Case 484. (Hirschfeld, February, 1915.)

A banker, a volunteer (articular rheumatism at three years; at 18, some form of lung and tracheal inflammation; tendency to fainting spells on cold days—heart disease was said to have been found), as a result of the strain and excitement of the war had hysterical attacks during a fortnight before observation in hospital, consisting of sensations suddenly developing in the region of the heart, stiffness of the whole body, disorders of movement, without loss of consciousness.

November 23, 1914, he was examined in bed in the dorsal position, with the muscles of the legs, back, and neck in a state of tonic contraction. He was unable to answer questions. The pupil reactions were normal in the seizure. The attack ceased in two minutes, as the result of hitting heavy blows on the chest with a moist handkerchief and the threat of a strong and painful application of the electric current. The patient then got out of bed at request, walked about a little incoördinately for a time, but after a few minutes was able to walk perfectly and to talk once more.

Examined, November 25, he was found to be pale, fairly well nourished, with a somewhat accelerated pulse, and a melancholy, slightly apathetic expression. A systolic murmur at the right apex; accentuation of secondary pulmonary sound; increased knee-jerks; trembling of the lids (Rosenbach).

By December 12, the patient was completely well. The seizures had not recurred. The treatment was by hydrotherapy. A preliminary treatment is advocated by Hirschfeld, to insure peripheral circulation, either by light baths, hot douches, or packs. More important than this preliminary treatment is the cooling off process by means of tepid douches or partial baths. These partial baths are given at 28°C. for the intense effect of the cold. Sometimes this treatment can be concluded with a dry pack. The patients are treated by Hirschfeld three times a week with both the warming and the cooling procedure.

Re hydrotherapy, Mott has found the continuous warm bath of great value in Shell-shock cases coming back from France. He keeps the patient in the water from a quarter to three-quarters of an hour, or longer. A warm bath and a drink of warm milk at bedtime may permit a man to get on without hypnotics, or to get on with lesser amounts of hypnotics. The effect of these baths is doubtless largely somatic. Some writers stress the suggestive value of hydrotherapy as well as of electricity, radiant heat baths, and the like (Ballard). A neuropsychiatric center properly equipped with a hydrotherapeutic plant can do therapeutic work by means of the suggestion afforded by a cold shower, which may act quasi miraculously, like electricity (Roussy and Boisseau). In fatigue and exhaustion cases, along with adrenalin and strychnin, Aimé gives mild hydrotherapy without other sedatives. Laehr’s free sanatorium at Schönow treats the arrhythmia and tachycardia cases with rest and hydrotherapy.

Brasch reports rather poor results with hydrotherapy in the cardiac neuroses. Weichardt has used the continuous bath as a form of psychotherapy and permits the symptoms of psychoneurosis to subside therein.