The viewpoint advanced here with reference to the mechanism of hysteria is borne out not only by the conditions under which the disabling symptoms arise, but also by the conditions under which they disappear. Various methods of cure have been in vogue and all have their advocates and opponents: rest, work, massage, electricity, chloroform anaesthesia (for deaf-mutism), hypnotism, vocal exercises, psychoanalysis, etc.

I am able to report from my own experience that the particular method of therapy is a matter of comparatively little importance in the cure of hysterical manifestations. The mechanism of cure readily reveals itself when studied in the light of the above discussed mechanism of etiology. One or more of the following factors are frequently seen to be operative in cures: (1) An attitude on the part of medical officers impressing patients in such a way as to preclude any hope of successful imposition. (2) Demonstration of the unreal nature of the disability. (3) Strict discipline as opposed to sympathy, coddling, or humoring. (4) Painful or otherwise disagreeable features of treatment. (5) Removal of motive, actuating the symptoms, by change in situation. These factors deserve somewhat detailed discussion.

The first mentioned factor is all important for the prevention of hysterical manifestations and for their suppression in the earliest stages. "In the army in which we had the direction of the neurological center we have had the satisfaction of seeing the number of ' nervous seizures' diminish from the time the rumor was spread - through soldiers who had returned to their organizations without permission - that with us ' the seizures were not in good repute and were regarded rather with disfavor.' As to mutism and deaf-mutism, we have seen them arise in certain armies in the form of veritable little epidemics, whereas in others they were almost unknown." 1

1 A. Leri. Commotions et Emotions de Guerre. Paris, 1918.

As to the second factor - demonstration of the unreal nature of the disability - it is plainly operative in the cures of aphonia and mutism by means of general anaesthesia and of paralyses by means of strong electrical stimulation. Patients dread being detected in the act of simulation and therefore yield to "the treatment" rather than allow it to appear too clearly that they are able to phonate, talk, or move their limbs and yet will not do so. "The administration of ether for the cure of functional deafness and functional loss of voice has always in our hands proved satisfactory. It is essential that the loss of consciousness be slight, and that the patient be suddenly roused so as to realize that he is speaking or hearing." 1 The principle involved in the cure of paralyses and anaesthesias by electricity likewise consists in surprising or forcing the patient into betraying by an involuntary movement the functional integrity of both motion and sensation.

The third factor - strict discipline - is unanimously insisted on by all who have had cases of war hysteria to treat, although they have so widely disagreed on other points.

The fourth factor - painful or otherwise disagreeable features of treatment - very often succeeds where others have failed. "Prof. Otto Schultze (Munch, med. Woch., Sept. 19, 1916), who published a review of the reception the Kaufmann system (painful electric shocks) has been given by the medical profession in Germany, admits that it has been stigmatized as inhuman, although it does not, he thinks, inflict pain very different from that which a woman in labor suffers. At his nerve hospital he found the ordinary methods of treating hysterical motor disturbances unsatisfactory, whereas the adoption of Kaufmann's system led to far better results. Before practicing the Kaufmann system he relied mainly on the peaceful atmosphere of his mountain hospital, on good food, rest in bed, kindly treatment, the ignoring of symptoms, and the use of sedatives and hypnotics. In 54 cases thus treated marked improvement or recovery was obtained in 4 only; but out of 15 patients treated on Kaufmann's lines 13 benefited appreciably." 1

1 A. N. Bruce. The Treatment of Functional Blindness and Functional Loss of Voice. Rev. of Neurol, and Psychiatry, May, 1916.

The fifth factor - that of removal of motive, actuating the symptoms, by change in situation - is the most effective and theoretically the most significant one. The cases which were sent to the Plattsburg hospital from overseas were for the most part those which had proved most refractory to treatment in hospitals in France. Yet a great many of them had recovered spontaneously at the time they reached Plattsburg; and there was an outbreak of spontaneous cures following the signing of the armistice. This experience is analogous to the peace-time traumatic hysteria. "The hysteria observed in litigants is provoked not by trauma, not by fright, but is the direct result of the psychology of compensation; namely, of the recognition by the plaintiff that the success of his claim for compensation depends upon the existence and persistence of symptoms. For this reason treatment, no matter of what character, is without avail. The plaintiff neither gets well nor improves, and this situation may continue indefinitely, sometimes for years; indeed so long as any hope of settlement persists in the plaintiff's mind. However, all medical attendance ceases with settlement. The symptoms disappear, the plaintiff forgetting all about them.

The immediate absence of the plaintiff from physicians' offices and hospital clinics, the moment the money has been paid him, is one of the notorious and striking facts of compensation hysteria." 2