Overfeeding is the third factor in the treatment. Milk alone should be given for the first ten days, at frequent intervals, and gradually in creased as massage is commenced, until enormous quantities arc con sumed. After three or four days sometimes 6 or 8 pints are swallowed daily. Strong beef tea, chicken soup, meat jellies, tea, coffee, chops, fish, steaks, poultry, eggs, bread and butter, oysters, oatmeal porridge, vegetables of all kinds, puddings, and any form of plain, wholesome, digestible food may be administered in very large quantities.
Massage is an important part of the treatment. It should he com menced upon the third day and be carried out in the most thorough manner, gradually extending the operation till an hour's good deep kneading of the muscles and tissues of the body can he borne by the patient. In bad cases two applications lasting for three-quarters of an hour each, morning and evening, may be required. At the beginning it is well to confine the operations to the extremities. and the movements should be limited to the superficial structures. Afterwards the deeper tissues and muscles may he kneaded till in a few days the entire body. excepting the head and fare, receives a fair share of manipulation.
In this way the blood and lymph circulations are greatly stimulated, effete products are washed away, waste materials removed, and fresh pabulum brought with great rapidity to the refreshed tissues. The increased amount of nourishment is thus used up to the greatest advan tage, and the patient's body weight increases to an astonishing extent. Wasted muscles and emaciated limbs become plump and agile, and the change in the patient's aspect and dimensions is such in TO or 12 weeks' treatment as to tax the credulity of those who had not previously wit nessed the success of the treatment.
Hydropathy is now usually added to the other elements of the Weir Mitchell treatment; it may be commenced with cold sponging after each massage seance. the warm, tepid and finally the cold bath being in dulged in every day after the third week of treatment. Pouches and cold sprays to the spine may follow the warm or tepid bath advan tageously, and the needle bath is often very valuable when spasmodic seizures are threatening.
Electricity is the last element in the Weir Mitchell plan of treating hysteria. The uses of electricity will be more fully mentioned under the head of the treatment of the local manifestations in the following pages. When used as a factor in this method it is employed as an ad
junct to massage. The interrupted strong current is selected, and the various muscles or groups of muscles are thrown into contractions. The moral effect produced upon the patient by demonstrating that the muscles which she believed to be permanently paralysed are still capable of active movement should be further strengthened by suggestion on the part of the physician, whose way is thus opened up to the successful persuasion of the invalid to exercise her feeble will upon the muscles. Each attempt at voluntary movement may be assisted by the electrode if this is applied at the psychological moment.
After the conclusion of the Weir Mitchell course it is a good plan to insist upon the patient having a change to a seaside resort before return ing to her home.
Of late years hypnotism has been employed in the treatment of hysteria, but the physician will be wise who leaves the use of this remedy to those few who have made a study of it. Consciously or unconsciously he is successfully employing suggestion all through the treatment every time he assures the patient that she is certain to get well and every time that he confidently states that the remedies, medicinal, dietetic, &c., are certain to do good.
It is this element of suggestion which adds therapeutic value to many drugs from time to time prescribed for the disease, and which cannot conceivably act in any other way. Thus the hypodermic administration of a little saline solution is often followed by astonishing results, and Lutton and Crocq were led to state that in the allied neurasthenic con dition 75 mins. injected every month enabled weakened and invalided patients to develop energy sufficient to fit them for earning a living. The injection of brain matter, cardin and other organic products acts similarly.
Special symptoms will require individual treatment, thus— The most serious condition which the physician can be called to treat is that in which the line between hysteria and insanity has been already crossed by the patient; Weir Mitchell treatment as ordinarily carried out in a nursing home is not suitable in such cases, and the only resource left is to send the sufferer to a properly equipped asylum.