HYSTERIA.
The prophylaxis of hysteria is an important problem, the solution of which becomes imperative when the mother of neurotic children is deeply tainted herself with the neurosis. As it is usually impossible to prevent the patient speaking of her ailment in the presence of her children or of dealing in a rational manner with any neurotic symptoms which may appear in them, the question of separation becomes an important one. It is easier to send the female children to a school at a distance than to remove the parent for a prolonged sojourn in a nursing home.
The elements of preventive treatment suitable to a neurotic child are essentially the same as those indicated for the cure of the hysterical condition in older patients.
As soon as any hysterical manifestation shows itself the general health of the patient should be carefully looked into. Her diet should be liberal and administered with frequency and regularity. Active open-air exercise should be insisted upon, even to the extent of producing slight fatigue. Regular hours for rest are essential. Everything which over stimulates the hypersensitive cerebral centres is to be avoided, as is also every excitement of the emotions or passions. Healthy and constant mental occupation should be advised, with avoidance of the evils atten dant upon social dissipations, with their late hours and unnatural excite ments. Few things are so detrimental to precocious neurotic children as the modern institution of juvenile at-homes and late dancing parties. Sound, wholesome literature instead of the maudlin, sentimental trash of cheap novels, should he supplied as food for the mind, care being taken that the patient be nut permitted to tax the memory or perceptive faculties too severely. Recreations or exercises, as sketching, painting or music, are certainly to he preferred to mechanical needlework or lace-making, which permits of too much introspection and moping. Sea bathing and the morning cold bath when admissible arc valuable adjuncts; the patient should be strongly advised to retire early to bed and to persist in early rising, and take some mild form of exercise before breakfast.
Errors in digestion or assimilation require to be remedied. Anaemia calls for iron; menstrnal disorders, constipation and all sources of peri pheral irritation as errors of refraction, adenoids, &c., should be dealt %%ith on approved principles.
The main element in the treatment of hysteria must be moral or suggestive, and directed to the strengthening of the inhibitory power of the conscious self and the educating of the subconscious self as in the preventive treatment of insanity. Though the neurosis is not to be
regarded as a form of insanity, the mental state of the patient demands the most careful hygienic management. As in many forms of insanity home treatment is usually unsuccessful, so in hysteria the best results are only obtainable in confirmed cases by removal to a good nursing in which complete isolation from her friends is rigidly carried out.
In the early stages of hysteria, before isolation is pronounced to be necessary, an attempt may be made to treat the patient at home if her relations possess sufficient tact and firmness to carry out moral treat ment alone or with the assistance of a skilled nurse. The physician should take her relatives into his confidence, and make it clear beyond the possibility of being misunderstood how her case stands. This is generally only half attempted, and her friends too often interpret the physician's remarks as meaning that the patient is either malingering or labouring under some delusions or fancies. Consequently their management of her, with this erroneous impression, is fraught with disaster. The co-operation of a strong-minded, judicious relative, possessing tact and firmness, though not devoid of sympathy, but capable of suppressing sympathetic manifestations, is of infinitely more value than drugs. The influence of such a mind operating upon the victim of hysteria can be guided by the physician in such a way as to strengthen the patient's will-power and enable her to successfully combat the ten dency to yield to displays of emotional disturbances. Lecturing or scolding the patient continually is to be condemned, and ridicule is most injurious. Each case must be managed as the judgment or tact of the physician directs. Sometimes the influence of the strong will of the physician may accomplish results which appear as almost miraculous, but these ran only be obtained after he has entirely gained the complete confidence of the patient by a comprehensive study of her vafious symp toms, and convinced her that there is no mystery in her ailment and that recovery is certain if implicit obedience to instructions is maintained. Manifestations of sympathy and the attachment of undue importance to individual symptoms are as fatal to successful treatment as is the ignoring of these altogether by the physician—extremes which the well balanced medical mind always avoids.