Treatment

The treatment to be adopted regards, first, the paroxysm itself; secondly, the condition of the patient during the absence of the paroxysm.

One object during the paroxysm, is to prevent the patient from injuring herself, by her hands, or by her teeth, or in her convulsive movements. Her dress should be loosened; but it may be neces-sary to confine her hands and arms. The next thing is to put an end to the fit. The patient should be surrounded, as far as that is possible, with cool, fresh air. If she be able to swallow, you may sometimes shorten the attack by administering a couple of ounces of the Assafoetida mixture; or half a dram of Ether, with fifteen or twenty minims of Laudanum, in Camphor water; or a draught containing a dram of the Ammoniated Tincture of Valerian. If the patient cannot or will not swallow, the application of the stimulants to the nostrils, or an Assafoetida Injection, made by mixing two drams of Assafoetida with half a pint of water by means of the yolk of an egg, will often bring the fit to a termination. But the most speedy as well as the most effectual means of bringing the fit to an end is the dashing cold water over the face and head.

"In those long paroxysms," says Sir Thomas Watson, "in which some other disease is simulated by Hysteria, the cold effusion is a most valuable resource: especially in those forms of the disorder in which a limb is permanently bent, or incapable of motion. In several instances, in which such contraction had existed for a long time, it has yielded in the Middlesex Hospital, to a few minutes application of the cold douche. Dr. Corfe pours cold water from a tea-kettle, or any other convenient vessel, in a small stream, from a moderate height, upon the contracted limb. It has been bent up for weeks, perhaps; no power that you are able to exert can extend it; and any very forcible attempts to straighten it give the patient extreme pain. After the stream of water has been kept up for a short time, the patient complains of it very much; but Dr. Corfe is inflexible-more so than the culprit limb-he goes on. Presently the limb begins to tremble, the tight state of the muscles is evidently on the point of yielding, and in no long time they are entirely relaxed and manageable, and the member becomes as lithe and movable as ever. It often happens that the state of contraction recurs; but a repetition of the douche has always the same good effect, and by degrees the habit is broken, and the patient set free. It requires some determination to put this expedient in practice. The patient looks upon you as a monster of cruelty, and in private practice the friends will not always allow such "rough" treatment, as they consider it. Sir Charles Clarke was a great advocate of this ducking system.

"A medical practitioner whom I met lately at a patient's house, told me he had just come from another patient, upon whom he had seen a surprising cure performed. A young lady, for many days, had been affected with ' locked-jaw.' She was unable to open her jaws, and therefore could neither speak nor eat. At last Sir C. Clarke was called in to see her. He presently comprehended the nature of her ailment, had her placed with her head hanging over a tub by the side of the bed; and proceeded to pour pitchers of water on her face. Before he had emptied the second, the patient began to scream and scold, giving very audible indications that she could open her mouth. Although these patients get great relief by the treatment, they do not like it; and if they are convinced it will be put in force, they generally contrive not to require it.

"Of all the spasmodic affections, Hysteria is that which is most readily propagable by what may be called moral contagion. When, in a large ward one girl goes off in a fit, half a dozen others perhaps will experience a strong inclination to follow her example. But this chorus, as it were, of Hysteria, is much more common in some wards than in others. A stern nurse, or a general order that the cold effusion shall at once be employed in every instance of a hysterial fit, will keep the complaint wonderfully in check: while, on the other hand, any manifestation of sympathy has a striking effect in encouraging the paroxysms. These facts show that the symptoms are, to a great degree, under the patient's control, but not entirely so.

"Behind the moody, reserved, and tricky behaviour which I have described, there often lies some moral or emotional cause-some hope deferred or disappointment-which being ascertained, and capable of satisfaction, and satisfied, the patient may be restored to her customary health.

"It must be confessed, too, that the bounds between some forms of hysterical disorder, and some forms of decided insanity, are divided by very thin partitions."

Dr. E. I. Tilt thinks that Hysteria arises from an hereditary morbid state of the brain and nervous system, encouraged by injudicious training in childhood. He says: "In a family with which I am intimate there are ten healthy children, whose parents are not in the least nervous; but a paternal uncle is insane; two maternal uncles died of delirium tremens; one brother has been epileptic from childhood; and a sister died of inflammation of the brain. Out of these ten children, two little girls-one seven, the other eight years old-burst into tears if they are looked at, if they are not placed as they like at table, and are not helped in their right turn. They pass rapidly from laughter to tears, which will flow for hours, and very abundantly. They have sometimes globus hystericus. These symptoms have been repeatedly quelled by preparations of Iron; but they occasionally return, and must be taken as evidences of the hysterical state, very likely to be followed by the worst manifestations of the disease on slight provocation."

The patient may take the following:

Ammoniated Tincture of Valerian.........One Ounce.