Thiery13 of the Saint Pierre Hospital, Brussels, arrests paroxysms by what he calls torsion of the abdominal walls. He grasps in his hands the walls of the abdomen and imparts to them a certain kind of torsion, which he gradually increases. This treatment is practically the same as the deep ovarian pressure of Charcot. This compression of the ovary on the side of the seat of the lesion ordinarily will arrest immediately the convulsions. The patient is extended horizontally, and the physician plunges the closed fist into the iliac fossa, often using great force to overcome the muscular resistance. Poiner has invented an apparatus called a compressor of the ovaries, which can sometimes be used with advantage.
13 Medical and Surgical Reporter, Oct. 7, 1876.
Nitrate of amyl is undoubtedly of value in averting grave hysterical attacks—convulsions, trance, ecstasy, pseudo-coma, mania, etc. It is frequently used with marked success. Its action was studied on a vast scale at La Salpêtrière. The convulsions usually stop almost immediately after one, two, or three inhalations. It is to be preferred to inhalations of chloroform or ether.
Nitro-glycerin can be used in the treatment of the hystero-epileptoid convulsions. Notes of a very interesting case of hystero-epilepsy in which this remedy was successfully employed have been furnished me by David D. Stewart of Philadelphia. The case was one of hystero-epilepsy with combined crises. Amyl nitrate on several occasions broke the convulsive attack, but the patient did not completely regain consciousness. Stewart was called in during an attack, and found that the patient had been unconscious for an hour and a quarter. He gave her hypodermically three minims of a 1 per cent. solution of nitro-glycerin, and another injection after an interval of about eight minutes. She became conscious within one minute after the second injection. After this she had two seizures, both of which occurred on the same day, and yielded with remarkable promptness to a few minims of nitro-glycerin given by the mouth. She was put on three minims three times a day of this drug, the dose being gradually increased. Sufficient time has not elapsed to report as to the effect of the drug given during the intervals.
Strong faradic currents, applied with metallic electrodes to the soles of the feet or to the spine, are occasionally efficacious. The galvanic current to the head has been extensively employed in the service of Charcot to arrest hysterical and hystero-epileptic attacks of the grave variety. One electrode is applied to the forehead, the other to any convenient place upon the body, as the leg, the ovarian region, or the spine. The current is applied continuously for several minutes, or voltaic alternations are made. This method has been used with success in a few instances, but should never be resorted to by a physician uncertain of his diagnosis or one practically unfamiliar with the powers and properties of the electrical current.
The question of oöphorectomy for the relief of hystero-epilepsy is one of increasing importance in these days of major surgery. At the meeting of the American Neurological Association (June, 1884) G. L. Walton read a paper14 in which he concludes that hysteria is sometimes set up by ovarian irritation, and can be relieved by removing the offending organ. He cited a single case. Carsten15 concludes that it is criminal neglect not to perform Battey's operation in cases which fail to be benefited by other treatment. In the discussion which followed the reading of this paper the subject was well traversed by Spitzka of New York, Putnam of Boston, Putnam-Jacobi of New York, and others. Spitzka referred to one case of Israel's of Breslau, in which a patient was cured of hystero-epilepsy by a sham operation—a superficial incision in the parietes of the abdomen. Under the title of castration in hysteria the Lancet16 tells of an hysterical patient who had suffered for years from obstinate vomiting and severe ovarian pain. She became extremely weak, and finally consented to spaying as the only hope. The operation—performed under chloroform with antiseptic precautions—was a mockery, the skin only being incised; she was, however, perfectly cured of her hysterical symptoms.
14 “A Contribution to the Study of Hysteria as Bearing on the Question of Oöphorectomy.”
15 Quoted by Walton from American Journal of Obstetrics, March, 1883.
16 Vol. ii. p. 588.