the movement cure one object is to call out the suppressed will of the
patient. This is very applicable to cases of hysteria. The cure of
cases of this kind is often delayed by using massage alone, which is
absolutely passive. These movements are sometimes spoken of as active
and passive, or as single and duplicated. Active movements are those
more or less under the control of the individual making or taking part
in them, and they are performed under the advice or direction, and
sometimes with the assistance, of another. They proceed from within;
they are willed. Passive movements come from without; they are
performed on the patient and independently of her will. She is
subjected to pushings and pullings, to flexions and extensions, to
swingings and rotations, which she can neither help nor hinder. The
same movement may be active or passive according to circumstances. A
person's biceps may be exercised through the will, against the will,
or with reference to the will.
A single movement is one in which only a single individual is engaged;
speaking medically, single movements are those executed by the patient
under the direction of the physician or attendant; they are, of
course, active. Duplicated active movements require more than one for
their performance. In these the element of resistance plays an
important part. The operator with carefully-considered exertion
performs a movement which the patient is enjoined to resist, or the
latter undertakes a certain motion or series of motions which the
former, with measured force, resists. Still, tact and experience are
here of great value, in order that both direct effort and resistance
should be carefully regulated and properly modified to suit all the
requirements of the case. By changing the position of the patient or
the manner of operating on her from time to time any muscles or groups
of muscles may be brought into play. It is wonderful with what ease
even some of the smallest muscles can be exercised by an expert
manipulator.
The duplicated active movements are those which should be most
frequently performed or attempted in connection with massage in
hysterical patients. The very substance of this treatment is to call
out that which is wanting in hysteria—will-power. It is a coaxing,
insinuating treatment, and one which will enable the operator to gain
control of the patient in spite of herself. As the patient exerts her
power the operator should yield and allow the part to be moved.
Much of the value of massage and Swedish movements, in hysteria as in
other disorders, is self-evident. Acceleration of circulation,
increase of temperature, direct and reflex stimulation of nervous and
muscular action, the promotion of absorption by pressure,—these and
other results are readily understood. “The mode in which these
gymnastic proceedings exert an influence,” says Erb,[123] “consists,
no doubt, in occasioning frequently-repeated voluntary excitations of
the nerves and muscles, so that the act of conduction to the muscles
is gradually rendered {281} more facile, and ultimately the nutrition
of the nerves and muscles is augmented.”
[Footnote 123: _Ziemssen's Cyclopædia_.]
The objects to be attained by the use of electricity are nearly the
same as from massage and duplicated active movements: in the first
place, to improve the circulation and the condition of the muscles;
and in the second place, to make the patient use the muscles. The
faradic battery should be employed in these cases, and the patient
should be in a relaxed condition, preferably in bed. A method of
electrical treatment introduced some years ago by Beard and Rockwell
is known as general faradization. This is sometimes used in the office
of the physician. In this method the patient is placed in a chair with
his feet on a large plate covered with chamois-skin; the operator then
takes hold of the patient's hand and the other electrode is passed
over the muscles of the neck, back, trunk, and extremities.
When the patient is in bed, as in the regular rest treatment, this
method has to be modified, and then the best treatment is by direct
muscular faradization. Two sponge electrodes are employed. The sponges
are moistened, so that the current may pass through the skin and reach
the muscles. Both electrodes are taken in one hand, the handle of one,
pointing backward, being between the first and second fingers, while
the handle of the other is between the third and fourth fingers. In
this way the distance between the points of application can be readily
altered. The current is then applied to the muscles everywhere,
beginning with those of the feet. Muscles should be relaxed before
passing the current through them. The whole body can be gone over in
this way in the course of half an hour.
The hydropathic treatment of hysteria is one that has much in it to be
commended. Jolly approves the systematic external application of cold
water; Chambers advocates the daily morning use of shower-baths,
holding that the bracing up of the mind to the shock of a cold
shower-bath is a capital exercise for the weak will-power of the
hysterical individual, and some admirable results have been reported
by Charcot in inveterate neurasthenics and hysterics. Hydrotherapeutic
treatment, continued perseveringly for a long time, says Rosenthal,
“diminishes the extreme impressionability of hysterical patients,
strengthens them, and increases their power of resistance to
irritating influences, stimulates the organic functions, combats the
anæmia, calms the abnormal irritability of the peripheral nervous
system, and by diminishing the morbid increase of reflex power
relieves the violence of the spasmodic symptoms. Even chronic forms
which are combined with severe paroxysms of convulsions are
susceptible of recovery under this plan of treatment.”
The hydrotherapeutic treatment may be contrasted with the treatment by
seclusion, rest, massage, and electricity. Undoubtedly, one class of
hysterical patients is greatly benefited by the latter method
systematically carried out; these have already been described. In
other cases, however, this method of treatment is useless; in some of
them it has a tendency to prolong or aggravate the hysterical
disorder, while in the same cases a well-managed hydrotherapeutic
treatment will answer admirably. This is applicable in hysterical
patients who eat and drink well, who, as a rule, preserve a good
appearance, but whose mind and muscles are equally flabby and out of
tone, and need to be stirred up both physically and mentally.
{282} Dujardin-Beaumetz recommends prolonged warm baths of from one to
two hours' duration, and believes that the therapeutic virtues of
these baths are augmented by infusions of valerian.
In order to obtain satisfactory results from hydrotherapy, as well as
from massage, electricity, etc., it is best to remove patients from
their family surroundings. Good sanitariums near our large American
cities where hydrotherapy and other special methods of treatment can
be carried out are sadly needed. Hydrotherapeutic treatment is much
more efficacious when conducted at a well-regulated institution, for
several reasons. Measures troublesome in themselves are here carried
out as a matter of daily routine. Numerous patients permit of the
employment of competent attendants. The change is often of great
benefit. The close personal supervision which hysterical patients are
likely to have in a hydrotherapeutic establishment is also to be taken
into consideration. Better modes of living, proper forms of exercise,
regulated diet, etc. also enter; but still, a fair share of the good
which results can be attributed to the water treatment.
While, however, it is better to remove hysterical patients, for
hydrotherapeutic as well as for other treatment, from their family
surroundings, and to place them in some well-regulated establishment,
it is not by any means impossible to carry out such treatment in
private practice, particularly in a house supplied with a bath-room.
Many of our hydrotherapeutic institutions are in the hands of
charlatans or of individuals who are not practically well fitted for
their work. Not infrequently, however, good results are obtained even
under these circumstances. Much more can be done in this direction
with modest buildings and appliances than is generally supposed. It is
not necessary to have numerous apartments: three or four rooms in a
well-appointed house, if the arrangements for carrying out the
hydrotherapeutic treatment are of a proper kind, will suffice for a
large amount of good work. In almost any house provided with
bath-rooms with hot and cold water some useful hydrotherapy may be
attempted. The spinal douche or pour can be used by placing the
patient in a sitz- or ordinary hip-bath and pouring the water from a
spout or hose held at a certain height, the distance being regulated
according to the patient's condition. Again, the patient sitting in a
tub, water can be poured upon her, beginning at first with a high
temperature and gradually lowering it. The shower-bath may also be
used. An extemporaneous shower-bath can be provided by an ordinary
watering-pot. Whole, three-quarters, or half baths at different
temperatures can be given. One method of carrying out the wet pack is
very simple. A comforter is spread upon the bed; next to this is
placed a woollen blanket, and over the blanket a wet linen sheet, upon
which the patient rests, with the head on a low pillow. The wet sheet,
blanket, and comforter are then wrapped closely about the patient,
bottles of hot water being placed at the feet. The cold drip-sheet
method is another easily used. It consists in placing about the
patient, while sitting up or standing, a sheet wet with cold water,
and then vigorously rubbing her through the sheet.
Baths to the head may be used in some cases; cool head-baths are most
frequently applied. One method of using these baths is to have the
patient lie in such a position that the head projects a little beyond
the {283} edge of the bed and over a basin or receptacle of some kind.
Water of a suitable temperature is then poured gently or squeezed out
of a sponge over the head. For some forms of insomnia or some of the
disorders of sleep in hysteria this treatment is a valuable auxiliary
to other measures.
For the hysterical spine cold compresses may be used along the spine.
On the other hand, hot fomentations may be found of benefit in some
cases. Where hydrotherapeutic measures are employed attention should
be paid to the condition of the circulation, particularly in the
extremities. If the feet or hands are cold, hot applications or
frictions should be used.
For certain of the vaso-motor disorders of hysteria, such as cold or
hot feet, flushings, etc., local hydrotherapeusis will be of service.
In hysterical contractures local stimulation by the douche method or
by the steam bath may be tried. For the excitable rectum cold enemata
in small quantities, so as not to be expelled, will be found to be
very efficacious. For spasmodic attacks, whether purposive or
involuntary, the use of the wet pack or the plunge-bath will sometimes
be found of good service. In neuralgias and other painful local
disorders of hysteria, frictions, fomentations, Turkish or Russian
baths, and the wet pack are often very beneficial.
When hysteria is complicated, as it very often is, with disorders of
the liver and stomach, hydrotherapeutic measures will be of added
efficacy. When it is associated with genito-urinary disorders, even
though the latter are not regarded as the cause of the former, special
beneficial effects, both local and general, can be obtained from
hydrotherapeutic measures. Locally, sitz-baths, hip-baths,
douche-baths, hot and cold injections, and foot-baths may act as
revulsives, astringents, or local tonics, while at the same time they
are measures which tend to strengthen the system as a whole.
Sea-bathing is often of the greatest value, although it is sometimes
difficult to induce hysterical patients, who are willing enough to go
to the seashore, to resort to surf-bathing. Few measures are better
calculated to bring up the tone of the nervous system of an hysterical
or neurasthenic patient than well-directed sea-bathing. Where
sea-bathing cannot be employed sea-water may be used indoors.
Sea-water establishments, where baths at various temperatures may be
had, are now to be found at all the best seaside resorts. In a few
cases the internal use of large quantities of either hot or cold
water, or of the ferruginous mineral waters, may be associated with
the external treatment.
The climatic treatment of hysteria has received little or no
attention; undoubtedly, much could be said in this connection. In a
great country like ours a climate suited to the requirements of almost
every form of disease can be had. The climate of those regions, either
of the seaboard or inland, particularly well suited to cases of lung
trouble, will often be useless, and sometimes harmful, to neurotic
patients. For a certain class of hysterical patients a sojourn at the
seashore, if not too protracted, will prove of great value. On the
whole, for most hysterical patients of the neurasthenic type the best
plan is to go first to the seashore for a few weeks, and then resort
to an inland hilly or mountainous country, but not at too great an
elevation. I have known the climate of some of the high altitudes of
Colorado to be of positive injury by depressing the nervous system.
Resorts like Capon Springs in West Virginia, out of {284} the reach of
steam and worry, with prevailing south-west winds, are desirable
places.
The treatment of hysteria by the method of metallotherapy is worthy of
some consideration. It is a method by no means new. It was known and
practised by the ancients with rings and amulets. Popularized at the
beginning of the present century by certain travelling charlatans, it
was later, for a time, wholly ignored. In recent years it has been
received with considerable attention. One Burq for many years
practised metallotherapy in Paris disregarded or scouted by the
profession, but claiming many remarkable cures. Finally, Charcot was
induced to give him an opportunity of demonstrating the truth or
falsity of his claims at Salpêtrière.[124] Cases of grave hysteria
were submitted to the treatment, and in certain instances with
striking results.
[Footnote 124: _Lancet_, Jan. 19, 1878.]
After having determined by a series of experiments the particular
metal to which the patient is sensitive, bits of metal may be applied
to the surface of the body in various places; this constitutes
external metallotherapy. Or the metal, in the form of powder (as
reduced iron) or an oxide or some other salt, may be administered;
this is internal metallotherapy. That certain definite effects may be
produced by the application of metals to the surface of the body is
unquestionable. Some of the results which have followed their
employment are the removal of anæsthesia and analgesia, relief of
hysterical paralysis, improvement in the circulation, removal of
achromatopsia, relief of contracture.
Many investigations in Germany, England, France, and this country have
demonstrated that the same or similar effects can be produced by the
application of other non-metallic substances, such as discs of wood,
minerals, mustard plasters, etc. Hammond, among others, has shown
this. How the results are obtained is still a matter of dispute. On
the one hand, it is claimed, principally by the French observers, that
the cures are due to the metals themselves, either by virtue of some
intrinsic power or through some electrical currents generated by their
application. On the other hand, it is asserted, particularly by the
English observers, that the phenomena are best explained on the
doctrine of the influence of the mind on the body; in other words, by
the principle of expectant attention. Some at least of the effects are
to be explained on the latter hypothesis, but it is likely that the
monotonous impressions made upon the peripheral sense-organs by
different substances applied locally may act reflexly on the brain.
Seguin[125] reports a case of convulsion and hemianæsthesia in an
adult male cured by metallotherapy; the metal used was gold. Two
ordinary twenty-dollar gold pieces were placed in the patient's hands,
and afterward on his forearm, cheek, and tongue. Nothing else was
suggested or done to him; sensibility returned, and the staggering and
other symptoms disappeared. The patient left the hospital claiming to
be perfectly well. The same author reports several other successful
cases of metallotherapy, all of them reactions to gold. One was a girl
sixteen years old with analgesia.
[Footnote 125: _Arch. of Medicine_, New York, 1882.]
Not a few cases are now on record of the cure of hysterical
contracture and other forms of local hysterical disorders by the
application of a magnet. Charcot and Vigouroux cured one case of
hysterical contracture {285} of the left arm by repeated applications
of the magnet to the right or healthy arm. Debove by prolonged
application of magnets relieved hemianæsthesia and hemiplegias—not
only the hysterical varieties, but also, it is said, when dependent
upon such conditions as alcoholism, plumbism, and even cerebral
lesions. Maggiorani of Rome studied the physiological action of the
magnet and laid down the first rules for its therapeutic use. In the
case of powerful magnets we have more room for believing that an
actual, tangible force is at work in producing the results than in the
case of simple metals.
The question has been sometimes asked whether hypnotism can be used
with success in the treatment of hysteria. Richer reports a few cures
of hysteria through this agency. Braid has put on record between sixty
and seventy cases which he claims to have cured by the same means.
This list undoubtedly includes some hysterical cases—of paralysis,
anæsthesia, aphonia, blindness and deafness, spinal irritation, etc.
Both on theoretical grounds and from experience, however, I believe
that the practice of hypnotization may be productive of harm in some
cases of hysteria, and should be resorted to only in rare cases of
mental or motor excitement.
By some, special measures during the hysterical fit are regarded as
unnecessary. Jolly, for instance, says that we must merely take care
that the patients do not sustain injury in consequence of their
convulsive movements, and that respiration is not impeded by their
clothing. Rothrock[126] reports several cases of hysterical paroxysms
relieved by the application of either snow or ice to the neck. The
applications were made by stroking up and down either side of the neck
along the line of the sterno-cleido-mastoid muscles. He believed that
the most probable explanation of the results obtained was the shock
received from the cold substance, but that supplemental to this there
may have been supplied through the pneumogastric nerve a besoin de
respirer. This measure and the use of the cold spinal douche are both
to be recommended.
[Footnote 126: _Philada. Med. Times_, 1872-73, iii. 67.]
Emetics are sometimes valuable. Miles[127] reports several cases of
severe hysterical seizure in which tobacco was promptly efficient in
controlling the affection. He used the vinum tabaci in doses of one
drachm every half hour or hour until the system was relaxed and nausea
induced, the effects usually being produced after taking three or four
doses. Fifteen grains of sulphate of zinc may be used in adult cases.
James Allen for a case of hysterical coma successfully used a
hypodermic injection of one-tenth of a grain of apomorphia. Recently,
at the Philadelphia Hospital this remedy has been successfully
employed in two cases, one of hysterical coma and the other of
hysterical mania. Inhalations of nitrite of amyl are often of
surprising efficiency. This and other measures referred to under
HYSTERO-EPILEPSY are also applicable in the treatment of any form of
hysterical spasm.
[Footnote 127: _Clinical Med. Reporter_, 1871, iv. 25-27.]
For hysterical convulsions occurring during pregnancy an enema of
asafœtida, camphor, the yolk of an egg, and water, such as has been
recommended by Braun of Vienna, will often be found promptly
efficacious.
Fagge[128] mentions a procedure which he had often seen adopted by
Stocker—namely, pressure upon the arteries and other structures on
each side of the neck.
[Footnote 128: _British Medical Journal_, March 27, 1880.]
{286} For hysterical paralysis faradism and galvanism hold the chief
place. Metallic-brush electricity should be used in the treatment of
anæsthesia.
Whenever, in local hysteria, particularly of the paralytic, ataxic, or
spasmodic form, it is possible to coax or compel an organ or part to
perform its usual function long unperformed or improperly performed,
treatment should be largely directed to this end. Thus, as Mitchell
has shown, in some cases of aphonia, especially in those in which loss
of voice is due to the disassociation of the various organs needed in
phonation, by teaching the patient to speak with a very full chest an
involuntary success in driving air through the larynx may sometimes be
secured. Once compel a patient by firm but gentle means to swallow,
and œsophageal paralysis begins to vanish.
Mitchell makes some interesting remarks upon the treatment of the
peculiar disorders of sleep, which he describes and to which I have
referred. When the symptoms are directly traceable to tobacco, he
believes that strychnia and alcohol are the most available remedies,
but gives a warning against the too liberal use of the latter. A
treatment which was suggested to him by a clever woman who suffered
from these peculiar attacks consists in keeping in mind the need of
breaking the attack by motion and by an effort of the will. As soon as
the attack threatens the patient should resolutely turn over, sit up,
or jump out of bed, and move about, or in some such way overcome the
impending disorder. Drugs are of little direct use. Small doses of
chloral or morphia used until the habit is broken may answer, but
general improvement in health, proper exercise, good food, and natural
sleep are much more efficient.
Fagge says that he has seen more benefit in hysterical contracture
from straightening the affected joints under chloroform, and placing
the limb upon a splint, than from any other plan of treatment.
Hammond[129] (at a meeting of the New York Neurological Society, Nov.
6, 1876) reports a case of supposed hysterical contracture in the form
of wry neck, in which he divided one sterno-cleido-mastoid muscle;
immediately the corresponding muscle of the other side became
affected; he cut this; then contraction of other muscles took place,
which he kept on cutting. The case was given up, and got well
spontaneously about two years later. Huchard[130] entirely relieved an
hysterical contracture of the forearm by the application of an elastic
bandage.
[Footnote 129: _Philadelphia Medical Times_, vol. vii., Nov. 25,
1876.]
[Footnote 130: _Revue de Thérapeutique_, quoted in _Med. Times_, vol.
xiii., June 16, 1883.]
A lady with violent hysterical cough was chloroformed by Risel of
Messeberg[131] for fourteen days at every access of the cough, and
another for eight days. In both the symptoms were conquered. Nitrite
of amyl is useful in similar cases.
[Footnote 131: _Allg. Med. Centralzeitung_, Oct. 9, 1878.]