The absence of occupation on the one hand, and, on the other, the necessity of following work for which the individual is unfitted, particularly irritating lines of work, predispose to the occurrence of hysteria. It may be caused, therefore, either by no work, overwork, or irritating work. As to the special occupations, hysteria would seem to result most commonly in those positions where physical fatigue combines with undue mental irritation to harass and reduce the nervous system. In men it occurs often as the result of overwork conjoined with financial embarrassment. It is met with not infrequently among teachers, particularly those who are engaged in the straining and overstraining labor of preparing children for examinations. A good method of education is the best preventive; a bad method is one of the most fruitful causes of the affection. The injurious effect of American school or college life in the production of hysteria is undoubted, and should be thoroughly appreciated. Our educational processes act both as predisposing and exciting causes of this disorder. Both in our private and public educational institutions the {219} conditions are frequently such as to lead to the production of hysteria or to confirm and intensify the hysterical temperament. In our large cities all physicians in considerable practice are called upon to treat hysterical girls and boys, the former more frequently, but the latter oftener than is commonly supposed. Hysteria in boys, indeed, does not always meet with recognition, from the fact that it is in boys. Cases of hysteria in girls under twelve years of age have come under my observation somewhat frequently. About or just succeeding examination-time these cases are largely multiplied. The hysteria under such circumstances may assume almost any phase; usually, however, we have not to deal in such patients with convulsive types of the disease. Clarke[41] has considered some of these questions in connection particularly with the physiological processes of menstruation, and its bearing upon the inability of girls to maintain equally with boys the stress of such competition. [Footnote 41: _Sex in Education, etc._, by Edward H. Clarke, M.D., Boston, 1873.]