from, the December (1876) No. Chicago Medical Journal and Examiner. 
The Chicago Medical Journal 
AND EXAMINER. 
Ei itor : WILLIAM H. BYFORD, A.M., M.D. 
Associate Editors: JAMES H. ETHERIDGE, M.D. ; NORMAN BRIDGE, M.D. ; 
JAS. NEVINS HYDE, A.M., M.D. ; FERD. C. HOTZ, M.D. 
Terms-Four Dollars per annum jn advance-Postage Free. 
Address W. B. KEEN, COOKE & CO., Publishers, Chicago. 
THE THERAPEUTICS OF EPILEPSY. 
By ALLAN McLANE HAMILTON, M.D., 
Visiting Physician to Epileptic and Paralytic Hospital, Blackwell's Island, 
New York City, Etc. 
The object of this paper is the discussion of the present 
method of treating that most discouraging and imperfectly 
understood form of disease, Epilepsy. I wish more particu- 
larly to consider the value of the bromides, and at the same 
time to detail recent investigations undertaken to support a 
statement I made at the last meeting of the American Neuro- 
logical Association, where I advocated the medium dose, and 
endeavored then to show that of late there is an unwise ten- 
dency to administer these drugs in dangerous quantities. 
I may be pardoned, perhaps, in calling attention to certain 
practical points which may appear unimportant to some, but 
an experience gained from the management of a great many 
cases teaches me they are to be carefully considered in selecting 
a plan of treatment. These simple indications, I am convinced, 
are too often overlooked, even by painstaking and careful 
medical men. I allude to the necessity for discovering the 2 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
exciting cause. I am every day made to feel that the idio- 
pathic cases do not form so large a proportion as they were 
once thought to. With this belief I am satisfied that empiri- 
cism and routine management are bad methods. Any one 
who examines all his cases thoroughly will recognize the deli- 
cate shades in epilepsy, variations which are exhibited in 
other diseases presenting more pronounced and better defined 
symptoms; consequently there are evidences of pathological 
action, which are not always grouped alike, and consequently 
all cases are not to be treated in the same manner. I ascribe 
the moderate success I have had in the management of this 
disease to the recognition of these differences. 
Not only may obstinate epilepsy result from masturbation, 
but it may be due to many of the diseases of women, and is 
produced by other eecentric irritations of various kinds, or by 
centric irritation, such as may be associated with toxaemia. 
Sir Charles Locock {J\fed. Times and Gazette, May 23, 
1853,) called attention to many cases that he had treated where 
uterine irritation was the exciting cause; and I think others 
have had the same experience. In one of Locock's cases the 
patient was affected particularly at the menstrual periods. 
Some of these peripheral causes are curious in the extreme. 
Through the kindness of Dr. Gibney, of New York, I was 
enabled to see a child who had accidentally injured her ear 
with her parasol, the brass tip of which remained for some 
time imbeded in the external auditory meatus. As a result, 
convulsions of an epileptic character were caused, and it was 
not until some time afterward that the foreign body was dis- 
covered and removed. In another case I treated, the Epilepsy 
was unmistakably due to a bad habit the woman had of wear- 
ing a number of heavy garments about her hips, which pro- 
duced some uterine change. When this condition of affairs 
was noticed, and the skirts removed, she immediately recov- 
ered. At the root of many epilepsies, as well as other neuroses, 
are reflex causes - the starting point being the organs of 
digestion, or those contained in the pelvis. Of course there 
are varieties of epilepsy of an idiopathic nature, or others 
caused by traumatism or organic disease; and these THE THERAPEUTICS OF EPILEPSY. 
3 
the best directed efforts of the physicians, and we can do 
nothing. 
We should not lose sight of syphilitic epilepsy where pain 
always precedes the attack. It is generally curable. 
In prescribing for our patient there are five indications to 
observe: 
1. Removal of exciting cause, if possible. 
2. The diminution of exaggerated reflex susceptibility 
of the medulla. 
3. Equalization of cranial circulation. 
4. Abortion of paroxysms. 
5. Improvement of general condition. 
For the accomplishment of these, it is imperative that a 
judicious and discreet selection of drugs should be made; and 
as those which are the most effective I may mention: 
The Bromides: Sodium, Potassium, Calcium, Lithium, Iron. 
Belladonna. 
Digitalis. 
Strychnine. 
Ergot. 
Arsenic. ' ■ . 
Amy] Nitrite. 
Tri-Nitro-Glycerin. 
Cod Liver Oil. • 
I have not classified these remedies, as it is unnecessary to 
do so; but will now say a word in regard to their usefulness: 
No one drug can be declared a specific - as I am sorry to 
see has been done - and we must not be too eager to accept 
the sanguine results of certain over-enthusiastic authorities, 
and be governed thereby. I allude more especially to the 
almost universal use of the bromides, to the exclusion of every- 
thing else, and also to their employment in quantities, which 
often ruin the patients, and at any rate produce a condition 
of diminished vitality - which is inconsistent with any hope 
of success. 1 Radcliffe's idea in this respect is a good one: 
" There is reason to believe that the therapeutics of convulsion 
Pain. Epilepsy and Paralysis, p. 215. 4 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
must be based upon the notion that vital power has to be rein- 
forced, and not upon the contrary opinion." What the proper 
dose is, has not been clearly settled by any one. There are 
neurologists who believe in toxic doses, and there are others 
who prescribe quantities which are almost small enough to be 
inert. In England it has been the custom to prefer the very 
small doses. I have seen the prescription of a very dis- 
tinguished general practitioner, who thinks five grains 
of the bromide of potassium a sufficient dose. 1 Ringer 
recommends from 30 - 60 grains in the day; 2 Radcliffe, 
45 grains; 3 Russell Reynolds, 30 - 90 gains; 4 Bartholow, 
30 - 240; and 5 Hammond, 90 - 240 grains during the day. 
6 Handheld Jones remarks that there is a great difference 
in the tolerance of individuals in regard to the bromides - 
some persons not being able to stand five grains, wdiile others 
will not be affected by doses of less than forty grains in amount. 
My own experience has taught me that the best effect can 
be gained by the repeated administration of sixty grains in the 
twenty-four hours. The larger doses produce rapid bromism, 
while a medium dose seems to be better appropriated, but will 
do just as much mischief in the way of bromism as the larger 
ones, if given for a length of time. My records show me that 
the average time for development of symptoms of this kind is 
about three months, while anaesthesia of the fauces is produced 
in a few weeks, or even a much shorter time; and I agree with 
others that it is necessary to produce this condition before we 
can say that the medicine has produced its physiological effect. 
Brown-Sequard considers the appearance of acne to he an 
indication that the medicine has begun to do its work, in 
which opinion he is joined by 7 Dr. Putnam-Jacobi. 8 Voisin 
considers the u point of saturation to be indicated by the 
1 Handbook of Therapeutics, p. 92. 
2 Pain, Epilepsy and Paralysis, p. 202. 
3 System of Medicine, p. 323. Vol. II. 
4 Materia Medica and Therapeutics, p. 371. 
5 Clinical Lectures on Nervous Diseases. 
6 Functional Nervous Diseases, p. 325. 
7 Oral communication at Am. Neurological Association. 
3 Voisin, Archiv. de Medecine, Jan., 1873. THE THERAPEUTICS OF EPILEPSY. 
5 
anaesthesia of the pharynx and nares, so that in one case 
nausea is not produced by titillation with a spoon, and in the 
other sneezing and weeping does not follow the introduction 
of a straw into the nasal cavity." I should consider the latter 
a rather severe test. According to Danton1 the bromides act 
as vascular medicaments, diminishing excito-motor power. 
They act on the unstriped muscular fiber, producing local 
anaemia and moderating excitation resulting from temporary 
or 'permanent congestion. 2 ''They are agents that pass very 
rapidly into the blood (Ringer), and consequently their effects 
are very immediate, and they accumulate till the point of satu- 
ration is reached before they are eliminated in anything like 
considerable amounts." We are all aware that repeated and 
large doses of these drugs are followed by a most disagreeable 
and pernicious state of affairs. 3 Voisin has referred to two 
forms of poisoning, which he has divided into the slow and 
rapid. In the first the complexion becomes muddy, the eyes 
sunken, sight and hearing poor, and memory obscure. The 
patient cannot write, and cannot express himself, as he forgets 
words - there is tremulousness. In the other variety of the 
slow form there is dementia, or delirium with maniacal out- 
bursts. Ataxia is also a feature of this variety. In the rapid 
form - that with which we are most familiar - somnolence, 
headache, uncertain walk, difliculty of speech, loss of expression, 
"fishiness" of the eyes, drooling of saliva, etc., etc., are the 
ordinary symptoms. 
Various grades of toxmmia, or even a state which Voisin 
calls the "cachexie bromique," and which terminates in a 
typhoid condition, may result from a reckless use of this drug. 
As regards the variety of bromide, I think the sodic is the 
most reliable and stable; the potassic salt varying very much 
in strength. The others either have a tendency to deliquesce, 
or are expensive. It will be advisable to keep the solution in 
a tight-stoppered bottle, and have fresh quantities put up 
constantly, as it is very apt to undergo changes - in which 
1 Danton. Thfese de Paris, 1874. 
9 Ringer. Handbook of Therapeutics, p. 91. 
3 Voison. Archiv. de Medecine, Jan., 1873. 6 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
the bromine is evolved. And now a word regarding the time 
of administration. It has been shown repeatedly that these 
salts are much better absorbed when the stomach is empty. 
I have found also that a heavy dose at night is apt to do more 
good than if the amount prescribed is equally divided up 
through the day. In a great many patients I have found the 
attacks to occur at the waking hour, and I. suppose this is due 
to the sudden change in the cerebral circulation. A mild 
diffusive stimulant has overcome this, and in many cases 
warded off the attack. I direct my patients who have their 
convulsion at this time to keep a glass of sherry or a small 
quantity of Spts. Ammonite Aromaticus near at hand, to be 
taken before arising. Cold douches to the head are valuable. 
If the attacks be irregular, it will be found necessary to divide 
up the dose. 
The treatment of the disease in women should be directed 
as well to the pelvic organs. It will be found that the bro- 
mides will markedly affect the flow, and relieve the pain or 
uneasiness which is connected with the menstrual period. 
Locally I have found that cold applied for a few minutes daily 
over the ovaries, will modify the attacks should they be con- 
nected with irritation of any of the pelvic viscera. The pro- 
gress of the disease should be soon modified by the doses I 
have recommended, and it will be seen by the table condensed 
from that prepared by Dr. Hollis and published in the British 
Medical that even smaller doses modified or cured 
the majority of the cases he cites. At the Epileptic and 
Paralytic Hospital, where most of the cases are the very worst 
that can be collected as regards chronicity, I find that sixty 
grains a day will cut short the attacks of a great many patients, 
and 1 have cured a number of private patients by this method. 
Dr. Hollis' cases were not selected, and are evidently hos- 
pital patients, like my own. 
1 Br. Med. Journal, July 1, 1876, p. 4. THE THERAPEUTICS OF EPILE PS Y. 
7 
ANALYSIS OF ELEVEN CASES OF EPILEPSY. 
S. B.-Sodic Bromide. P. B.-Potassic Bromide. 
w 
on 
◄ 
O 
fc 
o 
d 
M 
0 
◄ 
M 
M 
QQ 
DURATION OF 
DISEASE. 
AVERAGE NO.! 
OF ATTACKS 
BEFORE 
TREATMENT 
a 
s 
a 
w W 
X ® 
■< P 
a 
a 
p 
a 
a 
DIMINUTION. 
REMARKS. 
1 
Male, 15 
Since birth 
1-2 weekly. 
S.B. gr. 
XX. 
S.B. gr. 
xv, 
t.i.d... 
t.i.d... 
. . . . 
2 in 8 weeks 
Weak intel- 
2 
3 
Male, 22 
Male, 25 
Two years. 
One year.. 
1-2 weekly. 
1 or* more 
S.B. gr. 
XV. 
.... 
1 in 20 wks. 
lect. 
Disease fol- 
lowed snn- 
in week. 
stroke jtreat- 
sometimes 
ment lasted 
4 
Fem., 2 
18 months. 
many in a 
day 
1-2 weekly, 
S. B. xxv., 
P.B. gr. xxx 
S.B. gr. ij.. 
None in 8 
weeks .... 
3 months. 
Hard drinker, 
feeble intel- 
sometimes 
3 in a day. 
Very small 
doses 
None in 8 
weeks .... 
lect; Potas- 
sium salt in- 
ert. 
Fits followed 
d c n t i t ion; 
5 
Fem., 18 
One year.. 
1 a week... 
S.B. gr. 
xxx 
Gr. xx. 
None in 4 
ricketty con- 
stitution. 
6 
Male, 18 
Five years. 
4 in week.. 
S.B. gr. 
XV. 
weeks .... 
None from 
Tuberculous 
disease. 
5 weeks... 
No affection 
7 
Fem., 11 
Five years. 
2-3 in week 
S.B. gr. 
XX. 
S.B. gr. 
XV. 
1 in 5 weeks 
of intellect. 
Followed a 
8 
Fem., 1? 
Several mos 
Sometimes 
blow; sub- 
ject to head- 
9 
Male, 20 
19 years.... 
4-5 daily.. 
2-3 weekly. 
S.B. gr. xv. 
S.B. gr xl. 
S.B. gr. 
XV. 
None after 
treatment. 
No fits for 
ache. 
lias bitten 
tongue. 
10 
Male, 13 
Two years. 
3 weekly... 
S.B. gr. xxv 
S.B. gr. 
XV. 
2 weeks... 
1 in 3 weeks 
No aura. 
Well dcvel- 
oped disease. 
11 
Male, 25 
Eleven yrs. 
1 in 2 weeks 
S.B. gr. 
XX. 
1 in 5 weeks 
facies Epi- 
lept ica well 
marked. 
No fits since 
beginning of 
treatment. 
By this table it will be seen that from fifteen to twenty- 
grains of the sodic salt were required to immediately decrease 
the number of attacks. 
Below will be found two tables. In one are tabulated the 
interesting features of twelve cases of epilepsy. They are old 
hospital patients, and had applied for admission after outside 
treatment had been exhausted. Even here the bromides, in 
the doses I have given, seem to do much for the sufferer. 
Syphilis, traumatism and actual insanity make the prognosis 
as bad as it well can be, and treatment is simply palliative. 
Large doses have aggravated many of these cases. 
The other observations are selected from my note book, and 
are illustrative of the efficacy of the dose I have advocated. 8 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
Bromism occurred in spite of all I could do in most of them, 
though it was a mild form and under control. They were all 
patients of the better class, and of course had all the advan- 
tages of comfortable homes, attentive friends, substantial food 
and good air, although many of them were inclined to over- 
eating, as in fact all epileptics are. In this respect there is an 
advantage in favor of the poorer patients, who cannot obtain 
rich food. THE THERAPEUTICS OR EPILEPSY. 
9 
6 
% 
w 
fc 
o 
w 
o •< 
E® 
« S 
ta 
Q 
AVERAGE NO. 
OF ATTACKS 
BEFORE TREAT- 
MENT. 
AVERAGE NO. 
OF ATTACKS 
DURING TREAT- 
MENT. 
MAXIMUM DOSE 
OF DRUG. 
MINIMUM DOSE 
OF DRUG. 
FORMER TREAT- 
H 
DURATION OF 
PRESENT 
TREATMENT. 
REMARKS. 
1 
28 
16 years 
1 monthly. 
1 in 2 months 
P. Br. gr. xx., t.i.d. 
P. Br. xv. t.i.d. 
6 months. 
Has taken H. Br. for 1 month-fits increased. 
2 
25 
12 years 
6 monthly. 
1 monthly ... 
H. Br. 1 dr., t.i.d... 
8. Br. 
1 month.. 
Melancholic. 
8 
25 
20 years 
18 monthly. 
3 weekly 
Ergot (for 1 month) 
P. Br. gr. xx., t.i.d. 
P. Br. xv. t.i.d. 
S. Br. 
6 months. 
When under S. Br. attacks were 3 In month. 
■1 
27 
14 years 
4 monthly. 
1 monthty ... 
... 
1 month. 
Masturbates. 
5 
19 
6 vears 
7 monthly. 
1 monthly ... 
S. Br. gr. xx., t.i.d. 
......... 
P. Br. 
4 months. 
Hysterical. 
6 
20 
19 years 
2 monthly. 
1 in 6 weeks . 
P. Br. gr. lx., daily. 
S. Br. x. t.i.d .. 
Chloral,etc. 
6 months. 
7 
22 
10 years 
21 monthly. 
2 weekly 
P. Br. gr. lx., daily. 
. .... 
9 months. 
Menstrual complication. 
8 
22 
6 years 
7 monthly. 
1 weekly 
P. Br. gr. xv.. t.i.d. 
.... ............ 
6 months. 
9 
18 
4 years 
8 monthly. 
1 monthly ... 
F.ExErg.% dr.,t.i.d 
................ 
4 months. 
Bad habits. 
10 
23 
23 years 
3 monthly. 
1 in 2 months 
P. Br. gr. xv., t.i.d. 
.... .... .... 
...... 
...... 
4 months. 
11 
29 
27 years 
5 monthly. 
1 in 3 months 
S. Br. xx., t.i.d 
6 months. 
Bad habits. 
12 
25 
12 years 
6 monthly. 
1 weekly 
P. Br. gr. xx., t.i.d. 
S. Br. xv. t.i.d.. 
.. 
3 months. 
ANALYSIS OF TWELVE CASES OF CHRONIC EPILEPSY. 
S. BR.-SODIC BROMIDE. P. BR.-POTASSIC BROMIDE. H. BR.-HYDROBROMIC ACID. 10 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
ANALYSIS OF FOUR SUCCESSFUL CURES OF EPILEPSY WITH MODERATE DOSES OF THE SODIC BROMIDE. 
G. M.-GRAND MAL. P. M.-PETIT MAL. 
• 
6 
K 
M 
C 
◄ 
M 
M 
CD 
DURATION. 
NO. ATTACKS 
BEFORE 
TREATMENT. 
i 
NO. OF ATTACKS 
DURING 
TREATMENT.' 
CD 
P5 
■4 
AVERAGE DOSE, 
ETC. 
DURATION OF 
ACTIVE 
TREATMENT. 
continu'd sub- 
sequent 
'treatment. 
1 
VARIETY OF DIS- 
EASE. 
PERIOD UNDER 
OBSERVATION. 
REMARKS. 
1 
15 
M.. 
10 years 
G. m., about 4 
weekly; p.m. 
10,40 daily... 
For first 3 mos. 
5; for next 6 
mos., none .. 
2 in 2 years. 
20 grains Sodic 
Brom., t.i.d.; 
auxil'ry treat- 
ment; Ergot, 
Arsenic,Iron, 
etc 
About 9 mo. 
X-xx grs. Sodic 
Bromide at 
night; strict 
hygienic care 
gm.at night 
4 years 
Bright boy; Epileptic 
habit almost con- 
firmed; intelligent 
parents, who aided 
in general manage- 
ment & discipline; 
apparently idio- 
pathic origin. 
2 
29 
F.. 
12 years 
1 to 2 weekly; 
g. m 
After xx. grs., 
S. Br. 2 in a 
week. 3 in 
next 2 weeks, 
1 in next 5 
weeks, 2 in 
next month, 1 
in next 4 mos. 
1 in next 9 
months .. .. 
3 in 2 years. 
Cod Liver Oil, 
Sodic Brom- 
ide. xxv. grs., 
t.i.d.; atropia 
hypoder'cally 
About 19mo 
Gr. x., t.i.d. ... 
1 
Mixed 
About 4 yrs 
Over study; hysteri- 
cal ; no uterine 
trouble. 
8 
36 
M.. 
9 years 
1 or 2 every 2 
months; g.m. 
S. Br. gr. xx. at 
3 in 7 
months 
1 in V/2 yrs. 
S. Br. gr. xx., at 
night 
About 2 yrs 
Gr. x-xx., t.i.d. 
Sea voyage; 
cod liver oil. 
Nocturnal. 
About 3 yrs 
Business man; over- 
work; supposed 
blow on head; at- 
tacks excited by 
over-eating. 
4 
17 
F.. 
5 years 
About 2 m'thly 
S. Br. gr. xx..'t. 
i.d.; Ergot in- 
creased them 
to about 5 
m'thly; worse 
at menstrual 
periods; stop- 
ped Ergot;fits 
about once a 
month 
1 in 2d year; 
none to 
date, Sep. 
20, 1876. 
S. Br. gr. xx., t. 
i.d.; uterine 
treatm't; Syr. 
Lacto - phos., 
Arsenic. 
About 4 mo. 
Lacto-phos. of 
Lime; S. Br. 
gr. v., t.i.d. 
for 6 months. 
Mixed; gen- 
erally ma- 
tutional.. 
About 4 yrs 
Case undoubtedly de- 
pendent upon ante- 
version of uterus; 
immediate cessa- 
tion of disease 
when the position 
of this organ was 
rectified. THE THERAPEUTICS OF EPILEPSY. 
11 
And now regarding the large doses. If the idea is to thor- 
oughly ruin the patient's health, enfeeble his mind, or perhaps 
drive him to an asylum, the toxic administration may be 
indulged in. It is very true that sometimes a rapid restora- 
tion may be brought about by "Iron and Quinine;" but there 
are many cases where the recovery is not quite so complete as 
one could wish for. Memory is enfeebled, and there is a 
cachexia which remains for an indefinite time. A darker side 
of the picture is not always displayed when brilliant results 
are detailed. This is the list of demented and those that have 
died. My friend, Dr. Janeway, was present at the autopsies 
of two patients who died brominized- for certainly the exam- 
inations disclosed no other cause for death. I myself have 
seen several demented cases, and I have no doubt others could 
tell the same story. 
Belladonna and its alkaloids are of great value when the 
seizures occur in the daytime, or are of the variety known as 
petit mat. I have injected the Sulphate of Atropia in gr, 
doses beneath the skin at the back of the neck with good effect, 
and have given it in the manner directed by Trousseau. In 
either way it should be administered until dryness of the 
throat is obtained, and should be given a patient trial. The 
property possessed by belladonna of blunting reflex suscepti- 
bility assures it a great advantage over other methods of treat- 
ment, when there are centers of irritation such as in gastric 
epilepsy. 
In Ergot we have a remedy which controls the cranial circu- 
lation much more readily than any drug I am acquainted with. 
As the object is to diminish the congestion at the floor of the 
fourth ventricle, its combination with the bromides greatly 
increases the action of the latter. Ergotin may be given alone 
in the form of Bonjean's capsules. 
To 1 Tyrrell belongs the credit of suggesting Strychnine. 
He believes that this remedy controls excitation of the medulla 
oblongata. In one individual who averaged fifty-one attacks 
in a month, the number was reduced by the Strychnine to. 
1 Med. Times and Gazette, May and Aug., 1867. 12 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
eleven in two years. 1 Handheld Jones does not favor the 
remedy, nor do others, although it has advocates in this 
country. In small doses it certainly does good; but I have 
found that in larger doses than gr., ter in die, it rather 
aggravates the disease. 
Arsenic is excellent, both for its anti-periodic and alterative 
action, and as an agent to relieve the acne. 2 Clemens, of 
Frankfort, has lately advocated the Bromide of Arsenic, but in 
such small doses as to seem useless. He claims for it remark- 
able virtue when the disease depends upon idiocy, and appears 
in patients with deformity of the skull. He reports two cures. 
Where there is an irregularity of heart action, sluggish cir- 
culation, blueness or duskiness of the skin, I think digitalis is 
indicated; in fact, I generally use it in every chronic case. It 
is a drug well tolerated by epileptics, who can take it in sur- 
prisingly large doses. 
An agent has been lately given to the profession which 
seemed all that was needed at first, but which I am convinced 
is very much over-estimated, except as an abortant. I speak 
of the Amyl Nitrite. Drs. Weir Mitchell, Zeigler and Alex- 
ander McBride, as well as several foreign writers, have praised 
it, and several cures have been reported. In epilepsy there 
seems to be a " habit," (if I may use the expression.) or tendency 
to periodicity. Amyl is well adapted to stop this, as is any 
other remedy of the same class. Crichton Browne alludes to 
the effects of this drug upon the status epileptlcus. His 
patient had had a great succession of fits, and was at the 
point of death - the pupils were contracted to an intense 
degree, pulse 116, temperature 102°, with stertorous breathing. 
Voluntary movements and yawning wrere caused by inhalation 
of the Amyl Nitrite, and the patient subsequently raised his 
head and looked about him. Dr. Browne relates ten other 
cases which were seen with Dr. Mierson. 
1 Handfield Jones' Functional Nervous Affections, p. 326. 
8 Allg. Medicinische Central Zeitung, May 24, 1876. THE THERAPEUTICS OF EPILEPSY. 
13 
Dr. C. Steketec 1 draws the following conclusion in regard 
to the action of this drug in Epilepsy: 
"It exerts an important influence where the epilepsy is due 
to, or connected with cerebral anaemia, for the reason that it 
'anticipates the attack when there are prodromata - cuts off 
the attack when it appears, relieves symptoms due to inter- 
rupted innervation after the attack-and the attacks become less 
frequent'" (? by the author). He also considers it injurious 
where the attacks are due to cerebral hyperaemia, for the reason 
that they last longer and become more frequent, and when 
either maniacal or convulsive, increase in intensity. 
My own experience with Amyl Nitrite has clearly settled in 
my mind the fact that it has great virtues in cutting short or 
averting attacks, but that it has no permanent influence. 
Whether we can or cannot make the delicate distinctions of 
Dr. Steketec, future clinical experience I think must decide. 
Those who have used it say that it does good in a very limited 
number of cases; and it is a difficult task to decide which are 
to be benefitted. I have tried it in every grade of Epilepsy, 
and And in some of the worst cases, where the fits occur all 
through the day, with very slight intervals, and even where 
there is time enough to be prepared, that it is often of no avail. 
It may be given enclosed in the little glass capsules invented 
by Dr. McBride, of New York; for hospital use, and for 
patients who are not intelligent, in alcoholic solution. 
I may be pardoned for bringing another remedy to the 
notice of the profession, and one that has.never been used for 
this purpose. I allude to Tri-Nitro-Glycerine. Its properties 
are almost enough to intimidate the patient, but it is as power- 
ful a medicinal agent as it is an explosive. The tenth part of 
a drop touched to the tongue is sufficient in a space of time 
which is almost inappreciable to produce a rapid cerebral 
hyperaemia. The face is flushed, the eyes become bright, and 
the temporal vessels throb, while at the same time there are 
the marked sensations of fullness. It produces more lasting 
congestion than does Amyl Nitrite, is much safer, and I have 
1 Thesis abstracted by Chicago Journal of Nervous and Mental Disease, 
April, 1874, p. 260. 14 
CHICAGO MEDICAL JOURNAL AND EXAMINER. 
found it to act better as an abortant than the latter. Any good 
pharmacist can prepare a solution containing one drop to ten of 
alcohol. This can be further diluted so that ten drops of alcohol 
shall contain one-tenth of a drop of the Nitro-Glycerine. 11 may 
be kept safely in this way, for alcohol prevents its explosion. 
A dose of a tenth of a drop is sufficient in the majority of cases. 
Last of all, it seems almost unnecessary for me to direct 
attention to that most familiar remedy, Cod Liver Oil, which 
is so valuable in all nervous diseases. 
Anstie treated a number of cases by Cod Liver Oil alone 
and cured seven out of twenty patients put upon this plan of 
treatment alone. Picrotoxin, a remedy recently brought for- 
ward, I have tried, and consider valuless. 
The question of diet and personal habits are very important 
ones - particularly as the stomach is so often the seat of irri- 
tations which are transmitted to the over-active centers. 
Beyond the question of over-eating, it has been found that a 
vegetable diet is better suited to this class of patients. Mier- 
son, in the last volume of the West Biding Reports, publishes 
cases and makes comparisons between those epileptics placed 
upon a meat and vegetable diet. The results pointed to the 
superiority of the latter. As the greater number of epileptics 
have inordinate appetites, the diet should be strictly regulated. 
It is a good plan, I think, to combine the remedies I have 
alluded to; and in conclusion I take the liberty of presenting 
a prescription I have used for several years: 
If Strychnias Sulph gr. j. 
Fl. Ext. Ergotae § iss. 
Sol. Potass. Arsenit 3 ij« 
Sodii Bromidi §iss. 
Tr. Digitalis 3iij. 
Aquae Menth. pip ad. 
M. Sig.: A teaspoonful before eating, in a half tumblerful 
of water. 
If the attacks be of the form known as petit mal, I think 
either Ergot or Belladonna are our best agents. With either 
form of treatment it may be found often necessary to use aux- 
iliary general treatment. The syrup of the combined phos- THE PROCESS OF REPAIR. 
15 
phates, or the syrup of the Lacto-Phosphate of Lime, are good 
adjuncts; and salt baths, cold head douches, regular food, 
early hours, and the breaking off of bad habits, will often 
cure the disease, even when it has lasted for many years. 
As a last resort, should continued medication prove useless, 
the actual cautery or a deep seton at the back of the neck will 
occasionally arrest these bad cases. 
123 East 30th Street, New York, Sept. 27, 1876.