CASE OF HYSTERIA IN A FEMALE. HATCH, F.R.C.S. (Eng.), Surgn.-Lt.-Col., Principal, Grant Medical College, Bombay. By W. K.
Hysteria is
common
enough
among Parsee
females, but it is seldom that deception is actually resorted to; in this instance the woman was
distinctly hysterical, and there was a well-marked history of hysteria in the familj'-. It is now several years ago since I first saw the patient for the first time, and on that occasion I did not succeed in making any diagnosis. I was called iu consultation and found the patient, a strongly built, stout, and unemotional looking woman of between 35 and 40 years of age. She was married and had children; she complained of pain in the back and constant tenderness in the lumbar region. The urine was stated to be very scanty and occasionally tinged with blood. On examining the abdomen, I was unable to make out any tumour in the lumbar or any other region; she complained of tenderness on pressure, and I thought at the time that the pain seemed to be out of proportion to the pressure exerted, and I remarked on this ; the organs were healthy, and
I could make out nothing definite as the urine, when examined, turned out to be normal, I therefore requested to see the patient again after a short time. As, however, it very often happens in Bombay practice that one consultant after another is called, so here also I did not again see the patient for more than a year. Meanwhile having heard that a friend of mine had also been in consultation to the case, I asked him what opinion ho had formed; he told me that he had been unable to come to any conclusion as to the nature of the complaint. On the second visit I was told by the medical attendant that the symptoms of which the patient had previously complained were still present, but that hematuria was more frequent. I was, therefore, surprised to find the patient as well-nourished as before, and again on examination could detect nothing wrong into the kidneys. On inspecting the urine, I noticed that the blood did not appear to be very intimately mixed with it; the whole quantity passed in the 24 hours was shewn to me was about two ounces only, I was accordingly extremely doubtful of the truth of this statement. I therefore took away the urine for microscopical examination and found under the microscope many blood corpuscles and also large cells of squamous epithelium, which evidently were derived from the mouth. I then stated my suspicions to her medical man, but he was not inclined to believe it possible that the woman should have behaved in such a way, not only giving rise to great anxiety and expense for medical treatment, but also making several trips to sanatariums for the improvement of her health. I examined also the patient's mouth, but could not detect any signs of laceration of the gum or of bad teeth. I suggested, however, that a careful watch should be kept on her that her clothes should be searched for pins, but nothing could be found when this was done. Her clothes having been completely changed, it was noticed that no blood appeared in her urine for a very considerable interval. Having at last enlisted the services of a medical relation, we ascertained that a lota full of water was taken by her into a room daily for the purposes of ablution. On taking the specific gravity of the fluid in the lota and of the fluid left in it after washing, we discovered the specific gravity had risen to 115 on more than one occasion, moreover the water had a distinctly 3rellow tinge. Shortly after we had made out this fact, I was called in the middle of the night to see the patient who was said to be dangerously ill; most of her relatives had in fact assembled under the idea that she was about to die. On arrival at the house, I found her apparently unconscious and in very strong convulsions, I therefore at once had her removed to a room away from the crowd of grieving relatives, and saying to the medical man in attendance that we would put her to the o
oo
'
378
test, I procured
THE INDIAN MEDICAL GAZETTE.
a catheter and proceeded to pass it into the urethra. As soon however as she discovered my intention, she began to struggle most violently, and I found it impossible to insert the instrument; as, however, I persisted in my efforts, she very soon thought it advisable to become conscious, and to request that the catheter should not be passed. I thought it, therefore, a good opportunity to bring the whole farce to a conclusion, and, as I did not wish to expose the deception to all the relatives in case of making her desperate, I dismissed everyone with the exception of her mother and medical attendant and told her plainly that the whole matter was now discovered, viz., that she pricked her gums and spat blood into the urine, and was not suffering from any disease of the kidneys. She at once became reasonable, and asked if she must take any more medicine. I replied no medicine need be given her if she would leave off" her practices. She promised to do so, and I have since learnt that the pin she used was found in her clothes, and that, owing to family squabbles, she had become despondent and resorted to this deception for the purpose of gaining sympathy. Since then she has, so far as I know, remained perfectly well, and has shewn no further hysterical tendencies.
[Oct.
1898.
Hysteria is
common
enough
among Parsee
females, but it is seldom that deception is actually resorted to; in this instance the woman was
distinctly hysterical, and there was a well-marked history of hysteria in the familj'-. It is now several years ago since I first saw the patient for the first time, and on that occasion I did not succeed in making any diagnosis. I was called iu consultation and found the patient, a strongly built, stout, and unemotional looking woman of between 35 and 40 years of age. She was married and had children; she complained of pain in the back and constant tenderness in the lumbar region. The urine was stated to be very scanty and occasionally tinged with blood. On examining the abdomen, I was unable to make out any tumour in the lumbar or any other region; she complained of tenderness on pressure, and I thought at the time that the pain seemed to be out of proportion to the pressure exerted, and I remarked on this ; the organs were healthy, and
I could make out nothing definite as the urine, when examined, turned out to be normal, I therefore requested to see the patient again after a short time. As, however, it very often happens in Bombay practice that one consultant after another is called, so here also I did not again see the patient for more than a year. Meanwhile having heard that a friend of mine had also been in consultation to the case, I asked him what opinion ho had formed; he told me that he had been unable to come to any conclusion as to the nature of the complaint. On the second visit I was told by the medical attendant that the symptoms of which the patient had previously complained were still present, but that hematuria was more frequent. I was, therefore, surprised to find the patient as well-nourished as before, and again on examination could detect nothing wrong into the kidneys. On inspecting the urine, I noticed that the blood did not appear to be very intimately mixed with it; the whole quantity passed in the 24 hours was shewn to me was about two ounces only, I was accordingly extremely doubtful of the truth of this statement. I therefore took away the urine for microscopical examination and found under the microscope many blood corpuscles and also large cells of squamous epithelium, which evidently were derived from the mouth. I then stated my suspicions to her medical man, but he was not inclined to believe it possible that the woman should have behaved in such a way, not only giving rise to great anxiety and expense for medical treatment, but also making several trips to sanatariums for the improvement of her health. I examined also the patient's mouth, but could not detect any signs of laceration of the gum or of bad teeth. I suggested, however, that a careful watch should be kept on her that her clothes should be searched for pins, but nothing could be found when this was done. Her clothes having been completely changed, it was noticed that no blood appeared in her urine for a very considerable interval. Having at last enlisted the services of a medical relation, we ascertained that a lota full of water was taken by her into a room daily for the purposes of ablution. On taking the specific gravity of the fluid in the lota and of the fluid left in it after washing, we discovered the specific gravity had risen to 115 on more than one occasion, moreover the water had a distinctly 3rellow tinge. Shortly after we had made out this fact, I was called in the middle of the night to see the patient who was said to be dangerously ill; most of her relatives had in fact assembled under the idea that she was about to die. On arrival at the house, I found her apparently unconscious and in very strong convulsions, I therefore at once had her removed to a room away from the crowd of grieving relatives, and saying to the medical man in attendance that we would put her to the o
oo
'
378
test, I procured
THE INDIAN MEDICAL GAZETTE.
a catheter and proceeded to pass it into the urethra. As soon however as she discovered my intention, she began to struggle most violently, and I found it impossible to insert the instrument; as, however, I persisted in my efforts, she very soon thought it advisable to become conscious, and to request that the catheter should not be passed. I thought it, therefore, a good opportunity to bring the whole farce to a conclusion, and, as I did not wish to expose the deception to all the relatives in case of making her desperate, I dismissed everyone with the exception of her mother and medical attendant and told her plainly that the whole matter was now discovered, viz., that she pricked her gums and spat blood into the urine, and was not suffering from any disease of the kidneys. She at once became reasonable, and asked if she must take any more medicine. I replied no medicine need be given her if she would leave off" her practices. She promised to do so, and I have since learnt that the pin she used was found in her clothes, and that, owing to family squabbles, she had become despondent and resorted to this deception for the purpose of gaining sympathy. Since then she has, so far as I know, remained perfectly well, and has shewn no further hysterical tendencies.
[Oct.
1898.
