EPILEPTIC CONVULSION.—There will, as a rule, be little difficulty in distin guishing between an epileptic and an hysterical convulsion, especially if the physician is fortunate enough to witness the seizure. If this is impossible the presence of an educated nurse, especially trained for this purpose, is absolutely necessary for information on which to base a diagnosis. Points in the diag nosis will be found in this article in con nection with the description of the hys terical convulsion. Almost the reverse of these conditions obtain in an epileptic fit.
is not infrequently nec essary to differentiate between an hyster ical and a feigned convulsion. This is not difficult unless the malingerer is familiar with the stigmata and paroxys mal symptoms of hysteria. The latter, like dementia, is a most difficult condi tion for the ignorant to feign. If the malingerer should be a physician or a clever trained nurse the differential diag nosis might be most difficult, and some times, perhaps, impossible.
Etiology.—Can a person who is not the subject of a vitiated inheritance de velop hysteria on being subjected, for a prolonged period, to some of the well known causes of hysteria? Or, to put it differently, is the only predisposing cause to hysteria heredity? Such a con clusion has been reached by some alien ists in regard to the predisposition to in sanity. So few are born with a nervous system free from hereditary taint of some kind that it is very difficult to answer the query here propounded. Per sonally, I can see no reason why such exciting causes of hysteria as trauma, toxmmia, shock, and certain chronic dis eases may not so exhaust and disarrange the nervous apparatus that it will be come almost, if not quite, as weak and unstable as that which may be inherited from an unhealthy ancestry. Probably the predisposition to hysteria when ac quired is less typical than when in herited.
HEREDITY.—Herman B. Sheffield is almost alone in attributing slight influ ence to heredity in the causation of hys teria. It does seem, especially to those
who have given the subject of heredity much careful study and who have ob served the offspring of unhealthy ances try, that it is impossible to belittle the direct and indirect influences of heredity as a predisposing cause of hysteria. It is probable that the children of hysterical parents would not themselves become hysterical could they be excluded from all the trying ordeals of life. Such chil dren, however, have weakened, irritable, and unstable nervous organizations, and even the little home annoyances, from which no one is free, are often sufficient to give rise to an attack of hysteria. Briquet found in a study of 351 hyster ical subjects that a neurotic element ex isted in about 25 per cent. of the rela tives, and in healthy, non-hysterical women it was traced in only 2 per cent. As a rule, the earlier in life that hysteria develops, the greater the neu rotic element in the relatives. Any in fluence in the ancestry that vitiates the nervous organization may lead to a de generative taint in the children. Insan ity, epilepsy, alcoholism, syphilis, injur ies to the head, etc., in the parents, may indirectly predispose the children to hysteria. Fully-developed hysteria, of course, is never inherited, but a predis position to it, a soil favorable for its de velopment, well marked or slight, is prob ably almost universal in children of hys terical parents, and commonly exists in those who are born with weakened nerv ous organizations. While most women and many men have nervous organiza tions favorable for the development of hysteria if they are subjected to exciting causes sufficiently strong, yet they re tain ample resisting power to cope with all the ordinary trials of life to enable them to prevent manifesting the disease. I have met many strong men who ad mitted that they felt hysterical, although I could detect no symptoms of the dis ease.