Mrs. M., aged 26; the mother of one healthy child; rather adipose; short and firm of organization; flushed face; weight, 140 pounds; apparently a very vigorous woman. She cannot endure any muscular effort of any kind, as she becomes exhausted; dizziness, formication, sickness at the stomach, one day; coldness of feet and hands, with paresis of first one side then the other, tingling of the tongue; no hysterical manifestations, cramping or fainting, at any time. Uterus is normal; no tenderness along the spine. Sometimes a local hyperæmia of the brain exists, but only lasts a short time. Her heart-sounds are normal, and pulse regular; bowels perfectly regular at all times, and menses regular. Within a period of two years’ time, she produced four abortions upon herself. Each time at third month, and each time did so well that no physician was called. She informed me that she became more and more nervous after each abortion. I have not benefitted this case by any manner of treatment, as yet, and still there is no manifestation of any organic disease.
If ever a physician is perplexed, it is when he is called on to advise a patient whom he calls “nervous.” This is more commonly the case with the general practitioner, as he is looking for something to be the matter, and finds nothing but phenomena which he illy comprehends.
These cases are of vast interest to the neurologist, as he is in an expansive field for study, and he feels a pleasure with his work; not as to the rapidity with which he expects to see these manifestations pass away, but in the assurance that these most troublesome phenomena are harmless.
_Treatment._――In the management of these peculiar nervous appearances, many agents may become necessary; but to obtain rest is the all-important consideration. To aid nutrition is the next in importance, and thereby build up the structure of the nervous system, improving tone by assimilation. All causes, of course, must be removed. The medical treatment will consist of agents that stimulate evolution of nerve-forces. Tinct. pulsatilla, bromide ammonia, dil. phos. acid, are agents which act excellently, given one after the other, changed in a manner to perpetuate their influence. With determination of blood to the face and head, small doses of gelseminum or bromide potassium, for temporary relief, and ergotine continued in grain doses.