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Fat and Blood - An Essay on the Treatment of Certain Forms of Neurasthenia and Hysteria by S. Weir (Silas Weir) Mitchell
page 38 of 166 (22%)
is for some cases of hysteria the main difficulty in the way of a
cure,--it is so easy to disobey the familiar friendly attendant, so hard
to do this where the physician is a stranger. But we all know well
enough the personal value of certain doctors for certain cases. Mere
hygienic advice will win a victory in the hands of one man and obtain no
good results in those of another, for we are, after all, artists who all
use the same means to an end but fail or succeed according to our method
of using them. There are still other cases in which mischievous
tendencies to repose, to endless tire, to hysterical symptoms, and to
emotional displays have grown out of defects of nutrition so distinct
that no man ought to think for these persons of mere exertion as a sole
means of cure. The time comes for that, but it should not come until
entire rest has been used, with other means, to fit them for making use
of their muscles. Nothing upsets these cases like over-exertion, and the
attempt to make them walk usually ends in some mischievous emotional
display, and in creating a new reason for thinking that they cannot
walk. As to the two sets of cases just sketched, no one need hesitate;
the one must walk, the other should not until we have bettered her
nutritive state. She may be able to drag herself about, but no good will
be done by making her do so. But between these two classes, and allied
by certain symptoms to both, lie the larger number of such cases, giving
us every kind of real and imagined symptom, and dreadfully well fitted
to puzzle the most competent physician. As a rule, no harm is done by
rest, even in such people as give us doubts about whether it is or is
not well for them to exert themselves. There are plenty of these women
who are just well enough to make it likely that if they had motive
enough for exertion to cause them to forget themselves they would find
it useful. In the doubt I am rather given to insisting on rest, but the
rest I like for them is not at all their notion of rest. To lie abed
half the day, and sew a little and read a little, and be interesting as
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