HEALTH COLUMN.

Otago Witness, Issue 1978, 24 October 1889, Page 37

HEALTH COLUMN.

NERVOUSNESS AND HYSTERIA. ! Hysteria may be described as a serious disorder of the central nervous system, whereby every part of the body, without exception, may become the apparent seat of nonexistent disease. Mark, we do not say there is no disease, but that the disease is not in the part. Occasionally real disease of the part underlies the hysterical appearance on the surface. Some time ago a girl of 19 had been carefully treated for weeks in the old-fashioned style for a diseased knee, when one day her sister was to be married, and the girl determined to go. The doctor shuddered, but off the girl went, and the knee was well in a week. It is cases like these that lead to hysteria being considered a sham, when the truth is it is the doctor who is at fault in not discovering that the disease is not in the knee but in the brain. A short time ago, in the out-patient department of a large hospital, two quietlydressed ladies stood anxiously awaiting their turn to enter the doctor's room with a poor woman wrapped in blankets, whom they had brought in an invalid chair and an ambulance, with the greatest difficulty from home. When the doctor saw them he ascertained that the poor woman had suffered for years from a diseased spine, and for the last two years had been entirely supported and nursed ; by the two ladies, who, not being rich themselves, had at last found the burden more than they could bear, and had, as a last resource, brought her to the hospital, in the hopo it would provide a bed for her for the remainder of her life. The patient was a respectable looking person about £5, with a placid, well-fed appearance, bub emitting the most agonising cries whenever an attempt wa3 made to move her. The ladies were thereupon asked to withdraw and wait, and the back was carefully examined, and, in spite of intense apparent pain, the conclusion arrived at was that there was no disease but hysteria. Strong measures were of course needed to bring the patient to this point of view, and in the first place the spine was carefully galvanised, and she was then induced to walk. Further details would be wearisome. In two hours' time, so effectual were the means used, that the two ladies stared at the miraculous appearance of the one on whom they had spent so much care, walking all about the waiting room with case, and cured of her spinal complaint or.cc and for all. In this case, again, it was carefully explained that the woman was nob deceiving them, but that it, was her nerves, not her spine, which were disordered. I think Sir B. Brodie used to tell a story of a young lady of 24 whom he came across lying in a most extraordinary position on her face across a wooden machine made for the purpose, containing also a contrivance for feeding her in that position. It appeared she, too, had been suffering from severe spinal disease for six years, and -had been lying on her face, by mistaken medical advice for four years. By the discovery of the nervous nature of the malady and the soundness of the spine, and bj the use of judicious means, this young lady was sitting eating a table in five days, and in a fortnight could walk a quarter of a mile. Another case was that of a young married man, about 30 years of age, who had been overworked in an office, and had gradually become extremely hysterical. He was a martyr to various aches and pains, and often absented himself from the office, until the symptoms culminated in a sort of fit. He then took to his bed, where he fully expected to die. Trained nurses were engaged and sat up with him every night, when he apparently became delirious. His principal symptoms were intense weakness and exhaasbion, and agonising pains suddenly coming on, causing intense consternation, and commotion throughout the house. At last a physician came to see him, who discovered j the seat of the disease was in the nerves, and its name " hysteria." He divulged it to one or two of the strongest minded and most influential of the family, and advised instant action, for the young man was by this time getting violent, and worse every hour. His own home, unfortunately, was over 500 miles distant, and involved not only long rail journeys and changes, but steamboats and carriage driving. IS' evertheless a brother was telegraphed for, who arrived the next day, and then, according to a prearranged plot,- at 5 o'clock the doctor entered the sick man's room. He had just been saying he never would get up off the bed again, and his symptoms were worse. He was, however, told to get up, and assisted by two nurses, hurried into his clothes, with the sudden explanation that his brother had just arrived and wanted to see him downstairs at once. Too bewildered to resist, which he certainly would have done had time been given, he was bustled down, and found to his surprise his brother, who told, him that he, the invalid, must at once accompany him home at all risks. The doctor of course consented, but with apparent reluctance.' A good meal was waiting, of which he was forced to partake ; and at 6 the dying man was driving off to the station as hard as he could go, his brother and the doctor keeping up such an incessant jabber that he tried in vain to get in a word about himself or utter a protest. Far from his devoted nurse and sympathising sister, he felt he had no resource but to make the best of it. The same business-like proceedings were continued at the station. In all res.pects treated as in perfect health, he was put into his carriage, offered a paper, and at half -past 6 was gone. At the other end end he got into a steamer, which was late for the train on the other side, so he had to wait for hours; and when at last he arrived at the nearest station they had given him up and gone home, so he and his brother had. to hire a dogcart and drive over, and arrived all safe. Of course the next two days he was knocked up, but soon the familiar and much loved scenes asserted their influence, and in a week he was out shooting all over the place. i As a rale it is better that hysterical patients should not be at home, especially if

the disease develops there, but should at once be sent away. What they do want, wherever they are, in order to be cured, is the power of a very strong will and the patience of a very kind heart. Now there was no deception in this case, and yet sach might easily be suspected. One of the most remarkable testimonies as to the power of the hysterical person to simulate real disease is the fact that at a leading London hospital over 50 cases of one fatal disease have been sent in by medical men and certified, and yet in every one of the 50 the disease was hysteria, and hysteria only. The marvellous cures of hj sterical loss of voice are very interesting. A patient comes : at times a waiter in an hotel, who has lost his voice, and place in consequence ; at others a governess, or perhaps the mother of a family, or some delicate young lady. None of them can speak above a very soft whisper; and yet, without knowing it, they will cough or clear their throat quite audibly. The history is nearly always the same. The disease did not begin with hysteria. The patient had a severe cold at first, and did lose her voice. This, has, however, long since been cured ; but the voiceless state persists, and would do so till the end of time. A careful examination shows that everything is normal. And then, by the skilful use of judicious means, the voiceless condition, that has persisted for sometimes years, gradually is cured. These patients occasionally actually have slates to write on, and cannot speak at all. And yet after treatment, in five minutes they say "Oh ! " with wonderful vigour. In five minutes more they can count, and in half an hour can shout out every letter of the alphabet so as to be heard 50yds off. Sometimes, of course, they look puzzled at the rapidity of the cure, and sometimes dubious whether they arc not after all impostors ; but they aie not, as is evidenced by their often losing their very situations from this cause alone. In any case they are extremely grateful at being so rapidly cured A good collection of hysterical cures would far exceed in romance the wildest fables that ever made the reputation of a quack medicine. One extremely comical case, which we may just wind up with, was that of a very attractive young lady, "poor, but respectable," who entered the room of a hospital surgeon a short time ago a living skeleton, pursued by her anxious and careworn mother, holding in one hand a pot of Liebig and in the other a spoon. She apologised, and explained her extraordinary attitude by saying that her daughter had completely lost her power of swalicwiug for weeks, and had solely been kept alive by a mysterious process she called " suction " ; that she had tried all that day to induce her to take a little Liebig, that being a light nourishing diet, but in vain. The young lady said such was the case, that she wad truly sorry to grieve so excellent a mother, and besides ruin her own health, bub she felt that she was going fast, for she could swallow nothing. A glass of water on the table was tried after much persuasion, bub produced such spasms that not a drop was swallowed. The mother was then requested to wait, and the daughter was taken to the wards upstairs, and a brief course of treatment entered upon, the true nature of the disease being at once discovered, it was so satisfactory that after a few minutes the patient thought she felt better, and managed with difficulty to swallow a little water. This was not enough, however, so it was still continued, with the eminently satisfactory and happy result that in half an hour the young lady was sitting at a table with a plateful of boiled mutton, turnips, and potatoes before her ; and her mother was called up, and in her presence the daughter, with a radiant countenance, completely finished the meal. One curious thing is that all the distortions and contractions of hysteria disappear under chloroform. One very obstinate case of a contracted and bent arm defied all efforts to straighten it ; but when at last chloroform was given, it was at once perfectly straight. As the patient came round it contracted again, and in a few hours was as rigid as ever. She was therefore put to sleep a second time, the arm straightened, and then secured in that position with plaster of Paris. The result was a pefect cure. The secret of curing all hysteria is by feelJ.ng true sympathy from the conviction of the reality of the disease, but showing none. In fits, for instance, the friends should not struggle with the sufferer, or express either alarm or interest ; indeed, the fewer spectators the better, as the patient is nearly al- | ways partly conscious, and any interest always increases the violence of her performances. All alcohol should invariably be avoided, as it only increases the malady. One of the best and safest cures is to pcur steadily from a height a small stream of cold water on the face. This will be borne for a few minutes, and then efforts made to avoid it, and then consciousness regained with a long drawn sigh. One has been asked to account for the exceeding rapidity of many of these cures if the disease be real. The answer is that it is because the disease is not organic or involving any actual change in the part; to cure which would necessarily be a work of time, but purely functional, or dependent on nerve force, and hence quickly curable. Catalepsy is such a serious perversion of nerve force and intellect, and its manifestations are so dreadful, that this is hardly the place to discuss it, especially as it is not at all common. Nervousness and hysteria are everywhere, however, and we certainly think that all should be aware of their real nature, how far they are removed from shamming and deceit, and how they constitute a troublesome and increasing class of very real disease, though in no case is the disease ever where the patient imagines it to be. There are, of course, malades imaginaires ; but even of these we would try and say a good word, for it is quite true that if a man is so ill, as to imagine he is ill when he is not ill, he must be very ill indeed. • One remark it occurs to us to make before concluding. In the discussions that sometimes take place in connection with " faith healing," it is well to remember the vast difference between cases of organic disease and of mere nervous disorder. The symptoms may be in both equally conspicuous, bat the good effects of moral as distinguished, from physical remedies will be

chiefly found in the latter class of cases.— A. T. Sohofield, M.D., in the "Leisure Hour."