344 THE TREATMENT OF DISEASES. 



case of true hysteria, but a combination of hysteria and epilepsy. These mixed 

 cases are not common, but they are occasionally met with. In the majority of 

 instances the attack is less severe than we have described. Although these fits 

 constitute the most characteristic feature of hysteria, they are by no means essential 

 to its existence. Many people are distinctly hysterical, but never have a fit 

 of hysterics. "We often meet with young women who, from their hysterical 

 tendencies, are a source of constant anxiety to their friends, but who, nevertheless, 

 never have any definite outbreak. 



For the better understanding of that condition which we call hysteria, it will be 

 convenient to consider in detail the circumstances that favour its production. 

 It occurs almost exclusively in the female sex, but still we meet with it every now 

 and then both in men and boys. Thus the case is recorded of a young doctor who 

 was distinctly hysterical. He was exceedingly attentive to his own sensations, and 

 fancied that he laboured under a number of diseases that had no existence but in 

 his own imagination; he showed great uneasiness and infirmity of purpose; was 

 what is called " very nervous," and had occasional outbursts of choking tears and 

 laughter, exactly resembling those so frequently met with in the other sex. In 

 women hysteria generally makes its appearance about the age of sixteen, or from 

 that to twenty. When once established it may last for years in fact, for a life-time. 

 When it occurs in men, it generally begins later about the age of forty. In them 

 it is usually the result of over-work or excessive worry and anxiety, and that is 

 about the age at which these begin to tell There is often considerable deterioration 

 of health, an impaired nutrition, and a feeble circulation, with exhausted brain. 

 Hysteria occurs in all conditions of life, but it is more frequently met with in the 

 unmarried than in the married, although it is by no means confined to the former. 

 It was at one time thought that this preponderance of hysteria in single women 

 showed that it was in some way connected with the womb, but this idea is now 

 pretty well exploded. Its more frequent occurrence in single women is probably 

 rather the result of their social surroundings. A woman, if not married, has, as a 

 rule, very little to do at all events, in the middle and upper classes of society. She 

 has no housekeeping to attend to, no children to look after, nothing, in fact, to 

 occupy her mind and rouse her out of herself, and this condition is pre-eminently 

 favourable to the development of hysteria. On the other hand, a wife with a family 

 lias a good deal to occupy her attention, in fact, she is more likely to be over-worked 

 than not ; she has to think of other people besides herself, and an attack of hysteria 

 finds no place in the routine of her daily duties. An active employment and hysteria 

 seem almost to be antagonistic. Many women who are hysterical exhibit some disr 

 turbance of the menstrual function, but then, on the other hand, many women are 

 irregular in this respect without exhibiting any tendency to hysteria, so that these 

 two conditions obviously do not of necessity stand in the relation of cause and effect. 

 There is no evidence to show that hysteria is hereditary, and this is no more than 

 we should expect considering that it occurs with the greatest frequency in the 

 unmarried. The determining cause of an outburst of hysterics is usually some 

 mental or moral disturbance, often enough some trivial circumstance, which, taking 

 the individual by surprise, overcomes her power of self-restraint. 



