EPILEPSY.
Grave doubts must be entertained about all recent reports of the discovery of a causal microbe in this disease; though the trend of opinion is strongly in favour of a toxmnic theory, this view has not yet led to any advance in treatment, this being still purely symptomatic or empiric. The management of the patient during an attack, immediately before and after an attack, and in the intervals between the attacks, may be separ ately considered.
During an attack of convulsions the physician should abstain from too active interference; all constrictions about the neck or throat should be removed, and the patient placed flat upon his back if he has not already naturally assumed this A soft pillow may he placed under his head, and attention given to the state of his mouth. If the tongue protrudes, a large cork or piece of rubber tubing may be inserted between teeth to prevent its being injured. Any food or artificial teeth should, if possible, he removed from the mouth. It is useless to make attempts to restrain the movements by forcibly holding down the convulsed limbs; all that can he done is to watch and see that the patient inflicts no injury upon himself during the clonic spasms, especially hyliammering his head against the floor or any hard object.
The following plans have been found to modify the severity of the clonic convulsions in some cases, and very occasionally they may avert a cning attack when resorted to just before the seizure—viz., pressure over the carotid artery upon each side by thrusting the thumbs deeply against the skin at the root of the neck, and making firm pressure backwards, or compressing the tissues very firmly between the thumbs and the spine. Nitrite of Amyl may he inhaled, and when the attack is of long duration Chloroform may he administered, but the occasions on which the latter drug is indicated during the attack are very rare. When a distinct aura or warning is experienced the above measures may be tried in order to prevent the attack; the best results are to be expected from the Amyl. Tying a ligature tightly round the limb where the aura is felt, or irritating the region by pinching, pricking or galvanism may put off the seizure. Where contractions of muscles warn the patient that an attack is coming on, prompt forcible extension of the contracted limb sometimes is effectual. Many other means have been discovered and resorted to by patients who I experience warnings—thus violent breathing, shouting, jumping, electric shocks, ammonia and pungent snuff have been utilised by patients who have found their employment to cause postponement of the attack.
Counter-irritation to the spot in which the aura is felt, or blistering of the limb above the spot, sometimes prevents further attacks. If any portion of the body is discovered upon which pressure or irritation causes an attack to come on, Brown-Sequard advised counter-irritation of this site.
The treatment of the patient immediately after the cessation of the convulsive movements should consist in leaving him entirely to the natural undisturbed sleep which usually supervenes; no attempt should he made to arouse him suddenly by shouting into his ear or roughly shaking him. His friends should, however, be warned to watch him for a short time, as sudden homicidal or other impulses in some patients are liable to manifest themselves in the post-epileptic condition.
Between the seizures the following should be attended to: Diet should be moderate in amount and varied; over-eating after long fasts is most injurious; the meals should be light, all food being thoroughly masticated and taken at regular intervals of 4 or 5 hours, a heavy supper being especially forbidden. Animal red foods should be restricted unless when the patient is following some occupation which entails free muscular exertion. Fish and poultry afford a good routine, with eggs, fresh vege tables and farinaceous foods; tea and coffee should be used sparingly and alcohol in every form avoided. Many patients do best on a strict vege tarian diet, and this is the writer's routine when the patient can be got to consent to it. Gowers stated that no advantage is derivable from a purely vegetarian diet, but he admitted that many epileptics find it advisable to abstain from beef. The best and only rational procedure is to educate the patient to change his diet for a month or two at a time and to keep a correct register of his attacks, from which valuable information may he obtained regarding the most suitable foods for his maintenance. A Koumiss or sour milk dietary may be advantageously used from time to time. A salt free dietary has been shown to he of value by Richet, as by this means the necessary amount of Bromides may be considerably reduced in the drug treatment of the disease.