Paralysis occurs in these cases; it is variable in distribution and may come on suddenly after a convulsive attack or without it; it may be flaccid or associated with contracture; it may come on slowly; it may be confined to one limb or be hemiplegic in type.
Hysterics are easily affected by pleasurable or painful impressions, and there is often a morbid craving for sympathy and attention. They may show moral perversion; may lie, steal, quarrel with and intrigue against their own family; may form and change attachments and dislikes without obvious reason; may mani fest aversions, as to frogs, spiders, mice, cats, etc.; may deceive for deception's sake or to excite wonder. Some are painfully depressed; they have forebodings or are compelled to do certain acts. Here the hysterical insanities are approached on the one hand and the imperative conceptions and neurasthenias on the other.
Hystero-epileptic attacks in their greatest severity are often preceded by general discom fort or by hallucinations of vision and hearing. Usually sudden, they may be preceded by an *aura,' globus hystericus, singing in the ear, etc. Breathing is spasmodic; consciousness is obscured; the convulsion may be similar to those of mild epilepsy. In some cases the body is thrown into all sorts of contortions. An ex treme opisthotonos may be present, the -body being bent backward, resting on the head and heels. Gestures and noises are made. Some times religious ideas have an influence over the attitudes assumed; at other times, ideas of de moniacal possession.
From milder forms, recovery is the rule. In graver cases, and when there is a strong neuro pathic tendency, the persons will probably pass from one hysterical manifestation to another.
In cases where there is deterioration of the physical health, tonics and nutritious diet should be given. Hydrotherapy improves nutrition and also the mental state. Many drugs have been recommended, but they are all uncertain in their action, at one time giving a result and failing at another: Convul sive attacks may at times be stopped by the cold douche to the spine. Isolation from the family circle is of the utmost importance in the treat ment of these cases. Every effort should be made to discover the psychic shock which has produced the attack. Only the patient may have knowledge of this and he will not often reveal it. There is no disease the treatment of which it is more difficult to describe. Suggestion therapy gives by far the best results, but the great difficulty is that good results are rarely permanent.
Bibliography.— Charcot, sur les maladies du systerne nerveux,) tome 3; Fox, of Hysteria' (Boston 1913); Freud, (Studien caber Hysteric' (Vienna 1909); (Selected Papers on Hysteria and Other Psychoneuroses' (New York 1912); Jolly, 'Hys teria'; Ziemssen, of Medicine); Seguin, Symptoms in Organic Dis Janet, 'Mental State of Hystericals) (1902) ; Richer, (Paralysis et contractures (Paris 1892).