Prognosis.—The disease is rarely dan gerous to the life of the patient, yet it must be borne in mind that a person may become so exhausted that death takes place in spite of the efforts made to improve nutrition. Gowers mentions one case of death from spasm of the larynx. The prognosis of severe hysteria in childhood is not as good as some writers seem inclined to believe. Chil dren so afflicted not infrequently become chronic hysterical subjects as they grow to years of maturity. The mental de velopment is often deficient in such chil dren. The lighter forms of hysteria, both in children and adults, usually re cover comparatively rapidly if judicious treatment is instituted. The inherited nervous or hysterical temperaments, and sometimes the acquired predisposition, also continue through life. The natural tendency of all cases of hysteria is to chronicity. In nearly all the milder cases, and in the vast majority of the severer ones, the symptoms, including the stigmata and the paroxysms, disap pear entirely under favorable circum stances, but relapses are common if the patients are subsequently subjected to trying ordeals. Cases which show evi dences of beginning mental degeneration are practically hopeless. Traumatic hys teria may last for years, or even a life time. Spontaneous cure rarely occurs in the male, although hysteria in the male subject is usually curable. It seems to be the experiences of most physicians that hysteria in the female, associated with chronic pelvic troubles, is very ob stinate, and often rebellious to treat ment. Paralysis, contracture, or aims thesia may persist for a long time and finally disappear rapidly or even sud denly.
A fatal termination may sometimes re sult from the different effects of hysteria, and death may be due to spasm of the glottis so severe as to require trache otomy. Sudden death may occur after hysterical vomiting,—in one such case no lesion of any kind being found on post-mortem examination. Fournier and
Sollier (Jour. de Med., Aug. 25, '96).
Treatment. —PREVENTION is of great importance. If more attention were paid to it during childhood and early youth there would be fewer cases of hysteria, both in children and adults. Vitiated states of the nervous system in parents and their ancestors may give to the off spring weak, irritable, and unstable nerv ous organization. The associations and environments of such children, fre quently consisting of hysterical manifes tations in the parents or other relatives, undue parental anxiety and sympathy, lack of self-control, vicious habits and methods of education, may suggest trains of thoughts and actions to the children that will sooner or later lead to the de velopment of hysteria in them. When practicable, oversympathetic and over anxious parents should delegate the early education and care of their children to suitable nurses or attendants. Separa tion of the children from such parents and other relatives is followed by good results if tutors and companions are se lected with judgment, so that the train ing is in the right direction. While the mental training, which is the more im portant, should be carefully looked after and continued for years, the physical should not be neglected. Open-air life and exercise should be insisted upon as much as possible; cool or cold baths ought to be given night and morning, followed by brisk rubbing of the skin by means of a coarse towel; the diet should be nutritious and easy of digestion, and most of the sweetmeats excluded; regu lar and systematic habits as to eating, sleeping, exercise, and study should be rigorously maintained; and any disorder of the health should be corrected as soon as possible.