The definition given asserts that hysteria is a functional disease. In the present state of knowledge this is the only ground that can be taken. It is claimed that in a strict sense no disease can be regarded as functional; but it is practically necessary to use such terms as functional in reference to affections in which disordered action without recognizable permanent alteration of structure is present. Temporary anatomical changes must sometimes be present in hysteria; organic disease may be a complication in special cases; post-mortem appearances may {206} occasionally be found as accidents or coincidences; it is possible that structural alterations may result from hysteria; but no pathologist has as yet shown the existence of a special morbid anatomy underlying as a permanent basis the hysterical condition. The mental, motor, sensory, and other phenomena of hysteria cannot be explained except by regarding the cerebro-spinal nervous system as the starting-point or active agency in their production. The term vaso-motor is used in a broad sense to include not only peripheral vascular disturbances, but also cardiac, respiratory, secretory, and excretory affections of varying type. Some of these disorders are also visceral, but under visceral affections are also included such hysterical phenomena as abdominal phantom tumors, hysterical tympanites, and the like. That all hysterical phenomena are related in varying degree to abnormal psychical conditions may perhaps, at first sight, be regarded as open to dispute and grave doubt. It is questionable whether in every case of hysteria the relation of the symptoms to psychical states could be easily demonstrated. I certainly do not look upon every hysterical patient as a case of insanity in the technical sense, but hold that a psychical element is or has been present, even when the manifestations of the disorder are pre-eminently physical. James Hendrie Lloyd,[2] in a valuable paper, has ably sustained this position, one which has been held by others, although seldom, if ever, so clearly defined as by this writer. [Footnote 2: “Hysteria: A Study in Psychology,” _Journal of Nervous and Mental Disease_, vol. x., No. 4, October, 1883.] The alleged uterine origin of hysteria has been entirely disregarded in the definition. This has been done intentionally. It is high time for the medical profession to throw off the thraldom of this ancient view. The truth is, as asserted by Chambers,[3] that hysteria “has no more to do with the organs of reproduction than with any other of the female body; and it is no truer to say that women are hysterical because they have wombs, than that men are gouty because they have beards.” [Footnote 3: _Brit. Med. Journ._, December 21, 1861, 651.]