Disorders of menstruation play a prominent part as exciting causes of special hysterical manifestations. The period of the establishment of the menstrual function is one that is particularly fertile in the production of hysteria, much more so than acquired disorders of menstruation occurring later. Menorrhagia, dysmenorrhœa, and certain local utero-vaginal disorders may act upon those predisposed to hysteria as exciting causes. These conditions themselves are, on the other hand, sometimes caused by nervous, hysterical states in the individual.
With reference to the very common assertions that continence on the one hand, and sexual over-indulgence on the other, are the most prolific causes of hysteria, the true stand to take is that neither of these positions is philosophically correct; for, as Briquet has shown, nuns on the one hand and prostitutes on the other are frequent victims of this protean disorder.
As affirmed by Jolly, sexual over-irritation, particularly that induced by onanism, more frequently causes hysteria than sexual abstinence or deprivation.
The occurrence of hysteria and hysterical choreas among pregnant women has long been recognized. Scanzoni, quoted by Jolly,46 states that of 217 patients whom he had treated, 165, or 76 per cent. had been puerperal, and that of the latter not less than 65 per cent. had borne children more than three times. Cases of grave hysteria or hystero-epilepsy have been aggravated by pregnancy and have led to premature labor.
46 Op. cit.
Chrobak attacks the etiological problem of hysteria by referring its causation to movable kidneys! He observed 19 such patients in Vienna, 16 being in Oppolzer's clinic.47 Three times no subjective symptoms accompanied the anomaly; eight times the trouble could be referred either to the dislocation of the kidneys or to disease of the same; and eight times the evidence of hysteria was unmistakable. Among the latter eight cases neither vaginal, uterine, nor ovarian conditions were recognized. He concludes that there is a direct nervous connection between the kidneys and the genital organs, and between both and hysteria.
47 Medizinische-Chirurgische Rundschan, quoted by Boston Medical and Surgical Journal, 1870, lxxxiii. 430-432.
In brief, the truth is that frequent or severe local irritation in any part of the body in an individual of the hysterical diathesis may act as the exciting cause of an hysterical paroxysm or of special hysterical manifestations. Irritation or disease of the uterus or ovaries may result in hysteria, as may the bite of a dog, a tumor of the brain, a polypus in the nose, a phymosis, an irritated clitoris, a gastric ulcer, a stenosis of the larynx, a foreign body in the eye, a toe-nail ulcer, or a movable kidney.
Whatever tends to exhaust the nervous system will also cause hysteria, but only in those who have some inherited predisposition to the disorder. C. Handfield Jones48 mentions heatstroke and severe physical labor as such causes. One of the sequelæ of heatstroke enumerated by Sir R. Martin, and quoted by Jones, is a distressing hysterical state of the nervous system, with an absence of self-control in laughing and crying, the paroxysm being followed by great prostration of nervous power.
48 Op. cit.