That any form of irritation in a patient predisposed to hysteria may act as an exciting cause in this affection has led Laségue to apply the term peripheral hysteria to certain cases. One of his cases was a girl fourteen years old, who, having suffered for a few hours with her eyes because of some sand thrown into one of them by a playmate, awoke the next morning with a spasm of the eyelid on that side, which rendered it impossible for her to open that eye; and it remained closed during four months. He considered that the irritation produced by the sand was not the immediate cause of the spasm, but that its long duration was an hysterical phenomenon. The patient afterward became the subject of hysterical manifestations. In another complete hysterical aphonia came on after a slight bronchitis. Another, after an attack of indigestion, refused to touch either food or drink for twenty-four hours, and later was troubled with regurgitation from constriction of the pharynx or œsophagus which lasted for some weeks. Anæmia and chlorosis are frequent exciting causes of hysteria in children, particularly in girls. Disorders of menstruation play a prominent part as exciting causes of {221} special hysterical manifestations. The period of the establishment of the menstrual function is one that is particularly fertile in the production of hysteria, much more so than acquired disorders of menstruation occurring later. Menorrhagia, dysmenorrhœa, and certain local utero-vaginal disorders may act upon those predisposed to hysteria as exciting causes. These conditions themselves are, on the other hand, sometimes caused by nervous, hysterical states in the individual. With reference to the very common assertions that continence on the one hand, and sexual over-indulgence on the other, are the most prolific causes of hysteria, the true stand to take is that neither of these positions is philosophically correct; for, as Briquet has shown, nuns on the one hand and prostitutes on the other are frequent victims of this protean disorder. As affirmed by Jolly, sexual over-irritation, particularly that induced by onanism, more frequently causes hysteria than sexual abstinence or deprivation. The occurrence of hysteria and hysterical choreas among pregnant women has long been recognized. Scanzoni, quoted by Jolly,[46] states that of 217 patients whom he had treated, 165, or 76 per cent. had been puerperal, and that of the latter not less than 65 per cent. had borne children more than three times. Cases of grave hysteria or hystero-epilepsy have been aggravated by pregnancy and have led to premature labor. [Footnote 46: _Op. cit._]