Psychic Elements and Other Remedies.—When organo-therapeutics became the fad paralysis agitans was treated also by this method. Some cases were treated with reported good results by thyroid. Later when the parathyroids attracted attention they were administered with reported good success in even very severe cases. I think that there is a report of some cases of paralysis agitans being improved by injections of diphtheria serum. In other words, anything that was given to a patient with the promise that he would be better after it and that produced a definite effect upon his mind was likely to do him temporary good. If the remedy had some special theory behind it, if there was a story of some new scientific significance for the material employed or the method of giving it, then this improvement was sure to take place. [{545}] In the drug treatment of the disease the same principles applied. Earlier, when nitrate of silver was the main recourse for organic nervous diseases, cases were reported improved by its administration. When the alterative properties of arsenic became a therapeutic fad this produced good effects. Atropin had for some time a reputation of relieving patient's symptoms. After a time all of them ceased to be used to any extent.
The Frenkel Method.—In recent years the application of the Frenkel directed movement method, modified somewhat from its application in tabes, has attracted attention in the therapeutics of paralysis agitans. It is interesting to note how often a mode of treatment that has been applied successfully to one of these diseases has also proved successful with the other. The two diseases are, of course, very different in etiology and pathology; but have one thing in common. The control over muscles has been lost to some degree in both cases in the progress of the disease, and a special effort of attention is required on the part of the patient in order to regulate movement. Anything that will arouse the patient to make this special effort will relieve the symptoms for a while and in tabes may bring about a lasting improvement, because the habit becomes easier after a time, though apparently this does not occur in paralysis agitans, except perhaps in the younger patients. It might very well be expected, then, that Frenkel's method in many cases would do good in paralysis agitans and it has proved to be another adjunct in the treatment of the affection. It must be used with great care not to exhaust the patient, but this is true also in tabes. The real source of its therapeutic quality seems to be the patient's interest in it and if this cannot be aroused it usually fails to do good. The success of these various mechanical methods makes it easy to understand why these patients often improve for a time under osteopathic treatment.
Psychotherapy.—It is clear, then, that the most important aid for these cases is the arousing of mental interest in some form of treatment that promises to be of benefit to them. New forms of treatment cannot always be invented and mental occupation must be secured by interest in other things. Patients suffering from paralysis agitans are prone to allow themselves to give up efforts to do things in which their interest would be aroused. They must be encouraged to do many things. Carriage riding, automobiling, train excursions, because of the effort required to resist vibration, are all helpful. They must not be allowed to drift into vacuous habits in which they make no effort for themselves. They can thus be made much more comfortable and most of their symptoms can be relieved to a marked degree. This requires constant attention and ever-renewed efforts to arouse the patient's mind and to have him make such efforts as will overcome rigidity and control the tremor to some extent; but with care an amelioration of the condition can always be brought about and can be maintained, at least to the extent of making the patient much more comfortable than would otherwise be the case.
CHAPTER VII
HEADACHE
In spite of the improvement in the general health of the community, due to more hygienic living, more healthy food and better ventilation, headache, instead of decreasing, has increased to a great degree. Any number of headache cures are advertised in the daily papers, in the street cars, on the signboards, even in medical journals, and besides these nearly every druggist has his own special preparation for headache, so it would seem as though literally many millions of doses of these headache cures must be taken every week. It would seem as though there must be some special unhygienic factor at work to produce headaches at a time when all other pathological conditions are being reduced in number and severity.
A study of the patients who are especially affected by headache seems to furnish evidence as to the special factor that has led to the increase of the affection. It occurs much more frequently in women than in men. It is complained of particularly by those who have less regular occupation, and the notable increase has come with the opportunity for leisure on the part of large numbers of the community due to the growth of wealth.
A feeling of discomfort in the head to which much attention is paid will become such a painful condition as to deserve the name of ache, if it develops in those who have no serious occupation in life and no interests that demand peremptory attention. With the noise of many children around them in the olden times women suffered comparatively little from headaches. Most of our grandmothers scarcely knew what it was to have a headache. Now most business men are likely to say the same thing. Very rarely do they suffer from headache. When they do, there is some specific reason and when this is removed the headache disappears. There are many women of leisure who have regular headaches for which they must have some remedy at hand or the pain becomes intolerable, but there are few women strenuously occupied with business affairs or with interests in which their attention is absorbed who find themselves under any such necessity.
It is evident that certain conditions predispose to headache. The principal of these is having sufficient time to advert to certain uncomfortable feelings in or around the head. Few people who stop to think of what their head feelings are but will find there is some unusual sensation somewhere in or outside the head which if dwelt upon becomes emphasized into an ache. If the mind can be diverted it disappears. If there has been some injury of the head or some pathological conditions set up by congestion or anemia, the feelings may become emphasized and occupy the center of attention, and even after the injury has disappeared or the pathological condition been ameliorated some sensations remain which with advertence produce achy feelings of discomfort. This is the history of a great deal of the increase of headache in our time. There are, of course, real headaches due to definite pathological conditions, but the great majority of headaches complained of [{547}] are the result of over-attention to certain sensations, some of them normal, some of them only slightly abnormal, which are emphasized by concentration of attention on them until they become a torment.
Two main classes of headaches come to the physician for treatment. One class is seen in patients who suffer from real and even acute pain that cannot be distracted by diversion of mind, that is usually worse when they try to sleep, as toothache is, and is evidently due to definite physical disturbance. In the second class are the many queer feelings about the head called headaches, though the patient suffers rather from annoyance than from pain. It is said that the Chinese in olden times put criminals to a lingering death by fastening them in such a way that a drop of water fell every minute on their heads. It was impossible to avoid the falling drop, and its constant recurrence became an awful torture. Any feeling that engrosses consciousness will be followed by the same sense of torment. The constant exercise of function of any nerve without rest is of itself physically disturbing to a serious degree. This must be realized with regard to many forms of headache which, though trivial in origin, are the source of bitter complaint.