Arsenic is often serviceable and may be combined with iron and quinine in:a pill. Valerianates may be prescribed as a routine in all cases exhibit ing much nervous irritability or fidgetiness. A pill containing r gr. each of the zinc, iron and quinine salt may he taken for long periods without ill-effects.
Insomnia is a symptom usually calling for thorough treatment, as little improvement is to be expected as long as sleep is markedly disturbed. Opiates are contra-indicated in this condition. Bromides may be given freely in the evening and at bed-time, but they should be suspended at intervals, and the routine drugging with large doses of these salts several times a day for a long period is productive of much mischief, since bromism greatly increases the mental and physical depression of the patient.
'Friona] or Paraldehyde or one large dose of Alcohol occasionally at bed-time will act satisfactorily. Verona] is extolled by some nerve specialists, but the writer has frequently observed untoward results from doses under so grs. Sulphonal is especially to be avoided, as it causes a depressing drowsiness upon the day following its administration. Chloral Hydrate should be only administered occasionally. A long walk imme diately before retiring to rest is the best hypnotic for the neurasthenic, and if to this he added a small (5 grs.) dose of trional which will act mainly by suggestion, excellent results may be expected. Tea and Coffee should not be permitted except at the morning meal.
Anorexia and digestive disturbances figure prominently in the so-called " visceral " type of neurasthenia, and these call for gastric tonics and digestives, as no real progress can be expected so long as the patient is unable to take abundance of nourishment and to digest the same within the normal period. Papain, Pepsin and Trypsin are valuable, and the
latter substance may be utilised for peptonisation of the food before its administration when necessary.
In the cardiac visceral type characterised by much functional disturb ance of the heart's action and abnormal sensations in the precordial region, Strophanthus in 3-min. doses of the tincture is clearly indicated, or gr. of the extract may be combined with the triple valerianate pill, or the tincture may he prescribed with Sumbul and Bromides.
Electricity, massage and hydropathy are valuable remedial agents, and, as already stated, constitute important elements in the Weir Mitchell treatment. All these adjuncts may, however, be employed by patients whose symptoms do not warrant such a rigid course. Hence the value of a sojourn at a suitable spa or health resort where the services of a trained masseur can be obtained, and if a suitable natural mineral water is available which will excite the eliminatory organs so much the better.
There are few more potent factors in completing the cure of neurasthenia than open-air sea-bathing for those who take the full value out of swimming exercises under the best surroundings. But this powerful remedial agent, like electricity, douching and high altitude treatment, is too stimulating in the earlier stages of the condition. Benefit may be obtained by the administration of the triphase form of sinusoidal currents as carried out by Herschel].