DEVELOPED HYSTERIA.—As isolation is of the utmost importance in the treat ment of hysteria, considerable judgment and. skill are necessary in selecting those who are to form the companions of hys terical subjects. The nurse should be faithful, educated, and well trained, and have good sense, tact, patience, gentle ness, firmness, and diligence in her work. The patient is often compelled to be alone with her nurse for months, and if the latter is tactless and irritating the best-directed efforts of the most skillful physician will be defeated. The phy sician should be firm, but gentle, and the possessor of considerable personal mag netism. the physician can in spire the confidence and respect of his patient he should not undertake the treatment of a severe case of hysteria.
Influence of marriage upon hysterical women. Formerly it was thought that marriage exercised a beneficial effect upon hysteria, but at present the oppo site view prevails. A change in condi tion is sometimes productive of benefit, but, in the light of the modern idea that hysteria- is a psychosis, the new home of the hysterical woman after her marriage may be looked upon as a private asylum in which the hysterical patient may or may not be wisely treated. Meinert (Centralb. f. Gyniik., Nov. 4, '09).
The rest-cure of Weir Mitchell has many advantages in the treatment of hysteria. It gives an opportunity to separate the patient from parents and sympathetic relatives and friends; it enables the physician to carry out to the letter, without interference, special plans of treatment; and it affords an oppor tunity to inspire the patient with hope by the proper suggestions, without the latter being constantly counteracted by "Job's comforters." The rest-cure is not necessary for all cases of hysteria, but there are few that will not improve much more rapidly by isolation from relatives and friends than they will at home.
Many marked cases react well under the rest-cure when organic disease is absent. The treatment is as follows: The patient is placed in a private house (according to means), and best if away from home, the room being sunshiny and freely capable of ventilation. The nurse
should be, preferably, young, of agree able manner, and a stranger to the pa ment. She should be able to read aloud. the patient about symptoms or treat ment. She should be able to read aloud. Isolation is most impoftant, and the more distinctly hysterical the disease is, the more strict the isolation must be. "No letters are sent or received, no visi tors seen, and but three or four person; enter the room: the nurse, the physi cian, the masseuse, and the servant." In ordinary cases six to eight weeks of isolation are long enough, after which a single visitor may be allowed. Letters may then be received or written in the way of reward for good conduct. This long isolation is necessary to break up radically the habits of long invalidism. Rest, at first ill borne and irksome, is well borne after a week. At first feed ing should be done by the nurse, and the patient overfed. All voluntary movements should be forbidden, except sitting up for the bowels, etc. The cir culation and thinking are thus kept at a low level, and one result soon ob served is the improvement of the ability to sleep.
Diet: Milk in small quantities is given every three hours, skimmed, if ordinary milk is not tolerated. On the fifth day of treatment a chop or steak at midday is given. From the sixth day onward bread and butter and eggs are allowed. If milk is badly borne, broth and jellies will give satisfaction.
Massage: A separate masseuse is de sirable. Massage should begin on the third day with light massage lasting twenty minutes, and increasing daily to deep massage lasting one hour or more. If the patient is obese, long and deep massage is good. A second rubbing of the abdomen and spine by the nurse be fore sleep is helpful. At the end of the first week the patient will begin to put on weight, but if this goes up too fast, massage is not thorough enough and should be increased. Oil is not neces sary to aid massage.