The total seance may last up to seventy-five minutes. This is comparatively rare, and so long a time should never be devoted to treatment in the early stages. At first twenty minutes should often suffice, then the duration of treatment may be advanced by very gradual stages, and towards the end should be decreased in similar manner. The one thing above all others to avoid is fatiguing the patient. It is often possible to leave patients sound asleep. Before this stage is reached the patient is frequently in what the psycho-therapists describe as the "hypnoidal state." Verbal suggestion can play its part with greatest effect during the continuance of this condition.

It is impossible to over-emphasise the danger of using the treatment here advocated for neurasthenia in cases of hysteria, unless it is demanded by the physician as a preliminary to suggestion treatment. Used as a purely physical remedy, its great potentialities for good in the neurasthenic become almost equally powerful for ill in the hysteric. For the latter, massage treatment to be effective must partake of the nature of a moral persuasion which is little short of actual punishment. Treatment of this character is a degradation of the art of massage and should be strenuously discouraged. Electricity, on the other hand, affords a physical treatment which can often be used with the greatest of benefit in hysteria. On the individual who is liable to break out into noisy fits of laughter or crying at frequent intervals the static breeze has often a very marked sedative effect. Sparking may effectually allay hysterical aches and pains. High frequency can remove a multitude of hysterical symptoms provided the patient is properly prepared from the psychical standpoint. Faradism, by producing visible contraction, can often convince a patient that movements which he does not perform owing to hysterical "paralysis" are really within his power. This is the scientific method of dealing with these cases. As Buzzard has pointed out, it is untrue to say of the hysteric that he cannot perform an action, it is unfair to say that he will not, and so we must be content with the simple fact that he does not. If by Faradism we can ensure that the action is performed, we are at least on the road to cure. If. in addition, moral persuasion can induce the patient to copy the movement performed in response to the current, the cure is established.

Since the beginning of the war we have heard much about the rapid or intensive cure of various "functional" or hysterical conditions. When we consider the nature of hysteria in its widest and most comprehensive form, and cease to regard it as a sort of whim on the part of a naughty girl, there is nothing mysterious or wonderful in this treatment. It is, in fact, the natural outcome of a true understanding of conditions as they exist; and is merely rational, though, from a spectacular point of view, it may be sensational. If we regard hysteria as an illness which is characterised by a definite lesion, we shall at once realise that the symptoms - however fantastic - are none the less real, are beyond the power of the patient to control without help, and are alike due neither to, so to speak, voluntary imagination nor yet to insanity. At first sight it would often seem that the symptoms must be attributable to one or other of these causes. There is, however, a third possibility, and this is the true one.

Hysteria is due to a definite contraction of the field of personal consciousness, and thereby control - be it in the form of volitional movement or of suppression - is completely cut off from the higher or volitional controlling centres as by a knife. The result is varied. If the dissociation is complete, we get the extraordinary condition known as "dual personality"; if it is only very slight we get "functional" inability, for example, to open a flexed finger that has not, in reality, suffered any injury. In all cases of hysterical paralysis the part affected is entirely outside the field of conscious control, just as much as if it had been amputated. Sensation is utterly and actually lost in so far as the patient does not feel, and movement is impossible, until the part is brought once more within the field of consciousness.

In all cases of true hysteria there is of necessity a mental conflict. The conscious mind is convinced of the existence of a definite lesion, the sub-conscious knows that no such lesion exists. The outward signs of this conflict are various. There may be abnormal excitability or an undue placidity in accepting the disability. Some deep reflexes are almost invariably exaggerated, and particularly the knee-jerks.

Now suppose we apply massage for this condition. What are we doing? We are simply conveying to the patient's mind the fact that we believe his limb to be paralysed: we are, in other words, confirming his delusion and doing all in our power to keep the limb outside the field of consciousness. What is required is the exact reverse. The patient must be persuaded that, although control has been lost through illness, it can be regained, and that speedily, and that we know how to restore control. He must be shown that the disability is due to the fact that nerve impulses do not pass the apparent block, be assured that they can pass it, and then, with a little patience, he can be shown that some impulse has passed it. The faintest sign of involuntary movement that can be elicited is at once demonstrated, then another, and so on till cure is complete. But the cure is one of mental persuasion - mental coercion it may be - based on physical demonstration, and not of physical manipulation. It is, in other words, the successful result of an attempt to make the patient help himself.

Not every one who practises massage can cure a case of hysteria. The process is psychical and not physical; it requires skill, perseverance and tact, and the person who undertakes it must come to his task fresh and ready, if need be, for a long fight. We hear of cases being cured at "one sitting." Here are two examples: -

A patient with multiple superficial wounds of his fore-arm had all the symptoms of posterior interosseous paralysis. He had been under treatment by electricity and massage for several months. He was made to grasp a pole in full supination, then in various degrees of pronation up to the mid-position and then quickly on through all the various stages up to full pronation, when the pole was supported without difficulty in full dorsi-flexion. He was "cured," save for lack of strength due to disuse, in a few minutes. Another patient had a "functional" paralysis of the whole upper extremity of two years' duration. It took three hours of hard work to secure voluntary movement throughout the limb, and this may be considered rapid. It might well have required six, had it not been found that, though the hand was kept tightly clenched so that at first the fingers could not be opened, the nails had been kept short. This was demonstrable proof that relaxation was possible; having secured it, it was possible to demonstrate that active flexion of the fingers was also possible. From this point the remainder was comparatively simple.