HYSTERIA. 



421 



always aggravated; sometimes, indeed, there never are any fits, ex- 

 cepting at this period. There is no fixed rule as to the duration of 

 hysteria. It may continue for years, with varying intensity, although, 

 during the climacteric years, it nearly always becomes milder. Recov- 

 ery is not uncommon, the physician's art having many a triumph over 

 hysteria to celebrate. There are plenty of cases, it is true, which are 

 never cured, and, indeed, which do not even improve. Sometimes the 

 malady runs into epilepsy or insanity. Death from hysteria, however, 

 is rare. There are only a few scattered cases on record, in which 

 death has occurred during violent convulsions, probably owing to em- 

 barrassment of respiration. 



TREATMENT. After what has been said above regarding the effect 

 of education and of habit in inducing hysteria, the necessary prophy- 

 lactic measures so important to the patient will have become suf- 

 ficiently evident, and will not require any further specification. 



Cases where there is no doubt that the nervous derangement pro- 

 ceeds from disease of the sexual organs, call for appropriate treatment 

 of the infarction, ulcer, flexion, or other disease of the womb which 

 may be present. For further remarks upon this subject we refer to 

 the second division of this volume. Where the hysteria is the result 

 of psychical influences, and nevertheless the patient is compelled to 

 submit to the extremely unpleasant procedures necessary for the appli- 

 cation of leeches or caustic to the os uteri, the malady is almost always 

 aggravated. In hospital practice, it generally is impossible to meet 

 the indication as to cause in cases of this kind ; but, in private prac- 

 tice, a physician, who is intrusted by his patients with a most intimate 

 knowledge of their private relations, is often able to exert the most 

 happy influence in this variety of hysteria. It is impossible to lay 

 down any general rules of procedure. When the disease depends 

 upon impoverishment of the blood and upon chlorosis, the indication as 

 to cause requires that we should endeavor to improve the state of the 

 blood by the exhibition of iron and an appropriate diet. By means 

 of such treatment our object is soon effected, and the hysteria disap- 

 pears as the red cheeks return, without it having been necessary for 

 us to have recourse to antihysteric remedies. Hysteria which is trace- 

 able to anaemia is perhaps the most satisfactory of all forms of the 

 disease to treat. 



The indications as to the disease demand that we shall attempt to 

 allay the nutritive derangement of the nervous system upon which the 

 hysterical phenomena depend. We must not expect to effect a final 

 cure of an hysteria by the mere healing of an erosion upon the os uteri, 

 although this may have been the original cause of the malady. It may 

 happen, but is by no means the rule. The proper means for attaining 



