DISSEMINATED SOLEROSIS.—Buzzard says: "Multiple sclerosis, like hysteria, is common in women at puberty; a his tory of some moral shock often precedes both; there are few cases of multiple sclerosis in which there are not hyster ical symptoms added; and many symp toms of the former have long been looked upon as hysterical." The same writer states that the plantar reflexes are usu ally well marked in multiple sclerosis, and feeble or absent in hysteria. Paraly sis is usually sudden in its onset, and more complete and flaccid in the latter than in the former. When blindness occurs in one eye, it is generally com plete at first and comes on suddenly in hysteria, whereas in multiple sclerosis absolute blindness in one eye is rare. In the latter the acuity of vision lessens gradually with contraction of the visual fields, until the eye is almost useless; then vision improves in this eye and fails in its fellow. Atrophy of the optic nerve and nystagmus occur in multiple scle rosis, but are probably never of hysterical origin. The tremor of multiple sclerosis may be simulated by an irregular tremor occurring on voluntary movement in hysteria, but in the latter the excursions are usually less; there are a tardiness of the initial muscular effort and a con traction of the antagonistic muscles. Gowers lays considerable stress upon the diagnostic importance of the presence of the last symptom. The hysterical pa tient affected with tremor will often touch a small object with the index fin ger without much difficulty, but after the finger has remained a few seconds in contact with the object the arm be comes affected with an irregular or jerky tremor, differing from the tremor of dis seminated sclerosis, in which great effort is frequently required in bringing the finger in contact with an object, but as soon as this has been accomplished the tremor ceases.
Cases of CEREBRAL SYPHILIS fre quently present hysterical symptoms. If the symptoms are typical of the latter, and there is no positive evidence of or ganic intracranial lesion, the true nature of the malady can only be suspected from the history of infection or from the evi dences of syphilis in other portions of the body.
most cases of hysteria that I have met there has been an exag geration of some symptoms, and in not a few some have been intentionally or unintentionally feigned. It is a com paratively easy matter to distinguish be tween a case of simple feigning and hys teria. Given a case of traumatic hysteria with the stigmata of the disease well marked, it is not always an easy matter to say just to what extent intentional feigning enters into the symptoms.
INSANITY.—It is a mistake to class symptoms of monomania, such as claus trophobia, mysophobia, etc., among those of hysteria.