Biographies de neurologues
Nouvelle Iconographie de La Salpêtrière
 L'histoire des neurosciences à La Pitié et à La Salpêtrière J Poirier
The history of neurosciences at La Pitié and La Salpêtrière J Poirier 

mise à jour du
25 août 2005
 (MSS. Collection, National Library of Medicine, Bethesda, Maryland, USA)
 Hysteria at the Edinburgh Infirmary
A lecture by James Gregory delivered in 1788-1789


This disease under which we have had several patients labouring is very disagreeable to the practitioner especially in an hospital where exercise, air and employment of mind are precluded though they may be reckoned among its most powerful remedies. For this reason I wish to take in as few hysteric patients as possible as I believe that more have been seized with this disease in the hospital than have been cured in it. I have known six seized with it in one night. It generally happens that a temporary relief is obtained by various remedies and as soon as that happens I send them out.
Tho the disease is not dangerous, it ought by no means to be passed over in silence as it is frequently very severe and many of the symptoms and forms it assumes are apt to deceive the young practitioner. As to the definition and description of it Dr. Cullen's are the best, but you must not expect to find the combination he finds in every case, for sometimes one symptom appears and sometimes another. Whenever the globus is present, I think the disease characterized, tho its absence by no means proves that hydrothorax is not present. I have sometimes known the sole symptoms of the disease to be a paralysis or loss of motion of every muscle of the body for some minutes; sometimes in the form of an intermittent.
The globus sometimes though rarely produces vomiting when it answers at the stomach, when in the throat it induces difficulty of deglutition: dysphagia hysterica, sometimes of the speech and at others asphyxia hysterica. The pulse is sometimes immoderately frequent. I have counted it at 180 and Dr. Whyte mentions having found it 220. Patients are at different times affected with weeping, laughing. They sometimes fall down motionless and at others have violent pains of the bladder and kidneys, and it has sometimes on this account been mistaken for calculous complaints.
I had a woman in the clinical ward labouring under hysteria who was affected with the most astonishing cough I have ever observed, continuing for two days without a second of intermission, and the conclusions are sometimes so astonishingly strong as to require the strait waistcoat. I believe I never knew hysteria produce an affection of the mind as epilepsy does though I think the frantic state of the mind may arrive at such a height as to produce similar effects. It has been supposed that hysteria may go to such a height as to promote epilepsy though I do not know that such has ever been the case. I had once a patient indeed in whom the two diseases completely marked were combined so that the patient would now perhaps be seized with an hysteric paroxysm and in a short time after with a fit of epilepsy. In the fit the distinction between the two diseases is rather difficult. The foaming is not always present in epilepsy and sometimes though not frequently accompanies hysteric paroxyms, but during the intervals and at the coming on of the disease it can readily be distinguished.
It has been a prevailing notion among physicians that hysteria was somehow associated with venereal appetite but though this may sometimes, yet it is not always the case. It is brought on by different passions as grief, anger, fear, and many women who might be supposed to make no scruple of owning it have on being questioned denied it.
Once circumstance in hysteria is to be particularly noticed, viz. that it depends on a particular predisposition proceeding from a certain mobility which is frequently connected with Debility.
Baron [a patient) was not in this state, and the mobility I mention by no means depends upon it constantly - a peculiar concomitant irritability is likewise present; hence females are so subject to it. I would not, however, confine it entirely to them, though the instances of hysteric affections in the other sex are very few and in those cases which have been related I believe many mistakes have been made. I never saw but one instance of the kind myseL and that was in a young man who was affected with globus and he was of a very irritable habit, but I may safely say for one man 10,000 women are affected with the disease.
Hysteria does not depend upon a general irritability on mobility alone, it seems in general to proceed from a particular irritability connected with the genital system. The general irritability is greater in infancy when no hysteria appears and it almost only occurs from the age of puberty to the cessation of the menses, and to this there are but few exceptions. Y have seen women of 40 or 5O atacked with it and I knew a lady who was much affected with the disease in her younger days, attacked with strongly marked hysterical symptoms at the age of 66. It frequently attends the sanguine temperament which is generally much connected with irritability. There is a remarkable connection too between it and the period of menstruation. I knew a lady who was affected with hysteria during the flowing of the menses from causes which at another time could produce no such effect, and it may be observed that the period of menstruation is one of usual and general irritability.
This peculiar irritability of the system productive of the disease may arise from innumerable causes, but the proximate cause may remain unknown to us as long as the nature of the nervous system sensations, and is so little understood. It seems much connected with a flaccidity of the simple solids and it is partly by its effects on these, partly by its action on the living principle that heat such as warm rooms has such a tendency to produce it.
This irritability is likewise connected with plethora as is shown by the temperament. It frequently attacks by its arising from the stoppage of evacuations and it is likewise connected with debility especially of the bowels and stomach, hence it accompanies dyspepsia. Custom seems to have a strong effect in resetting the disease as it has in asthma, epilepsy, intermittents. The effects of predisposition are in hysteria very remarkable-certain circumstances and causes which are indeed inevitable, often bring on the paroxysms in the predisposed which, if applied to 10,000 others not predisposed, would be productive of no effect. Such are the passions, external senses, sudden noise, certain smells either fragrant or otherwise, particular objects as cats or other mimais disagreeable sights particularly those of mother person labouring under the disease and it frequently first commences that way.
The same tendency to imitate is observed in many other instances as yawning, laughing, etc. As the muscles however employed in these last actions are in general subservient to the will, we can prevent the operation of that remarkable tendency towards them and I am sure much may be effected in that in hysteria. It is a maxim I inculcate very strongly to my patients, to use their utmost endeavours to prevent the coming on of fits. I have often known it succeed though my advice is by many not well received.
In others their predisposition is so strong that their endeavours are ineffectual. In some there is a peculiar pleasure that attends the coming on of the fit analogous I suppose to that we experience in yawning, and that they really encourage them and bring them on by reason of every possible effort, and in cases like these I should suppose every remedy must prove inefficacious. Fits are frequently brought on by theatrical performances. This happened in several instances during Mrs. Siddon's performing at Edinburgh. I knew one instance in Paris where death was the consequence of a violent fit occasioned by the representation of a tradgedy.
External heat is often likewise an exciting cause; hence are hysteric fits so frequently observed in crowded assemblies. Any great stoppage of an evacuation, any disorder of the stomach, renders the fits more violent. Hence it has been known to be brought on by full living and to come on constantly after a meal. I believe hysteric fits will never come on without some exciting cause; though our patients will frequently deny it, but this is no proof against it, for passions of the mind which they will not own and circustanccs so trifling that they are ashamed to acknowledge frequently induce it. I knew one instance in the clinical ward of a woman being seimd with a violent fit on being deniedadrink of water. As to the proximate cause, so little with respect toit is known that it is by no means applicable to practice.
Our indications of cure are 1st, in the intervals, to diminish extraordinary irritability and stop or moderate the fits. The first is answered by tonics such as the Peruvian Cortex from 3-3,5 g 2-3 times a day. Steel, in doses of 15 g or thereabouts, sometimes conjoined with bitters asgentian, columba, etc. Copper has been recommended. I have tried it in many respects but doubt much as to its good effects in hysteria. Exercice is of the greatest benefits and I believe has sometimes produced cures alone, and more especially when combined with the occupation of the mind.
We are often obliged to compel our patients to use it. I had an account of a lady who on the slightest threatening of a fit was immediately placed on horseback and obliged to ride pretty hard; this always prevented the further progress of the paroxysme and at length performed a cure. From hence it will appear of what service it must prove to undertake ajourney especially on horseback for the cure of the disease.
With respect to moderating the fits, they are never attended with danger; at least I never saw them, so that we have generally nothing else to do but to prevent the patients from hurting themselves. The principal disadvantage that arises from them is that habit they induce, and to prevent this and stop the progress of the fits many medicines have been proposed, asfoetids to the nose, pedilùvium, dipping the hands in cold or warm water, dashing cold water on the face, and I have frequently known attended with success draughts with volatile alkali or ether, immediately before the fit and frequently to prevent its formation. I believe they possess more power then than at any other time.
Opium has likewise been given with the same intent by the mouth or by glyster, but they generally loose their effects in a little time. Camphor has been recommended and I have tried it without much success. With respect to my particular practice in these cases we had under our care, I ordered the pediluviwn, the pi! abet with a view to bring on the menses, though I confess we ought to be cautious about administrating them. For we are frequently deceived by women with child who wishing to get rid of their burden produce a miscarriage and attribute many complaints to a cessation of the menses which they are cunning enough to say, happened many a month before.
How far this was the case with our patient I shall not say - but supposing a real amenorrhoea present,! know nothing so powerful in restoring the menses as the aloctic pills from the great irritability given the rectum. She was remarkable hard to work as a scruple had no effect. The anodyne castor, ara foetida. were given without any benefit. At the period of the menses, electricity and oil of Savin were employed to which! believe the root owes its virtues and I look upon lias the best mode of exhibiting it, but lam far from placing much trust in this or any other emniagogue. The only remedy which seemed to have any effect was the cold bath. Some of you saw the good effects of the draughts of ether and the fetid julep.