Attention called to the comparative frequency with which hysterical symp toms are superimposed upon cases of or ganic disease of the nervous system. In these cases there is often a neuropathic ancestry, which may be considered the predisposing, as the disease itself is the determining, cause of the neurosis. C. H. Hughes (Jour. Amer. Med. Assoc., Sept. 17, '92).
Direct heredity is frequent in hysteria, and, according to Briquet, half the hys terical mothers give birth to hysterical children. Liability to convulsions is one of the nervous manifestations most fre quently transmitted to offspring (Eke). Silvio Ciarroeca (Dior. Inter. delle Scienze "Med.; Can. Bract., July, '98).
AGE.—Hysteria is most common be tween the tenth and twentieth years of life. In nearly one-half the cases the disease first manifests itself during the second decade of life. The disease rarely begins after the fortieth year and is in frequent before the seventh. Of the 92 cases reported in America occurring be fore the fifteenth year, one child was 1 V, years old; one 2 years; three 3 years; and four 4 years.
Two epidemics of hysteria observed in Moscow. One occurred in a school for girls (aged 10 to 1:11. as many as 18 out of 21 being consecutively attacked. The other case was observed in a lace-factory where a number of young girls, aged from 19 to 20, were engaged. Shataloff (Wratsch, No. 9, '91).
Hysterical angina occurs more fre quently in women under forty, tends to periodicity, to become nocturnal, and the attacks are induced by violent emotion.
II. T. Patrick (N. V. Med. Jour., Feb. 22, '96).
Hysteria exists in children at all ages.
Eight of the eighteen cases observed were below four years of age, and as many of them were boys as girls. It is as frequent in children as in adults. M. Terrien (Archives de Neurol., p. 299, Oct., '97).
During childhood the discrepancy be tween the sexes in regard to the relative frequency of the disease is less marked than later in life. Of the 92 cases occur ring in children, analyzed by Sheffield, 61 were found in the female and 31 in the male, a proportion of two to one in favor of the female. In adults the dis ease is ten or fifteen times more frequent in the female than in the male.
Twenty-two cases of male hysteria seen in the course of four years in a ward of thirty-eight beds. Most of these patients were robust, vigorous men, quite able to follow their occupations. Bitot (Jour. de Med. at de Chin Prat., Jan. 10, '91).
In the male hysteria usually presents itself iu one of the milder forms, and such manifestations as the contractions, the vomiting, and the hystero-epilepsy rarely occur. N. P. Dandridge (Boston Med. and Surg. Jour., Sept. 19, '95).
RACE.—Hysteria is found among all races; even the savage does not escape altogether, but to a much greater extent than the civilized. The negro in Amer
ica is frequently the subject of the dis ease. The Jews, especially the Russian Jews, in proportion to their limited pop ulation, give the largest number of cases. Among the Latin races, of our popula tion is found more hysteria relatively than is met with in the native-born. The disease is apparently more frequent in the mild and warmer climates than in the cold.
—Persons who are exceed ingly nervous, impressionable, and pre disposed to hysteria are probably more likely to develop the disease on coming to a high altitude than at sea-level. Like chorea, hysteria is probably most fre quent during spring and fall. The con ditions inseparable from civilization, es pecially worry, overwork, and excitement favor the development of hysteria. We meet with cases of habit- or imitation hysteria just as we see cases of "habit chorea." Defective education and vicious home-influences, especially as seen with hysterical mothers and oversympathetic friends, are potent causes of hysteria among weakly children and emotional young women.
—The influence of trauma tism in the causation of hysteria has re ceived a great deal of attention from the neurologists during the past fifteen years, and, I think, deservedly so. The cases have formed a group by themselves, and have received the names: "traumatic neurosis," "traumatic psychoneurosis," and "traumatic neurasthenia." They are apparently cases of pure hysteria, and the name "traumatic hysteria," proposed by James Hendrie Lloyd, is probably the best we have. Cases of hysteria from traumatism are frequently the subjects of litigation. It may occur in its most persistent form from apparently slight injuries, and is often found in persons who have no claims for damages. Hys teria from traumatism often persists for years, and sometimes for life. The par oxysmal symptoms are frequently well marked, and those that may persist for an indefinite time arc spinal hyperms thesia, hemianmsthesia, local paralysis, tremor, contraction of the visual fields, headache, nervousness, and exhaustion. These cases may be distinguished from feigned disease by the presence of the stigmata of hysteria. Traumatic hys teria is by no means limited to the female Various neuroses may originate from accidents of all kinds, and frequently in consequence of very slight traumatisms in which the psychical element is the main factor. In most cases the phenom ena can readily be placed under the head of hysteria. Very frequently hysteria is mixed with neurasthenic symptoms, or the latter alone present. Dubois (Corres. f. Schweizer Aerzte, Sept. 15, '91).