OF HYSTERIC AFFECTIONS.
These likewise belong to the numerous tribe of nervous diseases, which may be justly reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose nervous system is extremely sensible, are most subject to hysteric complaints. In such persons a hysteric fit, as it is called, may be brought on by an irritation of the nerves of the stomach or intestines, by wind, acrid humour, or the like. A sudden suppression of the menses often gives rise to hysteric fits. They may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments.
Sometimes the hysteric fit resembles a swoon or fainting fit, during which the patient lies as in a sleep, only the breathing is so low as scarce to be perceived. At other times the patient is affected with catchings and strong convulsions. The symptoms which precede hysteric fits are likewise various in different persons. Sometimes the fits come on with coldness of the extremities, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the approach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rises towards the stomach, where it occasions inflation, sickness, and sometimes vomiting; afterwards it rises into the gullet, and occasions a degree of suffocation, to which quick breathing, palpitation of the heart, giddiness of the head, dimness of the sight, loss of hearing, with convulsive motions of the extremities and other parts of the body, succeed. The hysteric paroxysm is often introduced by an immoderate fit of laughter, and sometimes it goes off by crying. Indeed there is not much difference between the laughing and crying of an highly hysteric lady.
Our aim in the treatment of this disease must be to shorten the fit or paroxysm when present, and to prevent its return. The longer the fits continue, and the more frequently they return, the disease becomes the more obstinate. Their strength is increased by habit, and they induce so great a relaxation of the system, that it is with difficulty removed.
It is customary, during the hysteric fit or paroxysm, to bleed the patient. In strong persons of a plethoric habit, and where the pulse is full, this may be proper; but in weak and delicate constitutions, or where the disease has been of long standing, or arises from inanition, it is not safe. The best course in such cases is to rouse the patient by strong smells, as burnt feathers, asafœtida, or spirits of hartshorn, held to the nose. Hot bricks may also be applied to the soles of the feet, and the legs, arms, and belly may be strongly rubbed with a warm cloth. But the best application is to put the feet and legs into warm water. This is peculiarly proper when the fits precede the flow of the menses. In case of costiveness, a laxative clyster with asafœtida will be proper; and as soon as the patient can swallow, two table-spoonfuls of a solution of asafœtida, or of some cordial julep, may be given[[151]].
The radical cure of this disorder will be best attempted at a time when the patient is most free from the fits. It will be greatly promoted by a proper attention to diet. A milk and vegetable diet, when duly persisted in, will often perform a cure. If however the patient has been accustomed to a more generous diet, it will not be safe to leave it off all at once, but by degrees. The most proper drink is water with a small quantity of spirits. A cool dry air is the best. Cold bathing and every thing that braces the nerves, and invigorates the system, is beneficial; but lying too long in bed, or whatever relaxes the body, is hurtful. It is of the greatest importance to have the mind kept constantly easy and cheerful, and, if possible, to have it always engaged in some agreeable and interesting pursuit.
The proper medicines are those which strengthen the alimentary canal and the whole nervous system, as the preparations of iron, the Peruvian bark, and other bitters. Twenty drops of the elixir of vitriol, in a cup of the infusion of the bark, may be taken twice or thrice a day. The bark and iron may likewise be taken in substance, provided the stomach can bear them; but they are generally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder.
If the stomach is loaded with phlegm, vomits will be of use; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there be a tendency to costiveness, it must be removed either by diet, or by taking an opening pill as often as it shall be found necessary.
To lessen the irritability of the system, antispasmodic medicines will be of use. The best antispasmodic medicines are musk, opium, and castor. When opium disagrees with the stomach, it may either be applied externally, or given in clysters. It is often successful in removing those periodical head-achs to which hysteric and hypochondriac patients are subject. Castor has in some cases been found to procure sleep where opium failed; for which reason Dr. Whytt advises, that they should be joined together. He likewise recommends the anti-hysteric plaster to be applied to the abdomen[[152]].
Hysteric women are often afflicted with cramps in various parts of the body, which are most apt to seize them in bed, or when asleep. The most efficacious medicines in this case are opium, blistering-plasters, and warm bathing or fomentations. When the cramp or spasm is very violent, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in warm water, or applying a blistering-plaster to the part affected, will often be sufficient to remove the complaint. In patients whose nerves are uncommonly delicate and sensible, it will be better to omit the blistering-plaster, and to attempt the cure by opiates, musk, camphire, and the warm bath.