Hysterical  Neuralgias.— Neuralgic  pains_are  common  in  hysteria,  but  a
distinction  must  be  drawn  between  those  which  are  merely  associated  with,
and  those  which  are  due  to,  the  general  neurosis.  Of  associated  forms,
every  variety  of  true  neuralgia  may  be  met  with,  due  to  the  neuropathic  dis-
position, which  is  also  the  cause  of  the  hysteria,  and  they  present  the  charac-
teristic distribution,  tender  points,  etc.,  of  the  ordinary  form.  Anaemic
neuralgias  are  also  common  in  hysterical  patients,  in  whom  the  nerve  dis-
turbance is  often  due  to  poorness  of  blood.  Of  the  neuralgic  pains  that  are
due  to  hysteria,  some  are  in  the  cerebro-spinal  system,  some  in  that  of  the
sympathetic.  Certain  local  pains  in  the  head  are  very  common,  but'  these
differ  from  ordinary  neuralgia  in  being  confined  to  one  small  spot,  instead  of
following  the  course  of  nerves,  and  the  local  pain  has  a  sharp  stabbing  or
boring  charactar,  as  if  a  nail  were  being  driven  in,  and  hence  has  received
the  name  of  "  clavus  hystericus."  It  is  important  to  remember  that  a  similar
pain  may  be  met  with  apart  from  hysteria,  especially  in  anasmic  persons.
Pains  in  the  spine  are  also  extremely  common,  sometimes  very  local,  and  of
various  characters.  Other  pains  referred  to  the  trunk  are  usually  associated
with  local  tenderness,  in  the  so-called  "hysterogenic  points."  The  most
important  neuralgias  of  hysteria  are  those  of  the  viscera,  ovarialgia  (not
necessarily  in  the  ovary  itself),  and  gastralgia,  being  the  most  frequent.
Pains  in  the  joints  and  muscles  are  also  common.  The  visceral  neuralgias,
and  those  associated  with  parietal  tenderness,  are  usually  persistent,  but  the
local  boring  pains,  and  those  in  the  joints  and  muscles,  are  often  fugacious
and  migratory,  and  this  cofistitutes  a  diagnostic  point  of  considerable
importance.
