Bromides certainly exercise a much more powerful action over the typical major attacks than over petit mal, but this does not mean that they should not be employed in the minor attacks also. One serious difficulty in pushing bromide treatment, especially in the latter type of the disease, is the appearance of symptoms of mental deterioration which are so liable to supervene; the patient and his friends get convinced that the mental condition is solely caused by the treatment, and they sometimes refuse to continue it. It certainly should not be pushed so far in petit mal as can with perfect safety be done in the major type of the malady. As soon as the diminished frequency of the attacks as counted by the chart or register demonstrates that the bromide has the disease under some degree of control it may be gradually reduced to 4o grs. per day, and ultimately to 3o grs., but its administration must be kept up for years as a rule. About i case in every to will be able to dispense with the drug entirely.
Brown-Sequard advocated the following solution of mixed bromides with iodide—viz., Pot. Brom. 3j., Ammon. Brom. 3iij., Pot. Iod. 5ij., Pot. Bicarh. 3j., Tr. Calumbie Aquw ad 3 j Of this a teaspoonful in water was given thrice daily before meals and 3iij. at bed-time. In petit mal the ammonium salt was increased and the potassium one diminished, and he continued this for S to ro years without harm, the dosage of bromide being almost II drs. daily exclusive of the iodide: a tonic bitter with Strychnine or Arsenic was given after meals.
Other drugs should be tried when the patient's register has proved that the bromide possesses no influence in diminishing the number and severity of the seizures.
Borax is the best of these. Before placing the patient upon full doses (to grs. ter die) it will be wise to test its action in half this amount com bined with the bromide. It may in its turn, if it fails, be combined with Tr. Belladonna to mins. or gr. Atropine, hut it is so liable to upset the stomach and to cause dermatitis that its use cannot be long continued. It is a good routine in the treatment of petit mal during the intervals when the bromide is stopped. Nitroglycerin in small oft repeated doses has sometimes proved of value alone, or in combination with bromide; if it is to do any good, this will become apparent after r to 2 weeks' trial; should it fail, Digitalis may be tried in a similar manner. These drugs are indicated in petit mal. Camphor Monobromide is beneficial in both types, and is less objectionable than Chloral when an hypnotic is required.
Antipyrinein the majorform has proved a valuable adjuvant to bromides, but its use should not be long continued. Flechsig combines Opium with
the bromide treatment in alternating courses, commencing with II grs. daily, which are gradually increased till 15 grs. opium are taken daily by the end of the sixth week. 2 drs. potassium bromide are then adminis tered every day for the next six weeks; this is reduced to r drs. during the third course of a month, and finally to 1 dr. daily during the next 12 weeks, no opium being given after the termination of the first six weeks. The writer has no experience of this method and would be slow to try it, owing to the danger of establishing the opium habit, but it might be quite safe in hospital practice where the patient was under close supervision.
Trousseau's routine when bromides failed consisted of Belladonna or Atropine alone; he gave the green extract in doses up to I i grs. ter die. Not more than r min. of the II.P. Liquor .1 tropias should he given.
Salts of Zinc (c grs. of the oxide), of Silver gr. of the nitrate), of Gold (,'„ gr. double chloride), of Copper (1 gr. ammonio-sulphate), of Cerium grs. of the oxalate), of Nickel (r; grs. of the bromide), of Lithium and Strontium (3o grs. of the bromide), of Calcium (15 grs. of the chloride)— these are but a few of the inorganic substances which have been tried and at times found valuable. But of organic compounds and vegetable preparations there is practically no end. These may he passed over with the exception of those already referred to.
In epilepsy occurring in syphilitic patients the routine treatment after a course of mercury %viten this drug has nut already been freely administered should he large doses of Iodides (6o grs. prr diem), but recent statistics prove that there is no sub thing as a true syphilitic epilepsy: Smits Fp/it/vie/ff.—This is often fatal. Chloroform should be admin istered at one and a large dose of Chloral Hydrate ((to grs.) should be given by the rectum. Nitrite of Amyl may be tried at the same time. Gowers obtained excellent results from the hypodermic injection of a full dose of I fyoscine ( to gr.). Bromides are useless, hut occasionally a full hypodermic of Alorphia is beneficial, and blood-letting has sometimes apparently saved life. Where hyperpyrexia is present the cold pack or ice to the spine and head should be employed. If the patient can swallow, full doses of Cannabis Indica with I lemlock Juice may be given or Coniine gr. to i gr.) may be administered by the skin. In the comatose stage with failing heart and respiration gr. Strychnine may be injected, but this drug should not he given in the early convulsive stage.