headache. We put her in the pack, and during the day she had three slight convulsive seizures.

On account of her age, her obesity, and the slight chance of saving the child, it was decided to wait before delivering, unless the convulsions continued or increased. It seemed a mild case if such a term can ever be applied to Eclampsia. A sample of her urine showed only a moderate amount of albumin. In the evening, twelve hours after the first convulsion, the os was dilated, with the idea of inducing labor and allowing delivery to take place naturally if it would. The os surprised us by dilating rather easily, and safely, and then it was found that the cord was beating faintly. The child being small and the head of course very compressible, at seven months, a version was done and a living child delivered, without injury to the mother. Both are well at the present time.

Case 3. Mrs. C― Primipara; age thirty-five years. Operated for extra uterine pregnancy two years before. Health good; habits regular; plenty of exercise; careful diet, etc.

Slight decrease in proportion of urea toward close of pregnancy, but this improved with more strict diet. At this time trace of albumin, and a few hyaline casts were found. Slight occasional nausea toward close of pregnancy. Labor was normal in every way. She was given a little ether during the perineal stage, and was a bit restless following. An hour and three quarters after delivery she complained of severe pain in the back of her head, and immediately went into a convulsion. These continued at intervals of half an hour to an hour for nearly twenty-four hours. After twelve hours, morph. sul., wet pack, rectal saline, and chloroform were used, but not being followed by improvement, she was bled 12 or 14 oz. and three pints of saline were allowed to run into the vein. All the symptoms improved at once. The skin became more active; urine passed, as evidenced by the odor. Intervals between the convulsions increased, and they finally ceased. The breathing bebecame easier, and she seemed in a natural sleep from which she could be partially aroused to swallow. She made a complete recovery and baby is well.

Case 4. Mrs. D- Primipara; twenty-eight years of age; nervous active temperament. Health during pregnancy good; no nausea, or vomiting; no headache. Increased in weight some thirty pounds. A decided trace of albumin, one week before trouble began; urea normal. Patient was taken with vomiting, epigastric pain and headache with confusion; ankles swollen. Immediate hot wet pack, rectal saline, etc., were used. She felt better; skin became moist, and she went to sleep. Two hours later a convulsion occurred. Convulsions followed at intervals of about an hour, and she became unconscious. She had 20 grains of chloral hydrate from a physician called at

the moment. Later was removed to the hospital, and the convulsions continuing, chloroform was given, and patient delivered by podalic version. She lost a considerable amount of blood, rather more than the average amount in a normal labor. She was put to bed with hot wet pack, and a rectal saline administered. Convulsions continued once in ten minutes for five or six hours. Chloroform continued lightly most of this time. Then she was bled 8 or 10 oz. and two pints of saline given by the veins. There was improvement for a time, when the convulsions returned with greater severity and frequency.

Twenty hours after delivery she had three convulsions in ten minutes, and then one which lasted ten minutes. She was evidently going bad very fast, A vein in the other arm was opened and allowed to bleed until the patient's face showed a change; two pounds by actual weight were removed and then three pints of saline injected. One slight convulsion followed, but that was the last. She has made a complete recovery.

DISCUSSION OF DR. EARL'S PAPER.

Dr. Caroline E. Hastings:- Dr. Earl has given a plan of treatment for Eclampsia which so far as the hot pack and the giving of much water to drink are considered is, as he has said, rational, and one to which there may be no objection; but when it comes to bleeding it is a question whether we have not entered into the realm of the irrational and the dangerous. The point which he makes, that in the administration of drugs in massive doses, "the patient has both the original and the drug disease to combat" is well taken. But in this plan of treatment, no place has been given to, nor any recognition made, of the law of cure which gives to us the distinctive name of Homœopathists; of which name, I am sorry to see some seem to be anxious to divest themselves. Dr. Earl states that there is no known antidote. I believe there is an antidote, viz:- the indicated remedy, in each given case; and as proof of this, I wish briefly to relate how a series of thirteen (13) cases of Eclampsia occurring in Talitha Cumi Maternity Home, during the last eighteen years, have been treated, without the loss of a case. All cases coming into this home are primiparæ, and as a rule are in the Home several weeks before confinement. Upon the first indication of kidney complication, the patient is put upon a milk diet-and remedies administered as called for by the indications. In this way we have reason to believe some cases of convulsions have been averted, but as has been stated, during the last eighteen years thirteen (13) cases of Eclampsia have occurred. None of them have received a hypodermic injection of morphia. None of them have been put into the hot pack. One only has been put under ether. Not one has been bled. I shall not attempt to relate each case; time will not permit me to.

In the first case to be mentioned, convulsions came with the beginning of labor. Delivery was effected by version, but convulsions continued after delivery. Belladonna was the first remedy given, but later the indications for opium became clear; stertorous breathing, coma, hot sweat. Opium c. m. controlled the case.

In a second case Eclampsia did not appear till four or five hours after a normal delivery. The paroxysm began with sighing, groaning and stretching of the arms and legs. Ignatia was given and amelioration followed for a time. Then paroxysms became more violent; the face took on a bluish color, and the convulsions began in the eyelids, and extended to all the facial muscles; then became general. Hyos. c. m. in water was given. Previous to the giving of hyos. the paroxysms had become almost constant. The first dose was followed by an interval of forty-five minutes;-a second dose was given-and followed by an interval of two and one half hours. Another dose and — no more convulsions.

The above illustrates the method of administrating the remedy in all casess-a dose to be repeated after the recurrence of the paroxysm. In this case three doses were given.

In another case there was a series of sixty-nine paroxysms before a remedy was found which entirely controlled. It was very difficult to find the indicated remedy, as the symptoms were not clearly defined. Finally the rolling of the head and the boring of the head into the pillow, and the squinting of the eyes called for hellebore, which relieved very promptly and markedly. Here as before the remedy was given only after a recurring paroxysm, and three doses were sufficient.

In

Two cases were relieved by stramonium. In the first case, the graceful gyratory motions of the arms, lifted above the head was the keynote which led to the choice of stramonium. the second case in which Eclampsia came on after the birth of twins the one weighing eight, the other seven pounds the symptom which decided for stram. was a frightened look on going into and coming out of the convulsion. Stram. controlled, and rapid recovery followed.

The last case in the Home occurred during the last year. The girl fell in a convulsion while dressing at seven o'clock in the morning. She was delivered at 7 P.M. of a stillborn, 9 pound boy. During the twelve hours there were forty-three paroxysms. Bell. 2c. ameliorated but did not control. Bell. c.m. controlled. Here the symptoms were the flushed face, widely dilated pupils, and convulsion following each contraction of the

uterus.

I well remember the first case of Eclampsia to which I was called in the early years of my practice. The patient, an entire stranger to me had fallen from her chair in a convulsion. In

this case version was performed and the child was born alive, and is alive to-day as far as I know. The convulsions did not cease and I was besought by the friends to give ether. This I steadily refused to do; but instead gave opium 4x, and with such marked results that the friends were quite satisfied to let me conduct the case without further interference. In two weeks the patient who was boarding at the time, was housekeeping. I attended her again in less than two years and the case was normal in all respects.

Dr. Earl made mention in his paper of the fact, that, "steadily failing vision," in one case prompted him to hasten his method of treatment. I am wondering whether cocculus would have given relief to his patient. In the symptomatology of cocculus we find under eyes; "Pain in the head and eyes followed by blindness. Puerperal Eclampsia." Puerperal Eclampsia." I think one cannot fail to notice in the recital of these cases, that symptoms were the guides to the selection of the remedy. And just here comes in the beauty of, and the great dependence which can be placed upon, the law of cure as discovered by Hahnemann. To one who does not make use of this law, a convulsion is a convulsion and nothing more; or to quote Wordsworth

"A primrose by the river's brim

A yellow primrose was to him
And nothing more-"

With all due respect to the satisfactory results as shown by Dr. Earl's paper, may we not still inquire whether there is not for us a more excellent way? It is a more painstaking method and one which does not give the appearance of doing every thing that can be done, but in view of the results as illustrated by the thirteen cases I have referred to, with no loss of life and no complications remaining save in one case in which there was right-sided paralysis, which entirely disappeared in three weeks under phos., in view of these results is it too much to claim that the indicated remedy is an antidote?

Dr. George R. Southwick:-Dr. Hastings is to be congratulated on the successful treatment of a series of thirteen cases, some of which were severe. She has shown the courage of her convictions and her record is one to be proud of.

Besides the advantages of venesection which have been mentioned by Dr. Earl, another can be added. It is valuable to relieve the right side of the heart when the accents of the heart sounds are becoming equalized, the right ventricle overloaded with venous blood and the patient cyanosed.

When immediate delivery of the patient is a necessity, the Bossi dilater, though not safe, is less dangerous than Cæsarian section by either the abdominal or vaginal method.

The Champétier de Ribes' bags have been invaluable to me in some cases when immediate delivery was not imperative. The birth canal is fully and fairly rapidly dilated by them to nearly or quite full size. The presenting part of the child, usually the head, is protected from injury and pressure and premature infants are born in good condition, which would not have survived forceps or version, or even the traumatism of normal labor.

I saved in this way an infant of less than seven months, weighing only two and a quarter pounds which could have been seated in a pint measure, Her father's finger-ring easily passed over her arm and shoulder. She is now a fine healthy

child about five years old.

Dr. Earl:-In closing, I wish to heartily thank Dr. Hastings for emphasizing the use of remedies in eclampsia, and I am free to confess that that side of the question less often occurs to me than perhaps it should. It is largely lack of industry in learning the indications. From natural inclination the mechanical aspect of the problem is the one first thought of by me. I seldom see these cases except in the midst of the storm, and then the questions of delivery and control of the convulsions, by eliminating or diluting the poisons are the ones uppermost in my mind.

EPILEPSY.

BY FRANK C. RICHARDSON, M.D., PROFESSOR OF CLINICAL NEUROLOGY, BOSTON UNIVERSITY SCHOOL OF MEDICINE.

The intent of this article is to present as concisely as possible such of the present day views of epilepsy as will be of interest to the physician in general practice.

Since the time of Hippocrates there has been a more or less continuous output of literature upon epilepsy, and while persistent pathological research has failed to give us more than a speculative knowledge of its pathogenesis, painstaking observation has accomplished much for its more exact interpretation.

There is an increasing tendency to differentiate between convulsions occurring in the course of evident ailments of various kinds and true idiopathic epilepsy. It is becoming the custom to regard convulsive seizures due to organic cerebral disease— sclerosis, tumors, cysts and the like, those reflex from infantile disorders, or accompanying hysterias, as well as those resulting from toxæmia uræmic convulsions, puerperal eclampsia, hydrophobia, tetanus and the drug poisons as symptomatic of these affections, and to restrict the term epilepsy to cases the sole, or at least essential, symptom of which is either general