LUMINAL, BORAX, OR BROMIDE IN EPILEPSY.

892 to three times daily if improvement is not obtained. The addition of a few minims of liquor arsenicalis is useful in preventing a bromide rash. The prescription is really an old one and well established ; its value would appear to lie chiefly in the bromide rather "Audi alteram partem." than in the borax, although the latter may assist. With borax alone, even in large doses, in epilepsy, THE SANATORIUM AND AFTER. I have never met with any success. If a good result To the Editor of THE LANCET. is not obtained with the combination of sodium SIR,-All who are interested in the solution of the bromide and biborate, my experience has been that tuberculosis problem will agree with your statement it is useless to persevere with bromides and that one that " the after-treatment of ex-sanatorium patients must seek for another remedy. In a contribution to the discussion on the Mature is one of the most urgent and elusive problems which Treatment of Epilepsyat the B.M.A. meeting, and medical and social science has to face." Bradford, July, 1924, I gave the results of treatment of for those who have been considering Many different with remedies in a large number of cases of some years this aspect of the question will welcome the admission that " from the strictly medical stand- idopathic epilepsy, analysed in conjunction with We found that several cases point.... the combination of sanatorium, settlement, Dr. H. C. toBeccle. luminal in a most remarkable manner. responded the ideal offers conand training centre, workshop This is the ideal for the I am, however, in entire agreement with Dr. Williamsditions for after-care." of which Dr. Varrier-Jones, Walker that more than 3 gr. luminal per day is general acceptance without much outside support, has, at Papworth, undesirable, and I stated in the above communication been striving for years, and it will doubtless be a1that my experience had been that if one did not ( a obtain satisfactory result with 121gr. luminal source of much satisfaction to him to find that the and evening the case was unlikely to respond success of the pioneer work which he had carried morning out there has at length received public recognition. to luminal at all. It a dose of 3 gr. per day be not none of the unpleasant symptoms mentioned On a recent occasion Mr. Neville Chamberlain Dr. and Dr. Carlill will be seen. In general, Figdor by of the settlement expressed his complete approval have not found that luminal loses its effect after plan and stated that henceforth it would receive the aI few months, and have some cases that have been full support of the Ministry of Health. The observation that " settlements can only deal continuing on 3 gr. a day over a period of more than with a fraction of the tuberculous population " should two years without experiencing an attack. In patients possibly have been slightly modified and to be strictly who do not show an adequate response to either the accurate should read, " are at present only dealing bromideborate or luminal, a combination of sodium to 15 gr.) and luminal (121- gr.) night and with," but at Papworth alone the fraction is even bromide (10 morning will often produce a good result. In three now ten times larger than is being dealt with under cases so treated attacks had been entirely absent for any other combined scheme with which I am Of other remedies, some cases--especially over a year. and when near Preston Park, acquainted, Maidstone, which has recently been taken over by the British those in which the fits are nocturnal-respond to dialacetin (ligr. either at night or twice daily) Legion and which at their request is now being when other drugs have failed. Dr. Varrier-Jones on Papworth lines, by reorganised I am, Sir, yours faithfully, is reopened the fraction will be still larger. Private individuals are, of course, free to support such C. WORSTER-DROUGHT, M.D. charitable efforts as appeal most closely to their Cavendish-square, W., Oct. 19th, 1925. sympathy, but with regard to public money and quasi public funds thecase is different, efficiency and the welfare of the community as a whole are UNUNITED FRACTURES. then the guiding principles of action. To the Editor of THE LANCET. Having had somewhat exceptional opportunities of judging of the relative value of the methods SiR,-With some statements in Prof. E. W. Hey mentioned in your annotation I have come to the Groves’s interesting address on this subject, published unhesitating conclusion that the development of in THE LANCET of Oct. 10th, it is impossible for me settlements on Papworth lines around those of the to agree. Prof. Groves states that " unrestricted existing sanatoria which admit of such an evolution mobility " is one of the mechanical causes. This holds out the most hopeful prospect of a continuous recalls vividly to my mind the case of a man with an advance towards the solution of the problem of the unreduced dislocation of the humeral head. It was of after-care of the tuberculous worker, and to that end several weeks’ duration. In the attempt to reduce it 1 propose to devote such energy and influence as the surgical neck of the humerus was fractured. As I possess.-I am, Sir, yours faithfully, house surgeon my instructions were to apply no splints JAMES K. FOWLER. and to carry out passive movement at the site of fracture frequently and fully so as to establish a false Clarges.-strect, Mayfair, Oct. 19th, 1925. The proceedings were naturally very painful, and the result was absolute and strong union. This impressed me much, for at that time the teaching in LUMINAL, BORAX, OR BROMIDE IN fracture of the humerus was to immobilise the whole EPILEPSY. upper extremity, with even a shoulder-cap and a splint carried to the end of the fingers, lest non-union To the Editor of THE LANCET. should result. This case was an example of the most SiB,—Concerning the relative value of luminal, unrestricted mobility that I have ever heard of. bromide, and borate in epilepsy, I was interested to The next statement made with which I do not agree read of the very satisfactory results obtained by is that " in the case of the shaft of the humerus the Dr. Figdor with combinations of bromide and borax. of efficient fixation is the prime cause of difficulty For many years my initial treatment-apart from frequent non-union." Much depends on what is any general treatment or psychotherapeutic measures meant by " efficient fixation." arm it is In necessary-has been to prescribe a combination of impossible to apply splints that will in any absoway any sodium bromide and sodium biborate, and it is control the fragments from movement. That is lutely seldom indeed that some degree of improvement is the case in all fractures. How much more so when the not obtained, at least in decreased frequency and arm is swollen with the effused blood. There is only severity of the seizures and in the patient’s symptoms. one way to produce immobility and that is open A start is made with 15 gr. sodium bromide and There is no need, however, for any 7 gr. sodium biborate, together with 3 minims liquor operation. 1 Brit. Med. Jour., 1924, ii., 1054. .arsenicalis, given morning and evening, and increasing

Correspondence.

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exceeded,

joint.

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