4:12 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



appointed, who believes that she has failed in her vocation, and who, 

 under the depression consequent upon such feelings, is unable to divert 

 her thoughts into other channels. I admit that the manner in which 

 the continuous action of psychical impressions modifies the nutrition 

 of the general nervous system, and thus leads to hysteria, is obscure ; 

 but it cannot be maintained that our insight into the mode in which 

 disease of the genital nerves extends to other portions of the nervous 

 system is any more clear. The state of mind which leads to hysteria 

 depends not only upon external accidents, but much more upon the 

 mental impression made by the accident upon the individual. A fate 

 which may befall one person, without producing any apparent effect, 

 may be the source of the deepest and most lasting depression in an- 

 other. I heartily agree with JETasse, that, though hysteria is often 

 seen in women wedded to impotent men, yet it originates quite fre- 

 quently in the sombre feeling and miserable consciousness of a wasted 

 life, which result when social claims of married life are not duly re- 

 spected, or when the sentimental anticipations and fantastic ideals of a 

 foolish girl are not realized. 



The nutritive derangement of the nervous system from which hys- 

 teria arises may also be induced by improper nourishment. "We have 

 sufficient proof of this fact in the frequent occurrence of this complaint 

 in cases of chlorosis and impoverishment of the blood, unaccompanied 

 by any disease of the sexual organs, by sensual excitement or onanism, 

 and where it cannot be traced in the remotest degree to the psychical 

 impressions above alluded to. 



There is great variety as to the degree of predisposition to hy 

 teria. All the women with uterine infarction, or uterine flexion, or 

 who have ulceration of the os uteri, are not necessarily hysterical, noi 

 are all the old maids who believe their lives to have been thrown 

 away, nor all the chlorotic girls. On the other hand, I have no hesi- 

 tation in asserting that a tendency, either congenital or acquired, plays 

 a much more important role in inducing this affection than all other 

 causes mentioned hitherto. The truth of this assertion is easy of 

 proof. If we examine large numbers of women, we find moderate de- 

 grees of uterine infarction, slight flexions of the uterus, and erosions 

 of the os, to be so very common that the number of hysterical women 

 would be equal to that of the non-hysterical ones, if affections like 

 these alone sufficed to occasion hysteria, without the coexistence of a 

 decided predisposition to such disease. It rarely begins to manifest 

 itself before the twelfth or fifteenth year of life, and very seldom ap- 

 pears in old age. It frequently outlasts the period of child-bearing, 

 and continues in a moderate degree during the climacteric years. The 

 tendency to it is often congenital ; but, although a patient may have 



