Definition.—A state in which ideas control the body and produce morbid changes in its functions (Möbius).

Etiology.— The affection is most common in women, and usually appears first about the time of puberty, but the manifestations may continue until the menopause, or even until old age. Men and boys, however, are by no means exempt, and of late years hysteria in the male has attracted much attention. It occurs in all races, but is much more prevalent, particularly in its severer forms, in members of the Latin race. In this country the milder grades are common, but the graver forms are rare in comparison with the frequency with which they are seen in France.

Of predisposing causes, two are important—heredity and education. The former acts by endowing the child with a mobile, abnormally sensitive nervous organization. We see cases most frequently in families with marked neuropathic tendencies, the members of which have suffered from neuroses of various sorts. Education at home too often fails to inculcate habits of self-control. A child grows to girlhood with an entirely erroneous idea of her relations to others, and accustomed to have every whim gratified and abundant sympathy lavished on every woe, however trifling, she reaches womanhood with a moral organization unfitted to withstand the cares and worries of every-day life. At school, between the ages of twelve and fifteen, the most important period in her life, when the vital energies are absorbed in the rapid development of the body, she is often cramming for examinations and cooped in close school-rooms for six or eight hours daily. The result too frequently is an active, bright mind in an enfeebled body, ill adapted to subserve the functions for which it was framed, easily disordered, and prone to react abnormally to the ordinary stimuli of life. Among the more direct influences are emotions of various kinds, fright occasionally, more frequently love affairs, grief, and domestic worries. Physical causes less often bring on hysterical outbreaks, but they may follow directly upon an injury or develop during the convalescence from an acute illness or be associated with disease of the generative organs. The name hysteria indicates how important was believed to be the part played by the uterus in the causation of the disease. Opinions differ a good deal on this question, but undoubtedly in many cases there are ovarian and uterine disorders the rectification of which sometimes cures the disease. Sexual excess, particularly masturbation, is an important factor, both in girls and boys.

Treatment.—[…]To treat hysteria as a physical disorder is, after all, radically wrong. It is essentially a mental and emotional anomaly, and the important element in the treatment is moral control. At home, surrounded by loving relatives who misinterpret entirely the symptoms and have no appreciation of the nature of the disease, the severer forms of hysteria can rarely be cured. The necessary control is impossible; hence the special value of the method introduced by Weir Mitchell, which is particularly applicable to the advanced cases which have become chronic and bedridden. The treatment consists in isolation, rest, diet, massage, and electricity. Separation from friends and sympathetic relatives must be absolute, and can rarely, if ever, be obtained in the individual’s home. An essential element in the treatment is an intelligent nurse. No small share of the success which has attended the author of this plan has been due to the fact that he has persistently chosen as his allies bright, intelligent, women. The details of the plan are as follows: The patient is confined to bed and not allowed to get up, nor, at first, in aggravated cases, to read, write, or even to feed herself. Massage is used daily, at first for twenty minutes or half an hour, subsequently for a longer period. It is essential as a substitute for exercise. The induction current is applied to the various muscles and to the spine. Its use, however, is not so essential as that of massage. The diet may at first be entirely of milk, four ounces every two hours. It is better to give skimmed milk, and it may be diluted with soda water or barely water and, if necessary, peptonized. After a week or ten days the diet may be increased, the amount of milk still being kept up. A chop may be given at midday, a cup of coffee or cocoa with toast or bread and butter or a biscuit with the milk. The patients usually fatten rapidly as the solid food is added, and with the gain there is, as a rule, a diminution or cessation of the nervous symptoms. The milk is the essential element in the diet, and is itself amply sufficient.

The remarkable results obtained by this method are now universally recognized. The plan is more applicable to the lean than to fat, flabby hysterical patients. Not only is it suitable for the more obstinate varieties of hysteria with bodily manifestations, but in cases with mental symptoms the seclusion and separation from relatives and friends are particularly advantageous.

Source: William Osler, "The Principles and Practice of Medicine" (New York: Appelton, 1892), 967, 977-978

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