February 8 98-2/5 99-1/5

" 9 98-3/5 99

" 10 98-2/5 99

" 12 98-1/5 99-3/5

" 13 98-2/5 99

" 14 98-2/5 98-3/5

" 15 98-2/5 98-4/5

" 19 99 98-2/5

" 20 98 99

" 23 98-3/5 99-4/5 Thermometer in mouth five

" 24 99 99-2/5 minutes before and after.

" 27 99-1/5 99-3/5

" 28 98-4/5 99-4/5 Menstrual period.

Menstrual period.

Before Electricity. After Electricity.

March 13 99 99-2/5

" 14 98-4/5 98-4/5

" 15 99 99-1/5

Miss R., aet. 27, was a fair case of hysterical conditions; over-use of chloral and bromides; anorexia and loss of flesh and color.

Thermometer in mouth.

Before Electricity. After Electricity.

May 15 100 100 } } General faradization " 16 100 100 } for fifteen minutes.

} " 17 100-1/5 100-2/5 }

" 18 98-2/5 98-3/5 } General faradization, } fifteen minutes, also of " 19 99-4/5 100-1/10 } arm muscles, twenty minutes.

May 20 100-1/10 100 General faradization, ten " 22 99-2/5 99-3/5 minutes; arms and legs twenty minutes.

" 26 99-1/10 99-2/10

" 27 99-3/10 99-4/10

" 28 99-2/5 99-2/5

" 29 99-3/10 99-3/10

" 30 99-1/10 99-4/10

" 31 99-1/10 99-2/10

June 2 99-3/5 99-4/5

" 4 99-5/10 99-6/10

" 6 99-3/10 99-5/10

" 7 99-3/10 99-5/10

I have given these full details because I have not seen elsewhere any statement of the rather remarkable phenomena which they exemplify. It may be that a part at least of the thermal change is due to the muscular action, although this seems hardly competent to account for any large share in the alteration of temperature, and we must look further to explain it fully. No mental excitement can be called upon as a cause, since it continues after the patient is perfectly accustomed to the process. I should add, also, that in most cases the subject of the experiment was kept in ignorance of the fact that a rise of the thermometer was to be expected. Is it not possible that the current even of an induction battery has the power so to stimulate the tissues as to cause an increase in the ordinary rate of disintegrative change? Perhaps a careful study of the secretions might lend force to this suggestion.

That the muscular action produced by the battery is not essential to the increase of bodily heat is shown by the next set of facts to which I desire to call attention.

Some years ago, Messrs. Beard and Rockwell stated that when an induced current is used for fifteen to thirty minutes daily, one pole on the neck and one on either foot, or alternately on both, the persistent use of this form of treatment is decidedly tonic in its influence. I believe that in this opinion they were perfectly correct, and I am now able to show that, when thus employed, the induced current causes also a decided rise of temperature in many people, which proves at least that it is in some way an active agent, capable of positively influencing the nutritive changes of the body.

The rise of temperature thus caused is less constant, as well as less marked, than that occasioned by the muscle treatment. I do not think it necessary to give the tables in full. They show in the best cases, rises of one-fifth to four-fifths of a degree F., and were taken with the utmost care to exclude all possible causes of error.

The mode of treatment is as follows: At the close of the muscle-electrization one pole is placed on the nape of the neck and one on a foot for fifteen minutes. Then the foot pole is shifted to the other foot and left for the same length of time.

The primary current is used, as being less painful, and the interruptions are made as rapid as possible, while the cylinder or control wires are adjusted so as to give a current which is not uncomfortable.

It is desirable to have electricity used by a practised hand, but of late I have found that intelligent nurses may suffice, and this, of course, materially lessens the cost. In very timid or nervous people, or those who at some time have been severely "shocked" by the application of electricity in the hands of charlatans, it is common to find the patient greatly dreading a return to its use. In this case, if the battery be started and the poles moved about on the surface as usual, but without any connection being made, one of two things will happen,--either the patient will naturally find it very mild, and will submit fearlessly to a gentle and increasing treatment, or else her apprehensions will so dominate her as to cause her to complain of the effects as exciting or tiring her, or as spoiling her sleep. A few words of kindly explanation will suffice to show her how much expectation has to do with the apparent results, and she will be found, if the matter be managed with tact, to have learned a lesson of wide usefulness throughout her treatment.

However, there are occasional, though very rare, cases in which it is impossible to use faradism at all by reason of the insomnia and nervousness which result even after very careful and gentle application of the current. On the other hand, some patients find the effect of the electric application so soothing as to promote sleep, and will ask to have it repeated or regularly given in the evening.

I have been asked very often if all the means here described be necessary, and I have been criticised by some of the reviewers of my first edition because I had not pointed out the relative needfulness of the various agencies employed. In fact, I have made very numerous clinical studies of cases, in some of which I used rest, seclusion, and ma.s.sage, and in others rest, seclusion, and electricity. It is, of course, difficult, I may say impossible, to state in any numerical manner the reason for my conclusion in favor of the conjoined use of all these means. If one is to be left out, I have no hesitation in saying that it should be electricity.

CHAPTER VIII.

DIETETICS AND THERAPEUTICS.

The somewhat wearisome and minute details I have given as to seclusion, rest, ma.s.sage, and electricity have prepared the way for a discussion of the dietetic and medicinal treatment which without them would be neither possible nor useful.

As to diet, we have to be guided somewhat by the previous condition and history of the patient.

It is difficult to treat any of these cases without a resort at some time more or less to the use of milk. In most dyspeptic cases--and few neurasthenic women fail to be obstinately dyspeptic--milk given at the outset, and given alone by Karell's method for a fortnight or less, enormously simplifies our treatment. Even after that, milk is the best and most easily managed addition to a general diet. As to its use with rest and ma.s.sage as an exclusive diet in obesity alone or in extreme fatness with anaemia, I spoke in a former edition with a confidence which has been increased by the added experience of physicians on both sides of the Atlantic. Finally, there are exceptional cases of intestinal pain of obscure parentage or seemingly neuralgic, of dyspepsia incorrigible by other treatments, which, having resulted in grave general defects of nutrition, are best treated by several weeks of milk diet, combined with rest, ma.s.sage, and electricity. Milk, therefore, must be so much used in these cases in connection with the general treatment I am describing that it is perhaps as well to say more clearly how it is to be employed when given alone or with other food. I am the more willing to do this because I have learned certain facts as to the effects of milk diet which have, I believe, hitherto escaped observation. In fact, the study of the therapeutic influence and full results of exclusive diets is yet to be made; nor can I but believe that accurate dietetics will come to be a far more useful part of our means of managing certain cases than as yet seems possible.