The Status Vertiginosus.—I have tried to make clear elsewhere and in this article that in several forms of vertigo the disorder ceases to owe its onsets to extracentral irritations, and becomes essential, precisely as happens in some epilepsies, and that we then are apt to have, with more or less distinct attacks or with no attacks, long continuance of a group of symptoms which constitute the status vertiginosus. Its treatment is important, because of its alarming and disqualifying effects. The attacks are often the least part of it, while the lack of power to read and write, to go into crowded streets, to face light, or to exercise, or stand emotions or the slightest mental strain, surround its management with embarrassments, and are well fitted to end in melancholia or hypochondriasis.
In these cases, after the eye has been corrected, the diet should be regulated with care. In extreme cases it may become desirable to limit it to milk, fruit, and vegetables where no obvious peculiarities forbid such a regimen; and I have found it useful to insist also on some food being used between meals.
I like, also, that these patients rest an hour supine after each meal, and spend much time out of doors, disregarding their tendency to lie down. Exercise ought to be taken systematically, and if the vertigo still forbids it, massage is a good substitute. At first near use of the eyes is to be avoided, and when the patient resumes their use he should do this also by system, adding a minute each day until attainment of the limit of easy use enjoins a pause at that amount of reading for a time.
Now, as in vertigo, especially labyrinthine, the eyes become doubly valuable as guiding helps to correct equilibration, I have long found it useful to train these patients to stand and walk with them closed. At first this is as difficult, or may be as difficult, as in locomotor ataxia, but the practice is sure to add steadiness to the postures. Somewhat later I ask my patient deliberately to make such movements of the head and such efforts of mind or memory as are apt to cause vertigo or confusion of head, and to conquer or inhibit these consequences by a prearranged effort of will; and these means also I have found useful. Meanwhile, nothing usually in these cases forbids the use of tonics or of moderate doses of bromides. As I have said, change of air is very serviceable. It is indeed rare that cases do not yield to some such combination of means, but very often it will happen that the fears of the patient are his most grievous foes, and are to be dealt with after every real symptom has vanished.
TREMOR.
BY WHARTON SINKLER, M.D.