402 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



which may exist in the brain or intestines, etc. Whether the theory 

 be right or wrong, the success which Schroeder van der Koltfs mode 

 of treatment has attained imperatively demands its adoption. In two 

 very severe but still recent cases of epilepsy I have applied leeches to 

 the back of the neck (four at a time), repeating the application at in- 

 tervals of from a fortnight to four weeks. The after-bleeding was en- 

 couraged by means of elastic cups. The influence of this treatment 

 upon the number and violence of the fits was so brilliant that I could 

 not make up my mind to desist from the blood-letting, and to proceed 

 to the derivatives and medication. If the measures advised in discuss- 

 ing the causal indication, as well as the procedure above proposed, 

 remain without effect, nothing is left but to have recourse to the 

 remedies which are reputed to have a specific action against epilepsy. 

 It would savor too much of pessimism to deny that the commendation 

 awarded to these articles is based upon a certain amount of benefit 

 derived from them, but, unfortunately, it must be admitted that we 

 are quite ignorant as to the conditions under which one or other of 

 them is to be preferred. In this respect the most experienced physi- 

 cian stands upon a par with the tyro. He must try one or other of 

 these remedies, and, if it fail, must try another ; and, in this frightful 

 disease, he should never remain idle on account of mere theoretical 

 considerations. With respect to the use of the anaesthetics and nar- 

 cotics, excepting atropine, we agree with Schroeder van der Kolk in 

 condemning them, and for similar reasons. In epilepsy our task is not 

 to allay an exalted sensibility or pain, but to soothe the undue reflex 

 irritation which causes the convulsions. Now, narcotics actually tend 

 to increase reflex irritability, insomuch that in large doses they pro- 

 duce convulsions. Chloroform, too, although it interrupts sensation 

 generally, augments the reflex action. A person under its influence 

 is like a decapitated frog ; its reflex movements are more active than 

 ever, although it feels no pain. Atropine is an extremely energetic 

 article, but it seems nearly always to act favorably upon both the se- 

 verity and number of the fits, even in cases of very long standing. 

 True, I have not seen complete recovery of inveterate cases, and T 

 have never used atropine in recent ones. Moreover, even at a dose 

 not exceeding one-fiftieth of a grain, not only did some of my patients 

 complain of a disturbance of vision, so that they could not do the sim- 

 plest work, but they suffered for hours with a dryness in the throat 

 which actually prevented them from swallowing solid food. Trousseau, 

 who believes belladonna to be the most efficient remedy against epilepsy, 

 gives the following directions for its exhibition with his characteristic 

 thoroughness and precision : Extract of belladonna and the pulv. herb, 

 belladonna, aa 3j, are to be made into one hundred pills. Of these 



