The affected muscles do not waste. The feet are usually extended and turn inward. Sudden loss of voice occurs in many cases. The paralysis is generally paroxysmal, and is frequently a.s.sociated with contractures, shortening of the muscle. The contractures may come on suddenly or slowly, and may last minutes, hours, or months, and some cases even years.
Movements of the hands, arms, etc., like the motions in ch.o.r.ea are often seen in the young. A trembling (tremor) is sometimes seen in these patients. It most commonly involves the hands and arms, more rarely the head and legs. These movements are small and quick. Fourth--Swallowing may be difficult on account of spasms of the muscles of the pharynx. The larynx may be involved and interfere with respiration. Indigestion in some form is often present. The stomach and bowels may be very much bloated with gas. There may be a "phantom tumor" in the intestine (bowel).
Constipation may be very obstinate, vomiting may be present and persistent and hiccough present. The action of the heart may be irregular, and rapid heart action is common. The least motion may cause difficult breathing and false Angina Pectoris (heart pang); the urine is retained not infrequently in female patients.
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Symptoms of the Paroxysms.--Convulsive seizures are common manifestations of hysteria, and frequently present a great similarity to epilepsy. The prodromal (fore-running) symptoms are frequently present and may begin several days before the convulsion occurs. In milder forms, in which the cause may be due to a temporary physical exhaustion, or emotional shock, the fore-running symptoms are of short duration. The patient may become very nervous, irritable, impatient, have fits of laughing and crying, alternately, or have a feeling of a chill rising in the throat. The convulsion follows these symptoms. The patient generally falls in a comfortable place; consciousness is only apparently lost, for she frequently remembers what has taken place; the tongue is rarely bitten, In the milder forms the movements are apt to be disorderly. In the severe forms the movements are apt to be a lasting contraction of the muscles and the patient may have the head and feet drawn back and the abdomen drawn front. There then may follow a condition of ecstacy, sleepiness, catalepsy, trance, or the patient may show symptoms of a delirium with the most extraordinary sights of unreal things. These convulsions may last for several hours or days. Firm pressure over the ovaries may bring on a convulsion, or if made during a convulsion may arrest it. The disease is rarely dangerous to life, yet death has followed exhaustion induced by repeated convulsions or prolonged fasting. The duration of hysteria is very uncertain.
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DURING A CONVULSION. The first thing to do is not to be frightened. A patient in a convulsion from hysteria very seldom injures herself during the convulsions. If you are sure it is hysteria, give a nasty tasting medicine, asafoetida is a splendid remedy, but not in pill form, for there is no taste or smell to them. Sometimes a convulsion may be arrested by the sudden use of ice to the backbone or abdomen or by dashing cold water in the face and chest, or by pressing upon the ovaries. When the hysteria is of a mild form it is sometimes a good plan, when the convulsion comes on, to place the patient in a comfortable position and then leave her, and when the patient comes to and finds herself alone and without sympathy, the attacks are less likely to be repeated. Sometimes if you watch a patient closely when she is seemingly unconscious, you will see, if you look at her very guardedly, that one eyelid is not entirely closed, and that the patient really sees much that is occurring around her. I am writing of real genuine hysteria, in which the patient is not quite right, not only physically but mentally,--especially the latter,--during the attack at least. For that and other reasons such patients should not be treated cruelly.
Preventive Treatment of Hysteria.--In order to be successful in this line of treatment the cause must be found and treated. An English physician writes: "It is pitiable to think of the misery that has been inflicted on these unhappy victims of the harsh and unjust treatment which has resulted from false views of the nature of the trouble; on the other hand, worry and ill-health, often the wrecking of the mind, body and estate, are entailed upon the near relatives in the nursing of a protracted case of hysteria. The minor manifestations, attacks of the vapors, the crying and weeping spells are not of much moment, and rarely require treatment. The physical condition should be carefully looked into and the mode of life regulated, so as to insure system and order in everything. A congenial occupation offers the best remedy for many of these manifestations. Any functional disturbance should be attended to and a course of tonics prescribed. Special attention should be paid to the action of the bowels.
The best preventive treatment is the one that is given early, when the girl is growing from childhood to girlhood. It should be begun even earlier. A weakly baby should be built up by proper food and outdoor life.
Dainties should not be given to such a child. When the child is old enough, as some mothers think, to go to kindergarten school, keep the little one at home. It is plenty early enough to send such a child to school when she is seven years old. This early school work rushes the child, makes it nervous. If you should happen to listen to the heart of many young school children you would find it pounding away at a furious rate. Do not hurry a weakly child. Do not hurry or rush a young girl even though she is strong, from the ages of twelve to sixteen years. Our school system does just that. Instead of taking life easy when she is nearing the crisis (p.u.b.erty) or is in that period, she is hurried and rushed and crammed with her school work; the girl frequently goes to school during this period, even when she is unwell and sits there for an hour or more with wet skirts and sometimes wet shoes and stockings. Every day I see girls of all ages go past my office here in this cultured city of Ann Arbor, without rubbers, treading through the slush and water. Is it any wonder they become sickly, become victims of hysteria and suffer from menstrual disorders? Dysmenorrhea must follow such carelessness, and the parents are to blame in many cases. Be careful of your children, especially girls at this age, care less for their intellectual growth, and pay more attention to their body development, even if it should happen to be at the expense of their intellectual development. A healthy body is better than all the knowledge that can be obtained, if it goes, as it too often does, with a body that is weak and sick. Outdoor life is necessary.
Horseback riding is splendid; walking is also good exercise at a regular time each day."
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PHYSICIANS" TREATMENT for Hysteria.--If there is any womb trouble, it must be attended to. There is frequently trouble with the menses in cases of hysteria. It sometimes comes from anemia or simply comes without any special reason. Tonics like a.r.s.enic, iron, strychnine and cod-liver oil are needed for anemia. Iron valerate is good, in one grain doses, three times a day, in this disease, when the patient is not fleshy.
1. The following is recommended by Dr. Goodell:
Of each one scruple (20 grains).
Quinine Valerate Iron Valerate Ammonia Valerate
Make into twenty pills. Take one or two pills three times a day.
(This is a good tonic in such cases.)
2. Fowler"s Solution of a.r.s.enic in three to five drops doses is frequently used (three times a day) and is a good lasting tonic in cases where the patient has a very pale white looking skin.
3. Asafoetida in three to five-grain pills is a splendid tonic in such cases, and in that form is pleasant to take. Take three during the day, before meals.
4. Sumbul or musk root is a good remedy. Tincture in one-half dram doses three times a day. This is good when the patient is very nervous.
5. The following is good when anemia is prominent:
Dried Sulphate of Iron 20 grains Alcoholic extract of Sumbul 20 grains Asafoetida 10 grains a.r.s.enious acid 1/2 grain
Mix thoroughly and make twenty pills, one after each meal.
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6. Tincture of hops in doses of one-half to two teaspoonfuls is good for nervousness and sleeplessness, taken at bedtime. It can also be taken regularly four times a day in from one-half to one teaspoonful doses.
7. General Cautions.--Proper, easily digested foods must be taken. Keep the bowels open daily. Let trash and dainties alone. Pies, cakes, and rich foods are an abomination for such patients. Candy is not to be eaten. Let novels alone. Go to bed at nine and sleep until six or seven. Bathe five or ten minutes every morning or evening in tepid water or cool water. The patient should be warmly clothed. Sleep in a pleasant, sunshiny and airy room. In severe forms of the disease the "Rest Cure" and feeding described under Nervous Prostration should be used.
EPILEPSY. (Falling Sickness).--This is an affection of the nervous system, characterized by attacks of unconsciousness, with or without convulsion.
Causes.--In a large proportion of cases the disease begins before p.u.b.erty.
It rarely begins after twenty-five. It is more liable to attack females than males. Heredity is thought by some to play a big role. Dr. Osler says: "In our figures it appears to play a minor role." Another doctor says: "Heredity plays an important role in the production of the disease.
Besides epilepsy, insanity, migraine, alcoholism, near relationship of parents (consanguinity) and hysteria are among the more common ancestral taints observed." All factors which impair the health and exhaust the nervous system are predisposing causes. Injury to the head often causes it. Teething, worms, adherent foreskin and c.l.i.toris, closing of the internal opening of the womb, delayed menstruation, are sometimes the cause.
Symptoms.--There are two distinct types. The major attacks--or "grand mal"--in which there are severe convulsions with complete loss of consciousness, etc.; and the minor attacks or "pet.i.t mal," in which the convulsive movements are slight and may be absent, and in which the loss of consciousness is often but momentary or practically absent. In some the attacks occur during the day; in others during the night, and they may not be noticed for a long time.
Characteristic paroxysm of the Major attacks.--This may be ushered in by a localized sensation, known as the Aura, in some part of the body; but it may come without any warning and suddenly. The convulsions begin suddenly and at first are tonic, that is, it does not change but holds on. Thc patient falls unconscious regardless of the surroundings, and the unconsciousness may be preceded by an involuntary piercing cry. The head is drawn back and often turned to the right. The jaws are fixed (tonic spasm). The fingers are clenched over the thumb and the extremities are stiff. The breathing is affected and the face looks blue. The urine and bowel contents may escape; but this occurs oftener in the next stage. This tonic spasm usually lasts from a few seconds to a half minute when it is succeeded by the clonic spasm stage.
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Clonic spasm stage.--In this the contraction of the muscles is intermittent. (Tonic spasm is the opposite condition.) At first there is trembling, but it gradually becomes more rapid and the limbs are jerked and patient tosses violently about. The muscles of the face are in intermittent motion, the eyes roll, the eyelids are opened and closed convulsively. The jaws move forcibly and strongly, and the tongue is apt to be caught between the teeth and bitten. The blue look now gradually decreases. A frothy saliva, which may be bloodstained from the bitten tongue, escapes from the mouth. The urine and bowel contents may escape involuntarily. The length of time of this stage is variable. It may last two minutes. The contraction becomes less violent and the patient gradually sinks into the condition of deep sleep, when the breathing is noisy and stertorous, the face looks red and swollen, but no longer bluish. The limbs loose their stiffness and unconsciousness is profound.
The patient, if left alone, will sleep for some hours and then awakes and complains only of a dull headache. His mind is apt to be confused. He remembers nothing or little of what has occurred. Afterwards the patient may be irrational for some time and even dangerous.
The minor attack or "pet.i.t mal."--There is a convulsion; a short period of unconsciousness, and this may come at any time, and may be accompanied by a feeling of faintness or vertigo. Suddenly, for example, at dinner time the person stops talking and eating, the eyes are fixed and staring and the face is slightly pale. The patient usually drops anything he may be holding. The consciousness returns in a moment or two and the patient resumes conversation as if nothing had happened. In other instances there is a slight incoherency or the patient performs some almost automatic action. He may begin to undress himself, and on returning to consciousness find that he has partially disrobed. He may rub his beard or face, or may spit about in a careless way. An eminent physician states: "One of my patients, after an attack, was in the habit of tearing anything he could lay his hands on, particularly books; violent actions have been committed and a.s.saults made, frequently giving rise to questions which come before court. In the majority of cases of "pet.i.t mal" (light attacks) convulsions finally occur, at first slight, but ultimately the grand mal (major attacks) becomes well developed, and the attacks may then alternate."
Recovery.--The authority above goes on to say: "This may be given today in the words of Hippocrates: "The prognosis in epilepsy is unfavorable when the disease is congenital (that is, existing at birth), when it endures to manhood, and when it occurs in a grown person without any previous cause.
The cure may be attempted in young persons but not in old." " Death rarely occurs during the fit, but it may happen if the patient is eating.
If the attacks are frequent and the patient has marked mental disturbance the conditions are unfavorable. Males have a better outlook than females.
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PHYSICIANS" TREATMENT.--What to do during the Attack of Epilepsy.--Keep the patient from injuring himself, loosen the clothing, take off the collar or anything tight about the neck. Place a cork or spool or tooth-brush handle between the teeth to keep the patient from biting his tongue, but attach a stout cord to the object and hold it in that way.
Preventive and general treatment.--In the case of children the parents should be made to understand that in the great majority of cases epilepsy is incurable. The patients need firm but kind treatment. It does not render a person incapable of following some occupations. "Julius Caesar and Napoleon were subjects of epilepsy." The disease causes gradual impairment of the mind, and if such patients become extremely irritable or show signs of violence, they should be placed under supervision in an asylum. A person with this disease should not marry.
Diet.--Give the patient a light diet at regular hours, and the stomach should never be overloaded. There are cases in which meat is injurious, and it should not be eaten more than once a day and at noon time. A vegetable diet seems best. The patient should not go to sleep until the digestion is completed in the stomach.
Causes.--Should be removed if possible. Circ.u.mcision should be done, especially in the young. In case of a female child the "hood of the c.l.i.toris" should be kept free. Undue mental and physical excitement should be avoided. Systematic exercise should be taken. Baths in cold water in the morning, if possible, as the skin should be in good working condition.
Medicines.--The bromides are the best, and should always be given under proper supervision of a physician or nurse.
Caution.--I wish to add that parents should always attend to the seemingly harmless "fits" in their young children. It will not do to say they are due to teething or worms. If they are, the worms at least can be treated and that cause removed. They may be due to too tight opening in the p.e.n.i.s.
If that opening is small, or if the foreskin is tight it will make the child irritable and cause restless sleep. Attend to that immediately. The same advice applies to female children. The "cover" of the "c.l.i.toris" may be tight, making the little one nervous; loosen it. If your child keeps its fingers rubbing its private organs there is reason for you to have the parts examined and the cause removed as masturbation often starts in that way. The parts itch and the child tries to stop the itching. These little things often cause "big things" and I am sure "fits" can be stopped very often by looking after the private organs in both s.e.xes.
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SHAKING PALSY. (Paralysis Agitans).--This is a chronic affection of the nervous system, characterized by muscular weakness, trembling and rigidity.
Causes.--It usually occurs after the fortieth year, and is more common in men than in women. The exciting causes are exposure to cold and wet, business worries, anxieties, violent emotional excitement and specific fevers.
Symptoms.--The four prominent symptoms are trembling, weakness, rigidity, and a peculiar att.i.tude. It generally develops gradually, usually in one or the other hand. There is at first a fine trembling, beginning in the hands or feet, gradually extending to the arms, the legs and sometimes the whole body. The head is not involved so frequently. This trembling (tremor) consists of rapid, uniform "shakings." At first it may come in spells, but as the disease advances it is continuous. Any excitement makes it worse. It is very marked in the hands. The trembling generally ceases during sleep. The muscles become rigid and shortened; the head is bent and the body is bent forward; the arms are flexed (bent) and the thumbs are turned into the palms and grasped by the fingers; the legs are bent, movement soon becomes impaired and the extremities show some stiffness in motion. There is great weakness of the muscles and it is most marked, where the trembling is most developed. There is no expression on the face, and the person has a slow and measured speech. The walk is very peculiar, and in attempting to walk the steps are short and hurried. The steps gradually become faster and faster, while the body is bent forward and the patient must keep on going faster to keep from falling. It is difficult to go around in a short circle. The patient cannot change his position in bed easily. The mind is rarely affected.
Recovery.--It is an incurable disease. It may run on for twenty years or more. There may be times of improvement, but the tendency is to grow, gradually worse.
PHYSICIANS" TREATMENT for Shaking Palsy.--This is simply to make the patient as comfortable as possible. Regulate the diet. The patient should not worry or have much exercise. Frequent warm baths are sometimes beneficial with gentle ma.s.sage of the muscles.