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puerperal epilepsy, but places such cases in the class of convulsions known as eclampsiæ, from the Greek, Ek. and Lampsomai, to seize hold of, retaining for epilepsy those cases where no definite morbid anatomy exists. The French describe two conditions, le petit mal and le grand mal, an arbitrary division, but no better has been suggested. In le petit mal, often we meet those cases who furnish so many unelucidated problems in physiology and psychology. Le petit mal is characterized by loss of consciousness without any appreciable convulsion. While le grand mal is unconsciousness, loss of volition and convulsion. Often it is necessary to modify such a classification, to admit cases that partake more or less of each variety, but no case should be called epilepsy, where consciousness is never lost. In le petit mal, without any falling or spasm, the person becomes "lost" or unconscious for such a short period, that, if conversing, he pauses, becomes pale, his pupils dilate, and he wears a fixed expression; this is at once followed by flushing of the face, and he resumes his conversation where it was interrupted, unawares himself of the circumstances, but in an hour after would be unable to repeat what he was saying at the time of the seizure. I have seen a telegraph operator pause, lose two or three letters, resume the message, totally ignorant of any interruption in its continuity. At Salpetriere, M. Charcot showed a case of a woman affected with le petit mal, who when attacked would move around her table once or twice, then resume whatever she was occupied with. Le petit mal is even more difficult to explain than the other condition, for how can we reconcile our physiology with the facts here presented. We know that with loss of consciousness, whether naturally in sleep or produced by injury, that the muscles pass from the control of the will and become relaxed: thus, if "we sleep standing, we fall; if sitting, the head falls forward or to the side, and the jaw drops, the palate becomes relaxed or paralyzed, and we snore." Yet in petit mal the person never falls. There are persons who have this condition for years, and have it unknown to their own families. Dr. Wilks, of Guys, to whom I owe many obligations, told me a case of a medical man who had such attacks. He suffered from loss of memory after the paroxysms, so much so that he took his wife with him in his carriage in order to write

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down the prescribed medicines immediately on his leaving the house, and to direct him where next to call. If it had not been for her assistance he would not have known in the evening a single occurrence of the day's proceedings. Yet he was able to fulfil his professional duties, never having had any convulsions. Most cases seen in practice belong to le grand mal, or the chronic epilepsy, a condition so familiar to all that no description is necessary. Though there is an interesting feature often found, that of the aura. It is by no means a constant concomitant of epilepsy. Statistics admit of its being found in fifteen per cent. It is usually regarded as the peripheral manifestations of the disease, and starts from the point of irritation; but Dr. Jackson thinks it indicates the convolutions, and may be utilized in localizing. Where the aura starts from an extremity and proceeds towards the head by pressure upon the limb, a paroxysm can often be prevented; but these cases are mostly known as Jacksonian fits. In le grand mal, when the person is seized, the air, by the forcible contraction of the respiratory muscles, is forced through the larynx, producing the shrill expiratory cry so diagnostic of the condition. It is well to remember, as an important fact in jurisprudence, that the cry occurs but once, and is never repeated in the same seizure. The mental condition of epileptics is an important subject, and can only be discussed generally, as no rule applies. It is quite common to find persons who have been epileptics for years with no impairment of mentality. In the cases where a state approaching imbecility has been observed, some other condition has been coexistent, or the epilepsy the precursor. In these cases chronic thickening of the meninges has been found, especially in the region of the middle cerebral artery. In some, there exist gaiety almost to delirium before an attack, or melancholy, or irritability. Such cases, as a rule, do not suffer mental depression after the paroxysm. Others have the profoundest melancholy or apathy for hours or days after a seizure. Even by the profession, epileptics' mental condition is regarded as peculiar, but I think in many cases unjustly, as such a condition arises from the dread of their unhappy state, and not from any lack of brain quality. Dr. Falret maintains that no epileptic is a responsible agent. You have all heard of epileptic mania, and justice upon several

occasions has been instructed in epileptic homicide. A case was tried two years ago in London upon such a plea, and the unanimous opinion held by the leading neurologists was, that during a seizure of this mania, the epileptic unknowingly might inflict dire harm upon person or persons, and yet be perfectly compos mentis between seizures. When I was house physician to Dr. Hughlings Jackson, I admitted into the London hospital a German, æt. 28, sailor, who, six years previously, had received a sabre wound upon the right parietal bone. Two months after the injury epilepsy appeared, and he had a seizure every twenty eight days. He was under observation several months, but failed to improve his condition. No surgical interference was admissible. He occupied bed 18. The next bed (19) was filled by a patient in the third stage of phthisis pulmonalis. At the regular time the German had his seizure and had apparently ceased to be convulsed, when suddenly he arose, knocked the sister and two nurses down, picked up a chair and placed it on the thorax of his neighbor, and attempted to sit in it. He sat long enough to cause the death of 19. Porters were summoned and the German was put in a padded cell. He raved a short time, became dull and heavy. The next morning he failed to appreciate his surroundings, and insisted that it was cruelty on my part to confine him, and no amount of argument or proof could convince him of his doings.

Time bids me draw to a close this rambling paper; but the points here discussed have been learned from the study of several hundred cases, and may set aright those who have had but a too general idea of epilepsy. Its pathology is being gradually developed, and would exist purer had it not been for the intervention of morbid anatomy, which has tried to locate the disease in almost every imaginable part of the brain and spinal cord. Moxon has tersely said that a fit had no morbid anatomy. As epilepsy is but periodic fits, why waste time in the post mortem room, when an analysis of the paroxysm, aided by physiology, suggests the solution of this sphinx to medicine. The most important element is coma; then convulsion. For coma we need go no further than the convolutions. For the convulsions we have the highest development of the cord in the corpus striatum; or, regarding the vaso motor centre to be implicated, as evinced by fixation of the

chest, feeble action of the heart and the part the muscles of expression and respiration play, we might include the medulla. Why go further, and make the cord a factor to be admitted, when we are conscious the muscles obey through the will, the command is born in the convolutions, and carried out by the central ganglion, or those parts of the brain that are in immediate apposition with said convolutions, or, more properly, consciousness is the regulator of the medulla and cord. To have all functions harmoniously working, it is necessary that the equilibrium be maintained. This is done by the generator of the nerve tissuea something which we call force-believing that it is like the electric current; it is the stimulus to the brain, and is stored for use. If nutrition is interfered with, the equilibrium is destroyed. The brain being unstable, fails to maintain this force, and allows it, like the Leyden jar, to be discharged. Then, what follows? When the convolutions have lost their vital necessity, for the time they are dead, and death is oblivion and unconsciousness. With unconsciousness the muscles have only to respond to their contractibility, and will do so just in proportion to the stimulus or irritation they receive. Dr. Radcliff is not alone in the opinion that muscular motion is a power in the muscle suddenly let loose, and not a nerve force, finding its development or place of storage in the muscle. The time prevents me from giving an elaborate or, to me, satisfactory explanation; but my only object is to support the view that epilepsy is a functional disorder, due to impaired nutrition; has its commencement in the convolutions, and, by the implication of the central ganglia, a paroxysm is produced. The impairments to nutrition is brought about by contraction of the blood vessels. A spasm thus deprives the brain of blood; for the moment its function is lost; a discharge of its force takes place, which sets the whole muscular system in a commotion, and at the same time emptying the convolutions, leaves the person unconscious.

There is no lack of evidence to support the anemia theory. Profuse hemorrhage produces convulsions. Attacks are more common at night, when the brain has its minimum quantity of blood. Just as the seizure begins, the face and mucus membrane become pale; and by the ophthalmoscope, contraction of the retinal arteries

has been observed during an attack, and soon as the paleness was disappearing from the face the retinal arteries dilated. Therapeutics has furnished two remedies that help greatly in establishing the pathology-namely, nitrate of amyl, which produces the widest dilatation of the cerebral vessels, and check a paroxysm at once, and bromide potash, which produces dilatation of the minute vessels, but does not affect the middle and large sized ones, as proved by Bamberger and Mary Jacobi-observations in two cases where the brain was studied through holes, made by necrosis destroying nearly all the skull upon one side.

19 East Thirty-second Street, March, 1880.

"QUINSY."

BY O. E. NEWTON, M. D.

This is a very common trouble with the young, between the ages of ten and twenty years. It is nearly always the result of a cold, settling either upon one or both tonsils-but seldom on both sides. at once, though it is sometimes the case. The inflammation which attacks the tonsil is followed by swelling and suppuration, usually before relief is given, especially if the case is in the least neglected in the early stage. Upon looking into the throat, if I find no white spots, no ulcers, but find an enlarged tonsil which is very red, I calculate to a certainty that I have a case of quinsy.

The tonsil of such persons, when free from inflammation, is often honey combed, so that with a probe I can find openings passing from the centre to the surface. These openings, I find, will often act as holders of fragmentary remains of food eaten. Often lying there for a time will be a source of inflammation. The tubes closing at the outside end causing an abscess of the tonsil before relief is obtained.

I find such persons are very liable to quinsy; also from cold closing these sinuses. The treatment I use when called in early is hot poultices, gurgling the throat often with sol. of chlor. of potassa, eating of ice, placing the feet in hot mustard water, followed by sweating my patient. If similar general treatment fails to relieve in twenty-four hours, I favor suppuration by the in

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