ART. I.-BROMIDE OF POTASSIUM IN EPILEPSY. By B. W. STONE, M. D., Assistant Physician Western Lunatic Asylum, Kentucky. Much has been said and written lately of the value of bromide of potassium in the treatment of epilepsy. Few physi cians consider the remedy destitute of virtue in this disease; some have certainly overestimated its value. Dr. J. Russell Reynolds, London, and Brown Sequard, of Paris, have probably made as extensive trial of the medicine as any others, and the views of these distinguished physicians certainly are entitled to the highest consideration. They have agreed in their verdict as to its value. Of the cases under their charge, some (a considerable portion) seemed to have been relieved; at least have had no seizure for years, and are still well; others have gone for several months, even a year or two, without a seizure; and in the omissions of the medicine attacks re-commenced. These ceased again when the medicine was re-administered. In a third class the spells were materially moderated in severity, and were somewhat less frequent; these effects invariably ceased upon the withdrawal of the medicine. In a small proportion the drug was of service for a time; and afterwards seemed to lose its efficacy entirely. In a smaller number still it was of no service whatever. These results accord generally with those we have obtained from the use of the medicine in the management of epilepsy as it exists in this asylum, though to a less favorable extent; our cases generally being of a more serious type than those to be found outside of lunatic hospitals. The cases (between fifty and sixty in number) comprise a few slightly deranged; many who are periodically furiously maniacal, and a few demented; all of these have been under treatment with the bromide of potassium at different and for varying periods of time. With a large number the medicine has been constantly used for eighteen months. Only one patient seemed cured, a man, aged twenty-eight, was under treatment in the asylum four months for epilepsy, le haut mal, caused by fright during the late war. The spells which previously had occurred every day or two entirely ceased on the exhibition of the bromide. He took 22 grains bromide of potassium, and 3j. tincture of hops three times a day in about a gill of water. The dementia, under which he had been laboring, subsided, and he left the asylum, having promised faithfully to continue taking his medicine for fifteen months, and report to me immediately should his spells recur. We think he will carry out these promises, as he seemed anxious to recover entirely, and we promised him a better prescription should the one he was using fail, having previously endeavored to impress him with the conviction that we were "death on fits." Two cases had no epileptic seizures for periods of seven and nine months; after which both these refused obstinately to continue the medicine, avering they were cured of epilepsy, and their stomachs were being injured by the medicine. They had often neglected taking water with the medicine, a precaution necessary in long-continued use of bromide, as materially moderating the irritant effect of that drug upon the stomach. In ten days after the omission of the medicine both had convulsions. The medicine has been since recom menced with one of these, with its original effect. Eight patients have had over four months respite from the convulsions; twelve or fourteen have passed over two months without having a recurrence; a larger number over one month. About twenty patients were treated irregularly, the complications and other circumstances rendering the idea of cure hopeless. The medicine was administered to this class mainly (though all, with a small exception, had trial of the medicine for several consecutive months, in order to fully test their curability) during periods when they were afflicted with an unusual number of convulsions to check them and lessen their severity; this effect was generally obtained; and in not more than a half-dozen of the epileptic patients in the asylum has the beneficial effect of the bromide of potassium not been clearly manifest in some degree. The administration of the medicine has, in most instances, we believe, been faithfully attended to. The well-known, almost universal eagerness of epileptic patients for medicine, as well as the desire on the part of attendants to ward off the most violent and dreaded form of maniacal attacks, which often follow the convulsions, both together generally insure a pretty regular administration of the remedy. In the selection of a prescription for general hospital use, we defer to the experienced judgment of Brown Sequard, who combines with the bromide the iodide of potassium, the bicarbonate of potassa, and the bromide of ammonium, in about the following proportions: [We have used this prescription for the past thirteen months almost altogether.] R-Potasse bicarbonatis, 3ij. Ammonii bromidi, 3vij. Potassii bromidi, iij. Infus, calumbæ (British) Oj. Give a teaspoonful before each meal and three teaspoonfuls at bedtime, to be taken in water. The quantity of the bromide of potassium may be increased to ninety grains during the twenty-four hours, which is certainly a sufficient quantity, under any circumstances, for long-continued use, though we believe few require more than the quantity (673 grains) prescribed as above by Brown Sequard. At least fifteen or twenty of the patients taking the prescription have had upon the face and else where the vesicular eruption, which sometimes follow the administration of the bromide and indicates its full effect. For curative results the prescription should be taken for at least fifteen or sixteen months. The opportunities of watching patients at night in order to ascertain certainly whether or not they have had spells, have not been good, with a few exceptions it is, however, certainly extremely rare that persons have convulsions during the night, without being heard by fellow patients or attendants in the ward; there is also but little trouble in detecting, after the patient has arisen in the morning, that he has had a convulsion by the sluggish, stupid countenance and demeanor nearly always present. It is, of course, impossible that the bromide, or any other remedy, can ever relieve every case of epilepsy, originating as it does from so many different causes; the subsequent and dependent brain changes also being often of very degenerate character. The following case will abundantly establish this: The patient, a man, aged forty-five, had had epilepsy for a number of years; knew no cause of his affliction; had taken the bromide with but little effect. After his death, about eleven months ago, a num ber of osteophytes were found upon the surface of the dura mater; also a cylindrical mass of probably the phosphate of lime, three-quarters of an inch in length and one-half inch in thickness, embedded in the posterior lobe of the right hemisphere. (We preserved the specimen exhibiting this, it is now in possession of Prof. J. M. Holloway, of Louisville.) The partition between the lateral ventricles was entirely broken down, seemingly by ulceration-there were three ounces of fluid in the ventricles, about two ounces in the cavity of the arachnoid. There was no indication, during life, of paralysis, with the ex ception of a slight deficiency of articulation. In cases such as this, remedies may palliate, may ward off for long periods the convulsions, but can never entirely relieve. In conclusion, although owing, no doubt, to the grave and troublesome complication of insanity with all of our cases, we may have not yet effected any cures with the bromide of potassium, the efficiency of this drug in prolonging, in some cases indefinitely, the interval between the attacks, in often warding off immediately threatening attacks, in procuring sleep and relief from the terrible cephalalgia so often preceding or succeeding convulsions, in moderating the convulsive movements (during spells), in shortening their duration, certainly makes it an invaluable boon to the epileptic. No one will neglect the use of this remedy, so valuable in the amelioration of the condition of the unfortunate subjects of a most terrible malady, even though it may be powerless to cure. ART. II. SOME REMARKS SUGGESTED BY A REVIEW IN THE RICHMOND AND LOUISVILLE MEDICAL JOURNAL OF JANUARY, 1871, etc., of Dr. S. S. SATCHWELL'S Paper, termed "The Topography and Diseases of New Hanover County, and a Reply to the Paper previously Contributed by Dr. W. A. B. NORCOM, of Edenton, N. C." By R. E. PEYTON, M. D., The Plains, Va. Upon the merits of the two "papers" above named the writer of these remarks can say nothing, as he has not seen either of them, and knows nothing more about them than what is stated in this brief review. It is for some of the positions assumed by the reviewer, and by other writers, whose papers have appeared at different times in this journal, that these remarks are intended. To make this paper as brief as possible, I will state that I understand the reviewer, and the other writers alluded to, to take the position that the distinguished practitioners of an age |