SENSORY NEUROSES.
Gastralgia, or Castrodynia.—The treatment will resolve itself into the management of the case during the attack and during the intervals between the paroxysmal seizures.
Pain must be relieved promptly, as this is often as agonising as in angina, gall-stone colic, or acute perforation. The ideal treatment would be a hypodermic of Morphia were it not for the fact that the attacks are certain to recur and the repeated resort to the narcotic would establish the morphia habit. There is less danger of this if the drug be given by the mouth combined with other sedative agents. A good routine pain reliever will be found in 45 grs. Bicarbonate of Soda with to gr. morphia. Antipyrine io grs. or a proportional dose of any of the new analgesics, or 5 mins. Oil of Peppermint combined with an equal quantity of Chloroform or Ether, may be tried.
Ewald's favourite combination for the relief of gastric pain and hypenesthesia in irritative conditions of the gastric nerves, with or without vomiting, is— It. Morph. Hydrochlor. gr.
Cocaine-c Ilydrochlor. gr. vj.
Tinct. Belladonno Aquo Arnygdal. Anzarce, 3J. Misce.
Ft. soligio. Sig.-4o to 15 drops every how.
He also advocates washing the stomach out with 1- per cent. Chloroform water.
Mustard applied over the stomach or an iced poultice to this region may cut short the attack. The continuous current sent through the gastric region or the Faradic current applied to the sympathetic or pneu mogastric sometimes does away with the necessity of narcotics.
A full draught of hot water containing a drachm of Bicarbonate of Soda may cut short the attack, and if vomiting follows so much the better, as by this means the stomach is washed out.
Mild attacks of gastralgia often Yield to a 3 to 5 min. capsule of Creosote or to the same dose of Hydrocyanic Acid given with 3o grs. Bismuth Carbonate. Sometimes a full dose of powdered Charcoal in wafer paper cuts the attack short. In severe paroxysms the inhalation or internal administration of a few drops of Nitrite of Amyl may be tried.
Between the attacks the neurosis must receive judicious attention, and the usual agents found suitable in hysterical conditions should be administered, as Valerianates, &c. Some authorities regard the gastralgia as a true neuralgia of the gastric nerves, and treat it with large doses of Quinine and Iron between the attacks. Arsenic is a drug of great value, and Siebert affirms that functional gastralgia will be speedily cured by arsenic. The best routine will he to give t min. Fowler's Solution
before meals in 2 drs. water for a few weeks, and then 2 mins. with 3o grs. Bismuth after meals for a couple of weeks. The Salts of Silver appear to act in a similar beneficial manner.
Prolonged rest in bed is essential. Apart from the consideration of the underlying neurosis and its treatment, anything which experience demon strates to be an exciting cause must be remedied, as prolonged fatigue of body or mind, fasting or dietetic errors.
Gastric Hyperesthesia may be constantly present without gastralgia. and, like it, is often worst when the stomach is quite empty. Arsenic and Nitrate of Silver in small doses afford the best routine for these cases when given in alternate courses of 2 or 3 weeks' duration a short time before food. Large doses of Bismuth with to gr. Morphia may be given after or between meals. A blister to the pit of the stomach is the writer's preliminary method in all cases. In very irritable patients relief may be obtained by the application under oiled silk of a liniment consisting of r part of Lin. Belladonna and 4 of Lin. Chloroform.
Heartburn, when not accompanied by pyrosis or water-brash, may be regarded and treated as gastric hypenesthesia; when occurring in acute attacks it should be relieved by large doses of alkalies, as in the treatment of gastralgia.
Anorexia Nervosa is best treated by the Weir Mitchell method with complete isolation and forced feeding if necessary. Mild cases sometimes speedily respond to the introduction of the nasal tube, through which the stomach is to be moderately filled with liquid food: the forced feeding, acting through its moral influence, soon induces the patient to eat in order to avoid repetition of the operation. Bitter tonics should be persevered with; Strychnine, which nearly always aggravates the usual symptoms of hysteria, may he safely given in small doses before meals.
The abnormal sensations included under the head of sensory neuroses, such as Bulimia,Polvphagia or opposite condition to anorexia --and Pica ur Coprophagy, where indigestible substances or dirt are hankered after, if not due to insanity, must he treated as manifestations of the hysterical condition. The dietetic regulations for such patients, it is hardly necessary to say, will require the strictest supervision: