EPIDEMICS OF HYSTERIA. 545 



of all proportion to the growth of the general population, would 

 it not be superficial in the extreme to conclude, without further 

 data, that insanity was on the increase ? At present these statis- 

 tics mean nothing more than that the number of patients in such 

 institutions has considerably increased. But when we consider 

 what great advances have been made in the diagnosis of mental 

 diseases, and consider also that a great number of such cases, 

 which were formerly treated unsuccessfully at home, are now 

 treated in such institutions with good results, because there they 

 are removed from the detrimental influences of familiar sur- 

 roundings, while the proper means and methods for rational 

 treatment are at hand, we shall find that the seemingly enormous 

 increase of mental disturbances need not cause us uneasiness. 



Other extensive statistical material for nervous diseases is 

 afforded by the numerous dispensaries of the great cities; but 

 no extended experience is required to teach that a large propor- 

 tion of such cases would not appear if the patients had to pay 

 fixed fees, and round ones, as they had to do in the good old times 

 when physicians saw comparatively little of nervous diseases. 

 Our grandmothers had their "headaches" and their "twitchings 

 in the limbs" like the women of to-day ; but they never dreamed 

 of calling a doctor or going to the dispensary for such things, so 

 that they were not " statistical material." 



In the dispensaries for nervous diseases there are numerous 

 chronical patients who, becoming discouraged in one place, think 

 they would like to try another doctor ; and some of them make a 

 round of sojourns in different hospitals. Each of them is counted 

 as many times over in the statistics as there are places where he 

 is treated. This perceptibly increases the numbers. 



These considerations give some idea, though but a slight one, 

 of the extreme difficulty of making even rough approximate in- 

 ferences from sanitary statistics. But certain observers tell us 

 that exact enumeration is not required. Hysteria and degenera- 

 tion of the race stare us, as they aver, daily in the face. In every 

 department of human activity disorders of the nervous system 

 are seen. The very style and methods of the art and literature of 

 the day proclaim a general nervous prostration. 



Max Nordau is the protagonist of this widespread opinion. 

 In his eyes, mental degeneration has seized upon the majority of 

 civilized men to such a degree that " the upper strata of urban 

 population " form but a " suffering hospital." The art, the poetry, 

 the fiction, the philosophy of the day present the most manifold 

 embodiments of degeneration and of secular hysteria. 



Nordau admits, of course, that degeneration and hysteria have 

 always existed. "But," says he, "they were formerly sporadic 

 and were of no importance for the whole life of society." 



VOL. XLIX. — 44 



