O N 
PARALYTIC AND CONVULSIVE DISEASES 
OP THE 
CEREBROSPINAL SYSTEM, 
INCLUDING EPILEPSY, 
|ts IPlgsioIojs, anti Sriafmtnt. 
By H. P. DEWEES, M.D., 
NEW YORK. [From the Americas Medical Monthly for April and May, 1861.] 
O N 
PARALYTIC AND CONVULSIVE DISEASES 
OF THK 
CEREBROSPINAL SYSTEM, 
INCLUDING EPILEPSY, 
Its Hlpotogg, fhttjjotog!} anir treatment. 
By H. P. DEWEES, M.D 
N E W Y O R K. V 
[Read before the Medico-Chirurgical College, March, 1861.] 
Gentlemen—On retiring from the chair, at the meeting held at Dr. 
A. B. Mott’s, I offered for the subject of discussion, “ Epilepsy, its 
Physiology, Pathology, and Treatment.” As the habit in this College 
is to read a preliminary paper, I shall occupy your time only with such 
views as have been more recently propounded by others, and with the 
conclusions and results derived from my own observations, rather than 
by the repetition of more ancient surmises, which were founded on no 
scientific investigations, and which therefore offered no rational de- 
duction for treatment. 
But after considering in what manner I should treat the subject so 
proposed, numerous difficulties arose as to whether it should be merely 
taken up by a rigid adherence to the matter itself, or whether a more 
general and broader outline, embracing other connections and disorders, 2 
PARALYTIC AND CONVULSIVE DISEASES 
but which are not unfrequeutly precursory concomitants, or subse- 
quent complications, would not be profitably adopted. I have conclud- 
ed upon the latter, and beg that you will excuse a more discoursive 
entrance into the subject, than a mere logical adherence to the matter 
would permit; since epilepsy is a disorder starting from many points 
of induction, although the chief seat of its objective phenomena is en- 
compassed in a strict regional boundary—the medulla oblongata. 
Yet, to understand in what manner this cranio-spinal portion of the 
cord becomes the great focal point of radiation in the manifestations 
of this terrible disorder, a knowledge of its central actions, and of its 
reflective enlistment, whether from the conducting nerve-fibres of the 
brain and spinal cord, or from the various viscera and periphera, is 
highly essential. 
Therefore, in a disorder implicating so many conditions of the sen- 
sific, motor, and psychical apparatus of the body, a clear conception 
of their reciprocal relations, as well as of their independent action, is 
necessary, in order to comprehend their disturbances, either as direct 
sequences, or as indirect manifestations in the course of the epileptic 
disorder. By this comprehension the nature of the disease will be 
more clearly unfolded, the premonitory symptoms will become more 
instructive, and a nearer approach to a scientific therapeutical con- 
duction can be made. 
In searching for the seat or cause of any disorder of the motor 
nervous system, the objective phenomena should be correctly classified. 
A single muscle, or groups of muscles, may be affected, either by cen- 
tral disturbance in the ganglionic cells themselves, or by their incite- 
ment to action through eccentric or reflex conduction. This reflex in- 
citement may reside peripherally, extra-cranial, or spinal; or, it may 
arise within the cranium, or in the cord itself. For instance, the 
point of irritation may be seated in any part of the superficies, or it 
may reside in the posterior spinal columns, aud thence be reflected to 
the associated ganglionic motor origins in the anterior or true motor 
columns. When intra cranial, the point of irritation may lie either in 
the cerebrum proper, whereby its conducting fibres are implicated, or 
in those portions in which the psychical manifestations originate. 
Every irritated sensory fibre can induce or increase reflex sensibility 
of the cord, by centripetal action. 
In these conditions, two things are to be remembered. The motor 
centres may be in a normal state themselves, the inciting condition be- 
ing anormal; or the conducting fibres may be in a true physiological 
6tate, whilst the motor ganglionic cells may be overexcitable, or hy- OP THE CEREBRO-SPINAL SYSTEM. 
3 
pertrophic either as to number, by which the amount of muscular ac- 
tion is exaggerated; or as to inherent irritability or excitability, by 
which the force is proportionately overgenerated. 
This hypertrophic excess bears an inverted proportion to the oppo- 
site condition—viz., the atrophic. In the former, an undue supply 
of arterial blood may serve for the increase; or, the supply being 
normal, some special constituent of the blood may be in excess, or de- 
fective in quality, by which nutritive energy or functional manifesta- 
tion is exalted. But, both these latter conditions are not (infrequently 
established, independently of any peculiar blood composition, through 
an irritable or overexcitable state of the conducting fibres. 
In nervous atrophia, the opposite exists. The arterial blood may be 
insufficiently or defectively supplied, whereby the organic products are 
stinted, or rendered inert, although the cerebral impulse may be 
healthy. These states are instanced by those in whom the order or 
will is greater than the power or execution. Another form of atrophia 
is found in the executive portions of the nervous centres, from the im- 
peded or impaired condition of the conducting fibres, or of the 
psychical portions of the brain. Here the motor centres fall into the 
peculiar changes incident to parts whose functions have been long ab- 
rogated, and which may be termed the abuse of disuse. 
It is in these latter, particularly, that a paralytic state may exist 
in thg structures deriving their nerves from these atrophied centres, 
whilst a convulsive, spasmodic, or tetanoid condition of the associated 
or consensual parts exists, especially when the muscles thus partially 
paralyzed are endeavored to be acted on by the will, the impulse being 
distributed through those ganglionin cells giving origin to the nerves 
going to the associated muscles. Reflex causative action, both per- 
ipheric and cerebral, may happen in several ways. The impression may 
be conveyed through the peripheral sensory filaments of the paralyzed 
muscle or limb to the motor centres, or it may excite involuntary 
contraction in the sound limb, but which can be more or less restrain- 
ed by the voluntary action of the brain; or the organic system may 
be excited, producing static changes in the various viscera, with spas- 
tic retention or expulsion of their contents, &c. 
Although these various manifestations of the nervous system relate 
more to the multiform states of paralyses, yet the comprehension of the 
anatomical dependencies and physiological relations is all-important 
in the study of many nervous disorders, and especially of epilepsy. 
But I shall endeavor, in the physical details, to mingle as much physi- 
ological and pathological result from disordered regional action as 4 
PARALYTIC AND CONYULSIYE DISEASES 
will relieve the tedious tension of the mind, which is so apt to accrue 
from mere anatomical description. 
The medulla oblongata is the additional intermediate organ between 
the spinal cord and the brain. And, in advance of entering on the 
subject, I will here state that this intermediate portion is without 
doubt the seat of the chief objective phenomena of epilepsy. From 
this point of radiation the muscular disturbances ensue; and whether 
the pundum saliens morbi, or point of irritation, be in the brain, spinal 
marrow, mucous or cuticular surfaces, yet the phenomena constituting 
the fit of true epilepsy must arise in great measure from the engage- 
ment of the medulla oblongata, or from its being centrally affected. 
In the medulla oblongata, as in the spinal cord, a median furrow ex- 
ists, interrupted by a decussation of fibres below the pons varolii. 
Internally, on each side of this furrow, arise the pyramidal bodies, 
which extend into the pons varolii. Externally, are seated the cor- 
pora olivaria, which do not extend into the pons, but are separated 
from it by a deep sulcus. Each olivary body is connected to its fel- 
low by intercommunicating fibres, which arise from the ganglionic 
cells, to pass through the raphe of the medulla oblongata; whilst the 
nuclei for the hypoglossal nerves, on which the motions of the tongue 
chiefly depend, are in close apposition to these bodies on their re- 
spective sides. These latter nerves take their origin from a large 
number of multi-polar ganglionic cells. The corpora olivaria are.thns 
anatomically connected, and become physiologically auxiliary to the 
hypoglossal nerves, whereby certain lingual motor'combinations are 
effected. It may be well to remark here, that the olivary bodies do 
not exist in fishes, or in the amphibia, whilst in the lower mammalia 
they are more or less rudimental. 
In other words, these bodies are developed according to the two 
great functions of the tongue—viz., combined movement and articulate 
speech. The hypoglossal nuclei lie close to each other, near the 
raphe, their simultaneous action being secured through fibres of inter- 
communication. By a like arrangement, the corpora olivaria are acted 
on bilaterally. The hypoglossal intercommunicating fibres are limit- 
ed, so that unilateral motions of the tongue can be voluntarily excit- 
ed. But, for the combination necessary for articulate speech, the bi- 
lateral harmony must be insured. Hence, in hemiplegia, paralysis 
of the movement of the tongue, differs from that of the combined 
consent for articulation and the sustained action of speech. The or- 
ders of the will must be communicated simultaneously to both olivary 
bodies, to secure their harmonious engagement, and that of both hypo- OP THE CEREBRO-SPINAL SYSTEM. 
5 
glossal nerves. In deglutition the same conducting influences must be 
preserved. 
Sustaining the results of direct experiment are the records of 
pathological investigation, showing that the corpora olivaria are fre- 
quently found in various morbid conditions in paralysis attended with 
loss of speech. And more confirmatory are the researches establish- 
ing, in cases of congenital atrophy, or of arrested development and 
growth in these bodies, the coincidence of aphonia, difficulties of deg- 
lutition, and more or less loss of command of the tongue. Cases have 
also been reported, and have been examined by myself, in which loss 
of speech resulted from inflammation of the pons varolii, as well as of 
the corpora olivaria. In the former, neuralgia is generally a promi- 
nent symptom. 
But these ablations of special functions are not to be always attrib- 
uted to lesions of these bodies, or of the associated hypoglossal 
nerves, since the defects of muscular consensual performances may be 
confounded with absence in the mental conception of language and mem- 
ory of words; or with those lesions implicating the traditional action 
of the will, as when the striated bodies are impaired, and which are 
attended with paralysis of motion of other portions. Injuries to the 
anterior frontal cerebral lobes, especially, arc apt to be followed by 
what is commonly termed imperfection or loss of speech. But in 
these cases the conception of language, or rather of ideas for language, 
is more impaired than the power to execute is destroyed. Nor must 
those cases where both the conception and the olivary function are not 
disturbed be confounded with those in which the conducting fibres are 
exclusively at fault. In several cases falling under my own observa- 
tion, I have found that the patient could not voluntarily communicate 
his thoughts by speech, although the reflex movements of the tongue 
were perfect; yet he could do so by writing, indicating an interruption 
through the conducting fibres, but showing that the conception of 
language was intact. Again, I have witnessed the imitative or repe- 
titional actions perfect, without corresponding conception; thereby 
evincing the integrity of the conducting fibres and of the corpora 
olivaria, but showing that injury to the originating sensorial portions of 
the brain had taken place, as was afterwards verified by post-mortem 
examination. 
Traumatic injuries of the frontal bone, whereby the anterior por- 
tion of the cerebrum has been compressed or otherwise temporarily 
injured, have not unfrequently resulted in loss of speech, which has 6 
PARALYTIC AND CONVULSIVE DISEASES 
been in some cases restored by surgical aid, or by the recession of the 
local disturbance. 
These cases indicate the ablation of the couceptional power within 
the brain, and not of the capacity of performance through the olivary 
bodies and hypoglossal nerves. For although articulate speech is 
lost, yet the voice can be excited through reflex actions of the various 
surfaces, and especially by those attended with severe pain. But these 
centres, during long-continued arrest of the cerebral actions, are liable 
to fall into pathological changes, or jnto a physiological proportion of 
functional relation. Hence softening, fatty, or atrophic degeneration, 
induration, &c., occur, whereby not only the voluntary, but the reflective 
actions are lost, or rendered feeble. Even if the injury of the anterior 
lobes be recovered from, yet the olivary bodies are apt to undergo 
certain transmutations, which may abrogate their function, in accord- 
ance with the law which governs the propagation of consensual mor- 
bid states in organs correlated in function, or from the more general 
law which regulates the reproductive energies in parts functionally 
reciprocal. 
The congenital cases of the deaf and dumb cannot all be placed to 
arrest or imperfection of development in foetal life. The injuries sus- 
tained during labor by the anterior lobes from mechanical pressure of 
the pelvic bones, or by the instrumental or digital manipulations, must 
be taken into consideration. Nor need we expect to find a direct 
traumatic lesion, or its indication, when examining the brain in such 
accidental cases; since the pressure so exerted may merely induce a 
change in the molecular constitution of the impinged-on lobes, by 
which their nutrition is disturbed. And the same may happen to the 
posterior occipital region, whereby the medulla oblongata and its 
auxiliary ganglia, the pyramidal and olivary bodies, may be damaged, 
since the position of the parts are constantly varying, according to 
the flexed or extended position of the head. In some of these cases, 
a mere physiological atrophy is apparently established; as, in course 
of time, both hearing and speech become more and more established; 
differing in this progressive recuperation from pathological degener- 
ation, in which there can be no improvement. Aphonia, alternating 
with sudden return of speech, is not uncommon in hysterical cases; 
but when accompanied by persistent hemiplegia, either in the male 
or female, some cerebral lesion must be concluded on. In one gentle- 
man, whose voluntary command of deglutition and of speech was 
constantly varied from trivial indistinctness and inability to complete 
loss, I found, after death, a tumor in the pons, which pressed more or OP THE CEREBRO-SPINAL SYSTEM. 
7 
less, according to the vascular condition, on the medulla oblongata, 
whereby the functions of the auxiliary ganglia, the olivary and py- 
ramidal bodies, were interrupted. In this case, the legs and bladder 
were at times greatly paralyzed, probably from the interference with 
conducting fibres in the pons, and from the pressure exerted on the pyra- 
mids, whose function apparently presides over the movement of the 
extremities. There was also intense neuralgia. 
Yisible alterations or encroachments on the cerebro-spinal struc- 
tures do not always appear on autopsical examination, to account for 
losses of function of their various parts. The changes are those of 
molecular nutrition, at times scarcely recognizable by the microscope. 
Yet in many such cases neither proper conception nor power of speech 
has been destroyed, but the memory of words and of their combina- 
tion is lost. When spoken to, they are slow of comprehension, or 
are totally deprived of intellectual translation. Yet they will imitate 
the sound, or sometimes repeat like an echo a portion of the spoken 
sentence. It is, so to speak, a paralysis of memory, and not of the 
organs for speech. In others, I have witnessed a complete loss of 
memory of the customary language, with perfect return of another for 
years unemployed and forgotten. But these effects are not, gener- 
ally, from special cerebral disorder, although I have seen them in the 
hemiplegic. They happen mostly as consecutive complications in 
diseases of other organs. But, when happening, they are generally 
prognostic of fatal issue. The temporary exchange of one language 
for another, arising from traumatic injury, or from fever, with cere- 
bral engagement, must not be confounded with those just cited. In 
the case of a young medical gentleman from Georgia, who had suf- 
fered from the effect of deep cellular pelvic abscess, accompanied by de- 
lirium, and had been ignorantly bled into deliquium, followed by vio- 
lent mania, I found that he had lost the memory not only of his lan- 
guage, but also of his parents, friends, and letters. His education 
had to be begun again, from the very alphabet, and for months he 
made but slow daily progress. One morning, on rising, like a flash 
of light, all returned to him, and the comparative imbecile of the 
night before became the son of science once more. 
Injuries to the olivary body are apt to be followed by more or less 
paralysis of the facial nerve, through which the expression and motion of 
the corresponding side of the face are interfered with, as the supe- 
rior portions of the olivary bodies are connected with the seventh 
pair of nerves; whilst the inferior are connected with the hypoglos- 
sals, which may be included in the lesion, producing great difficulty of 8 
PARALYTIC AND CONVULSIVE DISEASES 
speech, <tc. On the floor of the fourth ventricle the facial nerves are 
reciprocally connected, and are united to other ganglionic groups— 
viz., the trigeminal, which lie between the auditory and seventh pair. 
To the corpora olivaria thus belongs the power to express by the 
movements of the face the various passions. Paralysis or section of 
the first branch of the fifth destroys the reflex excitement for winking 
on touching the eye; yet it may be excited by the impression of a 
strong light on the optic nerve, after section of the fifth, arising ap- 
parently from a connection between the roots of the optic nerves and 
the nuclei of the seventh pair. 
The anterior spinal columns pui’sue their course into the brain, 
through the pyramidal bodies. Injuries to these bodies are attended 
with muscular disturbances of the extremities. The lateral columns 
of the spinal cord do not pursue their course into the brain, but ter- 
minate in the medulla oblongata. They are brought into action by 
the pneumogastric nerves and by the orders of the will. These lat- 
eral columns preside over the movements of the trunk. Hence, in 
hemiplegia from cerebral haemorrhage, whilst the muscles of the side 
opposite to the lesion are paralyzed, the movements of the chest re- 
main intact. From the intimate junction of the vagi nerves with the 
fifth pair, and the connection of their nuclei with the longitudinal 
fibres constituting the upper portion of the lateral columns, any irri- 
tation applied to them will bring into action the muscles of the chest 
and abdomen. During ordinary respiration, the normal stimulus of 
the carbonic acid upon the peripheral portions of the pneumogastrics 
is conveyed to the lateral columns and phrenic nerves, by which the 
combined movement of the chest, diaphragm, and abdomen is estab- 
lished. 
When the stimulus is persistent to these columns, and through them 
to the medulla oblongata, the muscles of the chest become fixed as in 
tetanus, and respiration may be fatally stopped. The descending 
longitudinal fibres convey the orders of the will to the centres of res- 
piration; so that, although ordinary breathing is due to reflected 
stimulus, yet voluntary acceleration or retardation of the respiratory 
acts can be obtained. Hence we can understand how, in certain 
cerebral haemorrhages attended with palsy, that although ordinary 
reflex respiration continues unobstructed, yet it may remain uninflu- 
enced by the orders of the will, from the injury to the higher con- 
ducting fibres. In hemiplegia from decussative cerebral disorder, 
voluntary inspiratory efforts fail to excite equal dilatation of both 
sides of the chest; not because the respiratory centres themselves are OP THE CEREBRO-SPINAL SYSTEM. 
9 
damaged, but because their action can be only unilaterally invoked. These 
independent sources of respiratory conduction form, at times, a'valu- 
able basis of diagnosis. 
It is to be remembered that the medulla oblongata consists (or at 
least partly) of the longitudinal fibres derived from the cerebrum—* 
that is, from the corpora striata, thalami, and crura cerebri—so as to 
connect them with the ganglionic groups from whence the nerves of 
the medulla oblongata arise, in order to convey to them the orders 
of the will. Other fibres also leave the medulla to ascend to the seat 
of perception in the gray cerebral matter. The olivary bodies thus 
become the instruments of the voluntary acts of deglutition, even 
after the reflex sources from the trigeminus are interrupted. The act 
of swallowing, voluntary or reflex, to be correctly performed, requires 
a bilateral adjustment of the necessary muscles, and therefore the bi- 
lateral integrity of the corpora olivaria is essential. 
Although the medulla oblongata is generally called a continuation 
of the spinal cord, yet there are numerous other parts which either 
originate in it, or are derived elsewhere than from the cord. The 
pyramidal bodies are to be considered as the prolongations of the an- 
terior columns of the spinal cord; decussation of their fibres taking 
place before they enter the medulla oblongata, to pass through the 
pons varolii as the four principal columns, which serve, according to 
Van der Kolk, for the regulation of the extremities. There are also 
transverse filaments rising from the medulla oblongata, which unite the 
two halves, and serve to insure its bilateral action, for the movements 
of the face, tongue, larynx, and chest. 
We will now call attention to the numerous ganglionic cells con- 
tained in the gray matter of the spinal cord. From these cells in 
the cortical substance originate the nerve-fibres, which do not pursue, 
as formerly supposed, (until refuted by Ehrenburg and Remak,) a 
direct course through the spinal cord to the brain. These ganglionic 
cells are connected in groups, in harmony with the anatomically pre- 
arranged muscular groups, by which, from a stimulus applied, co-or- 
dinated or consentaneous movements are insured. If this stimulus is 
diffusive, or has a peculiar affinitive property of acting on other 
cells, either associated or disjoined, the groupal movements will vary 
from simple motion, to convulsion or spasm. And this excitative or 
depressive influence may be communicated directly through the blood, 
or through the will, or by reflective excitement. The carpo-pedal 
spasms of teething children—the circulation or local absorption of cer- 
tain poisons, as in hydrophobia, or in the special affinitive actions 10 
PARALYTIC AND CONVULSIVE DISEASES 
from strychnine, woorara, &c., &c., are instances of these conditions. 
Some forms of cerebral affections, wherein the will is preteruaturally 
exercised through certain channels, and of hysteria from utero-ovarian 
irritability, whereby reflex actions are propagated, are proofs of the 
direct as well as of reflected impulsion. 
The ganglionic cells are more numerously collected in those depots 
from whence the larger muscular groups receive their innervation. 
The medullary matter or nerves act merely as conductors of the im- 
pulse so excited in the ganglionic cells. This power, being conducted 
to the muscles, either adds to, or excites into action, the inherent con- 
tractility of the sarcous elements. 
It has been established by experiment, as also from symptoms dur- 
ing disease, that pain is not excited on transverse section or erosion 
of the gray matter of the spinal cord. The motor fibres for the 
extremities lie in the anterior columns, which are continued into the 
pyramidal bodies, and extend into, or receive fibres from, the brain; 
whilst the anterior portions of the posterior columns are received into 
the restiform bodies, or the peduncles of the cerebellum, whereby 
these bodies are endowed with sensibility. These lateral columns, as 
before stated, preside over the motion of the trunk. The posterior 
pyramidal and restiform bodies are probably derived from the cere- 
bellum, and terminate in the medulla oblongata, by resolving them- 
selves into numerous transverse fibres, through which the co-ordinate 
impulses are conveyed. But the anterior spinal columns do not 
merely give origin to the motor nerves. They probably receive or- 
ganic filaments from the stomach and other viscera. It is well 
known, from vivisection or other special injuries to the anterior 
spinal columns, that these organs are apt to undergo certain patho- 
logical changes; whilst, from morbid irritation of the sympathetic 
filaments in the viscera, spinal complications have resulted. 
As the pyramids pass and divide in the pons varolii a portion of 
the cerebellum, the transverse arched fibres passing to the restiform 
and pyramidal bodies probably form the conductors of the action of 
the will for co-ordination of movement. Pathological inquiry con- 
firms this view: as, in injury to the cerebellum, the power of volun- 
tary bilateral adjustment has been observed to be injured; although 
involuntary or reflex harmonization, as in yawning, leaping, Ac., may 
ensue, either in the muscles whose nerves issue directly from the medulla 
oblongata, or in those from the spinal cord; whilst injuries of the pons 
varolii are found to coincide with loss of motor power of the extremi- 
ties, as in hemiplegia, paraplegia, or crossed palsies, where the right OP THE CEREBRO-SPINAL SYSTEM. 
11 
arm and left leg are affected. In cases of tumor or other growth 
pressing on, or developed within the pons, the symptoms vary from 
convulsion to irregular paralysis; or from paralysis of a single mem- 
ber, to the engagement of two or more, according to its extension, or 
the accidental vascular conditions of the surrounding parts. These 
may be accompanied by neuralgia or aphonia, dysphagia or vesico- 
renal derangements, from encroachment upon, or by irritation of, the 
medulla oblongata. These conditions I have seen verified on autopsy, 
and possess the specimen from one case. 
In diseases affecting the structural integrity of the spinal cord, reflex 
actions not only occur, but are apt to become exceedingly trouble- 
some, as the anterior and posterior nerve-roots are closely connected 
on the same level. In spinal paraplegia induced by softening, partial 
tabes, dissecting abscess, &c., reflex actions may be excited by tickling 
the foot, or by acts of defecation or urination, &c., although all direct 
voluntary command is lost. In some instances, the act of coition can 
be performed, although the sensation may not be transmitted to the 
brain, from the solution of continuity of the conducting fibres. Of 
this singular condition I have known several instances. Others, 
again, can only cause their muscles to contract by the voluntary effort 
being first excited through sight. They walk awkwardly, with their 
eyes constantly viewing the ground, so that the brain can be informed 
of the necessity for voluntary action, but they fall if their sight 
be interrupted, or if left suddenly in the dark; since the transmission 
of the impression on the soles of the feet is annulled, by which either 
the cerebral perception for voluntary progression is destroyed, or by the 
reflex actions becoming uncontrollable and purposeless. From these 
causes, I have known such sufferers ignorant of the position of their 
legs or arms when in bed at night, or at table, and who could not 
redify, although they might change, their positions when wishing to 
do so, unless the sight could be employed for the direction. These 
eases are generally hopeless, and require great care in their conduc- 
tion, as troubles from the bladder, rectum, and kidneys are apt to 
complicate the disease; whilst troublesome abscess or posture sores 
are of frequent incurrence. Some die, worn out by the mere local 
derangements of function making such vast drafts on the constitution; 
whilst others, in addition to these, exhibit cerebral extension, result- 
ing from the severe efforts of the braiu in effecting voluntary move- 
ments, by which more intercellular albuminous fluid is effused, pro- 
ductive of fibrillar atrophy, and its special results; or of softening, 
inflammatory or non-inflammatory, with disturbances or exaggeration 12 
PARALYTIC AND CONVULSIVE DISEASES 
of intellect, varying from the incipient stages of mania to complete 
dementia or idiocy. 
Although the chief seat of reflex motor action is in the spinal 
column, yet the brain exhibits like reflex conditions, both sensory and 
motor. Nor is the cerebro-spinal axis in itself merely subject to 
these states, as the nervous centres of organic life, from their connec- 
tion with the spinal cord, may have induced in them reflex conditions, 
attended with disorder of secretion and nutrition. It is not uncom- 
mon, from injuries to the spine involving sensation and motion, to find 
the various internal organs disordered in function and changed in 
structure. 
Most of the manifestations of cerebral function appear to be uni- 
lateral above the level of the medulla oblongata. Hence local haem- 
orrhagic effusion, softening, tumor, specific or other structural altera- 
tions of one hemisphere, or corpus striatum especially, induce unilateral 
decussative paralysis. Strictly localized irritation in a hemisphere 
may result in unilateral spasm or convulsion, unless abnormal irritability 
of the medulla oblongata exists at the same time, by which a bilateral 
action is propagated into those parts served by the nerves of that 
region, through its transverse fibres, or the commissures between the 
nuclei of the nerves, or their trunks, as in the facial, hypoglossal, &c. 
The termination of the spinal sensific nerves is not in their point of 
entrance. They proceed upward, to terminate in the medulla oblon- 
gata. Nor do they penetrate into the gray matter of the anterior horns, 
the true seat of motor energy, or into the posterior horns of gray mat- 
ter which appear to preside over the reflex and combiued movements, 
and whose ganglionic cells give rise to the sensory nerves of the 
spinal cord. But the posterior sensory columns terminate in the 
medulla oblongata, and perhaps, according to recent investigations, 
partly amongst the group of ganglionic cells above. Hence the me- 
dulla oblongata is to be viewed as the seat of seusitivity, whilst the 
brain is the seat of perceptive sensation. The insensitivity of the brain 
proper, in its normal state, is known to every experimenter and opera- 
tive surgeon. 
From this arrangement for the reception of the descending and as- 
cending cerebro-spinal fibres, the medulla oblongata becomes the focus 
of radiatiou of sensory impressions. 
Although the fifth nerve is, in its thicker portion, termed a nerve of 
sensation, yet we must not allow ourselves to be led astray in refer- 
ence to the true function of the nerve itself, and its terminations. 
These serve merely to convey the impressions received to the OP THE CEREBRO-SPINAL SYSTEM. 
13 
medulla oblongata and the centres originating higher up, that the 
brain may exercise its function of perception. .For the medulla ob- 
longata can only be viewed as the seat of sensation when in connec- 
tion with perceptivity. When the influence of the brain is cut off, 
the medulla oblongata becomes the seat of excitability or sensitivity. 
Wherever the filaments of this portion of the fifth are distributed 
upon an organ of special sense, the peculiar function of the part 
is heightened or lowered according to this relative condition. Hence 
we find that either taste, facial touch, smell, hearing, or sight, are 
influenced more or less in injury of its branches, independently of the 
alteration of certain secretory or nutritive actions. The fifth nerve 
then becomes a nerve for, rather than of, sensation. Its influence 
over secretion does not appear to depend so much on its own special 
endowment, as from its reticular connection with the organic filaments, 
although a reflex motor protection to the secretory surfaces is essen- 
tial. Hence, severe injury or section of this nerve high up, may re- 
sult in destruction or sloughing of the parts supplied by it. 
The olfactory, optic, auditory, and gustatory nerves are called nerves 
of special sense; yet, in themselves, they do not convey to the brain 
the full measure of their functions for its perceptibility. This is ef- 
fected through the fifth, which is everywhere distributed over the por- 
tions receiving the impression. Hence, injuries to the branches, or 
to the roots of the trigeminus, are always more or less attended with 
alterations of one or more of the perceptible functions of the organs of 
special sense. During insensibility, arising from pure cerebral causes, 
the organs of special sense may remain intact. The eye may be open 
and perform its office as a mere optical instrument; the ear and its 
special nerves may receive the sonorous vibrations, yet the focal point 
within the brain being disturbed, the measure of their impressions is 
lost. It is in this special condition of relation between the inner world 
of perception and the outer world of mere manifestation of function, 
that the sensific branches of the fifth pair hold so prominent a position. 
The ganglionic cells of each organ of special sense differ from one 
another, and although their physical or functional actions may be cor- 
rectly performed, yet the sensory transmission of the results of their 
peculiar offices appears to depend chiefly on the accompanying fila- 
ments derived from the fifth pair. And this special preparatory reg- 
istration for cerebral interpretation seems to reside in the gangliaform 
vesicles, near the tactile papillm or sensitive surfaces, and partly in 
the ganglia themselves, since destruction of the first of these espe- 
cially, by cauterization, sloughing, or pressure, interferes with the per- 14 
PARALYTIC AND CONVULSIVE DISEASES 
ceptive manifestation of the sense special to the part; surgical as well 
as experimental operations prove this, whilst medical records attest 
the same. My attention to the influence of the fifth pair over retinal 
sensitivity, and the nutritive actions of the organs of special sense, 
was attracted in 1843, by the results attending an accident to a 
lad at that time. He received a wound from a clam-shell, which ac- 
cidentally cut completely through the supra-orbital brauch of the 
fifth. Dimness of vision in the eye of that side immediately followed, 
whilst in the course of a few months a hard cataract formed, by which 
the eye was entirely blinded. In this case, I was early struck with the 
fact of the immediate injury to vision following the section of this 
branch of the fifth. It was too rapid to attribute it to alteration of 
nutrition, and hence I looked upon the disorder of sensory relation as 
the most prominent; whilst the nutritive changes, probably through 
injury to the accompanying organic filaments, were effected more 
slowly. 
An impression generally exists that the brain becomes first affected 
during the administration of anaesthetics, by their absorption in sub- 
stance into the blood. This opinion is only partially correct, as proved 
daily by the phenomena. All the upper portions of the peripheral 
nerves directly subjected to the influence of the anaesthetic agent dur- 
ing inhalation, become more or less rapidly impressed, by which a re- 
tardation of impressional conducting power is induced, in advance of 
the effect upon the brain. This, iu very many cases, is consummated 
slowly. In some persons, the intelligent perception of surrounding 
circumstances remains; they can answer questions, rectify their posi- 
tions voluntarily, and are conscious during the operation of not suffer- 
ing pain. These conditions obtain mostly in superficial operations of 
parts supplied by the fifth pair of nerves, and which can be rapidly 
performed. In the operation on parts possessing sensory nerves from 
the spinal system, the absorption in substance of the chloroform or 
ether into the blood has to be effected. And even here, it is not 
always essential to carry the administration to the extent of submerge 
ing the brain. Held in the blood, the anaesthetic bathes every fibril 
of the nervous system, rendering both local conduction and central 
perception more tardy and less acute. With lying-in women I have 
communicated intelligibly, and have been assured that they were per- 
fectly conscious of the uterine efforts being without pain. In these 
cases, the arrest of conduction resembles that produced by tumor or 
pressure on some portion of the tract of a sensory nerve. If, how- 
ever, the etherization is carried beyond the point of local anaesthesia OF THE CEREBRO-SPINAL SYSTEM. 
15 
to saturation, the whole brain becomes deadened, the respiratory func- 
tions decline, whilst the natural surfaces of the lungs cannot eliminate 
from the blood the agent which is already surcharging the brain, and 
which, in its retardation in the bronchial extensions, still further in- 
creases the non-conducting condition of the pneumogastric termina- 
tions, through which the necessity for aeration is communicated. 
Hence the central power for inhalatory movements and the periphe- 
ral impression for supply are both lessened. In some patients, this 
local or nervous inconductibility does not apparently precede the loss of 
perception. Unconsciousness is first established, whilst reflex muscu- 
lar movements become greatly exalted. These are frequently mistaken 
for manifestations of pain, as cries are sometimes uttered and purpo- 
sive actions are apparently effected. But these latter are mere groupal 
co-ordinations, and are similar to those seen in vivisections, where the 
cerebral lobes have been removed. During the complete cerebral 
anaesthesia the individual may revel in fancies or dreams. The brain, 
except in the power of outward manifestation, is active beyond its 
usual wont; it is aesthetic to every internal pleasure, but anaesthetic 
to every pain. Oftentimes, this brain revel is distorted by incomplete 
remembrance into apparent reality on awakening, and has given rise 
to statements which have resulted injuriously to the operator. 
When the anaesthesia is complete, every fibre and ganglionic cell 
of the sensory spinal columns and of the fifth pair are locked in im- 
passibility. Reflex muscular impressibility becomes more and more 
obtuse, till the respiratory centres are paralyzed, and death may stand 
imminently near. Yet, during all this approach of apparent dissolu- 
tion, those organs whose reflective actions in part depend on the nerves 
of organic life still perform their duty. Nutrition is not entirely ar- 
rested. Secretions pour forth, and the uterus expels its contents. 
Sometimes, from the inequality of the anaesthetic effects on the right 
or left divisions of the sensory nervous system, or from some error of 
the central equilibriatiou, one side may be inertly relaxed, whilst the 
other may be convulsed by reflex action. 
In this light, the fifth pair, in their thicker portion, must be viewed 
as nerves of connective relation between the automatic sensitive cen- 
tres of the medulla oblongata and the upper irritable districts, and the 
perceptive cerebral lobes. These special relations of the trigeminal 
nerves, in their connective central manifestations, can be best studied in 
animals without distinct cerebral lobes, or during the progressive de- 
velopments in the human embryo, in whom the basilar contents of the 
cranium begin first to be evolved. In acephalous monsters, although 16 
PARALYTIC AND CONVULSIVE DISEASES 
the fifth pair may be anatomically distributed to the surfaces, as in- 
struments of impressional translation, and of excito-respiratory action, 
yet they do not convey any true sensation, any more than is perceived 
during the anaesthesia from chloroform. Although such brainless 
children may cry when pricked or otherwise irritated, it is merely the 
cry of reflex vocal action, and not of voluntary response from percep- 
tion. In other words, they may cry because they were pricked, but 
not because they were pained. In the normally growing foetus, the 
cerebral hemispheres are developed subsequently to the basilar portions 
with intercommunicating fibres, whose office it is to submit the im- 
pressions received to the proper seats of perception, and to convert 
the mandates of the will, or the phenomena of the higher cerebral 
functions, into sensory manifestations. 
From the views expressed above, a nearer approach to the inter- 
pretation of many of those remarkable and so-called mysterious 
phenomena witnessed in cataleptic, ecstatic, somnambulic, and like 
states, may be arrived at. In one, all power of voluntary motion may 
be lost, although the perception of impressions may exist, attended 
with reflex movement or not. In another, the power to will is intact, 
but the conducting fibres are paralyzed; whilst in a third, only such 
tracts are exalted which convey feelings and expressions of the high- 
est ecstasy. 
Of such conditions I have seen many examples. I have seen it 
even affect the person unilaterally, one side being willing to move, as 
she would say, whilst the other could not be persuaded to follow 1 In 
most of these so-called nervous cases, there has not been found, on ex- 
amination, any definite structural changes to which they could be 
attributed. Not even to the microscope has been revealed any marked 
anormality of texture or of conformation. We have, then, to con- 
clude that a specific influence has been exerted by some anormal con- 
dition in the nutritive fluids, as known to exist in many internal dis- 
orders, and in others, induced by external administration; or, that 
there has been a molecular perversion of the nervous masses them- 
selves. 
As molecular changes occur by the minute incidences of the rays of 
light, thrown from the surrounding objects upon the staff-like bodies of 
the retina through the auxiliary optic nerves and tubercula quad- 
rigemina, so does every molecule of the transmitting ganglionic vesi- 
cles and in the recipient sensory centres change, in order to record 
upon the perceptive portion of the brain the impressions that have 
been received. This property of molecular variation may be likened OF THE CEREBRO-SPINAL SYSTEM. 
17 
to that produced by the changing beads in the kaleidoscope, in which 
new forms are registered upon the eye at every movement. The beads 
remain the same, but new figures are induced at every change of position. 
Through the sensory portions of the trigeminus the varying conditions 
of the acts of the nerves for special sense are rendered more acutely 
and rapidly to the seat of perception, independently of the fibres which 
pass from their central nuclei to the brain. In this respect the action 
of the fifth pair is similar to the application of the galvanic pole by 
the daguerreotypist to the reception-plate in the camera, by which in 
an instant of time the impression is etched. It is very certian that in 
themselves, the mere nerve-filaments exercise no influence beyond their 
power of conduction, the transmutations and combinations ensuing in 
the ganglia and ganglionic central cells. Through the same conduct- 
ing channel travel pleasure and pain, which in many instances are 
but variations in degree; whilst through the same cerebral filaments 
traverse the orders of intelligence or the wild impulses of insanity. 
As, in written language, the alphabet becomes its molecular basis for 
intelligible combination, so in the nervous system molecular pertur- 
bations convey the results to the centres of motion and of perception; 
and these perturbations are focalized upon, and translated by the 
special recipient organs, according to their inherent properties. 
The recognition of this principle is of more importance than 
at first would be supposed, since it gives a definite substantiality 
for the actions of thought, in place of mere metaphysical conjecture. 
Nutrition, as cognizable to us, is but molecular substitution—innutri- 
tion is molecular subtraction. Disease, whether from tumor, mis- 
placed structural constituent, or subtle poison, from without or within, 
is but the cumulative evidence of molecular abnormities, be it in 
brain or ganglion, fluid or solid. For as there is a law of conformity, 
so is there one for inconformity. Oscillatory or perturbatory actions 
doubtless attend every corresponding impressional change in the ner- 
vous substance, attraction or repulsion ensuing in each ultimate par- 
ticle, according to the laws governing the regulation of affinities. And 
these affinitive changes, and their results, are either normal or anor- 
mal, typical or atypical; healthful relations attend one, whilst devia- 
tions from the sound standard follow the other. 
By this method of studying and comparing the natural processes 
with those inducing disease, a sound scientific basis can be attained. 
For it is to be remembered, that pathology is but perverted physi- 
ology. They stand to each other in the organic wrorld as do right 
and wrong in the moral world, 18 
PARALYTIC AND CONVULSIVE DISEASES 
The causes working disease are to be recognized—the cumulative 
evidences of its seat, or of its progress, are to be rigorously scruti- 
nized, in order to detect the individuality of the agent, as men know 
the type of the bird or beast by examining its nest or lair, and can 
attract or repel, either by supplying or denying the materials neces- 
sary for their habitation. But neither nest nor lair describes the 
natural habits or configuration of the animal, or would make it known 
when seen. They must be studied and compared together. Hence, 
in disease, the natural phenomena are to be contrasted with those per- 
verted or destroyed. The accidental, as well as the precursory or- 
ganic changes as discovered on autopsy, are to be carefully separated. 
In no disease are the autopsical findings more unsatisfactory than 
after fatal epilepsy. Although expert cerebral anatomists have clearly 
stated the results of their examinations, yet the essential causes of the 
disorder remain latent. Gross anatomical lesions are confounded with 
causes. The vital phenomena of the normal condition, their correla- 
tions and their irrelations, are yet too little comprehended to be able 
to define sharply the post-pathologic additions by the act of epilepsy, 
from the proximate lesions. The same apparent deviations from nor- 
mal structure are daily discovered in the brain, and other structural 
portions of individuals, in whom the departure from the normal vital 
phenomena have totally varied. Ossific deposits in the dura mater 
or falx cerebri, enlargement of the Paccioniau glands, stalactite or 
osteophyte growths from the base or dome of the cranium, tumors, 
tubercles, local or diffusive softening, induration, changes of consist- 
ence and color, aneurismatic pressure, haemorrhage, congestion, or so- 
called vascular inflammatory changes, with exudation or transudation, 
arrest of development or local plethora or anaemia, and 
a host of other pathological abnormities have been found, and set 
down as causes both of the symptoms and of death, in the cases examin- 
ed. Yet these same lesions have been found, where neither insanity 
of perception, sensation, or of motion has attended, or were in corre- 
spondence with, the symptoms. 
In the brains of the epileptic or maniacal, in whom other losses of 
function especially attended, many morbid conditions are at times dis- 
coverable on autopsy, and as yet no pathologist has clearly defined 
those findings in their relation to cause and effect. The laws which 
govern pathologic sequences or co-regulate morbid structural devia- 
tions, through mutual incongruities of assimilation, or through corre- 
sponding retrogression of cell-action, have not been kept rigorously 
in view, whilst the differential degrees between reparative excess and OF THE CEREBRO-SPINAL SYSTEM. 
19 
reparative deficiency, or between the deposits of compensation or those 
of encroachment, have not been pointed out. 
It is true that many expert cerebral pathologists can predict the 
nature and the seat of the morbid changes to be discovered on au- 
topsy. They can foretell that inflammation, degeneration, or certain 
depositions will be found, and they can lucidly detail the results of 
the disease; yet it is equally certain that, with all their meritorious 
research, they have thus far failed to know for themselves or to teach 
others the differential morbid conditions between the proximate cause 
and the results. Nor, with all the knowledge gained by experimental 
study of the normal vital phenomena, has treatment advanced in suc- 
cessful antagonism to the morbid action, or with helpful assistance to 
the processes of reparation. Their labors so far have indicated the 
inutility rather than the utility of the treatment adopted; so that the 
remedial basis is at this day more of restriction than of active inter- 
ference. Experimental as well as clinical observations, however, have 
shown that, as far as certain objective phenomena extend, they may 
be produced by, or are incurrent with, opposite conditions of the sys- 
tem. Thus, convulsions and other nervous manifestations may attend 
the reverse states of plethora, anaemia, &c. 
The premonitions of the epileptic attack are various. They may 
issue from the organs of intelligence, of sense, or from the centres of 
locomotion or of function. So regular are these premonitions in some, 
that they will quietly announce and prepare for the convulsive stage. 
Others will exclude themselves, and pass through the attack unob- 
served. Unnatural conditions of taste and smell may afford timely 
intimation, or noticeable disturbances of vision and hearing may pre- 
cede the seizure. The organic system in some is at fault, and evinces, 
by insufficiency or derangement of secretory action, the antecedence 
of the nutritive disturbances to the muscular engagement. Excessive 
or decreased micturition, sometimes accompanied by scalding; saliva- 
tion or buccal dryness; acrid discharges from the nostrils or bowels; 
bitter, unsavory regurgitations, or seminal discharges, with or without 
dream, may give unerring signals to the afflicted. 
Psychical changes more or less rapidly ensue in others. There is a 
misconception of time, place, and space. Errors of impersonation, or 
of the relative condition of rest and motion, occur, wherein all self- 
identity is lost, or others are clothed in unreal forms. Many are 
filled with visions of happiness for themselves, whilst they see their 
friends doomed to unutterable woe. Passions dormant during health, 
or restrained by moral force, burst forth with uncontrollable violence, 20 
PARALYTIC AND CONYDLSIYE DISEASES 
with risk to themselves or others. The timid become brave, the gen- 
tle become murderous, or the conscientious become unscrupulous and 
surreptitious. There is no phase of the human mind that may not 
either precede or follow the attack, and the knowledge of these con- 
ditions is most valuable in forensic as well as in clinical medicine. 
In others no such warnings exist. The loss of consciousness is im- 
mediate, whilst convulsive struggles pervade every muscle; or begin- 
ning with facial distortion, extend regularly from the upper to the 
lower extremities, whilst the trunk is writhed backward and for- 
ward, or from side to side. Frequently the loss of consciousness is 
preceded by facial spasm or drawing of the head to either shoulder, 
whilst the shriek, so peculiar to epilepsy, announces the reflex engage- 
ment of the larynx and chest. Many dash rapidly forward, or run 
staggeringly backward, and fall violently on the face or occiput. In 
others a twitching of the muscles, with gradual rigidity of the limbs 
and trunk, precede for a second or two the more manifest tension of 
the muscles of the neck, by which the large venous channels are more 
or less impeded, whilst the glottis rises high towards the chin with a 
stridulous noise, produced by the reversed action of the diaphragm 
and by the intercostal muscles, from the increasing demand for air. 
The eyes protrude, or are moved from side to side, or upward and 
downward, with inconceivable rapidity, whilst the lids are opened or 
shut with spasmodic quickness, or are widely retracted. The mouth 
is distorted, the teeth are ground crushingly together; a thick foam 
is shot from the lips by the explosive contractions of the diaphragm, 
or it wells over the chin, streaked with blood from the bitten tongue. 
The integuments of the head, face, and neck are gorged with venous 
blood; the head is drawn rigidly back on the upper portions of the 
occiput, raising the shoulders in an arch from the ground, whilst the 
respiration is short and struggling from the tetanic fixing of all the mus- 
cles of the trunk and of the glottal aperture. The heart throbs vio- 
lently; the bowels and bladder may be evacuated, and not unfrequently 
semen is ejaculated. Some die at this time of the fit from the fixing 
of the respiratory muscles; whilst in others, the high carbonization of 
the blood appears to subdue the nervous centres, and relaxation of all 
muscular tension ensues. The respiratory movements languidly re- 
commence; the heart becomes less wild; the swollen veins assume 
their natural calibre; the countenance becomes pallid, although dis- 
figured in some by dark ecchymotic effusion from the ruptured capilla- 
ries; whilst the mouth is relaxed, and the swollen, lacerated tongue 
fills its cavity. This is the “grand mal” of the French. The re- OP THE CEREBRO-SPINAL SYSTEM. 
21 
uewal of the fit may ensue suddenly, the duration varying according 
to the exhaustion of the nervous centres, and the contractile condition 
of the muscles themselves; or the interval may last from hours to 
months. Sometimes the injudicious and busy interference of the by- 
standers may again arouse, by reflex actions, the irritability of the 
centres, and fit after fit may be repeated, which otherwise, by cautious 
rest, might not have been excited. 
In some attacks, when the spasms are about to relax, the involun- 
tary muscles especially, and functions which were held in antagonistic 
submission, may evidence, by an overexcited physiological condition, 
their participation in the disorder of the nervous centres; vomiting, 
or other evacuations, hoarse, spasmedic coughing, screaming, phrenzied 
exclamations, or mad ragings, alternating with ecstatic vociferation or 
sputtering garrulity, may ensue. In others, the muscular paroxysms 
cease suddenly, and the brain instantly reacts. The previously dis- 
torted face becomes calm, the limbs assume positions of languor, and 
the patient, as though suddenly awakened from sleep, with a look of 
bewilderment repeatedly asks, “What it is all about!” when, ad- 
monished by the wounded tongue, and by the exhaustion of the aching 
muscles, he becomes conscious that he has just passed through an at- 
tack. Others, again, gradually emerge from unconsciousness into sleep, 
and many times are ignorant of having gone through the fit; or they 
pass from stupor into the heavy stertorous sopor of the apoplectic, 
which, after a time, again blends itself into calm and refreshing sleep. 
The intervals between the attacks vary. Sound and vigorous health 
is enjoyed by some, whilst others, passing their time in constant dread, 
become peevish and irritable, or dull, morose, and selfish, with evident 
alteration persistently accruing in the cerebral functions. The temper 
becomes uncontrollable, thoughts explode as it were in the brain, and 
drive the unfortunate victim into expressions and acts beyond his 
power of resistance. 
The epileptic attacks, by which the nutrition of the brain was first 
deranged, may cease in frequency, leaving the memory permanently 
weakened, or the higher intellectual faculties completely sapped. In 
others a reverse condition may ensue. The irritability of the reflect- 
ive centres apparently subsides, whilst exaggeration of the cerebral 
functions increases. The memory and intellect assume greater power 
and vivacity, till the very confines of insanity are reached. But sud- 
denly the attacks, which had been submissive to the irritation accru- 
ing in the upper brain, burst forth again; whilst the mind loses its ex- 
citement and tenacity, and debility bordering on general loss of volun- 22 
PARALYTIC AND CONVULSIVE DISEASES 
tary motion or power pervades the body. A mid condition of these 
two states sometimes exists. There is an alternation betwixt insanity 
and epilepsy. The irritability of the intercommunicating fibres takes 
place, so that from any undue action in the brain, either of anger, joy, 
or fright, or from any unusual amount of muscular expenditure, parox- 
ysms of insanity or of epilepsy may alternately ensue. 
It appears impossible to discover in some cases of epilepsy what are 
the disturbing or exciting causes. But whatever may be the errors in 
secretion or of nutrition, it is necessary that the medulla oblongata 
should be in an already irritable state, or that this condition should be 
readily impressed. The centripetal points of irritative induction vary 
not only in different cases, but even in the same case. And where 
this impressible habitude exists in the medulla oblongata, or in the 
irritable districts above, a mere touch, especially when the conservative 
actions of the brain are withdrawn, as during sleep, or during intense 
application to any one thing, will serve to bring on the attack, the 
patient leaping, or rather springing like a fish, out of bed upon the 
floor. A misstep which either shocks the spinal column, or from appre- 
hension calls suddenly on the co-ordinative regulation of the muscles, 
will sometimes be sufficient to induce a paroxysm. In one or two cases 
falling under my notice, the patients have stated that they were con- 
scious of the commencement of the convulsive stage before losing their 
recollection. Others will say that they were “ conscious of having be- 
come unconscious.” In one case of this kind, this brief condition was 
rapidly followed by violent intertwining of the feet and legs, accom- 
panied by grindiug of the teeth, and with tumultuous action of the 
heart before sleep, or in the morning as just waking. 
It is from their relation to paralysis, insanity, or imbecility, that the 
culminating issues or sequel® of epilepsy become so anxiously interest- 
ing to the physician, and so fearfully dreaded by the patient and his 
friends. In no disease are the relations between the corresponding or 
associate functions of the brain more strikingly defined than in epilep- 
sy. In the early conditions, either in childhood or more advanced life, 
idiocy may attend. The injury by which the intellectual functions are 
amerced may or may not induce paralysis. The result is as much a 
matter of situation, as of condition of nutrition. But when, with the 
early mental insufficiency, there exists muscular invalidation merging 
from complete paralysis of voluntary motion from certain destructive 
causes, into muscular atony from arrested cerebral development, or from 
defective nutrition, then the recognition of the laws mentioned in the 
foregoing portions of this paper must be made, in order to arrive at OF THE CEREBRO-SPINAL SYSTEM. 
23 
therapeutic as well as at diagnostic conclusions. Although it is true 
that many idiots are neither paralytic nor epileptic, yet it is equally 
true that these conditions are sometimes combined. And the same 
pathologic correlations exist in the deaf and dumb, (the statistical data 
of which I am ignorant.) But of the generalization of the law I am cer- 
tain, having under my knowledge wherein, from intermarriage, 
epilepsy, insanity, paralysis, and idiocy exist in the same family. 
Thus seeming to prove that diseases are as progressively related as are 
the successive developments followed out in the animal creation. In 
the individual, diseases are intercurrent or consecutive; or they are 
non-intercurrent, and sometimes antagonistic. Of this every experi- 
enced physician and surgeon must have seen examples. 
During the attack of epilepsy in those previously paralyzed, the 
phenomenon of convulsive movement may occur in the limbs, which 
had been long immovable by the orders of the will. 
Sometimes an individual is attacked by cerebral paralysis with epi- 
leptiform convulsions, which may sooner or later assume or merge into 
the periodic seizures of epilepsy. In these cases, it is not uncommon 
to find either great hebetude or irritability, which may gradually pass 
into meaningless idiocy, partial dementia, or acute mania; and these re- 
sultants may accrue from mere physical causes, or from direct morbific 
extension, or from some deviation in the integral nutrition of several 
special portions of the cerebral lobes. This deviation of nutrition 
may be marked as hypertrophic or atrophic; or it may be only 
recognizable by the objective changes in color, softness, or density. 
They may coexist with inflammation, with intercellular albuminous 
exudation and fibrillar displacement or adhesion, atteuded or not by 
membranous implication. 
These conditions are not merely persistent in those in whom epilep- 
sy has followed an apoplectic seizure with paralysis. They may also 
be found in those in whom the epileptic phenomena have preceded the 
apoplectic. In minor degree they may accompany epilepsy alone, 
being probably as much resultants from the intercranial disturbances 
caused by the convulsive efforts, as from any peculiar morbid action. 
In some epileptics, the cranial bones are found thickened and eburnat- 
ed, whilst bony excrescences from mere roughness to exostosic growths, 
from the vault or base of the skull, may encroach on its contents, and 
become sources of irritation or of progressive disease. Commonly 
ossific deposits exist in the dura mater and falx cerebri. 
The convulsions occurring during childbirth are, in many instances, 
epileptiform. The reflex sources from the irritative propagation 24 
PARALYTIC AND CONYULSIYE DISEASES 
through the uterine nerves especially are sufficient of themselves to in- 
duce convulsions. But owing to the immense demand on the function 
of the medulla oblongata by the fixing of all the muscles of respira- 
tion during the propulsive strainings, the conditions which have been 
referred to as inductive of epilepsy may be established. If the medulla 
oblongata has been already irritable or impressible, convulsive move- 
ments are more readily induced. Besides these regional disturbances, 
certain changes at times occur, not only within the brain, coincidental 
with the uterine development apparently in some, and during the 
parturient efforts in others, but also on the inner portions of the skull 
itself. These changes are the exostosic impingements found ou the 
inner cranium of puerperal women. The changes within the brain are 
mostly vascular, or from intercellular albuminous effusion. The para- 
lytic conditions after childbirth, as well as the convulsions or eclampsia 
during or before birth, are at times attributable to these states. When 
costal exostoses take place, the various neuralgic pains or local spasms 
are referrible to their irritation of the neighboring nervous filaments. 
In the other cases, previously referred to, the vascular changes 
vary from lessened or obstructed calibre to aneurismal dilatation. In 
some the corpora striata, the thalami and cerebellum, have been found 
extensively diseased or evidencing haemorrhagic changes, which have, 
by their impairment of function, indicated their lesions previously or 
coincidentally with that of the medulla oblongata. As above re- 
marked, during the epileptic attack the limbs that were paralyzed for 
voluntary motion may be convulsed, and the face, whose expression- 
less apathy masked every emotion, may start into spasmodic life aud 
purposeless motion. In the aphonic, the voice, long unused to articu- 
lation, may issue in wild shrieking, from the reflected action of the 
medulla oblongata. The sensific centres, both spinal and cranial, 
may be premonitorily affected, and before consciousness is lost may 
agonize the sufferer with unbearable pain, till the suffocating spasms, 
by inducing anaesthesia, destroy all perception, whilst the body is writh- 
ed in every possible contortion by the violence of the reflex actions. 
Although by many epilepsy is considered to be attended by uncon- 
sciousness, yet from my own observations this opinion is to be received 
with reserve. Epilepsy, like other disorders of innervation, has its 
degrees; and although unconsciousness may attend or usher in the 
convulsive stage in most severe attacks, yet I have seen cases in which 
the spasmodic muscular exhibitions were most powerful, without the 
perception of the surrounding conditions becoming effaced. It is true 
that the nervous centres of motion, being so engaged by the action of OP THE CEREBRO-SPINAL SYSTEM. 
25 
the disease, they cannot be made amenable to the orders of the will, 
yet the perception of this condition may be manifest to the patient. 
The varieties of the attack greatly depend on the anatomical seat 
of the affectipn. In some the involuntary or reflex expressions of the 
passions merely take place; the upper portions of the corpora olivaria, 
which are connected with the nuclei of the facial nerves, being the 
demonstrative seat. It may embrace the nuclei of the hypoglossal, 
causing the tongue to be convulsively moved. In others there may 
be mere spasm of the extremities, from irritation or lesion of the cor- 
pora pyramidalia, extending into the anterior spinal columns, or from 
some congestive irritation of the corpora striata. The objective symp- 
toms may be the resultants of the combined states just mentioned, or 
there may be merely partial spasm from regional exclusions; and 
these regional exclusions have lately been pointed out byVander 
Kolk, in his observations on those patients who bite or do not bite 
the tongue, to which reference will be hereafter made. 
The influence of the medulla oblongata over the calibre of the mi- 
nute vessels, especially through the vaso-motor nerves, by which the 
supply of blood to the whole brain is diminished or increased, is not 
to be forgotten. And here, although the primary conditions were in 
this upper spinal portion, yet the immediate objective symptoms are 
of apparent cerebral origin, since vertigo and loss of consciousness 
are the only recognizable conditions. 
From what has been necessarily so hastily said, it is easy to perceive 
how narrow are the boundaries which are assumed, and how insensibly 
they merge into each other, as to the medulla oblongata or the brain 
being the originating seat of epilepsy. But it is well for practical pur- 
poses to remember that the spasms, for the most part, occur in those 
muscles deriving their innervation from the nerves of the medulla ob- 
longata, viz.: the facial, the accessory, the hypoglossal, and the third 
branches of the fifth. It is also convenient to recall that for the most 
part the functions of the medulla oblongata are bilateral, correspond- 
ing to the muscular exhibitions in true epilepsy. 
But there are seizures with epileptiform convulsions which, at their 
first incurrence, render the diagnosis between them and true epilepsy 
somewhat difficult. A stout, plethoric man may be suddenly struck 
down, and by the time the by-standers have summoned medical aid, he 
may be found epileptically convulsed, and insensible. There is both 
stertor and foaming at the mouth, but the respiration, although labor- 
ed, is yet freer, and more regular, than in true epilepsy. The pulse 
varies, but it is rarely slow and hammer-like to the touch. The mouth, 26 
PARALYTIC AND CONVULSIVE DISEASES 
instead of being bilaterally acted on, is drawn more to one side than 
the other, whilst the facial muscles, in the intervals of spasm, appear 
unequally relaxed. The coming-to is longer than in uncomplicated 
epilepsy; the mind is more sluggish, and the voluntary transmissions, 
either for motion or speech, are impaired or imperfect. The arm and 
leg of one side become inactive, the speech is thick, indistinct, or con- 
fusedly labored. These and other paralytic conditions point to the 
brain as being the chief seat of lesion, although from some cause 
there may have existed at the time irritability of the medulla ob- 
longata, which has been called into active participation by irritative 
lesion of the conducting fibres. Cerebral haemorrhagic laceration has 
been found in some of these cases, and accounts for the symptoms 
which progressively occur. At intervals, other attacks ensue; and 
although insensibility may be the earliest symptom in a particular 
case, yet in others the spasmodic actions first evince themselves. 
These varying resultants depend as much on the situation of the hem- 
orrhage as on the quantity and rapidity of the effusion. I have known 
the pressure so gradually made, that the patient has stated he felt 
drowsy, and whilst apparently asleep, the stertorous respiration of 
apoplexy would ensue, quickly followed by the head being drawn 
rigidly to one side, whilst convulsive movements pervaded the extremi- 
ties, and sometimes the trunk. At every renewal of the haemorrhage 
the same symptoms are repeated. 
During the reparative processes in these epileptiform apoplexies, in- 
sensibility may not again occur; but from the contraction of the clot, 
and other efforts towards cicatrization or repair, spasmodic twitching 
or convulsions of the facial muscles especially, may recur. The spasms 
are in most cases unilateral, and on the side opposite to the cerebral 
injury; thus, in the very beginning, the convulsions are epileptiform, 
but not epileptic. The post-objective appearances also differ from 
those of true epilepsy. Ou opening the mouth, the whole palate may 
sometimes be seen to be so relaxed as to fall on to the tongue, or one 
side only droops, with the uvula horizontally retracted. The con- 
strictors of the pharynx are sometimes paralyzed, and the food, col- 
lecting in the pouches at the base of the tongue, becomes a source of 
intense misery, from the liability of portions to fall into the opening of 
the glottis on raising the head, thus inducing suffocative efforts for 
their dislodgment. 
The accessory nerves of Willis, which act on the muscles of the lar- 
ynx, and on the constrictors of the pharynx, together with the pala- 
tine ramifications of the second branch of the fifth, appear to be chiefly OP THE CEREBRO-SPINAL SYSTEM. 
27 
affected. Nor is it uncommon to find the oesophagus in the reverse 
conditions of contraction or dilatation; these structural differences de- 
pending upon the local nervous conditions of irritation, or of paralysis. 
A more immediately dangerous condition exists from the incurrence 
of oedema of the glottis. In one patient this was a rapid cause of 
death, whilst the difficulties from the paralytic retention of portions 
of the food, and its delay of transit through the oesophagus, existed in 
a most pitiable degree. 
The after-effects of an epileptic attack in some patients require 
discrimination. In many there are no prominent sequel®, but in 
others simulative disorders arise. Deglutition, both voluntary and 
reflex, may continue difficult. The lungs may assume a pneumonitic, 
bronchitic, or asthmatic state. The stomach may reject its nourish- 
ment, or refuse to digest. The heart may be deranged in its rhythm 
or sounds. The diaphragm may be acted on through direct irritation, 
producing explosive cough, hiccup, sighing, or anhelation. The abdo- 
men may shrink from the slightest touch, as in inflammatory invasion. 
The kidneys and bladder may pour out their irritating contents, 
scalding the urethra in its passage, or complete suppression may ensue. 
The urine may become albuminous, and deficient in extractive matter, 
or it may be loaded with lithates, purpurates, and other materials 
arising from the surcharge of animalized decomposition, or from the 
insufficiency of function in other organs. These conditions, although 
for the most part transitory in their excess, yet are to be carefully ex- 
amined into, inasmuch that they may serve to point out some latent 
difficulty, which has stealthily induced morbid states of nutrition in 
the nervous centres implicated in the phenomena of the epilepsy itself. 
The variety of remedies which have proved successful in different 
cases indicate the truth of the above assumption, and inculcate the 
doctrine that, although the nervous phenomena of the fit itself have 
their starting-point in certain regional bounds, yet the origin of the 
disturbances in the normal nutritive actions of these districts must be 
for the most part searched for elsewhere. For the structual changes 
which ensue during the epileptic condition are not peculiar to that 
disorder alone; they occur in other disorders as well. 
In chronic epilepsy, the intellectual faculties are prone to become 
weakened and changed. Perception and volition, the simplest condi- 
tions of mind, become enfeebled or vitiated. Irritability passes into 
more or less continued excitement, which, after a time, may assume at 
first the form of temporary mania, again to be tempered down to 
partial imbecility or complete idiocy, or to be increased into hopeless 28 
PARALYTIC AND CONVULSIVE DISEASES 
lunacy. In some, there is intermittence, but no respite. The epilep- 
tic expenditure may exhaust the frame and restrain the maniacal man- 
ifestations for a varying interval, but to recur in new force, till death 
takes place. 
Statistical records show that four-fifths of epileptics become subject 
to more or less mental alienation. Dementia is more frequent than 
mania. As might be supposed from the vast amount of morbid action 
discovered in the brains of the epileptic, monomania rarely occurs. 
But it is to be remembered that the monomaniacal may become sub- 
sequently epileptic. 
As before mentioned, the causes of epilepsy are various; but from 
the instinctive passions, none so frequently conduce to its incurrence 
as the venereal, when indulged in to relative excess. It is an instance 
of the infringement of the law already cited, viz., the correlation exist- 
ing between the central and centripetal nervous actions, independently 
of nutritive disturbances. Irritation or injury of the cerebellum is fre- 
quently attended with derangement of the genito-urinary system; 
whilst the disorders of the sexual organs, and especially when arising 
from overindulgence, usher in qualificative alterations of nutrition and 
function of the basilar contents within the occiput. The recognition 
of these neural reciprocities is highly important, both in a diagnostic 
and in a therapeutical point of view. 
The necro-statistics of epilepsy are generally unsatisfactory. The 
intercurrent morbid changes of the complications have not been satis- 
factorily distinguished from the pathologic essentiality. Post-mortem 
changes have not been rigorously separated from the nutritive altera- 
tions happening during life, and which were either causes or the 
sequences of the attacks. Reparative processes ensuing during the re- 
traction of the disorder, or perhaps long anterior or subsequent to the 
epileptic phenomena, have been frequently set down as elemental de- 
partures from normal structure; whilst the true morbid sources have 
not been compared in their various stages with the symptoms in their 
periods of manifestation. 
The localization of the originating causes of epilepsy has ever been 
a matter of dispute, and will continue to be, so long as the phenomena 
are mistaken for the existing causes. Wenzel regarded the pituitary 
body as being the chief pathologic seat; yet I have in more thad one 
instance seen this body greatly diseased without any epileptic tendency, 
but in none without great derangement of the general nutrition. In 
two cases there was unbearable ophthalmic neuralgia, with distortion 
of the eye, apparently confirming the statements of Littre and Lieu- OP THE CEREBRO-SPINAL SYSTEM. 
29 
taud that some of the branches of the fifth and sixth pairs of nerves 
penetrate this body, but which have not been demonstrated by other 
anatomists. 
In one case the emaciation was extreme, although nourishment was 
taken in large quantities. Involuntary spasms affected the face, tongue, 
neck, and shoulders, but unattended by loss of consciousness.. The 
spasms may be termed epileptiform, but not epileptic, as previously re- 
marked when speaking of the unilateral facial spasms during cerebral 
haemorrhage. Had irritability of the medulla oblongata existed at 
the time, there might have been excited a true epileptic seizure, with 
cerebral unconsciousness. 
Hereditary transmission has been statistically proved to exist in 
about one-third of the individuals affected; a proportion much greater 
than can be traced from any other one cause. But in what the essen- 
tial nature of this transmission consists, whether in deviation of the 
structural or dynamic conditions of the ultimate cell, in which a spe- 
cific so-called “ taint” is engrafted, or in some elemental changes in the 
nervous structures themselves, or in local hypertrophies reproduced in 
the offspring, or in certain radical alteration in the constituents of the 
blood, sufficient data have not yet been collected to justify the adop- 
tion of any one in preference to another. 
From my own observation, the children of the scrofulo-tuberculous 
are more prone to epilepsy, other things being equal, than are those 
in whom no such dyscrasia exists. The causes of this epileptic ten- 
dency arise chiefly from certain regional development of tuberculous 
matter within the brain, whereby its irritation or an exalted sensibility 
of the medulla oblongata is established, and from the erythism of the 
general nervous system, so commonly the attendant of this peculiar 
diathesis. Indications of tubercle, in the pulmonary tissues especially, 
are found in many in whom the epilepsy has Jseen more or less chronic. 
Their original incurrence, or their development as sequential to the 
strain on the lung during the fits, must be diagnosticated on examina- 
tion of the cases. The irritative or convulsive cough, with more or 
less bronchitic rales, especially in children who are growing rapidly 
and retain an outline of comparative vigor, should not lead into an 
erroneous belief of the lungs being primarily affected. These bron- 
chial conditions, in very many cases, proceed from an exalted sensi- 
bility of the respiratory centres, and yield more rapidly to derivato- 
ries at the upper cervical portion of the spine, than to pectoral syrups. 
In some, smart slapping on the neck and shoulders relieves the convul- 
sive coughing and shortness of breath. If, after a time, the irrita- 30 
PARALYTIC AND CONVULSIVE DISEASES 
bility of the medulla oblongata increases, cerebral disturbances from 
the suffocative or long-continued coughing ensue, and the child, com- 
plaining of vertigo, becomes suddenly unconscious, and is attacked 
with the convulsions of epilepsy. The same frequently occurs in per- 
sons of more advanced age, who, from frequent masturbation or ex- 
cessive sexual indulgence, have impaired the general nervous system, 
as well as excited an erythism of certain central districts. From the 
recovery attending many cases of so-called pulmonary consumption 
under my charge, in whom the central nervous causes were early rec- 
ognized, I can attest to the soundness of the pathological statements 
just offered, as to the pulmonary sequences without epileptic disorder. 
The period for the exhibition of these hereditary influences lies chief- 
ly between the first and the twentieth year. And this predisposition 
has some curious features. The child may be attacked before either 
the mother or father has exhibited at the time any epileptic tendency, 
of which I have seen several instances. Although excesses in venery 
or masturbation, and the changes incident to the period of menstrual 
decline, have been stereotyped as the most efficient productive causes, 
yet, when viewed apart from the coincidental or sequential regional de- 
rangement of the medulla oblongata, they form less frequent conditions 
than supposed. Yast excesses or severe menstrual difficulties are daily 
occurring without any noticeable convulsive disorder. But when from 
any cause the neuro-relations of the medulla oblongata, or of the dis- 
tricts behind or before the thalami, are disturbed, then epileptic, cata- 
leptic, or other departures involving the normal reciprocations between 
the cerebral and spinal functions may be engendered. In the old, the 
very changes incident to their age may produce epilepsy, (with more 
or less paralysis,) since ossification, obliteration, or dilatation of either 
the great or small arteries may become an inductive cause, through 
passive hypersemia or local ansemia, as may be relatively induced. 
Scholars both young and old, the overworked, the anaemic or the 
plethoric, may alike be attacked, as the brain or the medulla oblonga- 
ta may suffer together or correctively. In the young, paralysis and 
idiocy threaten as subsequent events. In the aged, dementia, mania, 
or imbecility, with creeping palsy, closes the scene of all useful life. 
Both the centric and eccentric causes of epilepsy have been studied 
by various authors. Marshall Hall early taught that the convulsions 
of apoplexy and of epilepsy were due to the venous congestions re- 
sulting from the pressure on the large vessels by the cervical muscles. 
Kussmaul and Tenner, in their admirable essay, make issue with these 
doctrines, by experimentally inducing through compression of the great OF THE CEREBRO-SPINAL SYSTEM. 
31 
cerebral arteries an opposite state of the brain, by which an anaemic 
condition of the brain is induced, resulting in convulsions in every way 
resembling those of epilepsy. They consider that, by thus cutting off 
the supply of blood to the brain, and especially to the medulla oblon- 
gata, the active nutrition of these parts is interrupted, and thereby 
certain material changes ensue, productive of convulsions. On slicing 
away the cerebrum and the thalami, and then renewing the pressure 
on the arterial vessels, convulsions immediately occurred, thereby in- 
dicating the medulla oblongata as the radiating centre. They con- 
clude from their experiments that the central seat of epileptic convul- 
sions is to be sought for in the excitable districts of the brain lying 
behind the thalami optici; and that ansemia of those parts of the brain 
situated before the crura cerebri, produce unconsciousness and paraly- 
sis in the human being. If spasms should occur with these symptoms, 
some portion of the excitable district behind the thalami optici must 
likewise have undergone some change; whilst ansemia of the spinal 
cord, instead of convulsions, produces paralysis of the limbs, of the 
muscles of the trunk, and of respiration. Although mere spinal anse- 
mia does not induce epileptic convulsions, as insisted on by Kussmaul 
and Tenner, yet this impoverished vascular condition must not be con- 
founded with traumatic lesions of the cord, as experimentally proved 
by Brown-Sequard, where the epileptic seizures could be produced by 
peripheric irritation of the integuments of the face and neck on the 
same side of the injury. 
Although Marshall Hall’s theory is incorrect respecting the com- 
pression on the venous trunks being the exciting cause of the convul- 
sions, yet it cannot be denied that the reactive effect from this condi- 
tion may serve to induce a more violent and rapid manifestation, and 
especially if the medulla oblongata had been in a previously irrita- 
ble state. This differs, however, from laryngismus as an exciting 
cause; since, in this condition, the medulla oblongata is either prima- 
rily affected, or it is called into violent action by the exalted condition 
of the peripheric excitor nerves of the larynx itself. Hence the suffo- 
cative conditions vary according to the persistence or power of the 
irritative cause. In some, fatal tetanoid epilepsy results, from the 
fixed condition of the respiratory muscles, inducing complete asphyxia. 
In others, the cause is less persistent, and there is no fixing of the 
muscles of the chest. The spasms are more distinct in their alteration 
of tension and relaxation, whilst their subsidence corresponds with the 
carbonization in the pulmonary and cerebral vessels. The effect is 
much the same as produced by etherization; reflex muscular act'ons 32 
PARALYTIC AND CONVULSIVE DISEASES 
ensue at first, but subside during the advancement of the anaesthetic 
influence. 
The exciting causes of these central or eccentric phenomena are very 
various, and the conditions of the nervous centres deviate from mere 
molecular perturbation to absolute disorder in their nutrition. The 
eccentric epileptic originations are more apt to be attended with the 
premonitory aura, consciousness being less speedily lost (and some- 
times not all) than in an attack from cerebral or central causes. 
When the result of wounds on the fingers, wrists, feet, limbs, &c., the 
aura not unfrequently attends, and the attack may sometimes be de- 
layed or stopped by ligaturing tightly just above the point of irrita- 
tion, by which either the perturbatory influences are checked, or a ve- 
nous condition of the part is produced. When the result of mere in- 
ternal irritations, many epileptics will, from instinct or from accidental 
discovery, throw themselves violently against some body, by which 
pressure can be made, thereby impeding the nervous perturbations, or 
inducing local venosity. That epileptic seizures, attended or not by 
laryngeal spasms, are apparently induced by mere nervous changes, 
independently of alteration of the calibre of the nutrient vessels, is 
verified by the mode which may at times be effectively pursued in ar- 
resting the epileptic attack that would have otherwise ensued. By 
calling imperatively to the patient to resist, and to make forced inspi- 
ratory efforts, the perturbations conveyed to the brain and medulla 
oblongata are neutralized by those caused by the exercise of the will, 
and the spasms do not ensue. Equilibrium is thus established. Some 
patients can in this way resist, by the exercise of strong voluntary im- 
pulse, the full effect of the attack. 
That these points of irritation, no matter where seated, should cause 
epileptic phenomena, it is necessary that two conditions should be es- 
tablished. The first is, coincident disorder of the medulla oblongata, 
and of certain cerebral districts already mentioned. The second is, 
that these points of irritation should convey the impression to other 
organs or centres correlated in function or innervation, and from thence 
to the focal regions at the base of the cranium. 
After all consciousness has departed, when all perception of sensation 
has ceased, the convulsions of epilepsy continue unabated or increase, 
from the exalted capacity of the medulla oblongata for reflex actions. 
An important addition to our knowledge of the pathology of epi- 
lepsy has recently been made by Prof. Schrceder Van der Kolk, who 
has verified, by his own minute dissections, the connections existing 
between the two sides of the medulla oblongata, whereby normal or OP TIIE CEREBRO-SPINAL SYSTEM. 
33 
morbid excitations of this part are distinguished by bilateral actions, 
thereby differing from the unilateral lesions of the spinal cord, and 
sometimes from the manifestations of injuries to the upper cerebral 
lobes. Hence, the early convulsions of epilepsy commence in bilateral 
movements of the face, tongue, and organs of respiration. The seat 
of these spasmodic actions lies in the ganglionic cells of the medulla 
oblongata, which, when irritated, excite tiie associated nervous fila- 
ments. The arterial supply of blood to these cells is even greater than 
to the gray matter of the brain and of the spinal cord. The medulla 
oblongata becomes the focus of reflexion through the conducting fibres 
from the brain, from the spinal cord, and from the viscera and sexual 
organs, by the influence of the sympathetic on the spinal cord through 
its filaments or its vascular reticulations. Although it may hap- 
pen, in early epilepsy, that no appreciable organic change exists, yet, 
from the repeated congestions, an albuminous intercellular fluid is ex- 
uded, causing more or less induration, which may subsequently undergo 
softening or fatty degeneration. Dilatation of the arterial capillaries 
in the medulla oblongata, especially, has been found to accompany 
this state. These dilated vessels are found running chiefly in the re- 
gion of the septum, corpora olivaria, and the roots of the hypoglossal 
and vagi nerves, the posterior half of the medulla oblongata appear- 
ing more hyperaemic than is normal. 
A memorable distinction is drawn by Prof Van der Kolk between 
those biting and those who do not bite their tongue. In the former, 
he usually discovered the capillary vessels wider in the corpora oli- 
varia, and in the course of the hvpoglossals; whilst in the latter, the 
vessels in the course of the vagi were dilated; and in these latter, 
from the greater disturbance of respiratory action, was induced a 
greater fatality during the fit. He also considers that epileptic de- 
mentia affords no proof of incurability, as it may result from the pres- 
sure exerted on the gray cerebral substance by the vascular disten- 
tion, which may disappear after the cessation of the attacks. But it 
is different with the dementia following acute mania, as this depends 
on degeneration of the cortical substance, and is incurable. Attacks 
of unconsciousness, attended by little or no spasm, depress the mental 
powers more rapidly thau attacks of convulsions without loss of con- 
sciousness. 
Strong and unexpected impressions made on the senses have origin- 
ated some of the most violent and irremediable epileptic attacks. 
Fright, grief, excessive joy, the immaterial influences from sudden or 34 
PARALYTIC AND CONVULSIVE DISEASES 
long-continued bright light upon the retina, of sound, and of mental 
conjurations, have produced every manifestation of the disease. 
The traumatic causes of epilepsy, from injuries to the head, have 
been purposely omitted, as their consideration would occupy too much 
space for this paper. The only remark that I will venture here is, 
that these traumatic cases, as a general rule, partake more or less of 
the epileptiform character, and on post mortem examination, the me- 
dulla oblongata and the irritable districts about the optic thalami are 
not found in the pathologic states as seen in uncomplicated epilepsy. 
The relief that has been immediately and permanently gained by the 
surgical aid of the trephine or elevator in some cases, also corrobo- 
rates the statement, especially when these means have been employed 
before the mere functional derangement of the medulla oblongata has 
eventuated in its structural alteration. 
The diagnosis of epilepsy from other convulsive disorders, impli- 
cating psychical or sensational manifestations, has been partially in- 
cluded in the delineations already made above, and will also be inci- 
dentally mentioned in the following portions of this paper, when 
speaking of treatment. The detection of spurious epilepsy affected 
by street impostors, or by army delinquents, criminals, and sympathy- 
craving individuals, can only be satisfactorily made by the scientific 
investigation of the subject, wherein the adoption of certain practical 
experiments on the reflex conditions of the nervous system afford the 
most reliable evidence, since they are unknown to, and beyond the 
control of the suspected person. T3ut even these reflex phenomena 
are to be carefully separated from the voluntary efforts of the expe- 
rienced pretender, who either modifies by restraint or exaggerates by 
will the sought-for effects. In tetanoid epilepsy, where the muscular 
tension of the trunk and upper portion is very great, the dashing of 
cold water on the face or over the chest does not, at times, produce 
any noticeable reflex change, and the observer might wrongly con- 
clude that the quivering or vibratory sustentation of the spasm was 
kept up by powerful voluntary act. I will also remark here, that 
sometimes this mode of treatment in these terrific cases may result in 
immediate relaxation, the nervous centres not being able to sustain 
the double action of the diseased exciting cause and of the peripheral 
excitation at the same time. But care is to be exercised, as cases 
have been reported in which the sudden dashing of cold water on the 
surface has proved almost immediately fatal, either by the sudden de- 
bility of the respiratory centres, or by their explosive increase of pow- OF THE CEREBRO-SPINAL SYSTEM. 
35 
er, inducing an unyielding rigidity of the laryngeal and thoracic mus- 
cles. 
As a general rule, however, the voluntary sustentation by the im- 
postor is longer, provided he is surrounded by a wondering or sympa- 
thizing crowd, than the reflex spasmodic tension of the true patient. 
But it is well to remember that in both the same regional tracts are 
really brought into action—in one by voluntary engagement, but in 
the other by involuntary reflex action. The impostor has an object 
to attain: he selects a place suitable and somewhat comfortabe for 
his imitations, and only accidentally endangers himself, and I believe 
never bites his tongue; whilst the unfortunate epileptic falls any- 
where, is unconscious of pain and danger, may bite his tongue, and 
evacuate the bowels or bladder, or vesicul® seminales, and never runs 
away at the approach of any well-known medical man, who might, for 
experiment, light the clothes or straw on which he is lying. 
A more difficult point of diagnosis lies in the interpretation of those 
cases wherein the incurrence of the disorder is unsuspected by the pa- 
tient or his friends. Night-fits, especially, happen unnoticed by the 
sufferer, the sequela) of which are complained of as original condi- 
tions, and may frequently be so treated by the medical attendant. 
Dullness of intellect, or irritability of temper, defective memory, 
stammering articulation, moral confusion, changes of habit and of 
affections, are frequently the early objects for professional consultation 
or observation, when the discovery is made, after a time, that the dread 
disorder of epilepsy had been latently existing, and had gained an im- 
pregnable foothold. Children, who sleep soundly, or others who sleep 
alone, may pass from slumber into epileptic sopor with rapid convulsion, 
and back into sleep again, without consciousness of the passage of the 
attack on waking, save a sensation of fatigue or of general malaise. 
Others merely notice a little blood on the pillow from the slightly- 
bitten tongue, but which is generally supposed to have come from the 
nose. Some cases of involuntary seminal emission, unattended, gen- 
erally, by pleasurable dreams, are referrible to these latent epileptic 
manifestations. Our space forbids further attraction to these unsus- 
pected cases of stealthy epilepsy, but enough has been said to render 
a more wary attention to many obscure cases of so-called ill health. 
REMARKS ON TREATMENT. 
From the antecedent portions of this paper, it must necessarily ap- 
pear that as the causes and conditions leading to epilepsy are variable 
and very numerous, that no specific remedy or class of remedies can 36 
PAPiALYTIC AND CONVULSIVE DISEASES 
be relied on in regard to treatment, either as to eradication, or even 
amelioration. It has been shown that, although the paroxysms of 
epilepsy are generally exhibited by convulsions, or static disturbances 
of those parts receiving innervation from the medulla oblongata, 
either directly or indirectly, yet other phenomena besides those of 
muscular convulsions may ensue. In some, vertigo, with subsequent 
loss of consciousness, or with unconsciousness to every other condition, 
is substituted for the epileptic paroxysms, which appear merely to af- 
fect the larynx more or less, without implicating other special regional 
portions of the medulla oblongata. In some, indeed, the medulla ob- 
longata, so far from being rendered excitable, seems to be temporarily 
paralyzed, and unable to sustain even the automatic actions so essential 
to life. Hence, in these cases, which appear to depend on some blood 
condition, either as regards its mechanical distribution from disease of 
the heart for instance, or its quality from some error of the organs of 
assimilation, the treatment must necessarily differ from those in whom 
no such condition exists, and in whom the phenomena vary. Epilepsy 
from disease of the basilar portions of the brain calls for a treatment 
differing from the attack induced by suppressed customary haemor- 
rhages, by abdominal tumors, or by reflected points of irritation in the 
genito urinary organs, &c., &c. In one, epilepsy may result from 
causes purely nervous; in another, from disturbances purely vascular; 
whilst in a third, both nervous and vascular derangements may arise 
from a mechanical or accidental source. 
Depravities of the blood, whether from kidney or liver disease, or 
other secernent impairments, are frequent causes of epilepsy. These 
depravities cannot be eliminated, or rendered innocuous, by mere 
treatment addressed to the local centre of radiation; it must be more 
comprehensive. The indications of blood-poisoning must necessarily 
be various; and this diversity depends mainly on the amount and 
quality retained, on the affinitive conditions of the different organs, 
and on the states of the nervous centres at the incursion of the blood pollu- 
tion. The phenomena vary according to the various groupal connec- 
tions, and the special derangements of nutrition. Poisons internally 
developed do not differ as regards their selective affinity and manifes- 
tation from those externally administered. Some arc generated by 
excess of nutritive supply; others by its deficiency, independently of 
any fault in the organism. And this proportion of nutritive supply is 
as frequently relative to the organic capacity of the individual, as to 
the amount ingested. Some organisms produce, by a peculiar vito- 
chemical action from moderate sources, the very agents so injuriously OF THE CEREBRO-SPINAL SYSTEM. 
37 
reactive in those who have habitually abused their powers of assimi- 
lation by excess of supply. The lithic condition, for instance, result- 
ing from organic generation in the former, represents a like state of 
non-transformation in the latter. It is seen in the gout of the starver, 
as well as of the feeder. So in rheumatism, where both the lithic and 
lactic poisoning are exhibited. In one, a mere affection of the non- 
epithelial fibrous structures ensues, resulting in general disorder from 
some known or traceable cause, as cold, damp, and exposure; whilst 
in another, the epithelial tissues become invaded, their disorder not 
being traceable to any undue exciting outer cause, but indicating a 
blood-dyscrasia from depraved secernent actions, with constitutional 
results more or less threatening to life, as well as impedimental y to 
motion.* 
In toxaemia, not only do the symptoms vary, but the causes of col- 
lection in the blood differ. Uraemia, with defective or contracted kid- 
ney, from which qualitative retention of noxious salts, or non-elimina- 
tion of urea with urinary decrease ensues, is very different from the 
condition of the system by which the blood is surcharged with the same 
poisons, from their overgeneration, whilst the watery excretion is nor- 
mal as to quantity, and its specific gravity higher as to qualitative 
extraction. In one, liydropical effusions ensue; in the other, emacia- 
tion with an ex-serous condition of the cellular tissue attends. Both 
may be convulsed, and the convulsions may be epileptic, apoplectic, 
or local, according to the portions invaded and the nature of the 
changes induced. If within the hemispheres, and the changes are 
those from congestion, apoplectic coma may result; if from mere irri- 
tation, the functions of the brain may be exalted into delirium or 
mania; if from depression of the nervous centres, stupor or lethargy 
may obtain. The convulsive actions or the paralytic inertness will de- 
pend on the rcciprocative condition of the medulla oblongata, and the 
conductive or non-couductive irritability of the medullary matter. In 
many, the uraemic symptoms are not prominent as deviations in the 
intellectual or automatic portions of the brain. They may arise from 
the intermediate regions, viz., the emotional. Hence, cataleptic, 
ecstatic, euthanastic states are impressed, at times without and some- 
times with convulsion, the flexor or extensor tension being frequently 
confined to one limb, or to certain muscles in groupal co-ordination. 
Yet, as regards treatment, these toxmmic cases differ essentially, 
* See my article on Rheumatism of the Epithelial and Non-Epithelial Tissues, 
in this Journal, vol. viii., 1857. 38 
PARALYTIC AND CONVULSIVE DISEASES 
and lienee the necessity for exactness of diagnosis. Since in one, a 
disorganized kidney may exist, from which there is no power of recu- 
peration; whilst in another, the eliminative organs are sound, and 
performing extra duty. The cause of death in the first really lies in 
the kidney; whilst in the second, it lies in some portion of the nervous 
or cell system. 
The epilepsy of the anaemiated from sexual abuses differs greatly 
from that of the plethoric, in whom the venereal function is restrained. 
In one is established an erethism, which responds violently to any 
cause invoking the function of the medulla oblongata; whilst in the 
other, the power is overgenerated, and explodes, so to say, as a spon- 
taneous mode of relief. In females, the derangement of the utero- 
ovarian function forms a like condition. In both the male and female, 
epilepsy may be the result of a mere functional derangement, or it may 
ensue upon certain organic changes, which, whilst they are mostly irrep- 
arable, yet can be rendered less injuriously excitant through appro- 
priate treatment. Epilepsy from erethism of the vascular nerves, by 
which the cerebral circulation is interfered with, resembles that excited 
through the changes induced in the vessels of the brain by disease of 
the heart. In one, the excitement of the vessels themselves is great; 
in the other, the vessels are mere carriers or holders, according to the 
cardiac condition, by which either more blood is forced into the brain, 
thereby exalting its nutrition, or, by overdistending the chambers of 
the heart, a surcharged venoid condition is established, which depresses 
the nutritive energies, whilst the pressure is increased. The treatment 
required in the one case is opposite to that of the other. 
In the epilepsies of children, especially when happening after the 
period of dentition, and in whom hereditariness cannot be traced as 
regards either parents or grandparents having been subject to the 
disorder, it is imperatively necessary to inquire into any syphilitic dis- 
ease having been incurred by the father or mother prior to the con- 
ception of these children. It is not uncommon to find eruptions, in- 
guinal ulcerations, and follicular disease of the throat in the offspring 
of such parents, in whom no secondary affection has as yet manifested 
itself. The anti syphilitic treatment relieves the condition of the child 
so afflicted, and is confirmatory of the origination, and as to the ap- 
pearances of the parts affected. After a variable period, the parent 
may evidence the syphilitic taint by the various teguinentary eruptive 
disorders, or by nodes or cranial exostoses, or deep excavativc ulcera- 
tion of the glands and follicles of the posterior pharynx and larynx. As, 
in the parent, the affection yields according to the condition of the OP THE CEREBRO-SPINAL SYSTEM. 
39 
other organs, and of the local specific manifestation, to Hydrarg., bi- 
chlor.: Proto.-iod. mere., or Iod. or Bromide potass., &c.; so, in the 
child, do the same remedies, judiciously administered, prove valuable 
in arresting the epileptic attacks. 
In some cases of hysteria greatly resembling epilepsy, with uterine 
or erratic erosions of the cervix, I have been able in several 
Semes to trace a syphilitic infection in the parent, and have, by cau- 
tiously administering the iodides and bromides of potash, &c., in con- 
junction with local treatment, been successful in removing the hyster 
ical condition. The muscles which derive their nervous supply from 
the medulla oblongata are, in the syphilitic cases of hysteria, brought 
into action more by the reflex irritation from the ulcerated or eroded 
portions of the posterior fauces, pharynx, and larynx, than by any 
specific central action. The cases are originally those of simple hys- 
teria, aggravated by nervous conduction from the latent syphilitic con- 
ditions affecting the inner throat. They differ from cases of syphilitic 
epilepsy in these essential features: that in the latter, the primary in- 
oculation of the virus originated in the individual, and not from an 
hereditary taint; that the syphilitic eventuations are elsewhere dis- 
tinctly recognizable by nodal exostoses, allopecia, or eruptive, ulcerative 
conditions. The phenomena are also those of epilepsy, viz., the soli- 
tary cry, unconsciousness, insensitiveness, biting the tongue, disregard 
of danger, tetanic condition of the larynx, deficient respiration, turgid 
or blackened face from capillary rupture, involuntary passing of the 
bowels or bladder, &c., &c.; and are not those of hysteria happening 
in persons tainted through syphilitic parents. In these, the hysteri- 
cal element is prominent, as exhibited in the repeated cries or sobs, 
emotional exclamations, unsubdued consciousness, watchfulness against 
injury of the tongue and person, globus, alternation of laughter and 
sobbing, and comparatively free respiration, with relaxed larynx, &c. 
When the cranial bones, becoming affected by syphilis, give a fair 
ground of suspicion as to the cause of the epilepsy, the preparations 
of mercury, of iodine and mercury, iodide of potash, &c., conjoined 
with tonic remedies for the debilitated, will do more to effect a cure 
than any of the medicines vaunted as specifics. If the skull becomes 
thickened, independently of any venereal taint, and organic disease of 
the brain appears threatening from the various symptoms of paralysis, 
disturbed mental functions, neuralgic pains, &c., the long pericranial 
seton or issue should be resorted to, in conjunction with internal rem- 
edies. The neck seton, high up to the base of the skull, answers well 
in those cases where, besides an undue excitability of the medulla 40 
PARALYTIC AND CONVULSIVE DISEASES 
oblongata, there appears a hypertrophy or overgeneration of the gan- 
glionic cells, by which a periodic discharge of nervous force is estab- 
lished. In some, the irritability appears at first to be increased; but, 
if the case be really suitable for the seton, this speedily diminishes as 
the suppuration increases. 
In the anaemic, the seton fails of success. The drain is too ex- 
hausting, and local irritation is added to the nervous erethism. So 
far from becoming a point of divarication, it becomes a radiating 
cause of eccentric irritation. The ulterior effects, in such conditions 
of the system, are the same as happen in certain spinal diseases, in 
which, besides the constitutional injury, a local exhaustive irritation 
is established by the worse than injudicious application of suppura- 
tive agents. 
There are other cases, however, in which a suppurative drain re- 
lieves the fullness of the vessels, and appears as equally efficient for 
good, as does the mechanical application which relieves in spinal dis- 
ease the crowding pressure of the vertebra}. When the blood is loaded 
with more or less impurity, a certain source of its elimination is es- 
tablished by opening a drain near the organ so greatly concerned in 
the phenomena of epilepsy. In local hypertrophy of the ganglionic 
cells, in which the amount of organic force and nutritive supply is in 
excess, a certain quantity will be expended in the wastage. 
In some syphilitic tumors found pressing on or within the brain, the 
changes are seemingly effected in the same manner as when the ulna 
and tibial bones to all appearance become enlarged, as a result of 
syphilis. A fibrinous material is effused around the bone, and is at- 
tended with a hardness so great as to give rise to the idea of true 
ossific enlargement. The pain is tormenting, both night and day; 
and where the effusion is not great, or is so situated as to be covered 
by the muscles, and is detected with difficulty, the case is generally 
viewed as simply neuralgic. That the disorder is periosteal, and not 
a real increase of the bones, is readily discovered by the rapid subsi- 
dence of the enlargement under leeching, and the internal and exter- 
nal use of iodide of potassium. Such tumors I have seen emerging from 
the coverings of the brain, which is pressed on and progressively ab- 
sorbed or condensed by the gradual encroachment. When examined, 
they are of a waxy, fibroid nature, without any appearance of cere- 
bral texture. These tumors are indicated by the severe and continued 
neuralgic pains, the loss or exaggeration of function, either mental or 
motor, being subsequent to the physical or molecular alteration of the 
cerebral substance, which conduces either to the excitation or abnega- OP TUE CEREBRO-SPINAL SYSTEM. 
41 
tion of power in the motor nerves below, since nutritive changes in 
the brain may eventuate in convulsive movements, as well as in paral- 
ysis. When such tumors are developed in situations by which the 
pons varolii is more or less encroached upon, neuralgia is a prominent 
symptom: the muscular symptoms being those of convulsion and pa- 
ralysis, as referred to in the fore-part of this paper. Deafness in one 
or both ears, more or less varying, from time to time, as to the amount 
of hearing lost, is a not unfrequent attendant. The protoiodide of mer- 
cury and iodide of potassium are the sheet-anchors of treatment; whilst 
pustulation or a seton in the neck will act as a derivative, or as a source 
for organic waste. As a matter of diagnosis in these cases, it must 
be remembered that the convulsions are not always epileptic; that is, 
they are not in the groupal muscles served by nerves from the me- 
dulla oblongata. They may merely affect the extremities, or one side 
only, without inducing general participation, whereby the larynx is 
more or less implicated. In place of convulsions, complete paraple- 
gia, or of one leg only, or hemiplegia, one-sided or crossed, may take 
place. 
Epilepsy accompanied by nocturnal pains should always lead to the 
suspicion of syphilitic contamination. Iod. potassa;, with lactuca- 
rium, hvoscyamns, or coni urn, will be found most trustworthy. 
In dilatation of the left ventricle, attended with thinning of the 
parietes and general cardiac asthenia, the nutrition of the brain is 
more or less interfered with, by the assimilation within its structures 
of the arterial blood to the venous. From such cardiac conditions, 
epilepsy is not an uncommon eventuation, and is frequently termed 
cerebral, when in reality it is the result of a disabled heart. In 
these states cure is impossible, but the treatment for temporary relief 
is at times practicable, although difficult to be decided on. When 
highly-carbonized blood circulates, or rather is delayed in the biain 
from such causes, it becomes highly important to know how long 
such a state can be safely borne, and if the spasms can be relaxed 
within a given time. Hence the propriety for the administration of 
chloroform depends on its power, in a certain case, to relax the spas- 
modic closure of the glottis, by which oxygenation may be re-estab- 
lished, or on its acting as a paralyzing agent over the peripheric and 
central respiratory functions. Without regard being paid to this latter 
contingency, the remedy at times so efficacious in the first condition 
would in the second become dangerous, by increasing the venoid 
stasis within the brain. 
Iu the poor-blooded, debilitating passions are apt to be of more 42 
PARALYTIC AND CONVULSIVE DISEASES 
frequent occurrence than in the plethoric. As a general rule, they 
are more prone to voluntary and involuntary losses of semen; and if 
addicted to the saturating abuse of alcohol, opium, or tobacco, or if 
affected with anaemia, they are more liable to epilepsy than arc those 
of more robust physical endowment. And the treatment in the one is 
less difficult than in the other, inasmuch as the organic constitution 
of the blood itself, in the rich-blooded, is not degraded, and does not 
require the additional medication for its reconstruction. 
It is highly important, to discriminate between the alterations of 
the brain-substance, inducing the epileptic attack, and the causes work 
ing such a deviation in the normal nutrition of the brain. The poi- 
son of syphilis in itself, for instance, does not excite the spasms, but 
the specific alterations of structural nutrition ensuing from its incu- 
bation induce the phenomena of the attack, which also in its turn 
may give rise to certain demonstrable local disorders, eventuating in 
an aggravation of the convulsions, or in a paralytic or maniacal con- 
dition, according to the situation. The treatment, therefore, in such 
cases, whilst it recognizes the proximate syphilitic entity, and is so di- 
rected as to destroy its specific action over the normal nutrition yet 
has to include such remedies as may possess the power of retarding 
the conduction for spasmodic action, and of reducing the quantity or 
quality of the fluids effused during the convulsive strainings. After 
the extinction of the syphilitic contamination, the normal type of the 
structures invaded may be reproduced, in preference to the anormal 
modifications, which were renewed during the specific toxaemia. 
The extra-cranial causes of epilepsy, such as cicatrices of the skin, 
or even of the cord itself, irritations from foreign bodies in the 
nerves, as from glass, thorns, needle-points, &c., or neuromas, or 
irritable districts in the mucous membrane, utero-ovarian derange- 
ments, &c., are to be searched for; and the knife, caustics, cathartics, 
eramenagogues, and the like, are to be resorted to. Both tardy and too 
profuse or frequent menstruation are sometimes premonitory exciting 
conditions: one by the hypercemia and uneliminated material; the 
other by the ncrvo-vascular excitement and anaemia. The treat- 
ment in these states has to be specially directed; antiperiodic rem- 
edies, such as quinine, chinoidine, beberine, and arsenic being con- 
joined or employed externally with those addressed to the disordered 
function. And this disordered function has to be redressed, either by 
overcoming the local condition which imperils the general system, with 
epilepsy as its indication, or through the general system which effects 
the reactive derangement of special function. OF THE CEREBRO-SPINAL SYSTEM. 
43 
In many cases there are no apparent conditions, as tubercles, or 
other morbific growths or alterations in the brain; but the proximate 
cause seems to lie in some derangement of the nervous centres them- 
selves, which excites the paroxysms. Psychical changes, suddenly in- 
duced by fright, repelling sights, or imitative impressions, produce 
certain physical or molecular alterations of the central ganglionic 
cells, through which contraction or dilatation of the minute vessels 
ensue, giving rise to loss of consciousness, sensibility, and to convul- 
sions. In the generality of such cases, the conditions are those of anae- 
mia, and hence require the judicious selection of the preparations of 
iron, zinc, and silver, combined with a nervo-stimulant or sedative, as 
valerianic, phosphoric, or hydrocyanic acid, in conjunction with a spe- 
cial tonic, as may be indicated. But remedial treatment is valueless, 
unless associated with rigid moral training. Exclusion from the spe- 
cial and all-exciting causes must be rigorously enforced, whilst the 
will of the patient should be perseveringly educated to oppose the effect 
of the sudden changes in the nervous centres, by instituting another 
and more powerful impression of resistance in the same centres or in 
others antagonistic to them. When glottal closure ensues, leading to 
almost complete suffocation, the application of a sol. of nit. nrg., 40 to 
60 grs. to the ounce, will be found of great benefit. If any warning 
is given before insensibility attends, the determined order by any one 
for the patient to take his breath, or the patient’s self-determination, 
will produce most marked results. If there be much arterial throb- 
bing, direct pressure should be made over the carotids, avoiding com- 
pression of the jugular veins. During the intervals between the attacks, 
air and non-exhaustive exercise, and the cautious use of the shower-bath, 
should be advised; the water being at first just below the temperature of 
the body, as otherwise the shock would induce a state similar to the one 
exciting the epileptic seizure. After a few trials, the temperature of the 
water can be gradually lowered. In conjunction with this, thepatieut 
must be subjected to self-moral training, the tonic remedies being cau- 
tiously administered. In the very fair-skinned, whose faces redden or 
paleeasily by any emotional act, the preparations of iron, if given in even 
moderate doses, erethism, which increases the suscep- 
tibility to every vascular changes from the increased ner- 
vous impressibility which is apt to be excited. Zinc and silver act 
more favorably; and as the appetite and capacity to bear food in 
greater quantities are generally increased by them, the blood recovers 
its normal composition. I fit does not, then a grain of lactate or phos- 
phate of iron can be mingled with the food, to be gradually increased 44 
PARALYTIC AND CONVULSIVE DISEASES 
as may he home or required. The susceptibility of the mind must he 
changed hy such studies, conversations, and employments of a sound 
practical nature as will tend to fortify the centres against emotional 
excitation. 
In these cases is seen the same condition of the emotional tract as 
found in previously strong-minded persons who have suffered from de- 
pressing illness or from debilitating losses of blood, viz., the complete 
powerlessness of the intellectual centres, with uncontrolled action of 
the emotional. This happens not from any sudden access of strength 
in those portions presiding over these manifestations, hut from the com- 
plete inability of the reasoning powers to govern them. When this 
emotional erethism is fairly established, habit is engendered. In other 
words, the nutrition being changed from the normal condition to the 
anormal, the function becomes anormal instead of normal. Hence 
dreams, fanciful reveries, sudden emotional excitement, or even reflex 
impressions from touch during sleep, or absence of mind, may 
cause an attack of convulsions. Now these very cases, from thcMi ri- 
tability of the basilar brain portions, are very apt to indulge in eunrtic 
feeling and actions, and to impair their general system by venereal 
excesses, or by secret vices. Hence, it may become essential to con- 
join those remedies which apparently exercise a controlling power over 
the venereal functions, such as the infusion dulcamara, hyd. potass., 
camphor, bromide of potash, &c. Hut whilst directing attention to the 
fact of this condition, a warning is also to be inculcated, viz., to be 
certain that such erotic mania exists before administering any so-called 
anaphrodisiacs, since when absent (and in many, complete inappe- 
tency exists,) the very state suspected may be alarmingly excited, as 
known to me in several instances. It is readily comprehended from 
this fact, that no remedy is specific in regard to its phrodisiae virtue, 
this condition being a result of a relative physical state induced. 
As a general rule, during the attack, even when practicable, the 
administration of narcotics is valueless, and such also is the result of 
their trial during the interval. But there are conditions in some cases 
in which the epileptic seizures are sequential to certain premonitory 
phenomena, that narcotics or anaesthetics prove valuable. In some 
neuralgia precedes the attack, and if this can be arrested, the convul- 
sions are not excited. Hence both narcotic remedies or even local stimu- 
lants of rapid action, and anaesthetics arc to be employed. I have known 
the application of diluted ess. ol. sinap. or Granville’s lotion over the 
appropriate regions stave off a paroxysm, even when not premonished 
by neuralgia. By the reflected action from the surface on the centres, OP THE CEREBRO-SPINAL SYSTEM. 
45 
an impression (molecular change) is made, which is more powerful 
than the one from the disorder, independent of the peculiar nature of 
that change. But in central epilepsy, where the medulla oblongata is 
especially the radiating point, peripheric stimulation is injurious, in- 
asmuch as its function is overexcited, and thereby more blood is invited to 
it by the distal irritation, and that blood being at the time poisoned, as re- 
gards the normal assimilation of that great centre. This effect of ir- 
ritants applied to the surface is readily seen in haemorrhagic effusion, 
fmm concussion especially, where the medulla oblongata or pons va- 
rolii is more or less impinged on by the pressure of the condensed 
brain, whilst the vascular condition is proportionately increased. By 
applying mustard or ammonia, &c., to the extremities, reflex move- 
ments ensue, and frequently add to the mischief of the case by the 
exhaustion attending the violence of the motious. 
Even injections of mucilaginous materials are responded to in these 
cases by spasms of some portion of the body, the manipulations neces- 
sary to their administration aiding not only in the excitement of the 
reflex movements, but also in fatiguing the patient. ]f the respiration 
be easy in the position assumed, no attempt at movement of the head 
should be made, as fatal consequences may suddenly ensue, as is so fre- 
quently seen in cases of fracture of the upper vertebra). The bladder, 
in these cases of epileptiform convulsions from effusion of blood, (and 
sometimes even from serous collection,) is apt to become greatly dis- 
tended ; and although its expulsion is restricted, yet the distention is 
sometimes sufficient to arouse reflex spasms, whilst the ureters filling, 
the kidneys become irritated and congested by the reflux of their 
secretion, The bladder can in almost every case be felt enormously 
enlarged above the pubes, and the withdrawal of the water in these 
cases is all-important. But the bladder should not be suddenly emp- 
tied, as in some it acts almost as fatally as a blow upon the stomach, 
or after sudden evacuation of ventral fluid. 
In all cases of epilepsy, it is important to inquire into the previous 
state of the urinary apparatus, since in many renal disorder is either 
an attendant or precursor; and where there is reason to suspect the 
forms of Bright’s disease, or other conditions rendering the renal func- 
tions more or less inoperative, it is not to be forgotten that a large 
amount of animalized matter is thrown into the blood from the ex- 
haustion of the tissues by the spasms themselves. In some a tetanoid 
affection is induced by a toxic condition of the blood. Generally, periph 
eric irritation causes no reflex spasms in these cases. The tetanoid 
spasm arises from ceutral poisoning of the portions chiefly deranged 46 
PARALYTIC AND CONVULSIVE DISEASES 
in the original attack. When the immediate spasmodic conditions 
have been subdued, the intervals may be occupied by an apparent 
rheumatic condition of the spinal region or of the extremities; but it 
is rcaily from a disordered membranous and neural nutrition from the poi- 
soning of the blood, not only by the retention of urea, but of oilier 
animalized excretion, rendered unfit for further uses of the organism. 
The treatment by sudorifics, hot-air baths, proportionate exercise, regi- 
men, and the stimulation of the, compensatory functions, must be sup- 
plied from the hints already given. 
Cutaneous repressions are in many cases followed by epileptic 
exhibitions. Their appearance is not unfrequently significant of somo 
irritation of the nervous centres themselves. This irritation may 
arise from toxaemia, induced by a derangement of elimination in some 
organ, by a plusage of supply to the blood from without, or by super- 
organic action of the secernent functions. At all events, the sudden 
suppression of the eruptions, by any topical treatment especially, is in- 
jurious and dangerous. The treatment must divide itself according to the 
constitutional condition. The cutaneous disorder is a mere topical prod- 
uct, frequently arising from a central disturbance, or from a blood condi- 
tion interfering with the normal nutrition of the distal or of the peripheric 
portions, and is not an independent process through which the bLod is 
contaminated, and the nutrition of the centres degraded. The direct 
treatment consists in endeavoring to reproduce the eruption which 
has been repelled, and in the employment of such sedatives or stimu- 
lants that may arrest, or restore if deficient, the central nervous irri- 
tability, and of such alteratives which may specifically change the blood 
composition and induce the normal status of the organs affected. The 
eczema of the habitually intemperate points as much to the disturbed cen- 
tral conditions of the cerebellum and medulla, as to the blood depravity 
from depraved secernent action. If the eruption is suddenly repelled in 
these inebriates, a fatal issue is not uncommonly induced or premon- 
ished by epileptic or epileptiform convulsions, with paralysis from cere- 
bral causes. The hemiplegia of the drunkard, which causes the par- 
alyzed arm to droop forward and to be apparently lengthened by the 
relaxation of the pectoral muscles, and the leg to drag the pointing 
toe wearingly along the ground, is not only ushered in by convulsions, 
but is apt, if not fatal at first, to be attended with their constant re- 
turns; whilst uraemia, with its dropsical heart and chest, and puffy, tal- 
lowy face, or cholaemia, with its ascitic belly and shrunken, tawny 
skin, evidences the vast organic changes in the kidney or liver. 
In all skin diseases with uraemic and cholaemic pollution, and even OP THE CEREBROSPINAL SYSTEM. 
47 
where no such conditions apparently attend, attention should be di- 
rected to the condition of innervation of the basilar portions of the 
6kull. Causes which act on these portions, by which the circulation is 
impeded, arc apt to induce congestions of the pulmonary vessels, at- 
tended more with the physical manifestations of transudation, than of 
exudation, which is an organic process. Hence hydrothorax and oed- 
ema, &c., are more frequent than pneumonia and pleurisy. In the inebri- 
ate a tardy decomposition of tissue attends the alcoholic absorption. 
In these the organic processes are more exhausted by their efforts of 
transformation than of conformation, and these transformations are 
more of accommodation than of repair. 
The term enteric epilepsy may be used in contradistinction to cere- 
bral or central epilepsy. The radiating points are somewhere within 
the intestinal canal, the participation of the medulla oblongata or of 
the superior irritable districts being established by preceding irrita- 
bility, or by some trophic irregularity. These points of reflex irrita- 
tion may be in themselves direct lesions, or they may be established by 
abnormal growths, by worms, by acrid ingesta or secretions, &c. The 
remedial measures are to be selected according to their specific or alter- 
ative action: Nit. or oxide of silver, hydrocyanic acid, oxide, phos- 
phate or valerianate of zinc, turpentine, croton oil, belladonna, opium, 
valerian, alterative prep, of mercury, of muriate of ammonia, &c. 
Sometimes an impacted gall-stone, by its reflex action, lies at the root 
of the epileptic evil, and the potash, opiate, turpentine, and the sweet 
oil treatment, which insures the dislodgment of the biliary calculus, 
relieves the convulsive tendency. The same may ensue from the irri- 
tation by intestinal concretions, either crystalline or faecal. The latter 
may be merely local, or the distensive pouches of the colon may become 
impacted, which may, however, allow the partial passage of faecal matter, 
or even give rise, by frequent watery, slimy dejections, to the opinion of 
chronic diarrhoea. Together with eccoprotic measures, these latter 
cases are relieved by the injection of a sol. of bicarb, soda through the 
O’Beirne tube, which not only partially dissolves the accumulated masses 
and scybalae, but induces a free discharge of bile from the liver. Epilep- 
sies of this kind have arisen from the frequent and incautious use of 
charcoal aud magnesia, which have collected in hard boluses, and tended 
to give supply for the formation of the magnesian concretions some- 
times lodged in the intestines. It is in these enteric epilepsies that 
the internal administration of chloroform will be found so beneficial. 
Kidney complications have already been referred to, but independent 
of albumen, lithic conditions of decrease or increase, with or with- 48 
PARALYTIC AND CONVULSIVE DISEASES. 
out renal calculi or sand, oxaluria, &c.; another condition of urine 
may exist which indicates not only uraemia, by which the centres 
are poisoned, but also a state of constitutional dis-ossimilation or dis- 
integration, by which the whole cerebrospinal nervous system is ex- 
hausted. This condition is indicated by phosphatic urine, with defi- 
ciency of urea. Besides out-door exposure, which must not be accom- 
panied by muscular fatigue, or by the indulgence of sexual excitement, 
(if the power be uot already lost,) the nitro-muriatic acid bath, and its 
internal use, forms a valuable adjuvant. Where the exhaustion is great, 
quinia, with phos. zinc , is indicated. As in this disorder the red blood- 
corpuscles rapidly diminish, and there exists a proportionate increase of 
the white, attended with defective respiration, an elegant and service- 
able preparation will be found in the elix. calisayaet ferri phosphorat. 
Albuminuria is not an unfrequent attendant in convulsive diseases; 
but mere albuminous urine should not be viewed as indicative of cer- 
tain renal changes, since oftentimes it is found in urine having no de- 
ficiency of extractive salts, or of normal specific gravity. In many 
cases, the albuminuria is a condition of compensation. It mostly ex- 
ists in undeveloped scrofulosis, and when the albumen is accidentally 
stopped or interfered with, its arrest becomes coincidental with tuber- 
culous development elsewhere. And the same albuminuria of excess 
sometimes ensues in scrofulosis on arresting or healing up of old sores, 
the excess being compensative, and not destructive. These states re- 
sult more frequently in scrofulosis of the syphilitic than where the taint 
is absent. The gauge for treatment depends on the quantitative anal- 
ysis of the urine. If the extractive salts are normal in quantity, it 
will not be found safe to interfere with the albuminous contingent. 
Air and proportional exercise, and surface depuration, are the only rem- 
edies, unless syphiiosis exits, the regimen being strictly followed that 
has been found to agree, by the patient’s own experience, which af- 
fords the best mode of analysis. It will be only necessary to remem- 
ber in case of violent convulsion in those states, epileptic or not, that 
the exhaustion following powerful and long-continued exertions (volun- 
tary or involuntary) are apt to induce cerebral congestion and effu- 
sion, with their sequential accompaniments. 
In the trismus attending epilepsy, opiate enemata or local hypodermic 
injections are sometimes advisable, the latter being found most service- 
able in enteric radiation. But locked-jaw in epilepsy may give place 
to the fixed open jaw. This result indicates no difference in the essen- 
tial nature of the disease; it is merely a variation of groupal action. OP THE CERBBIiO-SPINAL SYSTEM. 
49 
There is one distinguishing symptom as regards the jaw between hys- 
teria and epilepsy. In the latter, the teeth never chatter. 
The ancient Scots castrated their epileptics as a matter of cure; 
it has of late days been attempted, and sometimes successfully, when the 
eccentric cause laid in the testes; as a means of arresting its propaga- 
tion in offspring, it certainly forms, when complete excision is made, a 
most effectual remedy. Some years ago, whilst in a city of another 
State, I was consulted by the owner of several whaling ships relative 
to a man about 32 years of age, who was regularly seized with epi- 
leptic mania when about thirty days out at sea. Learning that this 
man when on shore was erotic to a great degree, and that otherwise 
he was well behaving and always enjoyed his health, excepting a 
severe pain in his left testis, I gave as a rough opinion, that the fits 
at sea, when apart from women, were probably owing to reflex irrita- 
tion from the testicle upon the cerebellum and medulla. On his re- 
turn from the voyage, during which he was constantly seized with 
epileptic convulsions, and violent but temporary mania, he heard of 
my opinion, and sought in a neighboring town the advice of a very 
skillful surgeon, who relieved him of the diseased testis. From that 
time to the time I last heard of him, about three years, he had enjoyed 
perfect health, without return of the symptoms. But in ceutral epi- 
lepsy, with subsequently diseased testicle, no such favorable result could 
be predicted, unless the exalted sensibility of the testis propagated 
through its nervous relations fresh organic changes, attended with 
vascular dilatation in the medulla oblongata, thereby hypertrophizing 
the ganglionic cells, and rendering them more liable to surcharge. 
As a rule in epilepsy, the torpid cannot be treated like the nervous 
and irritable; nor do remedies having control over the male act simi- 
larly over the female, since amenorrhoea, uterine ulceration, and 
leucorrhcea, or prolapsus aud other displacements, affect the epileptic 
female in a special manner, the mere regulation of womb difficulties 
frequently insuring a cure. 
From its peculiar action in diminishing the red blood-corpuscles, 
belladonna offers in the plethoric to form a valuable remedy, indepen- 
dently of its action over the sympathetic nerve, as also does digitalis 
in over-excitation of the heart, and especially when, from hyper- 
trophic dilatation, the brain evidences a maniacal tendency. In anae- 
mia with nervous erethism, inducing frequent, short attacks of epilepsy, 
the hydrocyanate of iron, steadily persisted in, induces the return of 
red corpuscles, whilst the nervous susceptibility is kept soothed. By 
many of the older practitioners indigo was esteemed as almost specific 50 
DISEASES OF THE CEREBROSPINAL SYSTEM. 
in the treatment of epilepsy. It acts more favorably on females, in 
whom some uterine derangement exists with the epilepsy. 
Both the oxide and phosphate of zinc are valuable alterative tonics; 
their employment is indicated in the anaemic and brain-wearied. In 
the plethoric they do not serve well. The valerianate of atropia has 
been recommended by high authority, in the dose of 120th of a grain. 
Atropine by injection has also been recommended; as yet, I cannot offer 
an opinion as to their adaptability, but should not recommend their 
use in the anaemiated, or those with heart complications. If given to 
the rather plethoric, and the fits are reduced considerably in interval 
one caution must be observed, lest an accumulation of force through 
apparent hypertrophy of the ganglionic cells should ensue, and prove 
fatal by the violence of the convulsions. Where this is dreaded, the 
seton should be employed as an exhaustive drain, and such exercise 
continuously but moderately enjoined as will tend to discharge a cer- 
tain amount of power. 
In conclusion, I will state that in eccentric epilepsy, where the glot- 
tal spasm is one of the first symptoms, I have been satisfied with the 
results of the application of the sol. nit. silver to the larynx, followed 
by a solution in glycerine of quinia as a local antiperiodic, and with 
the rubbing in of a strong sol. quinia in the spine after irritation, 
by ess. ol. sinapis dilut. Arsenical solution, internally administered, 
(and sometimes by injection per rectum, in a mucilaginous vehicle,) 
is also restrictive of the periodicity of the attacks. Arsenic appears to 
act through the peculiar influence it exercises over the rapid arrest of 
the albuminous tissues, and probably through its power of constrict- 
ing the capillaries and minute arterial terminals. This influence is 
sometimes exercised over the matrix supply of the nails, which have 
been known to drop off during its long or over use. 
The results of the trials known to me of the cotyledon umbilicus 
have not been favorable as to the arrest of epilepsy; yet, when scien- 
tific are forced to yield to empirical indications of treatment, it may 
be tried. 
Ice to the upper spine and back of the head I have found useful in con- 
trolling the violence of the fits; as a cure, it is inapplicable. Trache- 
otomy is a last resort, whilst scarifications of the internal larynx 
during the interval may relieve the tendency to engorgement, oedema, 
and reflex irritability. Powerful stimulants, as ammonia and ess. ol. 
sinap. dilut., to the spine, in proper eccentric cases, induce such changes 
in the centres as render them inoperative to those effected by the 
disease, or attract to superficial expenditure. 
791 BROADWAY.