SYMPTOMATOLOGY.—In considering the symptoms of hystero-epilepsy the subject must be approached from several points of view. In the first place, the disorder can be divided (1) into the regular or typical grave attack; and (2) into the irregular attacks. These irregular seizures can be greatly subdivided, but their discussion will be confined to those types which have been most observed in this country, although I do not think that any variety of hystero-epilepsy is distinctively American; and this is what might be supposed from the largeness of our country and the different nationalities of which it is composed.
I have seen but few cases of hystero-epilepsy of the regular type. One of these was first described at some length in the American Journal of Medical Sciences for October, 1881. I will here give the case, with illustrations, somewhat condensed from the accounts as first published.7
7 For the opportunity of studying and treating this case I was under obligations to Charles S. Turnbull and J. Solis Cohen, the patient having been for several months under their care at the German Hospital of Philadelphia. Carefully prepared notes of the case were furnished to me by H. S. Bissey and H. W. Norton, resident physicians at the hospital. I was also under great obligations to my friend J. M. Taylor for a series of sketches of the positions assumed by the patient at different stages of the attack.
R——, æt. 21, single, was first admitted to the German Hospital Nov. 13, 1879. Between her ninth and twelfth years she had had several attacks of chorea. During childhood she was often troubled with nightmare and unpleasant dreams; she often felt while asleep as if she were held down by hands. She was frequently beaten about the head and body. Her menses did not appear until she was nearly eighteen. Before and at her first menstrual epoch she suffered severe pain and cramp. During the first year of her menstruation, while at Atlantic City, the flow appeared in the morning, and she went in bathing the same afternoon. She stayed in the water two hours, was thoroughly chilled, and the discharge stopped. Ever since that time she had only menstruated one day at each period, and the flow had been scanty and attended with pain. When about eighteen she kept company with a man for five months, and after having put much confidence in him learned that he had a wife and two children. This episode caused her much worriment. She positively denied seduction. She became much depressed. September 2, 1879, she was seized in a street-car with a fainting fit. On coming to, she found her left arm was affected with an unremitting tremor. Seven weeks later she was admitted to the German Hospital. She had severe spasmodic attacks, and the diagnosis of hysteria was made. She remained in the hospital about four weeks. On leaving she again went into service. She was readmitted June 9, 1880, in an unconscious or semi-conscious condition. She had been on a picnic, and while swinging was taken with an attack of spasm and unconsciousness. During two hours after admission she had a series of convulsions. After this she had similar attacks two or three times a week, or even oftener.
I first saw her about the middle of January, 1881. She had an hysterical face, but was possessed of considerable intelligence, and when questioned talked freely about herself. The most prominent physical symptom that could be discovered was a large tremor, affecting the left arm, forearm, and hand. This was constant, and had been present since her admission to the hospital. The left half of her body was incompletely anæsthetic, the anæsthesia being especially marked in the left forearm. Ovarian hyperæsthesia could not at this time be made out. She was, however, hyperæsthetic over the occipital portion of the scalp and the cervico-dorsal region of the spine. Pressure or manipulation of these regions would in a few moments bring on an attack of spasm. The attacks, however, usually occurred without any apparent exciting cause.
For a period of from six to twelve hours before an attack she usually felt dull, melancholy, and strange in the head. Frequently she had noises like escaping steam in her ears, but more in the right ear than in the left. She complained of cardiac palpitations. She usually had pain in the small of her back. Her limbs felt weak and tired. Just as the attack was coming on her eyes became heavy and misty, her head felt as if it was sinking backward, and if not supported she would fall in the same direction.
On several occasions I had the opportunity of watching every phase of the attack or series of attacks, the spasms continuing sometimes from one to four or five hours. The order of events was not always the same, and yet a general similarity could usually be seen in the successive stages of the phenomena. I will try to give an outline of the different stages and phases as observed on an occasion when the seizures were severe.
FIG. 18.
