidences of hysteria with pulmonary and other tuberculous conditions that he is considering, but that hysteria may be, and often is, a manifestation of the tubercular diathesis. Two cases may present themselves: in one the neurosis is the only manifestation of the diathesis; in the other, it is continued in the same subject along with the other diathetic manifestations. In demonstration of his thesis he concludes with a series of most interesting cases, which he arranges into two groups. In the first, hysteria is the only manifestation of the tubercular diathesis; in the second, are simultaneous pulmonary and hysterical manifestations. In the first group he has arrayed eight personal observations and seventeen derived from various authors; in the second he has two personal and seventeen compiled observations.
33 “The Relation of Hysteria with the Scrofulous and the Tubercular Diathesis,” by J. Grasset, Brain, Jan., April, and July, 1884.
Personal experience and observation go far to confirm the views of Grasset, although I recognize fully the strength of the objection of Brachat and Dubois and others that, phthisis being such a common complaint, it might be demonstrated by statistics that it was related to almost any disease. Not only hysteria, but other neuroses or psychoses, have a close connection with the tubercular diathesis.
Among the insane and idiotic and among epileptics phthisis is of frequent occurrence. At the Pennsylvania Training School for Feeble-minded Children the frequency of phthisis among the inmates of the institution is one of the most striking clinical facts. The insane of our asylums die of pulmonary troubles oftener almost than of any other disease. The fact that hysteria is met with in the robust and vigorous does not invalidate the position taken, for the robust and vigorous who are not hysterical are not infrequently found in the descendants of the tuberculous.
Laycock34 believed that the gouty diathesis was particularly liable to give rise to the hysterical paroxysm or to irregular forms of hysteria. Gairdner, quoted by Handfield Jones,35 supports this view.
34 A Treatise on the Nervous Diseases of Women, by Thomas Laycock, M.D., London, 1840.
35 Studies on Functional Nervous Disorders.
Gout in England plays a greater part in the production of nervous and other disorders than in this country, but even here its instrumentality is too often overlooked. In Philadelphia are many families, some of them of English origin, in which gout has occurred, sometimes of the regular type, but oftener of anomalous forms. Among the most striking examples of hysteria that have fallen under my observation, some have been in these families. In a few of them remedies directed to the lithæmic or gouty conditions in connection with other measures have been efficient. More frequently they have failed, for while a relation may exist between the neurotic disorder and the diathesis, it is not the diathesis, but the neurotic disorder, which we are called upon to treat.
That a certain mental constitution predisposes to hysteria cannot be doubted. Ribot36 describes, chiefly from Huchard,37 the hysterical constitution. It is a state in which volition is nearly always lacking. The prominent trait is mobility. The hysterical pass with increditable rapidity from joy to sadness, from laughter to tears; they are changeable, freakish, or capricious; they have fits of sobbing or outbursts of laughter. Ch. Richét compares them to children, who oftentimes can be made to laugh heartily while their cheeks are still wet with tears. Sydenham says of them that inconstancy is their most common trait: their sensibilities are aroused by the most trivial cause, while profounder emotions scarcely touch them. They are in a condition of moral ataxy, lacking equilibrium between the higher and lower faculties.
36 Diseases of the Will.