ted with water enough for a foot-bath. Hebra recommends an ointment composed of equal parts of lead plaster and linseed oil spread on linen and wrapped around the feet, renewing the application every third day for nine days.-Chemist and Druggist. Iodoform as an Antiseptic.-Heyn and Roosing ("Fortschritte der Medicin, "v; "Ctrlbl. f. Chir., " 1887, No. 16) have made several experiments to determine the antiseptic value of iodoform. They find that mold fungi, the Staphylococcus pyogenes aureus, pneumococci, and other bacteria in serum, gelatin, and agar-agar live and grow equally well after the admixture of icdoform or iodoformized oil. The Staphylococcus pyogenes aureus remained alive more than a month in dry iodoform powder. The introduction of iodoform into sterilized gelatin by means of a blower or a brush was followed in a few days by flourishing colonies of bacteria They quote Johann Olsen as having found that the cocci of osteomyelitis grew abundantly on a slice of potato covered with a layer of iodoform a millimetre deep.-New York Med. Journal. Diagnosis of Beginning Carcinoma of the Cervix.-Admitting the difficulties in the way of an accurate diagnosis without the aid of the microscope, Straz, Contralblatt fur Gynak., No. 19, 1887) holds that such a diagnosis is not impossible. He gives the following as the principal diagnostic points: 1. The diseased part is in sharp contrast to the surrounding healthy tissue. 2. A difference in level between the sound and the diseased parts can always be seen. 3. The carcinomatous spots are always characterized by a light yellow color 4. The malignant portions exhibit small, yellowish white, shining elevations, at least in some parts.-Jour. Amer. Med. Ass'n. EDITORIAL. TREATMENT OF EPILEPSY BY ELECTRICITY. To Prof. C. H. Hughes, of St. Louis, belongs the credit of introducing electricity in the successful treatment of epilepsy, June 14,1881, he read a paper before the Association of American Institutions for the Insane at Toronto, Canada, upon "The Therapeutic Value of Cephalic and Spinal Electrization, " in which he said that from the "more satisfactory results since its regular employment in the treatment of epilepsias, conjoined with internal therapy, forces the conviction that it is an auxiliary in this affection which ought not to be despised. " Since the publication of this article a number of physicians, myself included, have employed this agent with a considerable degree of success, particularly when used as cephalic galvanization in conjunction with phosphated or arseniated bromides. My views and results were set forth in an article which was intended as an editorial commendation of the paper of Dr. C. H. Hughes in the Alienist and Neurologist for January, 1887, but accidentally published as an original article in the April number of this journal. Dr. A. D. Rockwell, of New York, may be numbered among the enthusiastic supporters of the galvanic treatment. His ideas may be thus summarized: First. Electricity possesses a certain value in the treatment of epilepsy. It is not known, nor is it claimed, that used alone it can ever cure epilepsy. When, however, it is used in connection with the Treatment of Epilepsy by Electricity. 449 bromides its value is unmistakable, and a certain number of patients recover who otherwise would remain uncured. Second.-The good effects of electricity are seen especially in cases in which the attacks occur in the night, although day attacks have been successfully controlled. Third.--Central galvanization and general faradization have been the most efficacious methods employed. Fourth. When electricity fails to either cure or aid the cure, it is often efficacious, by the method of general galvanization, in affording grateful relief from undefinable nervous symptoms recognized under the term neurasthenia. Fifth. The tolerance of bromides can be increased and bromic acne diminished by the systematic use of electricity. Sixth.-Electrical treatment must be administered with care and judg ment. All interruption of the current should be avoided in central galvanization, as the shock is liable to hasten rather than prevent an attack. To be more definite, perhaps it is well to quote extensively from the paper of Professor Hughes, above mentioned. Among other things he says: The physician who undertakes the treatment of a case of epilepsia, either petit or grand mal, with the expectation of being able to safely suspend treatment before the expiration of eighteen months, or two years, will, in most cases, have a record of failure for his pains; but the physician who, in the beginning of every case, has the courage to accept his cases only upon condition that they are to be constantly under his observation and treatment for a year and a half, or two years, and who will treat them in accordance with the plan which here follows, will, we confidently believe, have for his reward more successes than failures. least, such has been the writer's experience, and he confidently commends it to the profession. At Epilepsia is curable only through absolute medical control of the patient for a long time, the removal of all organically depressing influences and all central nerve excitation and over-tax. In some cases the time of treatment above indicated-eighteen months or two years-is too brief. A much longer period of central nerve tranquilization and reconstruction must be persistently maintained, in order to overcome the conditions upon which the characteristic, explosive paroxysms of nerve force depend. The purpose of this paper is not to discuss the pathology of epilepsia, though the writer, for want of better time and opportunity, would here briefly record his conviction that all true epilepsia and epileptoid is cortical in its origin, and essentially a brain disease, though the initial irritation may be, in many cases, of peripheral source. The following formula will indicate the writer's outline of therapy in this affection, a combination which he generally employs, varying the dosage according to circumstance of age, idiosyncrasy, etc. B Potass. brom. z iss. * Aq. menth. pip. q.s.ft. 3 vj. M. S. Two teaspoonfuls three times a day, till bromism is induc * Contrary to the views of McLane Hamilton and others, I consider scrychnia contra-indicated in Epilepsia. ed; then two doses daily, for a few days; after that two doses for two days, and three for two days, and so on. In this combination a bitter tonic ( as employed by Brown Séquard ) may displace some of the peppermint water, if desirable, and a half-ounce of the bromide of sodium or ammonium may take the place of half an ource of the potassic bromide; and if syphilis or malaria be complicating influences, iodide of potassium or quinine are given, in addition, in full and adequate doses. The bromide of calcium or syrup of lactophosphate of calcium, the bromide of lithium or manganese, may also be sometimes added to this mixture with advantage to the patient. Chloral, digitalis, iron, rhubarb, glycerine and creosote, or carbolic acid and gastric and pancreatic digestive compounds, are, in my practice, often indispensible for certain obvious indications of head, heart and gastro-intestinal tract. The bad breath which follows excess of bromides is always corrected by glycerine, listerine and carbolic acid, or creosote and the reduction of the quantity of bromide for a while. In regard to the employment of galvanism, a mild, constant current, plainly perceptible, but not painful when applied to the cheeks with wet sponge electrodes, should be passed from the forehead (each side, over the eyes) to the back of neck, and from the motor areas of the head to the hands of opposite sides. I use this designation of the current, instead of the more scientific Milleampére, because most physicians are unaccustomed to the use of the Mille impére meter, and because I consider this a good practical method of dosage measurement for cephalic galvanization. The current through the head should always be gentle, and never painful beyond a very slight and tolerable pricking over the superciliary arches at the superficial distributions of the supraorbital nerves, and a little more at the nucha. No epileptic can be cured who persists in the use of tobacco, alcohol or other depressing narcotic, or vicious habit or who does not give coffee and tea and learn to use milk and a minimum of animal food, or to use tea and coffee only very sparingly, in the forepart of the day only. up He must have acquired the habit of sleeping abundantly and quietly, and should avoid all sources of passionate outborsts and mental worry. His bowels should be kept uniformly regular by a laxative pill, containing aloin, ergot, colocynth and rhubarb extract, or blue mass, with belladonna (as indicated) at night, with an eighth of a grain of extract of belladonna and a fourth of a grain of extract of conium. An elegant liquid laxative, where capsules cannot be swallowed, is half a drachm, or more, each of fl. ext. ergot and cascara cordial. The indications for the successful management of epilepsia are to put the general and whole glandular system in physiological working order, remove all sources of eccentric nerve irritation, and daily tranquilize and reconstruct the irritable cerebral centers, keeping up the treatment till all tendency to psychical or motor explosion in the cerebral centers disappears, if it takes a lifetime to do it. The cephalic galvanization should be employed from three to five minutes at least three times a week, with a descending and labile current, until improvement in the cerebral nerve tone is accomplished and confirmed. Ordinarily a four to six-cell current from a simple McIntosh battery will suffice. I consider skillfully employed cephalic galvavization a most essen Treatment of Epilepsy by Electricity. 451 tial remedy for the permanent cure of epilepsia, notwithstanding it has been disparaged by those who ought better to understand its use and powers before condemning it. The same is true in my experience with its use in cholera,* and all central neuropathic states in which morbid irritability and a tendency to "explosive " cell action-motor or psychical as in active mania, the paroxysms of hysteria, tetanus and hydrophobia, exists. To sum up the matter: When the cure of epilepsy is possible by medical means, and it is very often possible to cure this disease if we treat it properly, it is necessary, in every case, to adopt a plan which consists of: 1st. A judicious combination of cerebral reconstructives, conservators and tranquilizers of nerve force and regulators of explosive action, epilepsy being a discharging lesion-the brain of an epileptic expending its accumulated psychical and motor force during a paroxysm, much as a spring and pendulum clock expends its power by suddenly running down all at once, whenever the pendulum or regulating ("inhibitory force") is removed. 2d. The control of the cerebral vasomotor system through persistent galvanizations ( never Faradizations). The galvanizations of epilepsy are with us, in some cases, an every-day affair (so to speak) for several months short seances, but long-continued treatments. 3d. The regulation of all the patient's habits, moral, social, physical and psychical; as much so as if he were a patient in an insane asylum, or a pupil in a school for the feeble-minded. To do this the patient must be studied and treated daily for awhile, and must be as well understood by the physician and cared for, as a case pneumonia, typhoid, or phthisis. of We cure epilepsy in this way--not always, but quite often--often enough to satisfy us well for our pains. The Surgical cures of epilepsia are infrequent and exceptional. records have many more reports of recoveries than the completed sequences of operations, if recorded after a year or two, instead of after a few weeks or months, would confirm. Our experience with trephining has never been satisfactory. We often found meningeal lacerations, and loose or imbedded spiculæ, which, when removed, left the patient worse off than before, so far as the recurrence of the epileptic paroxysms were concerned, and necessitating a return to medical treatment. Ligation and arterial compression of the carotids is but little better, in the long run, than trephining, without conjoint medical treatment. Neither the mechanical or surgical shutting off or diminution of the blood supply of the brain nor the removal of a localized mechanical compression will, as a rule, cure a chronic epileptic habit, which is due, whatever may be its initial source, to a final implication and consequent control-failure in the vasomotor center, permitting sudden arteriole spasm and unequal and alternating blood-tension in the cerebral capilla ries. But whether or not we attempt surgical relief of the formidable and distressful malady, the preliminary and after-treatment, if we would finally succeed in curing it in any particular case, must be accomplished in accordance with the principles of corrective and restorative neurotherapy above indicated, until our ability to manage epilepsia shall have *To this point this paper (barring some important typographical corrections, especially in the formula of hypophosphites, bromides, etc.,) was read before the Missouri State Medical Association, May 3d, 1886. been enlarged by a wider pathological knowledge, and even more extended observation than the extensive acquaintance medicine has thus far made, of this most ancient of diseases. I conclude this note with the scarcely necessary appendum, that, in addition to this outline management, no therapeutic resource is at times. unworthy of employment; nitrite of amyl, chloroform, ether, ammonia, or other pungent and vasomotor influencing inhalations; borax, valerian, ferrosocyanuret of iron, serpentaria, aurum bichloride, calabar bean, etc., and occasionally still argenti nitras. Measles is of rare occurrence during pregnancy, for only twenty or twenty-five cases at the most can be collected among the different authorities. According to Leveret it equals in gravity scarlatina, and is almost always accompanied by abortion and premature delivery (Charpentier.) During all of last winter measles were epidemic in Kansas City and vicinity. We will be glad to receive for publication a full report of any case of measles occuring during pregnancy. The record of such cases will prove of statistical value. In the Provincial Medical Journal a new and cheap substitute for quinine is brought forward by Dr. D. H. Martin Clark for the treatment of malarial diseases; it is picrate of ammonium. He states that he has used it for four and a half years with uniform success in the treatment of ten thousand cases, and he has found it answer as well as quinine. Curiously enough, however, in nine cases out of five thousand in which the picrate failed to cure, the use of quinine proved curative at once. In malarial neuralgia, headache, and colic, the picrate answers admirably, but in tertian ague, in the enlarged spleen of ague, and in remittent fever it is not of much use. The dose varies from one eighth of a grain to a grain, given four or five times a day, in the form of a pill. Its use is not attended by the disagreeable "head symptoms" attending the administration of the salts of cinchona bark. The Medical Times, the leading homoeopathic journal of New York, says: "We do not believe there is a single member of the faculties of the so called homeopathic colleges of New York and Philadelphia who does not almost daily administer remedies which in no sense can be called homœopathic. In name they are sectarian, fighting with all their force for a name which binds them to exclusive practice, and yet in the sick-room unsectarian, broad and liberal, bringing to their aid facts and suggestions culled from a large reading of the literature and experience of all schools. Dr. T. F. Allen, at one time one of the most enthusiastic apostles of so-called high-dilution homeopathy, now admits that it is unreliable and delusive, and says that homoeopathy should be taught in all medical schools, but it should constitute only a part of the course of study. We do not hold that homoeopathy is the exclusive and only law of healing." |