These patients need special treatment in spe cial hospitals. In ordinary military hospitals, surrounded by sufferers from actual physical conditions, they are the subject of unfavorabk suggestion and little incentive Ito get welt They must not be kept under circumstances. either at home or in hospital, where much sym pathy is afforded them and their stories must not be listened to sympathetically, for they have the tendency of all neurotics to assimilate as their own, experiences gleaned from various sources. The first requisite of successful treat ment is a careful examination which determines absolutely that no organic morbid condition is present. Then the patient must be given the feeling that his case is of no special signifi cane, but, on the contrary, is well understood and above all, has nothing exceptional in it. He must be made to understand that just as soon as the attending physician has the time to give to him, he will be able to remove his symp toms without delay. Three principles are in sisted on in the methods of treatment. (1) suggestion, (2) re-education, (3) discipline. The aim of suggestion is to make the patient believe firmly that he will be cured and then after treatment that he is cured to stay so. Re education overcomes the bad habit of lack of confidence that has been formed and discipline breaks down the psychic-resistance of the pa tient to the idea of recovery. For such symp toms as mutism or deafness, the patient is told that electricity will cure him and that as soon as he feels the •current when the electrode is applied, his power of speech or hearing will be restored pan passu, with sensation. The same method is used for blindness and other sensory symptoms. Paralyses are favorably affected the same way, though tremors are harder to deal with. A cure in a single treatment is the best method, for the patient readily relapses un less he has been made to feel that he has re covered his powers completely and that it would be his own fault to permit his symptoms to recur. The cases partake of the nature of hysteria, though typical hysterical symptoms, crying, the making of curious noises, hysterical convulsions, are rarely seen at the front. The experience has made it clear that rest is nearly always an abuse in the treatment of such cases and inveteratcs the symptoms. The physical condition must be improved but the state of mind must be changed completely at once, if cure is to be effected.
A very interesting development of the treat ment of these affections among the French, who had large experience, requiring over 20,000 places in their hospitals for the cases, was with regard to the value of severe discipline. In re fractory cases, patients were put in solitary confinement without reading or writing mate rials or tobacco. This changed the mental atti tude and helped to make counter-suggestion ef fective. In certain cases, strong Faradic cur rents were used which caused severe pain, so that patients who were mute had to scream out and those who could not use muscles were com pelled to move them. Once it became known that treatment of this kind was being used, symptoms were much less persistent. The rea son why the neuroses in officers were more dif ficult of treatment was that these measures were seldom employed on them. It became clear that the infliction of pain on a neurotic patient up to the point where he yields up his pathological suggestion is effective therapeu tics. Some older severe methods of dealing
with these cases which were condemned in our milder day are now justified by war discipline.
The surgical feature for which this war will he noted is the definite reconstruction work for the wounded which has been organized for the first time in history. Not only have artificial limbs and helpful apparatus of various kinds been provided, but the crippled have also been trained to do the work they are particularly suited for in their maimed condition. It has been found that some 95 per cent of those who lose an arm or hand can go back to their old occupations, while a very large proportion of those who have lost a leg can be trained to bench trades or given clerical or similar occupa tions which will make them thoroughly inde pendent of assistance. Even with the loss of both legs, a man can be self-supporting. In deed, the care exercised in training the crippled has resulted in a great many cases in giving them a better occupation in life than they had before. The temper of this aid has been such as to give men a hearty spirit of courage in facing life, so that they do not feel their han dicap as an incubus, but on the contrary, are ready to do their bit in civil life as well as they did in war. The idea that they are crippled is not allowed to overcome them and the old cus tom of having begging cripples after the war is not to be allowed. Even the blind and the deaf are made self-supporting and at the same time given such occupation of mind as keeps them from being depressed. The effect of example on the part of some of the more cour ageous has proved a wonderful stimulus, so that though the war is to leave many maimed men, it is not going to create many helpless and the spirit of helpfulness does not provide use less sympathy and paralyzing charity, butjust such encouragement as enables the men to help themselves.
Chronic affections of various kinds whia have developed as a consequence of the war are being treated by the same far-seeing after treatment that is given to the maimed. In a word, the soldier taken in health is either dis missed, after thorough examination, in as good health as before,— or usually much better,— or else he is given the advantage of scientific thoughtfulness and pre-vision in regard to his case, so as to restore him just as far as pos sible to his former usefulness as a member of the community.
Bibliography.—
jAmes J. WALSH, M.D., Author of 'The Thirteenth Greatest of Centu ries.)