HYSTERICAL AFFECTIONS.
If there is any one disease that more frequently than any other tempts the physician to have recourse to empirical treatment, it surely is hysteria. The obscurity, in many cases, of its etiology, as well as its frequent obstinacy under the most diverse methods of treatment, successively employed, are alone sufficient to warrant us in having recourse to electricity, where this has not already been employed. Where we can establish the etiology of a given case, we cannot of course be in doubt as to the remedy; and in many instances of this kind we find in electricity our most potent curative agent. But even where we are in doubt or positively ignorant as to the origin of the symptoms, we are justified in giving preference empirically to electricity, not only because, the disease being essentially of a nervous character, we find in electricity the most powerful of neurotics, but also because recent statistics, those that embrace a period when electricity has been permitted to participate, if not duly, at least more largely than heretofore, in the treatment of disease, go to show that by means of this remedy better average results have been obtained than with any other. Again, where there are no positive indications to employ any special method of electrization, either central or local, it appears rational to give the preference to a method that is at the same time central and peripheral, that admits of the application of either current with the utmost facility, and is susceptible of so many modifications that, with at best two or three tentative applications, it can be suitably adapted to almost any given case. The results I have thus far obtained justify me in asserting that, of the cases that are merely functional in their nature, by far the greater majority will yield completely to judicious electro-balneological treatment.
As to the mode of administration in this affection, I can suggest nothing. There is so little uniformity in the manifestations of hysteria, that it were idle to even attempt to establish anything like a routine electro-balneological treatment. Each case must make its own laws.
Case VIII.* Mrs. A., aet. 28, married, sterile, from the clientele of Dr. Kremer, was referred to me on June 12th, 1874. She had been a sufferer from hysteria for a number of years. Among the more prominent symptoms were intense pruritus, transient flushing and heat of the entire surface, with pricking sensations and headache. Six baths, in each of which both currents were employed, sufficed to effect a complete and permanent cure.
Case IX.* Mrs. E., from the clientele of Dr. Krehbiel, aet. 28, married, of an exceedingly nervous temperament, had suffered from excessive nervous irritability and prostration since her last confinement (about a year previous to my seeing her). There was no organic trouble, the symptoms pointing to pure functional hysteria. She was sent for electro-balneological treatment April 21st, 1874. Six baths, in which both currents were employed, restored her to perfect health.
NEURASTHENIA.
(Nervous Exhaustion.)
Those who are familiar with the pre-eminent qualities as a neurotic of electricity, will not be surprised to be told of the beneficial effects in the condition under consideration of electric baths. It is not only in general nervous exhaustion, however, that electric baths exercise this salutary influence, but in the condition known as cerebral exhaustion likewise. Judging from my own experience, their efficacy in this latter condition is far greater than that of local applications, whilst they are unattended with any of the irritant and other disagreeable effects that even with the greatest care and caution we cannot always disassociate from galvanization of the brain. They no doubt act here in two ways, i.e., first and chiefly, through reflex influence from the entire periphery; second, by derived currents on the brain directly. Whatever their mode of action, the results obtained are of the most gratifying kind. The pitiable condition in which some patients of this class present themselves, is familiar enough to every physician; but it appears that the greater the degree of exhaustion and the more prostrate the various functions, the more striking are the effects of the baths. The patients seem to live up anew under their influence. While in many if not most other complaints that come under electro-balneological treatment, a certain number of baths are requisite in order to get discernible effects, in the disease under consideration each bath, except perhaps the first, is followed by more or less immediate improvement, which, if the treatment is persevered in, remains permanent.
It is almost unnecessary to say, that in the more advanced cases great care is requisite in the administration of the baths. By over-stimulation at first, much harm may be done, and the patient, instead of getting better, get worse. In such cases very mild currents should be employed in the beginning. As recuperation advances, stronger currents may be gradually introduced. The intensity of the currents should be carefully regulated to keep pace with the gradually increasing capacity of the various organs to respond to the electric stimulus without detriment. Both currents may be used from the first. The galvanic current should precede the faradic, and be employed for not more than ten minutes. Where irritability is a feature of the case, the current should be descending; otherwise ascending. This may be followed by the faradic current, not of sufficient intensity for the first few baths, however, to cause any but slight muscular contractions. In most of these cases iron may be advantageously added to the bath. The duration of the baths should at first not exceed fifteen minutes; in some cases this even is too long, the patient complaining of being fatigued perhaps after the lapse of ten minutes. When this is the case, the bath should be at once terminated. It is in these instances not the electric current, but the warm water bath, that gives rise to the sense of fatigue. Later on in the treatment, the duration of the baths may be from twenty to twenty five minutes, according to indications.
Case X. Cerebral Exhaustion.—K. S., aet. 42, lawyer. First consulted me on June 2d, 1874. The salient points in the history of this most interesting case are as follows: Ten years prior to his calling on me he was engaged in some very heavy law cases and other duties requiring intense mental application. At that time he began to manifest occasional symptoms of cerebral exhaustion; was unable to endure mental exertion with same force as theretofore. These attacks, commencing in 1864, supervened at various times until 1868, sometimes incapacitating him for business for a few days at a time, and accompanied by intestinal catarrh, flatulence and gastric disturbances—probably the results of loss of nerve-power. In 1868, having been subject for a time to extra heavy mental strain, he was completely prostrated, and compelled to retire from the pursuit of his profession. By the advice of his physician he went to the country. There, without any premonitory symptom whatsoever, he suffered an attack of (left) hemiplegia. I quote from his recital as follows: “While standing in the office of the hotel registering my name in the book, I suddenly dropped down, retaining full consciousness. I lost the power of speech for some hours. After twenty-four hours the paralysis began to recede, and in a few days I had made a spontaneous recovery. I then went further into the interior. Two weeks subsequently I had a similar, but milder attack; retained full consciousness and mental control. Returned to city (New York) two weeks after this, in a very debilitated condition. On the third day after my return, I had a more violent attack than either of the preceding—again on the left side. I felt as if a line were drawn perpendicularly through my body, dividing it in halves. My stools were clay-colored. With this attack for the first time I became unconscious, and passed into a delirious state. So far as I know, no diagnosis of my condition was made. I was confined to bed for a month, at the end of which I was in a very feeble state. I then went to Europe, where I spent some years. While there I consulted the first physicians of London and Paris, with but little benefit, however. Both mind and body remained feeble. My normal weight is upwards of 120 pounds, but has for a long time past been in the neighborhood of 90 pounds.”
When Mr. S. came to consult me, he had but lately returned from Europe, whence, he stated, his physicians had sent him home to die. His complexion was sallow, sickly; skin of face plentifully wrinkled; features wearing the air of suffering and anxiety that so frequently accompanies painful chronic conditions. He had for some time past suffered from excessive cerebro-spinal irritability, for the relief of which cantharidal collodion had been employed in the cervico-spinal region (the same had also been used in the hepatic region, to meet the diagnostic views of some one of his medical attendants). He had a remittent chronic intestinal catarrh, with—noticeably during the periods of exacerbation—abundant discharge of a glairy mucus. The appetite was very capricious—not to say poor, and he was obliged to be exceedingly careful in his diet. He was not capable of any continued mental application. The muscular system was weak and flabby. All the vegetative functions were more or less impaired.
On June 3d, 1874, Mr. S., by my directions, took an electric bath. He continued the baths daily for some weeks; then every two or three days, all the time steadily improving. He had some adjuvant medicinal treatment, probably similar to what he had already had in Europe. He states, however, that his improvement commenced with the first bath he took; and the baths certainly constituted the main treatment throughout. He gained daily in every respect. Mind and body were invigorated; his muscles increased in size and hardness; color gradually returned to his cheeks, etc. He continued the baths with more or less regularity until the close of the year, taking in all sixty-one baths. He was then in a better condition than he had been for many years. Thinking a trip to Europe would benefit him, I advised him to go there and remain a few months. He left early in January and returned in the beginning of April, 1875. He had been very well during his absence, until within a few weeks prior to his departure from Europe, when he experienced a severe attack of cerebro-spinal congestion, which caused him much suffering. On his return he resumed the baths, and continued them throughout the spring, continually gaining in strength and weight. At the beginning of last summer he was practically well. He has regained his normal weight (120 pounds). As a criterion of his bodily vigor, I will simply state that I have seen him lift, with ease, 350 pounds, which, for a person of his weight, is not bad. His mental force is as good as it has ever been. The digestive disturbances have disappeared; he can eat things which for years he had been compelled to eschew. To use his own words: “I am well.” In view of the fact that he had already received, at the hands of competent men, all sorts of internal as well as external treatment, I believe I am justified in attributing his cure almost entirely if not solely to the baths.
Case XI. Mr. * * *, aet. about 50, lawyer, of large, vigorous frame, came to consult me January 4th, 1875. He complained of symptoms that are the frequent results of prolonged mental over-taxation. His intellect was as good as ever, but he lacked his wonted mental endurance and power of application. His mind was perfectly clear, but unable to work. It was a case of “limited cerebral exhaustion.” Physical nutrition was pretty good; yet his color was not normal, being rather paler than it had been and has since become again. His flesh was flabby. There were vague neurotic disturbances, etc., etc. He had until recently occupied a leading public position, and the onerous duties that devolved on him in connection with this, evidently stood in direct etiological relation to his trouble. I ordered an electric bath every other day. This was complied with until the end of February, when the patient had apparently entirely recovered his health, mentally as well as physically. I saw him not very long ago; he looked the picture of health, and told me that he was and had been since I saw him, perfectly well in every respect.
Case XII. Mr. L., aet. 23, presented himself for treatment in October, 1874. He had at various times made the attempt to study some profession, but had never been able to concentrate his mind sufficiently on any object to enable him to persevere in its pursuit. He was fretful, irritable and vacillating; would desire one thing to-day, another to-morrow; never long of the same mind. Melancholia, digestive disturbances and hypochondriacal phenomena accompanied this condition. No organic disease was discoverable. On October 1st he took his first bath. Very shortly after this he commenced the study of medicine. He improved rapidly in every respect. During the month of October he had six baths, which resulted in complete and permanent relief of all the symptoms. He progressed satisfactorily in his studies, and is at the present time taking his second course in one of our city medical colleges.
AGRYPNIA.
(INSOMNIA; SLEEPLESSNESS).
Although, as a rule, but the symptom of some definite pathological condition, agrypnia is of such frequent occurrence, and so detrimental to the general health, that it appears to me to merit special consideration. This holds good especially in this connection, because, even where electric baths fail to influence the disease giving rise to the insomnia, they almost invariably remove this, irrespective of its cause. Even where, the disease itself remaining uncured, the insomnia must return sooner or later, the sleep is very much improved while the baths are being had recourse to. We must of course endeavor in all cases to relieve the original disease, and, where the baths are not adapted to this purpose, resort to other and appropriate means. It will be found of no small service to us in the therapeutical management of every case, to be enabled to procure for the patient, without the aid of medicinal hypnotics, sufficient of sleep during treatment.
Case XIII. Mr. A., from the clientele of Dr. Leonard Weber, was sent by Dr. W. to take electric baths. He suffered from chronic spinal congestion. Among the most prominent and annoying symptoms was agrypnia. It was for the relief of this symptom chiefly that Dr. W. ordered him the baths. He began to improve in this respect from the time he took his first bath, and although the disease itself remained uncured, he enjoyed good sound sleep while he was under treatment, his general health improved, and he frequently spoke of the notable benefits that he received from the baths. He continued them until his departure for Europe, where, by direction of his physician, he went last spring. I have not seen him since, but Dr. W. tells me that he is doing well.
Case XIV. Mr. D. was brought on Sept. 30th, 1874, by his physician, Dr. Hogan. He was in the incipient stage of delirium tremens. Had not slept for some nights. Dr. H. had administered successively opiates, chloral and bromides in full doses, without effect. On the evening of above date the patient had a bath, in which the descending galvanic current was used. As a result, he slept well that night. The baths were repeated on the two succeeding days, with like effect. As the disease developed however it became necessary to send the patient to an asylum, whence he returned cured in a short time. The effect of the baths in this case, where full doses of the most powerful hypnotics of the materia medica had failed, was remarkably illustrative of their hypnotic power.