Read Ebook: Treatise on Thermodynamics by Planck Max Ogg Alexander Translator

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General premonitory symptoms in 47.4 per cent. Special Aurae in 72.8 per cent.

Prolonged vertigo in 46.4 per cent. Headache in 21.4 per cent. Nervousness in 14.2 per cent. Drowsiness in 3.5 per cent. Faintness in 3.5 per cent. Depression of spirits in 3.5 per cent. Cramps in 3.5 per cent. Numbness of extremities in 3.5 per cent.

Loss of sight in 2.3 per cent. Loss of speech in 13.9 per cent. Loss of hearing in 2.3 per cent. General tremor in 16.2 per cent. Tremor of one foot in 2.3 per cent. Sensation in epigastrium in 6.9 per cent. Sensation in abdomen in 4.6 per cent. Sensation in throat in 6.9 per cent. Sensation in left side in 2.3 per cent. Sensation in both hands in 2.3 per cent. Sensation in one hand in 2.3 per cent. Violent pain in head in 2.3 per cent. Pain in one foot in 2.3 per cent. Sparkling sensation in eyes in 6.9 per cent. Pumping sensation in head in 4.6 per cent. Noises in ears in 4.6 per cent. Diplopia in 2.3 per cent. Contraction of one leg in 2.3 per cent. Rotation of head in 2.3 per cent. Distortion of face in 2.3 per cent. Twitching of thumb in 2.3 per cent. Spasm of eye-balls in 2.3 per cent. Disagreeable smell in 2.3 per cent.

From these figures we find that in 34.4 per cent. of the cases of epilepsia gravior there are no special symptoms announcing the seizure, which takes place without warning of any kind; and it is especially in such cases that patients in falling, seriously injure themselves. In 65.5 per cent. there are premonitory symptoms of some kind, which indicate often many hours before the approach of an attack. Of these last 47.4 per cent. are of a general character, and in no less than 72.8 per cent. is there a distinct special aura, which in 25.4 per cent. alone precede the attack, the remainder being associated with the general premonitory symptoms.

The tongue was bitten in 68.8 per cent. The tongue was not bitten in 31.2 per cent.

Average of one or more attacks per day in 8.8 per cent. Average of one or more attacks per week in 31.1 per cent. Average of one or more attacks per month in 32.2 per cent. Average of one or more attacks per year in 15.5 per cent. At longer or more irregular intervals in 12.2 per cent.

This roughly indicates that, in the majority of cases, attacks of epilepsia gravior occur one or more times weekly or monthly. Under the last series, of attacks taking place at longer and more irregular intervals than a year, are included those cases where a few only have occurred during the lifetime of the patients.

Attacks occur at regular intervals in 21.1 per cent. Attacks occur at irregular intervals in 78.8 per cent.

Attacks only during sleep in 8.8 per cent. Attacks only during day while awake in 8.8 per cent. Attacks only during early morning in 15.5 per cent. Attacks at no particular time in 55.4 per cent.

The chief feature of this observation is that in 15.5 per cent. of cases of E. Gravior the attacks always took place immediately after the patients had wakened in the morning, and this is probably due to the sudden alteration of the cerebral circulation from the sleeping to the wakeful state.

Return to usual condition in 12.2 per cent. Drowsy in 66.6 per cent. Confused in 14.4 per cent. Stupid in 13.3 per cent. Irritable in 14.4 per cent. Excitable in 3.3 per cent. Vertigo in 13.3 per cent. Headache in 41.1 per cent.

The above conditions may last from an hour to several days.

Healthy in every respect in 17.7 per cent. With some abnormal peculiarity in 82.2 per cent.

General health good in 75.5 per cent. General health impaired in 24.4 per cent.

Robust in 66.6 per cent. Not robust in 33.3 per cent.

Intelligence intact in 74.4 per cent. Intelligence impaired in 25.5 per cent.

Loss of memory in 58.8 per cent. No loss of memory in 41.1 per cent.

Stupid in 16.6 per cent. Dull in 31.1 per cent. Irritable in 25.4 per cent. Frequent headaches in 41.1 per cent. Frequent vertigo in 22.2 per cent. Nervous in 21.1 per cent. Special diseases in 21.1 per cent.

Of the 21.1 per cent. under the heading of special diseases, there were--

Hemiplegia in 6.6 per cent. Paralysis of seventh nerve in 1.1 per cent. Impediment of speech in 1.1 per cent. Cicatrix over sciatic nerve in 1.1 per cent. Idiot in 1.1 per cent. Anaemia in 5.5 per cent. Phthisis in 2.2 per cent. Confirmed dyspepsia in 1.1 per cent.

From these details it is evident that epilepsy is not of necessity associated with impairment of the physical or mental health. On the contrary, we find that in 17.7 per cent. of the patients there was apparently no flaw of any kind in their constitutions, which were absolutely normal, with the exception of the periodic seizures. In no less than 75.5 per cent. was the general health good, and in 66.6 per cent. the patients were robust and vigorous. At the same time the health was markedly impaired in 24.4 per cent., and the sufferers were of delicate or weak habit in 33.3 per cent. The main fact, however, to be observed is that, in the majority of cases of epilepsy, the general health and vigour of the patient is not deteriorated. In the same way, the intellectual capacities are not of necessity affected. In 74.4 per cent. the intelligence is recorded as not seriously impaired; and in 41.1 per cent. the memory as good. On the other hand, the mental faculties were markedly deficient in 25.5 per cent.; the patients were dull and slow in 31.1 per cent.; and in more than half, or 58.8 per cent., was there evidence of loss of memory. Another frequent symptom is repeated and constant headache, which, in the present series of cases, existed in 41.1 per cent.

This occurred altogether in 38 per cent. of the total number of cases. In these it occurred--

Thus when epilepsia mitior exists, in the majority of cases the attacks are of daily occurrence.

Complete in 48.3 per cent. Partial in 51.6 per cent.

No aura in 20 per cent. Sensation in epigastrium in 20 per cent. Loss of speech in 10 per cent. Violent pain in head in 10 per cent. Tingling of extremities in 10 per cent. Choking sensation in 10 per cent. Hallucination in 10 per cent. Vertigo in 10 per cent.

The number of cases in E. Mitior is too limited to warrant further generalization.

FOOTNOTES:

Reprinted from the "British Medical Journal" of March 15 & 22, 1879.

AN INQUIRY

INTO THE

ACTION OF THE BROMIDES ON

EPILEPTIC ATTACKS.

Bromide of potassium is generally recognised as the most effective anti-epileptic remedy we at present possess. There exists, however, great difference of opinion as to its method of administration and to the amount of benefit which we may expect from its use. Some physicians who employ the drug after one method come to totally different conclusions as to its efficacy from those who use another. Many believe the remedy to be only useful in certain forms of the disease, and to be very uncertain and imperfect in its action. Others, again, maintain that it is positively injurious to the general health of the patient. These and other unsettled points the following inquiry attempts to make clear.

Epilepsy, like all other chronic diseases, presents great difficulties in scientifically estimating the exact value of any particular remedy; and unless the investigation of the subject is approached with the strictest impartiality, and observations made with rigid accuracy, we are liable to fall into the most misleading fallacies. I believe that these are to be avoided, and facts arrived at, however laborious it may be to the experimenter and wearisome to the student, only by the careful observation and elaborate record of an extensive series of cases. If, in epilepsy, the disease, from its prolonged duration, its doubtful causation and pathology, its serious complications and the many other mysterious circumstances connected with it, offers almost unsurmountable difficulties to any definite and uniform method of treatment and the systematic estimation of the same, its symptoms furnish us with tolerably accurate data upon which to base our observations. The attacks, although only symptoms, may be practically considered as representing the disease, as in the large majority of cases, in proportion as these are frequent and severe, so much the more serious is the affection. The influence of the bromides on these paroxysms is taken in the following inquiry to represent the action of these drugs on the epileptic state.

Before proceeding to detail the facts arrived at, it is necessary briefly to state the method of procedure adopted in treatment. Each case in succession, and without selection, which was pronounced to be epilepsy , was considered as a subject suitable for experiment. The general circumstances of the individual were studied; his diet, hygienic surroundings, habits, and so on, if faulty, were, when practicable, improved. The bromides were then ordered, and taken without intermission for periods which will subsequently be detailed. The minimum quantity for an adult, to begin with, was thirty grains three times a day, the first dose half an hour before rising in the morning, the second in the middle of the day on an empty stomach, and the third at bedtime. This was continued for a fortnight, and if with success, was persevered with, according to circumstances, for a period varying from two to six months. If, on the other hand, the attacks were not materially diminished in frequency, the dose was immediately increased by ten grains at a time till the paroxysms were arrested. In this way as much as from sixty to eighty grains have been administered three times daily, and, with one or two isolated exceptions to be afterwards pointed out, I have met with no case of epilepsy which altogether resisted the influence of these large doses; and, moreover, I have never seen any really serious symptoms of poisoning or injury to the general health ensue in consequence. Sometimes these quantities of the drugs have been taken for many months with advantage; but as a rule it is preferable, when possible, after a few weeks gradually to diminish the dose and endeavour to secure that amount which, while it does not injuriously affect the general condition of the patient, serves to keep the epileptic attacks in subjection. The form of prescription to begin with in an adult has been as follows:--

R. Pot. bromid., gr. xv. Ammon. bromid., gr. xv. Sp. ammon. aromat., m. xx. Infus. quassia, ad j

M. Ft. haust. ter die, sumendus.

According to the age of the patient so must the dose be

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