Constipation, so frequently present, is to be carefully guarded against; this object in the dietary should not be lost sight of, and hence one of the advantages of a vegetarian diet; boiled Spanish onion is a valuable aperient in all cases, and may be eaten freely. As auto-intoxication from the bowel may be the exciting cause of the seizures the intestinal tract must always be kept freely open, and occasional purgation by Salines should he resorted to when the diet fails to accomplish this desideratum.
environment of the epileptic has received much attention. An open-air life with abundance of exercise, unaccompanied by the excitement which follows such games as football, cricket or hockey, is essential. Any exercise or pastime which places the patient in a dangerous position during a seizure must be strictly forbidden, as cycling, horse riding, swimming, rowing, &c. This latter remark applies forcibly to the selection of a trade or occupation for the epileptic. An outdoor employ ment is always to be preferred, and as these are necessarily limited by the last-mentioned consideration the chief haven is that of farming or gardening.
The Township or Colony System meets all the requirements of the artisan and lower middle classes, where an open-air life spent in market gardening or other occupation affords a means of profitably enjoying a useful if uneventful existence. But the benefit of such institutions shows itself even more clearly in the facilities which it affords for the mental and moral training of young epileptics whose backwardness or deficient abilities cannot be improved by ordinary' school lessons. The colony system can rescue many such feeble-minded patients from the certainty of their becoming hopeless wastrels. Easy mental exercises can he combined with simple carpentry, basket-making, or other primitive handicraft.
The question of marriage may be considered; this should always be as tit tidy discountenanced, and the marriage of a male with a female epileptic should hr regarded as little short of criminal unless the female be beyond the child-bearing period.
A careful examination must be made for the discovery of any source of reflex irritation, such as intestinal worms, eye strain, adenoids, nasal polypi, mechanical dysmenorrhoea, scar tissue involving nerve trunks, adherent prepuce. ear troubles, &c. These should all be remedied, the hygiene of the mouth seen to, and the possibility of masturbation should be delicately inquired into and stopped by moral education.
Drug Treatment.—Ifromides are the most valuable of all agents em
ployed in idiopathic epilepsy, but their action is probably confined to their power of diminishing the hyperexcitability of the cortical centres without effecting any urative power over the still unknown causal agent in the production of the seizures. As regards the relative value of the salts of bromine little need be said: where one is markedly beneficial any of the others will also prove efficacious. The best routine practice is to employ the Bromide of Sodium, as its base is less depressing than potas sMin. when large doses must he given for long periods. 6o grs. may be daily taken in three divided doses of 20 grs. each freely diluted after meals, and this amount may be continued for many months or even years, without intermission. Sometimes. hut not often, larger doses may be required, and some physicians press the remedy till its full physiological effects of drowsiness and loss of the palatal reflex are obtained. It is claimed by many observers that smaller doses suffice when sodium chloride is elimi nated as far as possible from the diet, or when Chloral is combined with the Bromide. Valuable information may be obtained regarding dosage by a scrutiny from time to time of the register of the attacks kept by the patient or by an intimate associate. The dose should be reduced as the attacks become less frequent, and sometimes when this is undesirable the symptoms of bromism may he minimised by changing from one bromide to another. Bromipin or Brominol, which is an additive compound of bromine and sesame oil, may often he advantageously substituted for the soda salt in doses of 20 to 3o mins. of the 33 per cent. solution in syrup. llydrobromic Acid is extolled by some authorities, hut the writer finds it the least reliable of all the bromine preparations.
After a first seizure this treatment should be kept up for at least a year, since every epileptic seizure is believed to leave the nerve centres more susceptible to further attacks, but should the convulsion recur a pro longation of the treatment for two years after the second or subsequent seizure should be insisted upon. Before finally stopping the bromide, one large dose may he given nightly whilst the day doses are suspended, and a single large dose (6o grs.) may be used at bed-time only when the epilepsy is of the true nocturnal type throughout. The tendency towards acne may be minimised by combining 2 to 3 mins. Fowler's Solution with each dose.