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in the phthisical, which may be either gloomy or cheerful according to the temperament of the individual, Pain under the left mamma of the peculiar character pathognomonic of hysteria, sometimes suffices to determine the question. The spot in the middle of the sternum, which is naturally endowed with much sensibility, is often acutely sensitive to pressure; and, if pressure be made at the same time upon this part, and near the spine between the shoulder blade, the peculiar gasp and sense of suffocation, to which the term of hysterical asthma has been given, may be induced. But, among the most remarkable symptoms usually characteristic of phthisis, which may occur as a result of hysterical condition, hæmoptysis may be specially noticed. It is in such cases often profuse, and remarkably periodical in its occurrence, yet, partaking of the capriciousness of hysterical symptoms. The profuseness of hæmoptysis in some hysterical subjects may possibly be due to deficiency of crassamentum in the blood; a condition similar to that produced by Prevost and Dumas in cats, and by Le Canu in men, by blood-letting. If Le Canu be correct in the opinion, that the blood of women contains on an average, in a thousand parts, about thirty more of water, and proportionally less crassamentum than that of men and that this peculiarity is most observable at the catamenial period, we may perhaps approach to an explanation of the greater liability of the female sex to the occurrence of hæmoptysis, irrespective of consumption. : With a view to bring the different parts of the subject more prominently before you, I will briefly relate a few illustrative cases.
I lately saw Miss L., a lady aged thirty years, complaining of pain of the left chest extending to the arm, of dry cough, and occasional clear hæmoptysis. There was slight dulness on the left side posteriorly. The catamenia were three weeks behind time, but the pulse was only 72. The dulness on percussion had previously been observed on the right side, which on the occasion of my examination was clear; and I could not dismiss from my mind the impression, that the direction of the patient's attention to the suspected part led to congestion which proved transient. There was no evidence of pleurisy, but there was a rather significant pain under the left mamma, and an expression of countenance suggesting the conclusion, the correctness of which was confirmed on inquiry, that the patient was labouring under mental disquietude. Removal to the country proved beneficial. The patient's health gradually improved, the auscultatory signs became chiefly negative, nothing in this respect being observable but slightly prolonged expiratory murmur on the left side. There is still, however, a little cough, and occasional hæmoptysis. It will be remembered that the catamenial function is slightly disturbed; and pulmonary congestion from this cause may be sufficient to occasion dulness on percussion. This case might by some be regarded as threatened phthisis, but I am rather disposed to view it as hysteria depending on mental causes, and to refer the local congestion, in some degree, to a direction of the mind towards the parts temporarily affected. It presents no conclusive evidence of the presence of phthisis, and, under favourable circumstances, such disease will probably never occur. The next example presents the two conditions of hysterical and phthisical predisposition, in some degree combined.
Not long since, I received from a medical friend a note to this effect : “My wife is very poorly, her family have for the most part died consumptive; please come and see her.” I found a lady, aged twenty-four years, without either the languor, or the unnatural keenness of expression common in established phthisis, complaining of pain under the sternum, increased by deep inspiration. There were increased vocal fremitus, dull percussion sound under the right clavicle, and bronchophony in the right superscapular region. She was said to be getting thin, and her gums had the pearly border. Dry cupping, and an expectorant mixture were prescribed. The next day she was as before ; dry cupping had afforded no relief. Pulse 120 ; respirations 70 in a minute. Inspiration difficult and painful. The respiratory uneasiness was increased in paroxysms, and she walked about the chamber sighing. I prescribed a mixture containing cajuput oil and tincture of hops, to be taken every three hours ; for the great disproportion between the urgent complaints and the slight auscultatory phenomena, convinced me that the case must be treated more as nervous than as organic. After using the mixture, she slept about six hours, but on the next day was still troubled with fits of unquiet breathing; and pressure on the sternum produced pain about her spine, between the scapulæ. Compression of both these points at once occasioned much uneasiness and alarm. The patient was evidently impressed with the idea that her life was in danger; but I succeeded in dispelling her fears, and she smiled when I said, “It is a very interesting little
complaint, and I must make a note of it.' I now ascertained that this lady had been long affected with profuse leucorrhoea; and it was evident that the respiratory disturbance was a “ climbing sorrow," and that its element was below. I recommended a draught of sulphate of zinc, with infusion of valerian, three times a day, and an opiate embrocation to the spine.
Oct. 20th. I again saw her. A visit to the country, and the administration of zinc had been useful. The pulse was 88. Respiration apparently natural, but she complained of seeming to have nerves in the left side, which suffered severe pain when the breathing reached them. No tenderness of spine, and very little of sternum. Voice more resonant on the right than on the left side ; but percussion here not distinctly dull, and expiration less obviously prolonged.
Among the circumstances worthy of attention in this case are, first, the temporary hysterical aggravation of pectoral symptoms, especially manifested by distressed respiration, and local uneasiness ; secondly, the disappearance for a time of consumptive symptoms, although there may be ground for apprehending that phthisis may ultimately be established. · The next case exhibits the hysterical temperament aggravating hæmoptysis and cough, without increasing the danger, or accelerating the progress of disease. E. B., a young woman in the hospital, aged sixteen years, of sanguine temperament, who had lost her mother, uncle, and two maternal aunts by phthisis, came under my observation at Christmas, 1850. She had suffered from cough for fourteen weeks ; at first dry, subsequently attended with expectoration. Lately, on awaking in the morning, she had found blood flowing from her mouth; the bed clothes were soaked with it; and about a pint was supposed to have been lost. After this there was no hæmoptysis during the day, but for a fortnight, about three ounces of blood were coughed up every night. During a part of the progress of this case vomiting occurred, and was so obstinate that chloroform inhalation was required to check it; and the cough was for some days and nights almost incessant, and very distressing. There was dull percussion sound under the right clavicle, and the expiratory murmur, on both sides, was prolonged. Antimony, digitalis, purgatives, and astringents, used in succession, exercised but a slight effect on the hæmoptysis. Turpentine, employed in draught and inhalation, moderated it, but was followed by strangury. The catamenia being interrupted, lytta was given, and proved useful. This patient's case is an illustration of phthisis, rendered more urgent in its symptoms, but not accelerated in its progress, by hysteria. Leucorrhoea of some years' duration, and very irregular, and often profuse catamenia, constituted a part of the history. She was benefited by treatment, and gained six pounds weight in three or four months.
The next case I have to introduce is that of S. G., a young woman, also in the hospital, a dressmaker, aged twenty-three years, with dark hair, and hazel eyes. You may observe her alert expression, as though on the watch for sympathy. She is affected with pain under the right clavicle, but is tolerably plump, and without clubbed fingers, or lines on the gums. Among other symptoms may be enumerated dyspepsia, cough, dyspnoa, headache, nausea, and mucous expectoration with black