Drugs should be considered as of secondary importance when com pared with the moral treatment. Valerian has enjoyed the reputa tion of being the most valuable member of this class of remedies. Tu be of any use, however, it must be given in doses much above the strength of those usually employed. Drachm doses of the simple tincture, or an equal quantity of the ammoniated preparation freely diluted, may be given three or four times a day, or the following pill may be administered— IF. Zinex Valeriance Quinince I'aleriance Ferri Valeriance Asafcelido ana gr. j.
Extracti Valeriance q.s.
Ft. piluitt. Mille tales xxiv. Sumac imam ter in die post cibos.
Valerian and Asafoetida are regarded erroneously by some physicians as part of the moral treatment of hysteria, producing their good effects through the patient being compelled to swallow something nauseous and disgusting. Valerian benefits the hysterical condition in no such way, but it does good by diminishing the hypersensitiveness of the peripheral nervous apparatus, rendering sensory stimuli less powerful to affect the hypersensitive and unstable nerve centres. Asafoetida acts probably in the same manner, and Sumhul and Musk have similar action in less degree. Antipyrine in small doses intensifies the good effects of these drugs. Borneol-isovalerianate or Bornyyal is an elegant and efficacious substitute for valerian when given in 4-min. capsules, and it is hardly conceivable that it could act upon the moral or suggestive hypothesis, moreover, many hysterical patients manifest no marked repugnance to these drugs, though they continue to derive benefit from them.
Bromides are of value where there is evidence of insomnia and sexual excitement or ovarian tenderness. Their routine administration, especi ally in lean subjects, is productive of much mischief. They are certainly more suitable and more clearly indicated in the class of hysterical patients met with by Continental physicians, and which is rare in Britain.
Strychnine almost invariably intensifies the hysterical phenomena, probably through its power of rendering the peripheral and centric sensory portions of the nervous system more acutely sensitive. ,_11cohol, morphia, cocaine and chloral must be always avoided owing to the great danger of the establishment of a habit in hysterical patients; when hypnotics are indicated the newer drugs as Trional should be employed.
When the above methods fail in dispelling the manifestations of the neurosis, the only resource left to the physician is to insist upon Weir Mitchell treatment and rigid isolation for a period of 8 or ]o weeks. By this treatment cases have been brought under easy and rapid control which hitherto have been considered altogether outside the sphere of practical therapeutics. it is only in such grave cases that the method in its entirety should be recommended, and it is contra-indicated where marked melancholic symptoms arc present or where any serious organic lesion is known 1(1 Isolation must he complete; the patient therefore should he removed from all her friends and relatives and placed in a suitable nursing home with a reliable and well-chosen nurse, the character and experience of whom must be of the highest order, as absence of skill in the nurse is as serious an obstacle to success as is want of experience, tact and firmness in the physician. Isolation must exclude all intercourse by correspon dence or letters with the patient's relatives till the treatment has been wellnigh completed; she should see no one but the physician, nurse and masseuse. Should such arrangements not be thoroughly accepted by the patient and her friends before her removal, the physician should frankly decline to carry out the treatment after explaining to them that. without complete isolation failure is sure to follow.
Absolute ITS! of Gods' and mind is the next essential, the patient not being permitted even to stand upon her feet for a moment, just as if she were suffering from severe typhoid fever. She is not allowed to use her arms or hands, being fed by the nurse as a child. Books, games, sewing and usual ordinary harmless occupations are forbidden for the first few weeks, the routine of life being made as monotonous as possible so as to arouse longing for a new existence and create a desire to enter fully into the spirit of the treatment in order that recovery may be achieved as soon as possible. After 2 or 3 weeks the nurse may be per mitted to read to her, and the other restrictions may be gradually with drawn, letters being allowed from home at the end of the third or fourth week. It is wise to maintain the horizontal position in all severe cases for at least 6 weeks.