Convulsions.—When the physician is called to a patient during an attack of convulsions or of hysterical coma, if he be confident of the accuracy of his diagnosis, he can have the satisfaction of often bringing the fit to an abrupt termination, after dismissing the sympathetic and alarmed bystanders. The patient, if in bed or upon a sofa, is so placed as to enable the physician to pour a stream of cold water suddenly from a height upon her face, without saturating the bedclothes or garments of the patient. This free douching is soon followed by a return to com plete consciousness, and in subsequent fits the mention of it is often enough to arrest all symptoms. Sometimes a little cold water thrown forcibly against the face acts like magic, but the physician should state in the hearing of the patient that the application is to be repeated every 2 or 3 minutes till she gets out of her attack. Pinching the nostrils whilst the mouth is kept closed, so as to arrest the breathing entirely for a short period, may arrest an attack instantly. The vapour of strong Acetic Acid or Liquor Ammoniie to the nostrils may produce the same good result.
Deep pressure over one ovary sometimes arrests a fit of convulsions or of coma, but it often fails; and when it does appear to arouse the patient it leaves her in a very excited and excitable condition. A better plan is to make firm pressure upon the supra-orbital nerve as it emerges from its bony canal.
Electricity is always of value if at hand, and by placing one electrode over the front of the neck and the other over the pit of the stomach a smart interrupted current may stop the paroxysm in a few seconds. It has no such effect in epilepsy, and may be used therefore as a means of arriving at a positive diagnosis of the nature of the convulsion, and so strengthening the physician's confidence in proceeding upon moral or suggestive lines.
Deep pressure upon the arteries and tissues at the base of the neck, so as to interfere with the cerebral circulation, as is sometimes success fully tried in stopping epileptic fits, may cut short the attack of hysteria or hystero-epilepsy; firm pressure on almost any region of the body will often act effectually in controlling hysterical phenomena. The room should be cleared of all active sympathising spectators, and the physician should give his orders and carry out his operations without the least sign of hesitancy or wavering. This latter he cannot do unless he be very positive about his diagnosis; indeed, little can be done with hysterical patients as long as the physician has any doubt whatever lingering in his mind about the case being one of the genuine neuroses. The patient by intuition recognises his want of confidence in himself, as shown by some very trivial circumstance, and the result is that the demon refuses to be exorcised and his efforts prove futile to control the manifestations.
When the coma has lasted for a considerable time and the douche or electricity has failed, the application of a hot cautery iron gives prompt results. The writer has cut short attacks of both convulsions and coma by giving directions in a loud and firm tone of voice for the heating of an iron and the ordering of a portion of the skin to be exposed for cauteri sation. He has, however, never seen a case where the actual carrying out of this measure appeared to be justified. Nitrite of Amv1 sometimes arrests the paroxysm, and a hypodermic of Apomorphine to effect emesis is also a potent agent.
The paroxysm of coma, or convulsions, or delirium having been arrested, the routine moral treatment already detailed should be instituted and carried out with patience.
The various local forms of Paralysis should be treated by the means recommended as useful for the general hysterical condition. Massage, passive motion and electricity employed locally afford, in conjunction with moral treatment, the best hope of success. The same measures prove useful in dealing with contractures or flexions of joints, which are also successfully removed by the application of a circular blister around the joint. The Weir Mitchell method of treating contractures consists in the injection of Atropine into the contracted muscle before attempting massage or passive motion. Swedish movements and gymnastic exer cises are always beneficial. The method of employing these therapeutic agents will vary with the locality and nature of the affected parts or organs. Where there is much pain and tenderness over joints or bony prominences a sponge as hot as can be borne without risk of vesicating may be employed with benefit.
Aphonia may be treated by voice exercises and the methods described already under Aphonia. It yields readily to electricity, which may be employed in various ways for the treatment of this affection. By the aid of the laryngeal mirror one electrode is placed in contact with the vocal cords, the other being fastened to the outside of the larynx. By a button in the handle of the interior electrode the current is turned on, and the shock often causes the patient to instantly find the use of her voice, perhaps for the first time for many months. The applications should be repeated till the aphonia entirely disappears. Sometimes one sitting of a few minutes suffices, but more commonly several are required to insure that no return occurs. The Faradic or interrupted current should be used, and contact may be made 5 or 6 times during each sitting.