The Specific Treatment of Epilepsy.

(During the past two months I have published a number of articles on the treatment of Chorea. These have brought out the experiences of some of our best men, and show that there is a similarity in the course adopted by those of our physicians who adhere to the specific methods. Last month I published a number of articles on the use of mitchella in preparing an expectant mother for an easy labor.

I have adopted this course of collecting the individual experiences of a number of physicians in order that the reader may compare the methods of other successful practitioners and from these experiences be able to draw conclusions and obtain suggestions that will improve his own methods. By this means we will be enabled to get closer to the real object of this journal, which is to teach a precise method in all of the important disorders which are constantly met.

In this article I have prepared a symposium from a few writers on the treatment of epilepsy, and in our next month's issue I will present another symposium on the treatment of syphilis without mercury. These statements concerning epilepsy were made in answer to a series of questions, which I propounded to these physicians. I give the answers in each case under the name of the author.—ED.)

ROLLA M. THOMAS, M. D., CINCINNATI, OHIO

The following vegetable remedies have given me good results when used alone, gelsemium, solanum, and oenanthe.

There are cases in which I use these remedies in various combinations, but I find it necessary to study closely the indications in each case and to administer the indicated remedy. I place much importance upon the use of measures which will improve the general condition of the patient, but for the epileptic condition, I depend upon the above remedies, only occasionally finding use for the bromides.

LYDIA ROSS, M. D., WATERTOWN, MASS.

I am much interested in the treatment of epilepsy. I have some theories as to the psychic nature of the disturbance which I hope to get into writing some day. My own experience has been limited so that I have but little of value to present, and that is not very connected. I have had a young woman under treatment the past year, whom I took off the bromides at once and put on avena, dulcamara, phosphorus, xanthoxylum, laxatives and iron, in different combinations, with improvement in the general health and a lessening of the attacks. The case was complicated with a chronic gonorrheal endometritis which was treated locally, and internally with arsenic sulphide, manaca and calcium sulphide. She is still under treatment.

I do not use the bromides regularly, nor do I depend upon them at all for this disease if the spasms can be controlled even fairly well, with other remedies, which exercise more of an upbuilding influence. The remedies I am in the habit of using are avena, dulcamara, solanin, xanthoxylum rumex, scutellaria, phosphorus, hypericum, atropine and nitroglycerine, giving these remedies either singly or in combination, as the specific indications will demand.

As auxiliary measures I advise the judicious use of baths, and the proper use of intestinal antiseptics. I caution great moderation in eating, allowing but little meat but advising the whole grain of all cereals, in order to obtain the earthy salts. I keep the mind and the body wholesomely busy.

The "explosions of nerve force" in epilepsy indicate the need of a better balanced nervous system, and as this can hardly be obtained with defective nutrition it is questionable treatment to give the bromides routinely, with the resulting gastric catarrh, deranged digestion and assimilation, and anemia. The pale, unwholesome, "dopey", negative look of the chronic bromide patient suggests an impaired irritability of motor and sensory nerves, of brain and muscles, making up an induced pathological condition that is not promising for a cure of the original nerve instability.

The general condition of the individual patient should be considered. Remedies and foods which upbuild the nervous system should be selected; elimination by the bowels, kidneys, skin and lungs should be active. The quality of the blood should be looked after and especially should an active capillary circulation be encouraged, to promote tissue changes, and while relieving the internal organs and nerve centers of a passive vascular oppression to give the protective skin a more positive resistant quality with which to oppose auras and other influences.

The patients should have wholesome surroundings and activities, mental and physical. They should be instructed and encouraged in developing their will power and should positively resist a drifting, dreamy state of the mind which is allied to the feeling of the aura which precedes the drifting away into unconsciousness.

C. P. REED, M. D., HAMPSHIRE, ILL.

I depend but little upon the use of the bromides. That remedy which I have learned to depend upon the most is Passiflora incarnata. I use this either alone, or in conjunction with gelsemium, more often, however, alone. If I use the bromides at all, it is in conjunction with these remedies.

In giving passiflora, I expect to continue its influence over a long period and in reasonably full doses. I cannot say that I obtain an absolutely curative effect, but the spasms disappear, and do not return while the remedy is continued, and 1 have none of the unpleasant effects whatever of the bromides.

For six years I have had under my observation and care, a woman who had epilepsy for twenty years before I saw her. During the six years I have treated her she took passiflora continuously for the first three years; for the past three years she has taken it about one-half of the time. She had a solution of the bromide of soda in the house which she took occasionally, but for the past two years she has not taken any at all.

When she came under my treatment, the convulsions were very severe and frequent. Her mind was dull and this condition was slowly increasing. She was in every way an invalid and a burden to her family. For four years now, she has not had a single convulsion. She is apparently in perfect health. She does the housework for a small family and her mind is clear and in normal condition. About half of the time she takes thirty drops of Merrell's fluid extract of passiflora three times a day. Apparently this patient is cured. Whether the convulsions would return after a period, if the medicine was not taken, I am not prepared to say, but I believe they would not.

I have a number of other cases that take passiflora more or less continuously. These have gone from two to three years without a single convulsion. An especially remarkable case was that of a young man, who for nine years had been a helpless invalid from epilepsy when he came under my care. He is now apparently well, in every respect. He clerks in a store and attends to his business every day as any other man. He had taken bromides for a little time. I very soon relieved him with passiflora, almost exclusively.

I give the above named fluid extract in doses of from twenty-five to thirty drops three or four times each day for continued use. It may be given more frequently in the early stage of the treatment or when the convulsions are more frequent.

W. P. BEST, INDIANAPOLIS, IND.

In the treatment of epilepsy I have never used the bromides except in a single case and that one a nocturnal one, which needed the stimulating influence of the bromide of ammonium and belladonna. I prepared a prescription for ten drops of specific belladonna and five drams of the bromide of ammonium with four ounces of water, given in teaspoonful doses. This remedy, persisted in, cured this case completely. There has been no return of the spasms in fifteen years.

I have depended upon the following remedies used alone when indicated, belladonna, passiflora, hyoscyamus, solanum—a preparation made from the berries, by the McCry Howe Co.

I do not use combinations of remedies either vegetable or mineral for this disease, until by a most careful insight I have determined the specific indications, and it is to this fact that I attribute my success in the treatment of this stubborn disorder.

Among other measures that I have found to contribute very materially to a cure, are those of orificial surgery whenever indicated, such as circumcision and the repair of lacerations due to childbirth.

The following cases will illustrate my method:

Case 1. Miss Cora B., aet. 16, paternal grandmother died in Fletcher's sanatorium for nervous and mental diseases; maternal grandfather of irritable, irascible disposition; mother and maternal grandmother tubercular. Girl apparently well, attacks worse at or near the menstrual periods and nocturnal at first, becoming of grand mal type and occurring at any time and place later. She was treated for a year by an uncle, regular, who used bromides to saturation without relief.

I gave the following: Bromide of ammon., drams 5; specific belladonna, drops 10; syrup sim., ounces 4. M. Sig.: One teaspoonful every three hours. No return of the seizures after the third month. The preparation was used for two years, with no return of the seizures for ten years to my knowledge.

Case 2. Petit mal. Child, daughter of a blacksmith, who as well as his wife, was healthy and gave negative history. Attacks frequent, three to ten a day. Recovery complete; belladonna alone. Child six years old, has had no return.

Case 3. Nocturnal epilepsy, mild grand mal type. Child congenitally blind in left eye, otherwise well developed. Examination revealed clitoris covered and absolutely hidden from view by adhesions. She was anesthetized, clitoris released, and one bottle of passiflora, drams 3; water, ounces 4, was given for the first few days. Has had no spasms since. This was three years ago.

Epilepsy requires most careful and painstaking examination as to etiology and diagnosis. Specific diagnosis, in this disease, fully exemplifies the need and justifies the time for it, in the case under consideration.

LYMAN WATKINS, M. D., BLANCHESTEE, OHIO

In the treatment of epilepsy, as in all other conditions, I do not treat the name, but I treat the condition. I adapt the remedy to the symptoms. If I was to write fully on this subject my method would be contrary to the popular habit of applying remedies to nomenclature rather than to the patient.

I regard epilepsy, even iodopathic epilepsy, as but a symptom, the cause of which, with our limited powers of diagnosis, we are unable to determine, but a cause there certainly must be, as no disease occurs without a cause. The different forms of epilepsy require recognization and this includes a study of the low potential and premature fulmitating neurons of the Jacksonian type, and the inveterate hereditary forms.

The remedies that may be used, include almost our entire therapeutic resources as well as careful dietary, hygienic, and psychic measures.

F. H. FISK, M. D., NASHVILLE, TENN.

No two cases of epilepsy will be found to be similar, and it is impossible that any one course of treatment should be found to suffice for all. This disorder cannot be treated as a disease, per se. Each case must be studied to determine the exact conditions present at the time of treatment. I have not depended all on the bromides, in fact I very seldom prescribe them. I have found the following vegetable remedies, used alone, when indicated, to give good results; oenanthe crocata, solanum, gelsemium, and passiflora.

I have obtained satisfactory results from combining gelsemium and solanum in some cases. In others I have combined gelsemium and passiflora, following in each case most closely, the indications as then existing.

The other measures and remedies that I have found necessary to use, are those which would conduce to the general health, which must in every case have first attention. The diet is exceedingly important, and the food for each patient must be selected for that patient with great care. In accordance with our method of the specific adjustment of remedies to specific conditions we find indications in nearly every case, which demand remedies, often not prescribed for epilepsy, but which will yield the most satisfactory results in the case under treatment if clearly indicated.

J. B. MATTHEWS, M. D., BLUE MOUND, ILL.

In the treatment of epilepsy I depend to a considerable extent upon the use of the bromides. I have, however, used valerian more than any other one remedy. I give this alone, or in combination with phytolacca, using not only the bromides but the iodides as well, when they are plainly indicated.

I have obtained excellent results from a formula which I have used in a good many cases. It is a combination of the above remedies as follows: Bromide of potassium, three ounces; bromide of ammonium, one and one-half ounces; iodide of potassium, one and one-half ounces; fluid extract of valerian, half an ounce; water sufficient to make two pints. Mix. Sig.: Give a teaspoonful every two hours.

DR. GEMMELL, OF FOREST, OHIO

I have frequently made the observation that oenanthe crocata in the proportion of five drops in four ounces of water, given in tea-spoonful doses every four hours, is specific in those cases of epilepsy where there is a tendency to failure of the mind—increasing mental weakness, or threatened idiocy or imbecility. When this condition is present in even extreme cases, I have obtained complete and satisfactory results from the use of this remedy alone. I have not found it of much benefit in other forms of epilepsy.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.