Ovarian pressure gives rise to the spasmodic attacks: the same pressure arrests them. What is true of ovarian compression is equally true of all the hysterogenic zones. A light touch brings on the convulsions, which have scarcely commenced when they can be stopped by a new excitation of the same point.
As already stated, the attack of hystero-epilepsy, having fully begun, is divided by Richer into distinct periods. Although these are seldom seen in perfection, it is necessary to have some clear idea of their phenomena in order to view the affection comprehensively. They were seen well developed in the case given. These periods are—(1) The epileptoid period; (2) the period of contortions and of great movements; (3) the period of emotional attitudes; (4) the period of delirium.
In the first or epileptoid period of the hystero-epileptoid attack, which receives its name from its resemblance to true epilepsy, various phases always reproduce themselves in the same order. Loss of consciousness and arrest of respiration, muscular tetanization in various positions, followed by clonic spasms, and, finally, muscular resolution, are the successive phenomena of this period, which usually lasts several minutes. Loss of consciousness is complete during this period. Muscular tetanization shows itself in movements large and small, sometimes of the whole body. The trunk may become as stiff as a bar of iron; the face is sometimes cyanosed, puffed; froth even appears, which it is well to remember, as this is considered by some as absolutely diagnostic of epilepsy. Many positions may be assumed. The important significant features of the tonic phase of period are muscular tetanization with loss of consciousness and respiratory spasm. In the clonic phase movements at first rapid and short, later larger and more general, ensue, and are accompanied by whistling inspiration, jerking expiration, hiccoughs, noisy deglutition. The phase of muscular resolution comes on, in which the patient completely relaxes; sometimes a true stertor occurs. The epileptoid period usually lasts altogether several minutes, the first two phases usually occupying about one minute.
In the period of contortions and great movements wonderful attitudes and contortions are observed in one phase, and in another great movements. One of the attitudes particularly fashionable with hystero-epileptics is the arched position, in which the body is curved backward in the form of an arch so as to rest only on the head and feet. Sometimes the patient may rest on the belly or side, the remainder of the body preserving its curved position; the body may indeed assume almost any strange and seemingly impossible attitude. The so-called great movements are executed by the entire body or by a part of the body only; they are of great variety; sometimes they are movements of salutation; sometimes the semiflexed legs are projected upward, etc. Often the phase of great movements is marked at its beginning by a piercing cry; loss of consciousness is not the rule.
The period of emotional attitudes or statuesque positions is the most dramatic stage of a highly dramatic disease. Hallucinations ravish and transport the patient: sometimes they are gay, sometimes they are sad. The dramatic positions assumed are in consonance with the patient's hallucinations. The patient reproaches, opposes, supplicates, is angry, is furious; she assumes positions of supplication on her knees, becomes menacing, and even strikes. In the great works of Bourneville, of Regnard, and of Richer many cases are related at great length and with vivid details. Camera and pencil are frequently called in to assist the pen in presenting scenes which read as if drawn from an exciting drama or novel. Among the expressions and attitudes which they have succeeded in photographing are those illustrating emotions of menace, appeal, amorous supplication, erotism, ecstasy, mockery, beatitude.
After the period of the emotional attitude consciousness returns, but only in part, and for a time the patient remains a prey to a delirium whose character varies. This delirium may be concerned with subjects the most varied; it may be gay, sad, furious, religious, or obscene. It is mingled with hallucinations; voices are heard; sometimes are seen personages who are known; sometimes the scenes are purely imaginary. During this fourth period the patients will sometimes make the most astounding statements and accusations. They will wrongfully charge theft, abuse, etc. upon others; they believe in the reality of their hallucinations, and, what is more important, they will sometimes persist in this belief after the attack is over. The third and fourth periods are sometimes confounded. When the four periods described succeed each other in order, they constitute a regular and complete attack of hystero-epilepsy.
By comparing the notes upon the case detailed with the description given of the typical hystero-epileptic attack, it will be seen that the different periods, and even the phases, can be made out with but little difficulty. After a few moments of convulsive movements and irregular breathing the patient was attacked with muscular tetanization, arrested respiration, and loss of consciousness. Tonic convulsions followed, and then immobilization in certain positions. Next came the clonic spasms and resolution. In the period of contortions the arched position is one more extreme than any represented by the illustrations of the French authors, although it is closely approximated by some of their illustrations. After this position of opisthotonos had been taken a succession of springing and lifting movements occurred, probably corresponding to the phase of great movements. The period of emotional attitudes was very clearly represented by the position assumed, the expression of countenance, and sometimes by the words uttered. Even the period of delirium was imperfectly represented by the mutterings of the patient, which were sometimes long continued after the attack.
FIG. 24.
