Electricity: The slowly interrupted faradic current should be applied to the "motor points" all over the body so as to contract every muscle two or three times. This should be con tinued for three-fourths of an hour. Constipation is treated with aloes and strychnine pills, and for specially re fractory cases hot injections of castor oil per rectum may be given. Insomnia is diminished by massage before bed time. Hypnotics should be avoided, and the wet pack or abdominal compresses first tried.
After the first week the patient is al lowed to sit up fifteen minutes, the next day twenty minutes. etc. In a fort night she is allowed to walk in the room after passive movements of the legs have been carried out. Swedish move ments complete the exercises and the cure. The disease is not restricted to women of fashion and indolence, as it is often met with in school-teachers, washer-women, and other persons sub mitted to menial occupations. J. K. Mitchell (Jour. Amer. Med. Assoc., Mar. 9, 1901.
Forced feeding, massage, and faradiza tion are important aids in the treatment. Milk is one of the best articles of diet. It should be deprived of most of its cream at first. This may constitute the only article of diet in the rest-cure cases for two or more weeks. Food should be given the patient every two hours while she is awake. Massage and electricity may be employed daily or on alternate clays.
Strong galvanic currents (20 to 60 milliampi%res; electrodes, 6 by 12 centi metres) to the back and ovarian region used with almost uniformly good results in hysteria. Hirchfelder (Med. Stand ard, Aug., '91).
In hysteria the rain-shower and the jet are usually efficacious. Dana. (Di etetic Gaz.. Dec., '91).
Neurasthenic patients who are also hysterical often derive great benefit by static electricity or by franklinization.
Most, but not all, hysterical patients whose condition is improved by static electricity show an intolerance, varying in degree. toward the high-frequeney cur rents, and especially toward autocondue tion in the electric cage. Faradization, which is, as a rule, indicated as alone serving to produce an effect upon certain local hysterical troubles, especially those of sensibility in one organ or a limited region, is often powerless, while static electricity, which acts in a general man ner, may give more rapid and more effectual results. Apostoli and Planet (Annales d'Electro., May 15, '98).
The moral treatment is of great im portance and requires tact and skill on the part of the physician and nurse. In some cases hypnotism may be resorted to so that suggestions may be more effect ive; but, as a rule, this should be avoided, and is, in the vast majority of cases, un necessary. liepeafed assurances on the part of the physicians may inspire the hopes of the patient; especially is this true if the nurse has the tact and good judgment to increase the patient's con fidence in her physician.
As a rule, it is best to get along with as little medicine as possible. It is a mistake absolutely to prescribe the bro mides in hysteria, as some have done. Sodium bromide in 10-grain doses after each meal, diluted with half-glass of water, is often effective in relieving rest lessness and sleeplessness. It should be employed only for such special purposes. Its indiscriminate use in these cases can not be too strongly condemned. Such tonics as reduced or lactated iron, ar senic, valerianate of zinc, extract of sum bul, etc., may be given as occasion re quires. I have never employed oil of
turpentine, recommended by Gowers to be pushed to the point of strangury.
The special symptoms often require relief. Aphonia is sometimes relievable by the faradic current applied to the throat externally. Weir Mitchell has tried it with success in some cases, teach ing the patient to endeavor to speak only after fully inflating the lungs. Paralysis sometimes disappears suddenly. Usually after applying massage or electricity the patient may be induced to move a group of muscles, and if this is commented on favorably the voluntary movements may be increased after each treatment. Con tracture is best treated by gentle meas ures, such as rubbing the parts and grad ually extending the limbs a little from time to time. Sometimes it is necessary to etherize the patient and forcibly ex tend the limbs, or even perform tenot omy. Anorexia and vomiting are best overcome by absolute rest in bed, judi cious feeding, and firmness in the man agement of the patient. If the food con tinues to be ejected the nasal tube may be employed with good effect. The sen sory disturbances may be treated with the faradic brush, small and repeated blisters, and suggestion. Retention of urine should not be relieved by the cath eter until all other means have been ex hausted. One of the most effective methods that I have employed is the application of ice to the abdomen or a cold douche to the spine. Suggestion sometimes is sufficient to enable the pa tient to empty her bladder.
An hysterical convulsion may often be arrested by the sudden and unex pected application of ice to the spine or abdomen, or by placing the patient in a tub and pouring a bucket of cold water over the head and body. A prompt emetic will usually arrest a fit. The best for this purpose is grain of apomo phine given hypodermically. Inhalation of nitrite of amyl will often cause the convulsion to cease. H. A. Hare has recommended holding the patient's nos trils closed for 30 or 40 seconds. Press ure over the sensitive ovary does not always succeed. I have been able on two occasions to cause a sudden cessation of the convulsion by grasping the patient's great toes with each of my hands and firmly extending and flexing them.
In the treatment of hysterical convul sions all attendants who are not needed should be banished from the room. The first thing to be done is to put pressure upon any hysterogenic zone. Suggestion may be effective, but it often fails. A constant current, rapidly reversed, is also beneficial. In some cases the wearing of colored glasses, varying the color with the subject, has a distinct effect. Pitres (Pittsburgh Med. Review, May, '91).
Operations, especially unTeological ones, undertaken for the relief of a pos sible exciting cause of hysteria, will, in cases of short standing, be very apt to bring improvement, but in cases of long standing are very unlikely to be followed by any success, and, indeed, the irrita tion of the scar may give ground for fresh complaint. Sander (Dent. med. Woch., Sept. 7, '99).
Apomorphine recommended for hys terical attacks. An injection of V„ grain (0.006 gramme) cuts short hys terical attacks, hystero-epilepsy, and epilepsy. The vomiting and subsequent depression both have a sedative effect on the nervous system. One great ad vantage of the treatment is the saving in time. The doctor can leave the house within fifteen minutes. Faucher (Bull. MCid. de Quebec, Jan., 1902).