We now come to the important question of morbid and pathological mental conditions to which the female sex is liable and which are usually connected with those constitutional disturbances of the nervous system which pass under the name of hysteria. The word is, as everyone knows, derived from hystera—the womb, and was uniformly regarded by the ancients as directly due to disease of the uterus, this view maintaining itself in modern medicine up till well-nigh the middle of the nineteenth century. Thus Dr J. Mason Good (in his “Study of Medicine,” 1822, vol. iii., p. 528, an important medical text-book during the earlier half of the nineteenth century) says: “With a morbid condition of this organ, hysteria is in many instances very closely connected, though it is going too far to say that it is always dependent upon such condition, for we meet with instances, occasionally, in which no possible connexion can be traced between the disease and the organ,” etc. This is perhaps the first appearance, certainly in English medicine, of doubts being thrown on the uterine origin of the various symptoms grouped under the general term, hysteria. Towards the latter part of the nineteenth century the prevalent view tended more and more to dissociate hysteria from uterine trouble. Lately, however, some eminent pathologists have shown a tendency to qualify the terms of the latter view. Thus Dr Thomas Stevenson in 1902 admits that “it [hysteria] frequently accompanies a morbid state of the uterus,” especially where inflammation and congestion are present, and it is not an uncommon thing for surgeons at the present time to remove the ovaries in obstinate cases of hysteria. On the other hand Dr Thomas Buzzard, in an article on the subject in Quain’s Dictionary of Medicine, 1902, states that hysteria is only exceptionally found in women suffering from diseases of the genital organs, and its relation to uterine and ovarian disturbances is probably neither more nor less than that which pertains to the other affections of the nervous system which may occur without any obvious material cause. Dr Thomas Luff (“Text-Book on Forensic Medicine,” 1895) shows that the derangements of the reproductive functions are undoubtedly the cause of various attacks of insanity in the female. Dr Savage, in his book “On Neuroses,” says that acute mania in women occurs most frequently at the period of adult and mature life, and may occasionally take place at either extreme age. Acute mania sometimes occurs at the suppression of the menses. The same is true of melancholia and other pathological mental symptoms. Dr Luff states that acute mania may replace hysteria; that this happens at periods such as puberty, change of life and menstruation. These patients in the intervals of their attacks are often morbidly irritable or excitable, but as time goes on their energies become diminished and their emotions blunted (“Forensic Medicine,” ii. 307). Such patients are often seized with a desire to commit violence; they are often very mischievous, tearing up clothes, breaking windows, etc. In this mental disorder the patient is driven by a morbid and uncontrollable impulse to such acts. It is not accompanied by delusions, and frequently no change will have been noticed in the individual prior to the commission of the act, and consequently, says Dr Luff, “there is much difference of opinion as to the responsibility of the individual” (ii. 297). Among the acts spoken of Dr Luff mentions a propensity to set fire to furniture, houses, etc. All this, though written in 1895, might serve as a commentary on the Suffragette agitation of recent years. The renowned French professor, Dr Paul Janet (“Les Hysteriques,” 1894) thus defined hysteria: “Hysteria is a mental affection belonging to the large group of diseases due to cerebral weakness and debility. Its physical symptoms are somewhat indefinite, consisting chiefly in a general diminution of nutrition. It is largely characterised by moral symptoms, chief of which is an impairment of the faculty of psychological synthesis, an abolition and a contraction of the field of consciousness. This manifests itself in a peculiar manner and by a certain number of elementary phenomena. Thus sensations and images are no longer perceived, and appear to be blotted out from the individual perception, a tendency which results in their persistent and complete separation from the personality in some cases and in the formation of many independent groups. This series of psychological facts alternate the one with the other or co-exist. Finally this synthetic defect favours the formation of certain independent ideas, which develop complete in themselves, and unattached from the control of the consciousness of the personality. These ideas show themselves in affections possessing very various and unique characteristics.” According to Mr A. S. Millar, F.R.C.S.E. (Encyclopædia Medica, vol. v.), “Hysteria is that.. condition in which there is imagination, imitation, or exaggeration… It occurs mostly in females and persons of nervous temperament, and is due to some nervous derangement, which may or may not be pathological.” Sir James Paget (“Clinical Lectures on Mimicry”) says also that hysterical patients are mostly females of nervous temperament. “They think of themselves constantly, are fond of telling everyone of their troubles and thus court sympathy, for which they have a morbid craving. Will power is deficient in one direction, though some have it very strongly where their interests are concerned.” He thinks the term “hysteria” in the sense now employed incorrect, and would substitute “mimicry.” “The will should be controlled by the intellect,” observes Dr G. F. Still of King’s College Hospital, “rather than by the emotions and the lack of this control appears to be at the root of some, at least, of the manifestations of hysteria.”
Dr Thomas Buzzard, above mentioned, thus summarises the mental symptoms: “The intelligence may be apparently of good quality, the patient evincing sometimes remarkable quickness of apprehension; but carefully tested it is found to be wanting in the essentials of the highest class of mental power. The memory may be good, but the judgment is weak and the ability to concentrate the attention for any length of time upon a subject is absent. So also regard for accuracy, and the energy necessary to ensure it in any work that is undertaken, is deficient. The emotions are excited with undue readiness and when aroused are incapable of control. Tears are occasioned not only by pathetic ideas but by ridiculous subjects and peals of laughter may incongruously greet some tragic announcement, or the converse may take place. The ordinary signs of emotion may be absent and replaced by an attack of syncope, convulsion, pain or paralysis. Perhaps more constant than any other phenomenon in hysteria is a pronounced desire for the sympathy and interest of others. This is evidently only one of the most characteristic qualities of femininity, uncontrolled by the action of the higher nervous centres which in a healthy state keep it in subjection. There is very frequently not only a deficient regard for truthfulness, but a proneness to active deception and dishonesty. So common is this, that the various phases of hysteria are often assumed to be simple examples of voluntary simulation and the title of disease refused to the condition. But it seems more reasonable to refer the symptoms to impairment of the highly complex nervous processes which form the physiological side of the moral faculties” (Quain’s Dictionary of Medicine, 1902).
“It is not uncommon to find hysteria in females accompanied by an utter indifference and insensibility to sexual relations. Premature cessation of ovulation is a frequent determining cause. In cases where the ovaries are absent the change from girl to woman, which normally takes place at puberty, does not occur. The girl grows but does not develop, a masculine appearance supervenes, the voice becomes manly and harsh, sexual passion is absent, the health remains good. The most violent instances of hysteria are in young women of the most robust and masculine constitution” (John Mason Good, M.D., “Study of Medicine,” 1822). Other determining causes are given, as painful impressions, long fasting, strong emotions, imitation, luxury, ill-directed education and unhappy surroundings, celibacy, where not of choice but enforced by circumstances, unfortunate marriages, long-continued trouble, fright, worry, overwork, disappointment and such like nervous perturbations, all which causes predispose to hysteria. “It attacks childless women more frequently than mothers and particularly young widows,” and, says Dr J. Mason Good, “more especially still those who are constitutionally inclined to that morbid salacity which has often been called nymphomania.. the surest remedy is a happy marriage” (“Study of Medicine,” 1822, iii. 531). Hysteria is, in common with other nervous disorders, essentially a hereditary malady, and Briquet (“Traité de l’hysterie,” 1899) gives statistics to show that in nine cases out of ten hysterical parents have hysterical children. Dr Paul Sainton of the Faculty of Medicine, Paris, says: “The appearance of a symptom of hysteria generally proves that the malady has already existed