We shall adopt Bruns' suggestion and subdivide methods of treat ment employed in the hysteria of children into two groups; one method consists in taking the child by surprise, the other may be called the method of intentional neglect, or ignoring the child. Each of these methods has its special indications. The first is particularly effective in all cases of paralysis and contractures, in aphonia, deaf-mutism, etc.; the other is more appropriate for irritative conditions, especially those which occur paroxysmally- as spasms, delirium, somnambulism and the like.
When the plan of "taking the child unawares" is to be employed, the hysterical symptom is attacked directly-, either undisguisedly as we have just shown in the example of astasia-abasia, or under the guise of some physical method of treatment (with the faradic brush, the cold douche, by forcible extension of a contracted joint) and if possible removed at a single sitting. If this proves successful, the result is usually permanent; if not, or if the success is only partial, "the child may recover from its first surprise and astonishment at the doctor's actions and the rapid results affected," and what remains of the symptom as a rule becomes firmly rooted and can no longer be influenced by this method of treatment.
The second method, that of intentional neglect, which, as has been stated, is chiefly to be recommended in paroxysmal forms of hysteria, must then be resorted to. This method obviously requires so much more time, so much intelligent coiiperation on the part of the parents, and so much judgment to determine whether and to what extent it is necessary to take any notice of the morbid symptom, that it can rarely be carried out successfully at home and usually necessitates removing the child to an institution. The object of the method is to convince the child of the harmlessness of its disease by paying no attention to its spasms and other symptoms. It is the direct opposite to what the child is accustomed to receive at home, surrounded by the overanxious care of its excited and exciting parents. "If the symptoms no lo»ger attract attention, says Bruns, they gradually die of ennui; the child forgets them, so to speak, altogether." Whether the symptoms are to be ignored altogether or intentional neglect is to be combined with secondary- meth ods, such as hydrotherapeutic procedures, douches, wct packs and the like or by faradization, must be determined in the individual case by the physician's practical experience.
Isolation—not solitary confinement but removal from the accus tomed surroundings—is another important procedure. Isolation is often necessary not only for the proper carrying out of other methods of treatment but because it has a curative effect in itself by feeding the child's imagination with new, healthy impressions and neutralizing the injurious influence of the environment in which the hysteria developed. The greatest resistance is, as a rule, encountered on the part of the parents when the physician proposes isolation. Incapable of realizing that they have unconsciously injured their child, they are convinced that it will only be made worse by homesickness and the grief of isolation, and are therefor ready to make any sacrifice rather than consent to separation. As the mere dread of a prospective isolation often has a wholesome sug gestive influence on the ehild, it is not wise to propose isolation as the only means of salvation; but the physician should recommend it as early £1S possible before he has destroyed all chances of recovery by the failure of innumerable therapeutic experiments, not only on his own account but also on account of every other physician who may be called in after him and inay be under the additional disadvantage of being a stranger to the child. Once the physician has decided to insist upon isolation he should, as a rule, avoid entering into a prolonged and fruit less discussion of the advantages of the plan with the parents, but, as Bruns points out, simply take his stand on his experience as a physician.
A.side from the above-mentioned advantages, treatment in an institution has the additional adviintage that all unpleasant methods of treatment, hydrotherapeutic procedures and painful faradization, which arc often extremely useful, can be carried out much more easily than in the presence of the excited and anxious parents. In regard to these measures, however, we must insist that cruelty is neither necessary nor justifiable, and that the pain-inflicting treatment must never lay aside its mask and never be allowed to appear to the child as a simple punishment. If the child sees in the physician its enemy and tormentor, all suggestive influence is lost.