SOCIETY EEPOETS. 
307 
relief for a few months, or even a few years, was to report 
nothing, and this was all that had been done. Almost 
every therapeutic or surgical measure had done good, but 
there was nothing more in the way of cure reported by 
modern effort than could be found chronicled by Escarol 
in 1828. 
Dr. PRICE closed the discussion by reiterating his opin- 
ion, that permanent benefit was possible in properly selected 
cases. 
PHILADELPHIA NEUROLOGICAL SOCIETY 
Stated Meeting, January 25, 1892. 
Dr. Charles K. Mills, in the Chair. 
ABSTRACT.-A FURTHER REPORT UPON THE 
USE OF BROMIDE OF AMMONIA1 AND AN- 
TIPYRIN IN EPILEPSY. 
By CHARLES J. POTTS, M.D. 
Since the first report was made upon this subject in the 
" University Medical Magazine," for October, 1890, thirty 
cases have been treated by this method, with the following 
results: eight did not return after the first visit and three 
received no benefit. The following cases are reported as 
having been remarkably benefited. 
Case I.-P. McK., male, aet. thirty-two. Had been hav- 
ing one spell a week since childhood; he has been under 
treatmentby this method for two years and has had but thir- 
teen spells of lessened severity. 
CASE II.-W. S., male, aet. thirty-two, first spell three 
months ago; has had twelve since. Number of spells re- 
duced to four in nine months. 
Case III.-H. S., male, aet. fourteen. Has been having 
six seizures a week for past three years. Under treatment; 
had eleven spells during first six months; further reduced 
to but one during the following year. 
Case V.-W. R., male, aet. twenty-five. Seven to eight 
spells a week since infancy. During five months' treat- 
ment averaged seven fits a month. 
Case VIII.-W. R., male, aet. thirty-one. Has been 
having very frequent epileptic seizures since he was three 
years of age. These were reduced by the treatment to 
eighteen of decreased severity in a year. 
1 Published in University Medical Magazine, February, 1892. 308 
SOCIETY REPORTS. 
CASE IX.-G. H., male, aet. twenty-three. First spell 
three years ago; has averaged one a month since. During 
a period of nine months has had no spells, and describes 
himself as " enjoying the best of health." 
Case X.-E. Y., male, aet. fifteen. Had one severe 
spell a month and about twelve "light ones" every day; 
at end of two months he was averaging one mild spell a 
day. Had gained flesh and mental condition was improved. 
CASE XIII.-Female, aet. three. Number of spells re- 
duced from three a week to two in a year. 
CASE XIV.-Female, aet. two-and-a-half. Three to four 
spells a week; no relief was afforded during first three 
weeks of treatment, at the end of which time improvement 
commenced, and when last heard from she had had no 
spells for six months. 
The advantages claimed for this combination are, First, 
that it exercises a most powerful influence in decreasing 
the number of epileptic paroxysms. In the majority of the 
cases treated the average number of seizures had either 
been stationary for some time or was increasing, and they 
had previously been treated with other drugs. Second, 
that when a seizure does occur it is of much lessened se- 
verity. Third, while lessening the number and severity of 
the seizures, it does not do this at the expense of the re- 
maining physical and mental health of the patient. The 
doses used were of antipyrin, eight grains, ammonium 
bromide, twenty grains; children in proportion. 
TREATMENT OF EPILEPSY BY ANTIFEBRIN 
AND SULPHONAL. 
Dr. HiNSDALE made a report of the use of antifebrin in 
epilepsy at the Infirmary for Nervous Diseases. Better re- 
sults were obtained in the lesser epilepsies in which brom- 
ides failed than in the greater epilepsies. One case was 
reported in which bromides made the condition worse, 
while antifebrin kept the attacks down to such a number as 
to make it possible to follow his vocation as a compositor. 
He took from ten to twenty grains three times a day for 
three years, and excepting an appearance of slight cyanosis 
there was no evident disadvantage in its use. 
Nine other patients were temporarily benefited by 
antifebrin, but eventually were compelled to return to 
bromides. 
Sulphonal was used in a large number of cases, seven of 
which were reported as having been under treatment a 
sufficient length of time to form an estimate of its value. SOCIE T y REPOR TS. 
309 
The dose employed was from three to six grains three 
times a day, and the period of treatment varied from one 
month to ten months. 
In one case, Maggie E. R., aged twenty, epileptic at- 
tacks occurred weekly. Duration of seizure variable, from 
one minute to one hour. Convulsions general. Petit mal tw 
or three times daily. Sulphonal in three or six grain doses 
thrice daily mitigated the severity of the attacks and re- 
duced them in frequency, so that after three months and a 
half of treatment only one attack had occurred during a 
period of eight weeks. She is at present taking five grains 
of sulphonal three times a day. 
Besides these a large number of other cases of epilepsy 
were treated with sulphonal. The results were variable; 
temporary -improvement was usually noted, but in many 
instances the patients failed to continue its use for a suffi- 
cient length of time. 
The dose for children is three or four grains, and for 
adults, six or eight grains, three times a day. Frequently 
patients are made sleepy by the use of sulphonal in these 
amounts. In that case two doses daily may be given. 
The best results from sulphonal are in those cases where 
bromides cause so much skin trouble or mental disorder 
that their quantity must be lessened or altogether sus- 
pended; then sulphonal becomes valuable. 
Dr. Francis X. Dercum.-I have had the opportunity 
of observing both methods of treatment-that employed at 
the University of Pennsylvania and that used at the In- 
firmary for Nervous Diseases. The mixture of bromide of 
ammonium and antipyrin acts differently from either drug 
alone. Certainly antipyrin by itself will not decrease the 
number of attacks, and antifebrin will do it only occasion- 
ally. When antipyrin is added to the bromide it increases 
its efficacy. In this way a much smaller dose of bromide 
need be given and thus the liability to acne and bromide 
dementia is lessened. At a recent clinic, Dr. H. C. Wood 
mentioned a peculiarity which he thought that he had ob- 
served in those patients who took antipyrin and the bro- 
mide for a long time, and that is that there seemed to be a 
lessening of the heat-producing power. Such patients found 
that they had to dress more warmly than before, even quite 
heavily in comparatively warm weather. 
When I spoke to Dr. Hinsdale of sulphonal as second to 
the bromides, I meant bromide mixtures in general. Sul- 
DISCUSSION. 310 
SOCIE T Y RE FOR TS. 
phonal has, in my experience, a decided value in diminishing 
the number of epileptic attacks. I can recall, however, sev- 
eral cases in which the attacks of epilepsy recurred as soon 
as the dose of sulphonal was diminished short of an amount 
necessary to cause drowsiness. If in a given case four or 
five grains were sufficient to produce drowsiness, no attacks 
would occur as long as this dose was continued, but the 
moment the dose was lessened the attacks recurred; and 
in a few instances when the sulphonal was kept up in full 
dose, the attacks would occur after a time with great vio- 
lence, although their onset had been delayed. However, 
in a number of instances I have succeeded in markedly 
diminishing both the violence and the frequency of the 
seizures by very moderate doses of the drug, and its chief 
value seems to be that it can be administered for quite long 
periods in place of the bromides thus enabling the patient 
to rally from the depressing effects of the latter. I have had 
four or five cases in which I alternated between sulphonal 
and the mixture of bromide of ammonia and antipyrine suc- 
cessfully for long periods. The prolonged administration 
of antipyrine apparently has no bad effect. But after it has 
been given for a time it is well to alternate with some drug 
that has less power. 
Dr. D. D. Stewart.-Would not some other bromide 
answer as well in this combination as that of ammonium ? 
The ammonium salt is the worst tasting of the bromides. 
I have used potassium bromide with antipyrin'with ad- 
vantage. I have found this combination singularly effica- 
cious in a girl who was having frequent attacks. She had 
been under my care for about a year and I had tried almost 
everything without effect, until I put her on eight grains 
of antipyrin with twenty grains of potassium bromide. 
Under this treatment, she had in a period of two weeks, 
only one light seizure, although prior to this she had from 
three to eight attacks a day, notwithstanding she was 
taking large doses of potassium bromide. 
I would ask if there is not some danger from giving sul- 
phonal in doses of six or eight grains, three or more times a 
day, for any length of time ? I believe that nephritis has 
been observed to follow the use of sulphonal. 
Dr. J. Madison Taylor.- I testify gladly to the value 
of antipyrine in combination with a bromide. I would like to 
know of any good reason why the bromide of ammonium is 
best to go with it, however; that of lithium has 
served me well in this connection. In a few instances this 
mixture has wrought most satisfactory results at my hands; 
not curative but largely palliative and promising even better. SOCIETY EE PORTS. 
311 
Sulphonal has disappointed me. The cases Dr. Hinsdale 
relates are well known to me at Dr. Mitchell's clinic where 
we hoped much from this drug. In certain instances there 
antifebrin gave excellent results causing, however, a steady- 
cyanosis at times which seemed menacing, but really work- 
ing no hurt. There are yet combinations to be learned 
which promise better than any single drug. 
Dr. James Hendrie Lloyd.-We hear a great deal 
about the poisonous effects of antipyrin. I would be glad 
to hear the opinion of those who have used antipyrin for a 
long time; does its use lower nutrition or tend to impair the 
vitality of the patient ? I have myself used antipyrin to a 
considerable extent, but I have failed to convince myself 
that it has any serious effect in ordinary doses. Certainly 
its dangers are not so great as are popularly supposed. 
Have there been any studies made of the blood after the 
use of antipyrin ? I saw recently a statement, which was 
not substantiated, that antipyrin has not only a depressent 
action upon the nervous system, but also a disturbing 
action upon the nutrition and composition of the blood. 
Dr. Joseph Leidy.-Some three years ago I reported 
a series of cases of epilepsy and other neuroses treated by 
the use of antipyrin and antifebrin. Several of these cases 
were under the care of Dr. Wood. It was found that anti- 
febrin proved more efficacious than antipyrin. In one case 
under treatment for several months antipyrin was used in 
quite large doses, as much as sixty grains a day. It dimin- 
ished the number and the intensity of the attacks, but as 
soon as the drug was withdrawn they recurred with great 
frequency. I think that thirty-one cases were reported, in 
four the attacks were considerably lessened by antipyrin, 
but in the others the drug had no effect. Upon the lesser 
antipyrin seemed to have considerable effect. 
In the majority of cases of petit mal the attacks were not 
only diminished, but were completely obliterated during 
the time that the drug was used. With antifebrin the results 
were better, in many of the slight epilepsies the attacks did 
not return after four or five months. I know of no case. 
Dr. W. H. Bochroch.-At the nervous department of 
the Northern Dispensary four cases of epilepsy are under 
treatment with antipyrin in combination with bromide of 
ammonium, or bromide of potassium. In all there has 
been a diminution of the number of attacks, and in two 
there is reason to hope that the attacks will remain away 
for some time. Two cases have been under observation for 
four months, and they show no change in nutrition. 312 
Dr. THOMAS J. Mays.-I have had considerable ex- 
perience with the administration of antipyrin, phenacetin, 
and antifebrin, and have given these agents for long periods. 
I think that there is a view abroad that these agents are 
depressent and really toxic. I think that this view is not 
borne out by anything that we know in the way of experi- 
mental research or clinical observation. Some have a 
horror of giving these agents in fever on account of the fear 
that they cause depression of the heart and collapse. Ex- 
periment on animals show that these agents do not have a 
depressing influence upon the heart. If there is any 
influence at all, it is to cause elevation of the blood pressure. 
I have given phenacetin and antifebrin for long periods. I 
have one patient who is under observation at the present 
time who has taken three or four grains, four times a day, 
for more than a year without any toxic effect that I can see, 
and the disease for which it was given, namely asthma, has 
entirely disappeared. I have given antifebrin in enormous 
doses to phthisical patients-as high as eighty grains a 
day for six or seven days. This is an agent which you can- 
not give in large doses for any long period. I used it to> 
depress temperature, but at the end of this period I have 
suspended it on account of the cyanotic appearance which 
it calls forth. This is not a true cyanosis, but a discolora- 
tion partly due to the decomposition of the blood. Anti- 
pyrin can be continued for about three weeks, when it 
produces an uncomfortable, distressing rash. 
Of the three agents mentioned, I think that phenacetin 
is the least likely to cause trouble, antifebrin has to be sus- 
pended on account of the discoloration, and antipyrin on 
account of the urticaria-like eruption, and even the ulcera- 
tion of the skin which it produces when it is continued more 
than three weeks in seven-and-a-half grain doses repeated 
every four hours. My experience has not been such as to 
make me think that these agents are depressent, but of 
course, if given in excessive doses they will depress just as 
well as other agents. 
Dr. Francis X. Dercum.-I have given antipyrin in 
ten grain doses four times a day for a very long period, but 
have never observed any rash, I should regard this as rather 
the exception than the rule. 
Dr. CHARLES K. Mills.-I have used antipyrin, anti- 
febrin, sulphonal and most of the other remedies which have 
been recommended, but I have invariably been driven back 
for most cases to the combination to which I resorted many 
years ago, that is, of the bromides with Fowler's solution 
SOCIETY REPORTS. and conium. This in the majority of cases gives the best 
results. Of course with all of these drugs you have to use 
nutrients and tonics. 
Dr. JOSEPH Leidy.-I should like to report the re- 
sults of a post-mortem in a case of death after the use of 
large doses of antipyrin. The patient was a man of forty- 
five or fifty years, who for about five weeks had been given 
antipyrin for epilepsy. The number of attacks diminished 
considerably, there was marked cyanosis which was in- 
variably found after the use of antipyrin, and was more 
marked with antipyrin than with antifebrin, but I do not 
remember the occurrence of a rash during or following the 
administration of these drugs. At the autopsy this case 
showed great congestion of the brain with oedema at the 
base. The 'internal organs also were congested. It was 
the opinion of those who had had this case under observa- 
tion that death was due to this action of the drug, and in all 
probability to a direct action upon the haemoglobin of the 
red-blood corpuscles. The blood of the epileptic cases was 
also examined, to determine the amount of haemoglobin, 
and also the number of corpuscles. Antipyrin seemed not 
only to diminish the number of corpuscles, but also the per- 
centage of haemoglobin. The corpuscles were reduced to 
three or three-and-a-half millions in the cubic millimetre, 
and the haemoglobin to seventy or eighty per cent. 
Dr. C. S. Potts.-Our reason for using the bromide of 
ammonium is that Dr. Wood believes that it has a more 
powerful influence than the other bromides, and from some 
comparative trials made, such seems to be the case. In 
none of the cases in which I have given the bromide of am- 
monium and antipyrin, have I seen any bad effects. Those 
cases that were reduced in health have improved. 
I should like to read the report of a few cases treated in 
this way by Dr. Hay, at the State Asylum for the Insane at 
Morris Plains, N. J., and published in the " Medical Age," 
July 25, 1891. 
Male, aet. forty-five. For eight months previous to 
the commencement of this treatment he had, on an average, 
thirteen convulsions a month, all extremely violent, and at- 
tended by pre-epileptic mania of short duration. During 
this time he was taking nitro-glycerine gr. four times 
daily. In October he was placed upon bromide of ammo- 
nium, gr. xx, with antipyrin, gr. vii, and at the end of one 
month the antipyrin was increased to gr. x in each dose. 
In all he took this combination three months with the fol- 
lowing result: during the first month he had twelve seizures; 
SOCIETY REPORTS. 
313 314 
SOCIETY REPORTS. 
during the second,nine,and during the third month,only three 
fits. The character of the fits was modified favorably, and 
he was far less violent than usual. 
Male, aet. thirty. In eighteen months previous he 
had an average of twelve convulsions a month, during 
which time he was given antifebrin, gr. viii three times a 
day. He was placed upon antipyrin and bromide of ammo- 
nium, and it was continued three months and a half, during 
which time he averaged eight fits a month. 
Male, aet. thirty-eight. Convulsions date back fifteen 
years. He has unusually violent attacks, with acute mania 
preceding them for some hours. After a succession of fits 
he would fall into profound coma lasting generally four 
days, after this the man would be dazed and stuporous 
for a few days more, when he would become sane, and re- 
main so until the next attack. He had received a prolonged 
course of the bromide of sodium and other drugs without 
any favorable result; during the three months the antipy- 
rin and bromide of ammonium was administered the attacks 
were mild, unattended by mania, and only followed by a 
slight degree of coma. 
Male, aet. forty-six years. Epileptic since ten years of 
age; six years ago began to be maniacal at his convulsive 
periods, which occur two or three times a month; had been 
treated chiefly with the bromides; during the previous six 
months he had had twelve convulsions; during the three 
months he was given the antipyrin and bromide of ammonia, 
he only had one convulsion, which was unattended with mania. 
Male, aet. eighteen. For thirteen months prior to trying 
this mixture, during which time he was successively treated 
with the bromides, ergot, nitro-glycerine and antifebrin, he 
had an average of seventy-four convulsions a month. He 
was given antipyrin, gr. viii, and bromide of ammonia, gr. 
xx to i.d., and for the first time a reduction in the number 
of fits occurred, the average number per month for three 
months falling to sixty. 
REPORT OF AUTOPSY ON A CASE OF THORACIC 
ANEURISM IN A PATIENT PRESENTED TO 
THE SOCIETY FOR DIAGNOSIS SOME MONTHS 
BEFORE DEATH. 
By Dr. THOMAS J. MAYS. 
J. E., aged forty-eight. Park policeman; was sent to me 
for examination by Dr. Chas. K. Mills, October 28, 1890, 
and from him I obtained the following history : For about