THE DIETETIC TREATMENT OF EPILEPSY.

300

_.

all to 130 cubic centimetres.

Membrane re-formed

on

the

eleventh day, but disappeared under an injection of 10 cubic centimetres. Another indication for increasing the quantity of antitoxin is diphtheritic bronchitis; the dose should be double or treble the ordinary one. Hence the importance of early diagnosis of this complication by careful examination of the chest and of matters expectorated or discharged by the

tracheotomy tube. Finally, the persistence of toxic symptoms is an indication to give more antitoxin. Thus a child showed toxic symptoms-prostration and acceleration and feebleness of pulse. The injection was repeated four times and on each occasion there wasmarked improvement, the prostration diminished, and the pulse became slower and stronger. THE

FOURTEENTH INTERNATIONAL CONGRESS OF MEDICINE, MADRID, 1903.

-7

_.___._._..,

_..,.,..

, s.,.,u.,N

",

""a.

work ...... he went to his foreman and comthat two of his fellow-workmen were plotting to kill him, and that one of them had a knife concealed in his clothing."" The man seemed so sincere and had always been such a sober, industrious, and peaceful workman that the foreman called the other two men to account, who being innocent were perfectly astounded. The patient, however, insisted vehemently on their guilt, and said he had heard their plotting and seen the knife. Of this there was no proof and he was taken home and thence to the Cleveland City Hospital and remained in bed a few days and was discharged. Before his discharge he realised he had been the victim of a delusion and seemed surprised and could assign no cause for it. He had not, says Dr. Aldrich, had a recurrence of any mental symptoms since then or any disturbance of the nature of insanity or of epilepsy. Kellog states that such cases of ephemeral mental disorder are of great judicial interest, " since responsibility cannot exist where consciousness is in abeyance."The treatment was devoted to relief of symptoms and included the administration of hyoscine and morphia as cerebral sedatives, and careful supervision to prevent criminal or suicidal acts during the period of impaired and abnormal consciousness. at

plained

THE Fourteenth International Congress of Medicine will be held at Madrid from April 23rd to the 30th, 1903, under the patronage of King Alphonso XIII. and the Queen Regent. The subscription is 30 pesetas (equivalent to 24s.). Ladies accompanying members will be entitled to the privileges of the members in the reduction of fares on the Spanish railways, &c., on payment of 12 pesetas apiece (or 108.). The National Committee for Great Britain and UNIVERSITY OF LONDON. Ireland remains the same as at the Paris Congress, Sir A MEETING of the Faculty of Medicine was held at the William MacCormac, Bart., K.C.B., K.C.V.O., being the President. The honorary secretaries are Dr. Percival University on Friday, July 20th, at 5 p.M. Although the Horton-Smith of 15, Upper Brook-street, Grosvenor-square, business was specially important less than 30 members were present. An interim report from the Concentration London, W., and Mr. D’Arcy Power, of 10A, was first presented, but its consideration was Committee W. , Cavendish-square, London, until a final report is laid before the members of postponed the faculty early next winter session. Reports were also EPHEMERAL MENTAL DISORDER AND ITS from the Boards of Preliminary and Intermediate received MEDICO-LEGAL ASPECTS. Medical Studies. The consideration of the reports was also DR. CHARLES ALDRICH, neurologist to the Cleveland City deferred until October, as there was much division of opinion Hospital, in the May number of the Philadelphia Medical as to whether there should be separate examinations at the Journal deals with the important subject of ephemeral M. B. Examination in botany and zoology, or mental disorder (mania transitoria) and refers to its medico- Preliminary whether these subjects should be taken collectively under legal aspects. The occurrence of such a condition having a the general term of biology. The Senate has decided to duration of a few hours or a few days-15 to 48 hours publish a gazette as a record of matters connected with according to Kellog-is usually followed by many hours of the University. deep sleep, and owing to its brief duration only symptomatic treatment is possible. The disease usually occurs in young THE DIETETIC TREATMENT OF EPILEPSY. persons and has close affinities with certain forms of THE dietetic treatment of epilepsy, one of the most psychical epilepsy. Dr. Aldrich records the following two Case 1.—A young woman aged 18 years, with a good hopeful and effective of the more recent therapeutic methods cases. family history and free from epileptic attacks or mental introduced, is dealt with in a recent issue of the Berliner aberration, was employed as a domestic servant. She was of Klinisohe Wochensohrift (June 10th, 1901), by Dr. Rudolf steady and religious habits and never addicted to alcohol or Bálint who contributes an important article based upon narcotics. One morning about 4 o’clock her mistress was observations made by himself at the Clinic of Professor aroused by someone beating at her door and loudly calling Koranyi in Budapest. The work was undertaken in conto her to come out. She opened the door and saw the sequence of the theory advocated by Richet and Toulouse in her servant standing night-clothes with a Bible under her that ’’salt-starvation " and the administration of alkaline She was saying bromides constituted the most effective form of treatment. arm urging her mistress to come with her. that "the world was about to end and Christ had sent her to Dr. Balint treated 28 epileptic patients who were the subjects " The mistress realised that the girl was of idiopathic epilepsy (petit mal and haut mal) with a diet save her mistress." in a delirium, soothed her, and told her to dress. The from which all chlorides were as far as possible removed, girl retired and reappeared dressed, ate a hearty break- after which a small amount of bromides was added. A fast, meanwhile talking incoherently on religion and the number of preliminary trials were made and eventually threatened destruction of the world. She then went the following daily diet table was adopted as one with a friend to see a procession, keeping her Bible under satisfying the necessary conditions-viz., from one to one her arm and maintaining perfect silence for over an hour. and a half litres of milk, from 40 to 50 grammes of butter, Then she said that she felt tired, and on returning home three eggs, and from 300 to 400 grammes of bread and fruit. immediately undressed herself and went to bed, sleeping The bread was specially prepared without common salt soundly for five hours, after which she awoke "with a dim and with the addition of three grammes of sodium bromide recollection of the street pageant." She was free from som- per loaf. Living on the above diet a patient would connambulistic traits and has since the above occurrence never sume altogether only about two grammes of sodium chloride manifested any other symptom of mental aberration, per diem, a quantity very much below the average consumpCase 2.-A man aged 40 years, married and in good tion of the salt in every-day diet, while at the same time he health, was employed as a workman. He had been would be unconsciously taking about three grammes of always free from mental aberration. "One day while sodium bromide daily in his food. The results obtained ___

Chandos-street,

-

301 tudos of tubercle bacilli swallowed by them in milk. Even if it were admitted that primary tuberculous intestinal lesions were as rare itt children as Kocli’s statistics indicated it was certainly true that tabes as mental clearness, and mesenterica existed in a considerable percentage of children who died an tuberculous disease without tubercle being found in any other of the mental confusion and so from a part of the body. When the mesonteric glands were thus affected. discoverable intestinal lesion, the natural, and, The often characteristic of inevitable, interpretation seemed to him to be that the tubercle health rose and bromism " was never had passed through the intestinal mucous membrane without causing in it, and had been arrested in the glands of the mesenThe salient feature was that the sedative action of the obviousItlesion was known that even typhoid bacilli, the essential place of tery. out that the treat- development of which was the intestinal mucous membrane, occasionally bromide was enhanced. Dr. Balint through it without producing the characteristic lesion. And if useful and passed ment is not difficult to carry out and is this might occur with the typhoid bacilli, how much more likely was in institutions where a diet can such an occurrence with tubercle bacilli ? If this were so, Koch’s main fell to the ground. As regarded the experiments which be enforced. It was a method of treatment attended with argument Koch had referred to of bovine animals with material to be useful in from the glands of children affected with tabes mesenterica, the result and it was no being negative, these experiments had been but few; and even were farm colonies and institutions of a like nature. they more numerous, they would not, to his mind, be quite conclusive. It might be that tubercle from milk in the intestines might be so modified by passing through the human subject that the bacilli in the THE first of the International Dental mesenteric glands, though derived from a bovine animal, might be no longer those of true bovine tubercle but bacilli having the characters of on Federation will be held in human tubercle little disposed to develop in cattle. The Congress searching inquiry into the subject before the after the conclusion of the of would probably require a more accepting this doctrine of the immunity of man to bovine tubercle.

were highly satisfactory in all the 28 cases. There were a reduction of the epileptic attacks in both frequency and

improvement intensity, regards disappearance epileptic patients. rapidly

practicable

stupidity general bodily produced.

without any

indeed, bacilli

points especially regulated

large

inoculating

especially likely

danger epileptic

general meeting

Cambridge

August 7th,

day

Wednesday, meeting

the British Dental Association in London. Trains for Cambridge leave King’s Cross at 9 A.M., Liverpool Street at 9.10 A.M., and St. Pancras at 9.15 A.M. Conferences and committee meetings will occupy the day from 11 A.M. to 5 P.M., when there will be a garden party at Merton Hall, followed by a banquet in Downing College. All members of the British Dental Association and other British dental societies are entitled to attend.

In the evening issue of the Berliner Lokal Anzeiger of Friday, July 26th, there appeared a report of interviews which a representative of that journal had had with Professor Virchow and Professor Heubner on the receipt in Berlin of the particulars of Professor Koch’s pronouncement as to the difference between bovine and human tuberculosis. following is a free translation of their remarks.

The

Professor Heubner’s lie,7v. Professor Heubner, who was first to be interviewed, said :— IN consequence of the great pressure on our space, owing If Koch in his address in London expressed the opinion that heredito the extensive reports of the British Congress on Tubercurare occurrence I am fully in agreement transmission is a tary losis and of the annual meeting of the British, Medical with him. In the coursevery of my very long experience of clinical investiAssociation at Cheltenham, we are compelled to hold over gation I have had innumerable children under my care whom I have closely observed, but I have not detected a single case of hereditary the publication of many articles and communications of transmission. I must emphasise the fact that I speak now only from experience, for I am well aware that other medical authorities interest and importance, including our comments on the my own that believe such transmission does occur, and I am by no means Interim Report of the Royal Commission on Sewageprepared to say that it does not or never has done. Still, I take up on this matter a position side by side with ProDisposal. fessor Koch. And this I do with regard to the second question. I, also, believe that the transmission of bovine tuberculosis to man is exceedingly unlikely. On the other hand, several arguments be brought against Professor Koch’s conclusions, and one of them IMPORTANT VIEWS ON THE RELATIONS can has already been well expressed in London by Lord Lister, who says :-. Human tuberculosis is regarded by Koch as not transmissible to cows BETWEEN HUMAN AND BOVINE even if they are inoculated with tubercle bacilli, but this does not prove ______________

"

TUBERCULOSIS.

AT the present juncture the views of the eminent men will be read with interest.

following

that bovine tuberculosis is not transmissible to man." The final word on the two questions under consideration has not as yet been spoken, but, as I have already said, I am in complete accord with Professor Koch in his opinion concerning them.

three

Lord Lister’s View. The following is the full text. of Lord Lister’s speech made at the second general meeting of the British Congress on Tuberculosis :—

Professor Virchow’s View. expressed himself as follows :—

Professor Virchow

I

I have ’for many years opposed the theoretical belief in hereditary of tuberculosis in man, but, on the whole, I do not agree with Koch. In a discourse which I gave at a recent meeting of the Berliner Medicinische Gesellschaft I left no doubt concerning my standpoint on this matter, for I dealt minutely with the conclusions He said that the discourse they had listened to was full of profound3 which Professor Koch enunciated before the Congress on Tuberculosis. interest from the beginning to the end. But what had chiefly riveted I would point out that Koch, in summarising the results of his their attention had been the startling thesis that bovine tubercle could investigations, disregarded the conclusions for which we are not develop in the human body. This was a matter of enormous prac- indebted to the Copenhagen school. In order to ascertain what tical importance because if this conclusion were sound it would greatly was best that could be done for the health of the people, and simplify their preventive measures, but it would be a very serious and particularly what foods and liquids they should avoid, the grievous thing if the rules now in force for securing purity of Government appointed a Commission which, it milk-supply should be relaxed and it should turn out after allconsisted mainly of medical officers and was known as the Council of the he that conclusion was erroneous. For his own part Health. Among the many questions which the council paid careful thought the evidence adduced by Dr. Koch to show thatatteution to was, of course, that of bovine tuberculosis, and for the human tubercle could not be communicated to bovine animals of settling the question in a scientific manner the most minute purpose ’t very conclusive. At the same time he agreed with him that investigations were made and the results of these investigations form in a matter of such great importance further inquiry was practically the basis upon which all subsequent public health acts are .0 desirable. But even if that were established it would by no I may refer to our enactments concerning quarantine, for founded. tmeans necessarily follow that bovine tubercle could not be cominstance, in illustration of the extent of our indebtedness to the municated to man. He took in illustration the case of variola. scientific work of the Copenhagen school. The conclusions arrived at Attempts to inoculate human small-pox into the calf had been n by the Danish scientists are very different in character from those of so very rarely successful that eminent pathologists had conKoch. The question is anything but settled. cluded that small-pox and cow-pox were two entirely different diseases. We now knew that this was an entire mistake; that ; cow-pox was small-pox modified by passing through the cow. He referred to some very instructive experiments by Dr. EDINBURGH UNIVERSITY.-At the summer Monckton Copeman, who entirely failed to inoculate human ceremonial of Edinburgh University, which took into the but it calf succeeded in invariably it graduation inoculating small-pox into the monkey, and was as invariably successful when he introon July 27th in the M Ewan Hall. the degree of Doctor oplace duced matter from the pustules in the monkey into the calf, the result of Medicine was conferred on 61 candidates, six of whom being ordinary cow-pox which could be used for vaccinating children. awarded gold medals for their theses. The gold It might be that some species of animal might serve as an intermediary host for tubercle between man and the bovine species. Or it might it medallists were: James Martin Beattie, Thomas Hastie turn out that, if a sufficient number of experiments were made, human Evan John Hewat Fraser, Alfred Charles Sandstein, tubercle might prove occasionally transmissible to the bovine animal, Sutherland Simpson, and Donald Bremner Waters. The as small-pox was in rare instances to the calf, and that the bovine tubercle so produced might be transmissible to man, as was the virus Ettles Scholarship was awarded to Caleb Williams Saleeby. js of vaccine. The evidence, necessarily indirect, on which Koch relied The degrees of M.B., C.M. was conferred on 11 candidates as showing that bovine tubercle could not be transmitted to man, did the degree of M.B., Ch. B. on 147. The address to the not seem at all conclusive. It consisted mainly in the alleged rarity oj primary tuberculous intestinal lesions in children in spite of the multi.graduates was delivered by Professor John Wyllie.

transmission

dDanish

Profossor

a. it were

ie a,Bryce, of and

appears,