difficult. The pus which issued at this time seldom exceeded two tablespoonfuls in quantity. Very serious hemorrhages within the purulent cavity threatened life on many occasions in August and December, 1836, and June, September, and December, 1837. These appeared to have supplanted the epistaxis to which the patient had been subject. The quantity of blackish fluid and coagulated blood sometimes reached a pint and a half. On stopping the mouth of the fistula, the blood occasioned severe oppression, and even cough, with sanguineous expectoration. As soon as the issue was re-established these symptoms ceased.

From time to time the patient is troubled with abdominal symptoms, which a purgative removes. He has often, also, palpitations of the heart; the urine is then diminished, and the hands and feet are cedematous. Digitalis always disperses these symptoms. At present, as during the preceding summer, the patient feels very well, attends to his domestic duties, and even walks nearly three quarters of a mile at a time.-Medicinische Annalen, P. 4, Vol. IV.

1

Living Worms under the Conjunctiva of the Negro.'-Blot, of Martinique, has, like Bajon, of Cayenne, and Mongin, of St. Domingo, seen two worms in active motion under the conjunctiva, which he removed by incision. One of these, which was sent to M. Blainville, was thread-shaped, thirty-eight millimetres long, with a black protuberance adapted for suction.

Bajon remarked (1768) a serpentine motion of a worm in the eye of a negress, which, without giving pain, caused constant epiphora. When an incision was made, the worm went to another part, and was obliged to be secured with a small forceps. In a second case (1771), the conjunctiva was more inflamed; the patient refused to submit to operation. In Blot's case (1828), the worm lay on the outside of the eye, and sometimes turned round a portion of the corner, causing stinging pains and nervous symptoms, arising probably from fear. The patient, an African negress, was unable to tell where she came from, or whether her fellow-country people were subject to this disease. A surgeon at Mompox (New Grenada) offered to extract this worm, but his services were refused. The worms found by M. Guyon were not of the species termed Filaria Medinensis, which are found in abundance amongst Africans, and could not be secured by the forceps.

BOOKS RECEIVED.

From the Author.-Address of L. P. Hildreth, M. D., President of the third Medical Convention of Ohio, delivered at Cleveland, May 14, 1839. 8vo. pp. 33. Cleveland, 1839. [This address has already been referred to in terms of commendation-"Intelligencer," July 15th, 1839, p. 126.]

From Professor Silliman.-Annual Circular of the Medical Institution of Yale College for the Lecture Term of 1839-40. 8vo. pp. 8. New Haven, 1839.

From Messrs. Haswell, Barrington_&_Haswell, the Publishers—The Lectures of Sir Astley Cooper, Bart., F. R. S., Surgeon to the King, &c., on the Principles and Practice of Surgery, with additional Notes and Cases. By Frederick Tyrrel, Esq., Surgeon to St. Thomas's Hospital, and to the London Ophthalmic Infirmary, First American from the last London edition. Complete in one volume. 8vo. pp. 580, with four lithographs.

Philad. 1839.

THE

AMERICAN MEDICAL INTELLIGENCER.

Vol. III.

September 16, 1839.

No. 12.

For the American Medical Intelligencer.

ART. I.-PHILADELPHIA HOSPITAL, (BLOCKLEY.)

Cases of Epilepsy. Reported by WILLIAM H. MCKEE, M. D., of Raleigh, N. C. Senior Resident Physician.

The following cases are selected out of twenty-five, treated in the epileptic ward, to show the result of some of the remedies, which have been published heretofore as nearly specifics in the treatment of Epilepsy.

CASE NO. I.-Ann L., æt. 36. Born in Philadelphia: single. Habits temperate. Occupation that of house work. Has auburn hair, gray eyes, long neck, of tall stature, and lymphatic temperament. She had always enjoyed good health up to the time of the attack of the first fit. Cannot trace it to any hereditary predisposition. Her situation has always been very comfortable, having but few cares to molest her mind.

The first paroxysm she had was about three years since. During the time of her catamenial discharge, she was employed in scouring the floor; her feet became very wet and they disappeared. Previous to this time she had always been regular. On that night she was taken with a violent pain in the head, which extended down the spine, and was attended with fever. No physician being called in, she remained in this situation until the next morning, at which time she had the first fit. A physician was now sent for, who prescribed a warm foot bath and a purgative. This gave relief, and soon enabled her to enter upon the duties of the house. They have continued to occur periodically every four weeks for nearly two years. She entered the epileptic ward twelve months since. At the time of her entrance, her general health had become much impaired. But little or nothing was done for her during the first three months. Nine months since, she was ordered the following prescription. &. pulv. aloes, gr. iii. pulv. ferri sulph. exsiccat. gr. ter die: and a sinapised pediluvium at night. She continued to follow the above treatment for three weeks, at the expiration of which time her catamenial courses were again restored.

The pills being discontinued, she was put upon the use of the cuprum ammoniatum, commencing with one fourth of a grain three times a day, increasing it as high as one grain three times during the day, until it produced vomiting and the other slight effects of copper upon the system. It was then suspended. During this time she continued to be regular, but had several very violent fits. When seen in one of them, the cold douche was freely used, and it acted most promptly in shortening their duration and violence.

The cuprum ammoniatum was commenced again in two weeks-at the minimum dose, and used as before. It was thus continued to be used and suspended alternately for six months, with but little benefit, except that the fits had ceased to be so periodical. She was then ordered the nitras argenti,

commencing with half gr. three times a day, and increasing it up as high as six grains daily-continuing and alternating as above, until the skin became very much blackened. Her improvement had become so very evident, that she often asked to be discharged, saying that she was perfectly well. The paroxysm had not occurred for twelve weeks-when, to the great mortification of all, she had seven fits in thirty-six hours. They have not been so bad for the last two months. Her general health is very good, and she continues to menstruate regularly every month.

CASE No. II.-Isabella C., æt. 27. Born in Delaware: single, and of medium size. Occupation that of a chambermaid. Habits temperate; has always enjoyed good health until since attacked with the fits.

She was bound to service for five years. The first fit occurred in her 17th year. She states that none of her family were ever affected with them except herself. Has been remarkable for the regularity of her menstrual function, which has continued. The fits she attributes to personal abuse received from her employers during her apprenticeship. She was confined nine months in the Pennsylvania Hospital, at the expiration of which time, she was discharged, not much if at all benefited. After her discharge from the hospital, her friends took her home, with the hope that change of air and society might be beneficial to her. But, in a few weeks, she was seized with a paroxysm, and fell into the fire, burning one arm very seriously. For this accident, she was sent to the Philadelphia Hospital, where she remained for several years in the women's surgical and medical wards, under treatment both for the burn and the fits.

Three years since, she was transferred to the epileptic ward. During this time, very little was attempted towards curing or even mitigating the disease. The fits came on at different periods,-occurring two to four times a week. Eight months ago, she commenced taking the cuprum ammoniatum, beginning with the one fourth of a grain and increased it to a grain three times a day-alternately suspending it when the full effects were produced. While under this treatment, I saw her frequently, and during many of her most violent attacks. The douche was used in every instance with marked benefit. As she generally had from three to four at a time, I determined to try the effects of animal magnetism,' and succeeded in several instances in arresting the paroxysm. They soon returned as the influence gradually went off.

The longest interval that has occurred was some weeks. While sitting at the dinner table eating, she was unexpectedly seized with a fit and fell to the floor. She continued to have them for twenty-four hours-during which time she had fourteen fits. She is at present in good health, and is able to attend to some business. The frequency of the paroxysms is diminished, but when she has them they are much more severe.

CASE No. III.-Jane B., æt. 24. Born in Philadelphia: single, and very temperate. Has been labouring under, epileptic fits for the last four years; states that they were occasioned by a fright received at the time she had her menstrual discharge. She fainted, and lay insensible for some time, and the discharge ceased. On the following day, she had the first fit. They have returned periodically every four weeks until very lately. During all this time but little was done in the way of medical treatment. Their frequency becoming more marked and violent, her friends sent her to the epileptic ward twelve months since. Nine months ago, she commenced taking the cuprum ammoniatum. Commencing with the one fourth of a grain three times a day, and increasing it to three grains daily. This she continued to take for five months—intermitting it whenever the effects were produced.

My friend Dr. Joseph B. Cottman, from Maryland, (at present one of the senior resident physicians)-informs me, that he had a violent case of Epilepsy, dependant upon the suppression of the catamenial discharge, of which he succeeded, in several instances, in arresting the paroxysms by means of animal magnetism. soon returned after the influence had passed off.

But they

Deriving no benefit from this remedy, she was put upon the use of the nitras argenti. Beginning with one fourth of a grain, and increasing it to two grains three times a day, until the skin became discoloured, and the general influence was experienced upon the system. In this case there is no improvement. At the time of her attacks, she has two or three for several days at a time, and they have become so severe as to threaten cerebral disease. Her mind is impaired, and when attacked she has to be transferred to the women's lunatic asylum, where she is subjected to the shower-bath three times a day. By this means she is soon restored to her reason. catamenia are very regular.

Her

CASE NO. IV.-Ann L., æt. 35. Born in Philadelphia. Occupation, house work. No hereditary traces of disease. The first fit occurred when in her 17th year. Attributes them to over excitement, having exerted herself very much over the fire and eaten a quantity of sweetmeats. While in this heated condition, she drank freely of ice water, which she says soon threw her into a spasm. She has had various treatment-both in the Pennsylvania and Philadelphia Hospitals.

She commenced taking the nitras argenti, gr. 3, and increasing the dose to two grains three times a day, until the skin became blackened, and the effects were produced upon the system. The fits observed no regularity; they came on at any time, and, for seriousness, surpassed any in the ward. The remedy was suspended, and the cuprum ammoniatum substituted in the doses of one fourth of a grain to a grain, three times a day, and continued until the effects of the copper were felt, intermitting the remedy alternately, and commencing again. She is but very little improved, although she says her feelings are better, and different from what she has experienced for sometime.

CASE NO. V.-Elizabeth R., æt. 19. Born in Germany: single. Came to America when but two years of age. No hereditary traces. Was attacked with the first fit four years since. While waiting at a tea party, she became very much exhausted from the weight of the tea board, and suffered it to fall, breaking the china, and precipitating the whole on the carpet. At this accident, she was very much frightened, as well as mortified, fearing the severe punishment and rebuke that awaited her. To this circumstance she attributes the fits, which occurred on the following morning. In three days after, she had four fits, succeeding each other with considerable violence. A physician was now called, who bled her. She has continued to have them ever since, and has been attended by four different physicians during the time, without receiving any benefit. She remains regular in her menstrual functions, and says they have never been otherwise.

She entered the epileptic ward in March last. Five months since, she was put upon the use of the zinci sulphas-commencing with grs. iii. and increasing the dose to grs. v. three times a day,-it was continued for some time without any benefit being experienced, and then discontinued. The plumbi acetas was next ordered in the dose of five grains-and the dose was increased to ten grains three times a day,-intermitting the remedy when its influence was experienced. The frequency of the fits is not quite so great nor are they as violent. But this may be attributed to the improvement of her general health, rather than to the remedies used.

CASE NO. VI.-Catharine H., æt. 32. Born in Delaware: married. The mother of three children. Nine months after her marriage, while standing at the door, she was seized with giddiness and sense of turning in the head, and fell to the floor in a state of insensibility. At this time, she was four months gone with her first child. The paroxysms recurred every three weeks, and have observed the periodical attacks ever since. No medical treatment was attempted, except that she was occasionally bled when seen in a fit, as it was thought to be dependent upon gestation. After her delivery, they continued as before. She has always been regular until

lately, for which she was relieved by aloetic purgatives, and sinapised pediluvia.

In November 1838, she entered the epileptic ward for the purpose of receiving medical treatment. The zinci oxidum was given in the dose of v. to xx. grs. three times a day, without benefit. It was then discontinued, and the plumbi acetas substituted, in the doses of v. to x. grains three times daily, and continued for some time without experiencing any favourable results. This was also discontinued, and the nitras argenti given in the usual doses, the results being but very little better than from the other articles. She is now taking the cuprum ammoniatum, and says she is better. There is one thing very evident, that the paroxysms are not as violent as formerly-but they have taken on the cataleptic character.

General Summary and Remarks.-During the last ten months, twentyfive cases have been treated, and not a single one has terminated fatally. Various remedies were given. The indigo, from its reputation, had an extensive trial. It was used in "seven cases," commencing with half a dram three times a day, and increasing the dose gradually to giv. This was continued for six months, with occasional intermissions, until the patient's clothing would become stained blue by the perspiration. In the latter doses, it was found to operate upon the bowels-and, on examination, could be detected in the stools. If therefore giv operate upon the alimentary canal, the heroic doses recommended by some practitioners would seem to be a useless waste of the article, independently of the inconvenience of so great a bulk of an unpleasant remedy-so unpleasant that force is occasionally required to compel the patient to submit to it. Like the other articles tried, it at first promised favourable results, but was followed by a return of the fits with equal severity.

Four cases were treated with the datura stramonium. It was used both in the form of tincture and extract. After continuing its use for some time, it was suspended, and an interval of several weeks elapsed before it was resumed. Having given it another fair trial without experiencing any benefit, at the request of the patients it was discontinued.

A mixture of equal parts of salvia officinalis, pulv. sinapis and pulv. zingiberis, given in 3iii. doses every morning, followed by a purgative every third day, seemed, for a while, to exert more influence upon the fits than any of the remedies before tried. Out of four cases, treated with it, one, who had been subject to fits for fifteen years, experienced an intermission of fourteen weeks, when they were previously wont to occur from two to four weeks. At the expiration of this time, the patient was attacked with Icterus, and a return of the fits followed with as much violence as formerly. Galvanism was also tried in several cases, and in one it mitigated the disease very much. It was not tried, however, so thoroughly as the other remedies. A small blister was applied to the nape of the neck, and one to the scrobiculus cordis, which remained on for three hours. They were then removed, and the negative plate applied to the neck, and the positive to the epigastric region. When attacked with a fit, she suffered very much at the time, and afterwards from dyspnoea. The plates removed this symptom. Five months since, she was discharged relieved, and has been able to attend to the duties of a chambermaid. She continues to improve in her general health, and has had several attacks of faintness since her discharge, resembling catalepsy rather than epilepsy.

It will be seen from the result of the above observations, with the various remedies tried, that but very little preference-if any-can be given to one over another. In the treatment of epilepsy, there is no single remedy to equal the cold douche. In every instance in which it was tried, it invariably mitigated, and shortened the paroxysm. The mind was sooner restored to its original function in several cases than by any of the other agents used alone. It will not succeed in totally arresting the fits, and can only be