It is rare to find any of the class of patients I have described so free from the influence of their habitual surroundings as to make it easy to treat them in their own homes.  It is needful to disentangle them from the meshes of old habits and to remove them from contact with those who have been the willing slaves of their caprices.  I have often made the effort to treat them where they have lived and to isolate them there, but I have rarely done so without promising myself that I would not again complicate my treatment by any such embarrassments.  Once separate the patient from the moral and physical surroundings which have become part of her life of sickness, and you will have made a change which will be in itself beneficial and will enormously aid in the treatment which is to follow.  Of course this step is not essential in such cases as are merely anaemic, feeble, and thin, owing to distinct causes, like the exhaustion of overwork, blood-losses, dyspepsia, low fevers, or nursing.  There are but too many women who have broken down under such causes and failed to climb again to the level of health, despite all that could be done for them; and when such persons are free from emotional excitement or hysterical complications there is no reason why the seclusion needful to secure them repose of mind should not be pleasantly modified in accordance with the dictates of common sense.  Very often a little experimentation as to what they will profitably bear in the way of visits and the like will inform us, as their treatment progresses, how far such indulgence is of use or free from hurtful influences.  Cases of extreme neurasthenia in men accompanied with nutritive failures require as to this matter cautious handling, because, for some reason, the ennui of rest and seclusion is far better borne by women than by the other sex.

Even in cases whose moral aspects do not at once suggest an imperative need for seclusion it is well to remember, as regards neurasthenic people, that the treatment involves for a time daily visits of some length from the masseur, the doctor, and possibly an electrician, and that to add to these even a single friendly visitor is often too much to be readily borne; but I am now speaking chiefly of the large and troublesome class of thin-blooded emotional women, for whom a state of weak health has become a long and, almost I might say, a cherished habit.  For them there is often no success possible until we have broken up the whole daily drama of the sick-room, with its little selfishness and its craving for sympathy and indulgence.  Nor should we hesitate to insist upon this change, for not only shall we then act in the true interests of the patient, but we shall also confer on those near to her an inestimable benefit.  An hysterical girl is, as Wendell Holmes has said in his decisive phrase, a vampire who sucks the blood of the healthy people about her; and I may add that pretty surely where there is one hysterical girl there will be soon or late two sick women.  If circumstances oblige us to treat such a person in her own home, let us at least change her room, and also have it well understood how far we are to control her surroundings and to govern as to visitors and the company of her own family.  Do as we may, we shall always lessen thus our chances of success, but we shall certainly not altogether destroy them.