PARALYSIS AGITANS.
Though this disease must be regarded as progressive and incurable, nevertheless much may be done to relieve the rigidity, to minimise the tremors and even to arrest the progress of the muscular weakness.
As soon as the diagnosis is certain, the patient should be urged to give up active business pursuits if these involve much brain-work or the worry of finance and competitive struggling. A quiet and retired life, such as has been sketched for the victim of arterio-sclerosis, should be recom mended. By these means there is every prospect of at least lengthening the periods during which the degenerative process tends to remain at a standstill.
The only drug of any real value is Hyoscine Hydrobromide, and by its judicious administration the wearying oscillating tremors may be reduced in intensity, and in the later stages of the disease the writer is satisfied that life may be prolonged considerably by its use. As regards dosage, a good routine is to commence with gr. thrice daily by the mouth; this may be gradually increased till double the amount is taken, and some patients can tolerate three times the above dose (i .e , gr.). It may be combined with bromides, which are often of some value, but as the effect of the hyoscine tends to diminish after a time it is advisable to suspend its administration periodically for several days or a week. The drug is liable to vary in purity, and when a large dosage has been reached it is a wise procedure to diminish the dose when a new specimen has been dispensed by the chemist in order to insure uniformity of result.
The effect of hyoseine appears to he intensified by the addition of a moderate amount of Antipyrine, especially when the general restlessness is very distressing, and the following mixture may be prescribed in courses of about 14 days at a time: Hyoscince Hydrobrom. gr. A.
Phenazoni Agnce Chlorof. ad :.3xx. Misce.
Ft. misInra. Cht. ass. ter in die post cib.
(The dose of hyoscine in the above mixture in each table. spoon fu 1.) Arsenic has long enjoyed some reputation in the treatment of paralysis agitans, but there must be room left for doubting any truly specific action of this drug. It may he given in full doses (5 to 74 mins.) of Solution ler die, and Gowers combines Strychnine and Indian Hemp with it. Parathyroid gland feeding has been recommended strongly by Berkeley and the injection of Pituitary Extract is on its trial; a host of agents have been from time to time recommended, but they are ar valueless. Formic Acid is stated to have a very beneficial effect upon the tremor; 5 to to mins. may he given, or as many grains of Sodium Format( many times a day. Massage, resistance movements, passive exercise: and electricity have been recommended. If the latter agent be it should be in the form of a weak continuous current. Friedlander advocates a systematic attempt on the part of the patient to restrain the oscillating tremors by a strong mental effort twice or thrice daily.
I)anzer urges the advantages obtainable by prolonged immersion (2 hours daily) in a bath at 9o'-9S° F.; the rigidity rapidly diminishes, ant the tremors are markedly lessened, the improvement, though temporary being superior to results obtainable by drugs. In the type of the disease where the tremors are entirely absent, the writer's experience has been that the rigidity is greatest, and persevering massage and passive extensior movements should he performed in order to prevent the approach of the chin to the sternum. 13y careful practice of extension movements tendin to counteract flexion of the neck and spine, and by walking very slowly with a wide stride, the patient may be able to considerably alter hi: festinating gait.