[Footnote 35: _Studies on Functional Nervous Disorders_.] Gout in England plays a greater part in the production of nervous and other disorders than in this country, but even here its instrumentality is too often overlooked. In Philadelphia are many families, some of them of English origin, in which gout has occurred, sometimes of the regular type, but oftener of anomalous forms. Among the most striking examples of hysteria that have fallen under my observation, some have been in these families. In a few of them remedies directed to the lithæmic or gouty conditions in connection with other measures have been efficient. More frequently they have failed, for while a relation may exist between the neurotic disorder and the diathesis, it is not the diathesis, but the neurotic disorder, which we are called upon to treat. That a certain mental constitution predisposes to hysteria cannot be doubted. Ribot[36] describes, chiefly from Huchard,[37] the hysterical constitution. It is a state in which volition is nearly always lacking. The prominent trait is mobility. The hysterical pass with increditable rapidity from joy to sadness, from laughter to tears; they are changeable, freakish, or capricious; they have fits of sobbing or outbursts of laughter. Ch. Richét compares them to children, who oftentimes can be made to laugh heartily while their cheeks are still wet with tears. Sydenham says of them that inconstancy is their most common trait: their sensibilities are aroused by the most trivial cause, while profounder emotions scarcely touch them. They are in a condition of moral ataxy, lacking equilibrium between the higher and lower faculties. [Footnote 36: _Diseases of the Will_.] [Footnote 37: Axenfeld et Huchard, _Traité des Neuroses_, 2d ed., 1883, pp. 958-971.] As to sex, it is almost unnecessary to say that hysteria occurs with greater frequency among females than males; and yet it is all important to emphasize the fact that it is not exclusively a disease of the former sex. Some statistics on this subject have been collected. In Briquet's often-quoted 1000 cases of hysteria, 50 only occurred in men. I believe, however, that the proportion of hysterical men to hysterical women is greater than this. Instead of a ratio of 1 to 20, as these statistics would indicate, 1 to 15 would probably be nearer the truth. Statistics upon this subject are deceptive. The occurrence of hysteria in the male was little discussed before the publication of Briquet's great work, but since that time it has received {216} great attention from the medical profession. Charcot[38] in some recent lectures at Salpêtrière has called attention to this subject. From 1875 to 1885 he says that five doctoral theses have been written on hysteria in men. Batault has collected 218 and Klein 80 cases. The _Index Catalogue_ contains 102 references to hysteria in the male. [Footnote 38: _Le Progrès médical_, 1885.]