ON THE TREATMENT OF EPILEPSY.

610 two examinations; one on the theory, the other on Among the wishes which you have expressed, there is not one practice of midwifery. Midwives should not be allowed to that I have not seen adopted with personal and public satispractise any serious obstetric operation, or to attend in cases of faction. I may call them old acquaintances, for they have all disease. The only operations which they ought to be permitted been agitated and discussed before a committee of the university, to perform are, bleeding and vaccination. over whom I shall always esteem it an honour to have presided. In conclusion, the congress, instituted in a spirit of concord, Some of them I have the power at once to accede to; as, for wished to finish its labours in a spirit of union, and consequently instance, the establishment of additional professorships in the adopted, as a last proposition, the following resolutions faculties, and the proposed increase in the salaries of the assistant That free medical associations should be formed wherever it professors; and that I shall do. Others must have the sanction is possible, with the double view of perfecting science and of of the government of the king, and those I can only introduce into the council of the crown. I shall, however, subsequently, organizing provident institutions. That these associations, formed in the chief town of each use my influence to induce the three legislative powers of the arrondissement, should, by delegates, constitute societies in the state to adopt them as the expression of the interests of the chief towns of each department, which would, lastly, centralize in medical body, and of society in general. You are about to return, gentlemen, to the departments which Paris. so many of you left for the purpose of discussing your common inThe above propositions embody the results at which the terests. Say to those who have delegated you, that the government Parisian congress has arrived, after the most searching investi- of the king watches over the interest of every class of society, that gations and discussions, carried on, firstly, in the committees, and it studies their wants, and does all it can to satisfy them. You secondly, in the public assemblies. All these discussions and de- have not expressed a wish which has not been heard, and which liberations took place publicly. The report of the secretary, will not be accepted and accomplished, unless opposed to interests briefly embodying the labours of the congress, was read at the of the same nature, and still more important. final meeting of that body, on the 14th of November, in the Gentlemen, let me avail myself of this opportunity to inform presence of M. de Salvandy, the Minister of Public Instruction, you that one of your wishes has already been satisfied. The who had been requested to attend the final meeting. After the National Gallery of Versailles,* which is dedicated to’all the reading of the report, M. de Salvandy rose, and made a most glories of France,’ would be incomplete, were it not to contain eloquent and emphatic speech, which we consider of importance, the medical celebrities. At this very time the brush of the from its showing the position which the medical profession painter and the chisel of the sculptor are at work, engaged in occupies in the estimation of the public authorities in France. reproducing the figures of your great men, a list of whom I myWe shall therefore extract a few of the most important passages. self presented to the illustrious monarch who watches with soliGentlemen-I came to hear and receive the wishes of the citude over the welfare of the country. You will thus not only congress; its assembling is a new and an important event, because find in our National Gallery the portraits of the warriors who it has fully succeeded, and because it has produced results have defended or aggrandized France; but you will also find It represented the features of your ancestors, of those who have to society and honourable to the medical body. useful is in order to witness these results, that I have come honoured France by their science, who have been your predecesamongst you. My presence may be considered a homage ren- sors, who are your models, and who find among you so many dered to our institutions. A body as numerous as that here imitators." (Continued applause.) The thanks of the meeting having been moved to the Minister assembled, which extends its action over every part of our territory, and which is intimately connected with all the interests of Public Instruction, and to the office-bearers of the Congress, of society, cannot meet to deliberate on its interests and its dignity, the former again rose and said,without the minister to whom they are confided by government I perceive, gentlemen, that I have remained amongst you a feeling it his duty also to come forward. A government like few minutes too long. Among the names of all those to whom ours rests on all the social interests; it is its duty to listen to you have voted your thanks, there is only one which I can prothem, to assist them, and to accede, as far as possible, to their pose you to erase, and that is, the name of the MINISTER OF wishes. It is an honour to our age, that an assembly such as the PUBLIC INSTRUCTION. He has no right to your thanks,for he present should be able thus to meet, to deliberate, and to produce has only done his duty." to

..

undergo

the

"

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"

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results marked with so much wisdom. " Gentlemen, the congress has already produced real results, a fact which I am happy to recognise. In your first deliberations, I remarked a solicitude respecting your dignity, both honourable and generous, but which appears to me to be in contradiction with the actual state of society. I have heard parallels made by some of you, which historydoes not sanction. Compare the social position of the medical body at the birth of Louis XIV., when Gui P .1tin flourished, and Descartes shone in all his glory, with that which it now occupies. You ought not to question, gentlemen, the social dignity of a profession which gives so many guarantees to the state as yours. You alone, previous to appearing before society, previous to affording it that assistance which is the fruit of your arduous labours, have to obtain the sanction of three different Faculties, that of Arts, that of Sciences, and, finally, that of Medicine. All the other professions and ranks of society are satisfied with less. It is indeed an error to doubt the high rank which the medical profession occupies in the FrenchI social fabric of 1830. This rank you have acquired by the I services which you render every day ; and I may add, with sincerity, that it will be still further merited for the future, by your conduct on the present important occasion. You have deliberated with maturity, and, at the same time, with promptitude. In a short time you have arrived at decided resolutions, and have had the wisdom, rare in numerous assemblies, to keep within the limits which you had traced for yourselves, and to present resolutions which, although they often admit of discussion, all deserve to be weighed, and have acquired additional importance from your

professional

approval.

Another result obtained is, that-perhaps without being confact-you have shown by your resolutions that, although many ameliorations are desirable, there are, ill the preYou have approved sent state of things, numerous guarantees. the general s) stem of instruction as it now exists, and have merely wished to extend and to strengthen it. The period of ’89 has been recalled by one of you. There is a great difference between this assembly and those which then met. Onr fathers met to destroy, whereas your votes have tended to strengthen and

scious of the

to consolidate

existing institutions.

ON

THE

TREATMENT

OF

EPILEPSY.

By M. K. O’SHEA, Esq., Surgeon, Lambeth. ON Friday, 28th March last, I was called on to attend Henry B-,aged fifty-four. On my arrival I found him in a state

of coma, occasionally disturbed from his lethargic condition by violent and frequent spasmodic convulsions, affecting the muscles of the face and body generally. During the intermission of these exacerbations, his breathing was laborious, re sembling apoplexy, and as his pulse was about eighty, full and strong, and the temperature of his head considerabiy increased, I was induced to bleed him to the amount of twenty ounces, after which the coma ceased, and the spasmodic convulsions were less frequent and less -violent. Notwithstanding great difficulty of deglutition, it was found practicable to administer five-grain doses of the chloride of mercury, followed up by an active saline aperient; the head was shaved, and cold lotions kept constantly applied thereto; a blister was also placed on the nape of the neck. Under this treatment, his epilepto-apoplectic seizure gradually disappeared, and subsequently degenerated into delirium and madness. On night, coma again supervened, and he died on the morning of Monday the 31st. On reverting to this man’s history, I found that he -was confined in the Surrey County Lunatic Asylum, for six months, from which he was discharged cured, in October, 1842. He was a carpenter by trade, but from the age of fifteen to twenty he was engaged as bell-ringer in a steeple with a peal of five bells. For the first two years of his infancy he did nothing but cry and knock his head about, evincing much restlessness and inquietude. His father was considered a maniac, and attempted suicide. My patient was also under an apprehension that he would commit self-destruction, in consequence of a delusion under which he laboured, that the wicked one advised him to such an act. For the 12st fifteen or twenty years he was subject to epilepsy

Sunday

* An extensive collection of paintings, brought together with a view to the illustration of the history of France, which occupies nearly the entire extent of the immense palace ot VersajUes.

611 intervals, but for the last five years he was visited by a fit every five weeks. He- was particularly lively before the fits

at distant

that he used to sing, and his friends invaa fit from his sprightliness, and the concomitant blush that mantled on his countenance. He was a man easily fatigued, and not very clever at his trade. Though not an ill-natured person, he used generally to seem out of temper, insomuch that his wife imagined she displeased him ; but he always attributed his conduct to the state of his head, complaining of pain and weight over the lateral ventricles. He was of temperate habits, with an appetite usually good. Three of his children died came on, so

much

so

riably diagnosticated

from head affections. Post-mortem examination.-As there existed some objection on the part of his friends to a post-mortem generally, an examination of the head was only obtained. There was nothing in the outward configuration of the cranium to attract particular notice, but the development of the lower maxillary forcibly reminded me of Hunter’s only pun in allusion to the growth of the lower jaw in proportion to the diminution of intellect. The arachnoid membrane was thickened, strong, and opaque, and capable of bearing much and violent extension when drawn between the hands. The turgescence of the vessels of the brain and investing membranes was sufficiently evident, notwithstanding the abstraction of blood, and there was serous effusion on the surface and in the ventricles, amounting in all to about seven ounces. The cineritious substance, which is generally soft and pulpy, was in this instance unusually firm, and the character of induration particularly attached to the pons varolii, corpus callosum, and medulla oblongata. Indeed, the latter, in consistence, approximated more to tendon, resisting the forcible compression of my :finger-nail, and only yielding to a section of the knife. The olfactory nerves were very dense and persistent, bearing as much tension as very strong cords, and with difficulty evulsed from their middle origin on the posterior convolution of the anterior lobe of the cerebrum; they were deposited in a fissure nearly On an inch deep, instead of a shallow triangular groove. opening into the ventricles, clusters of hydatids presented to my view, attached to the choroid plexus on either side of the mesian line. In reference to this case, I am not unwilling to confess, that had I been aware (when hurriedly summoned to his chamber) of all the minutise which I have just now detailed, I should have hesitated, in some measure, before I adopted venesection. Nor would my objection arise so much from the conviction of the absence of its necessity, as from the fear of the consequent debility tending ill to promote the process of absorption. His being frequently bled before, and deriving relief from the proceeding, in this as well as former instances, might be deemed sufficient evidence to guarantee such a procedure; and, no doubt, by lessening the sensibility of the cerebral structure, was calculated to make it less susceptible of the irritation which must have resulted from so morbid a condition as the post mortem disclosed. Nor is it to be lost sight of, that the occasional paralytic convulsions which ensued must necessarily impede the circulation of the brain, producing congestion, and thus increasing the danger ; and that whatever tends to alleviate such symptoms, must be considered advantageous. Still, in such a case as the present, I am of opinion that leeches to the temples and iced applications to the head would be preferable, by far, to general bloodletting; and I make these remarks lest it may be understood that I advocate venesection indiscriminately in epilepsy. There is much in this case to excite speculative theory, as in other epileptic cases which have come under my observation, where the aggravation, if not a fruitful source of the malady, may not be unreasonably attributed to the Godfrey-cordial system of the chemist, and the penny-farthing practice of the shopkeeping doctors." In B-,we have a man whose infancy was ushered in with symptoms of arachnitis ; and his having lived to the advanced age of fifty-four, only proves how powerful nature is in resistiag the progress of disease. It must, too, be evident, that from a very early period, and during the term of his life, there must have been serious obstruction to the mutual exhalat’on and absorption of the fine serous halites which is so wisely produced for the I purposes of motion between the opposing surfaces of arachnoid membrane. And when we consider the efforts made by nature, in various instances, for the removal of disease, by adventitious formations, and collections of matter, it may not be extravagant to decide, that the hydatids were the result of the exuberant operations of the same cause, and their being connected with so vascular a texture as the choroid plexus would not at all lessen the probability of this position, being thus once established by the over-active system of the cerebral circulation, giving rise to the effusion of coagulating lymph, which subsequently became ourganized in the form of hydatids, proving a new source of irrita-

to the serous secreting membranes, and thus exciting the aqueous deposit, which, by suspending the hydatids in a floating position, tended to remove, in some degree, their irritation and friction from the nervous centre, until the very effort of nature to remove irritation became, by accumulation and quantity, another cause of derangement, and by pressure gave rise to the convulsions and coma, with which this man’s health was so frequently interrupted during life. Should we adopt this as the rationale of Bdisease, we are constrained to admire the power of nature in restoring him so frequently, by the process of absorption, to his wonted consciousness and avocation, and may learn a lesson towards assisting her in the work, by directing our attention to the causes which produce epileptic symptoms. Perhaps the absence of success in the treatment of epilepsy is to be attributed in some degree to its not being applied in the early stage of the disease, and that epilepsy itself is only the sequence of other maladies. Remedies would have more influence before the brain becomes disorganized from causes unnoticed in infancy, and effects themselves in turn becoming secondary causes, producing changes of structure which might have been prevented by timely treatment. The case related by Dr. Elliotson, of the lady who, when a child, was subject to- epilepsy every few weeks, but which ceased when the menstrual period came on, indicates, to my satisfaction, that by proper evacuations, with local depletion by leeches, and the skilful administration of calomel, combined with cold applications to the head, as circumstances may warrant, the cause of the disease might have been obliterated in this individual, and we might not have had to record the disagreeable sequel, that when menstruation ceased, she had pain in the occiput for five years; that the disease returned, and she had a fit every year or two, when one day she suddenly fell down dead. Here the natural evacuation arrested for thirty years the progress of a disease which might have been eradicated, but appears only to have been and, as soon as nature’s remedial efforts ceased, the dormant malady arose from its slumbers, and terminated in the death of its victim. Bridge-road, Lambeth, March 10th, 1845.

tion

counterpoised;

ON SOME NEW INJECTIONAL FORMULÆ IN THE TREATMENT OF URETHRAL, VAGINAL, AND UTERINE AFFECTIONS. By THOMAS CATTELL, M.D., Surgeon, Braunston. DURING the past year several cases of gonorrhoea came under my care, in both sexes, in whom the administration of copaiba and cubebs, in their usual forms, superinduced gastric and nephritic symptoms, which coerced me either to abandon their employment, or to adopt some less objectionable modes of use. On consideration of the subject, the injectional mode appeared to be the only one of sufficient utility, but this was not accomplished for a considerable period, owing to the peculiarity of those substances. However, I am happy to state that, after repeated efforts, I succeeded in forming an aqueous impregnation, well adapted for injectional purposes, and which will, I anticipate, from the simplicity and practicability of their formula, be found to supply the desideratum particularly alluded to by illr. Oates, in an extract lately made into THE LANCET. These processes pharmaceutically embrace the constitution of an aqua copaibse and cubeboo. They are as follow :I. Distilled water of copaiba and cubebs. R 01. copaibae, (or cubebs,) two ounces; water, five gallons and a half. Draw over from three to four gallons. II. Extemporaneous water of copaiba and cubebs. 1. B. 01. eopaibse, (<’1’ cubebs,) two ounces ; magaesiae carb., six drachms. Rub together, and add four gallons, or less, of water. Filter. 2. R 01. copaibse, (or cubebs,) as in the preceding; but use pulverized pumice-stone, sand, Bath-brick, in the place of the magnesiae carb. III. Sacchar:zed caustic solution of the oils of copaiba and cubebs. R 01. copaiba, (or cubebs,) one drachm ; caustic potash, (or soda,) half an ounce; white sugar, six drachms. Twenty-four ounces of water to be added gradually. IV. Saponiform solution of the respective oils. R 01. copaibas, (or cubebs,) two ounces ; caustic solution of potash, (or soda,) one ounce. Rub together in a mortar, and add water as may be required. As it is relevant to the present subject, it may rot be amiss here to state, that I have applied the same chemical formula with but trifling variation, in producing an aqueous impregnation of the oils of turpentine, ergot of rye, creosote, &c., and used them in _