Epiliepsy

Front matter

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ON

EPILEPSY:

ANATOMO-PATHOLOGICAL AND CLINICAL NOTES.

BY

NEW YORK: WILLIAM WOOD A CO., PUBLISHERS, 61 Walker Street. 1870.

Entered aooording to Act of Congrefla, in the year 1870, by

WILLIAM WOOD & CO., In the Office of the libnurlan of CongreoB at Washington.

TO

DAVID LYMAN, ESQ.,

AS

A SINCERE TOKEN

OF

THE AUTHOR'S AFFECTION,

Preface

The object of this book is manifest by its title. It does not claim to offer any new discovery, althougli it is possible that it may shed some light on subjects not well established. Still less is it designed to be an English treatise on Epilepsy : classical for this purpose are the works of Sieveking, Hadcliffe, Keynolds, and the lectures of Trousseau and of Brown- S^quard, full of science, and in a form suited to the wants of teacher and learner. I have attempted to meet a deficiency in my own knowledge by comparing the cases of epilepsy I have carefully noted during the past ten years ; how far my notes meet the wants of others remains to be seen. It is more than a year since most of these researches went to press. Unavoidable circumstances, and the printing of the chromolithographs illustrating the text, have delayed their appearance beyond what I contemplated. Further opportunities of inquiry have occurred in the mean time, giving greater strength to my conclusions. Five additional autopsies of epileptics have regularly displa3'ed the alterations I have pointed out in the sympathetic. The lesion is constituted mainly by a proliferation of connective elements, and their subsequent substitution to the nerve-cells and fibres, finally undergoing retrograde degeneration. The change exhibits itself, in various stages, throughout the nervous plexus, around the vertebral and cerebral arteries, and in the cervical sympathetic. It operates essentially in the alterations of the capillaries in the brain and medulla, and I am not aware of any mention made of such a lesion of the sympathetic as proper to epilepsy.

VI PREFACE.

These being personal notes, I have, out of conciseness, not referred in every instance to doctrines or facts established by other authors ; and I wish that this acknowledgment will suffice for all cases in which no mention miMit be made of their researches. The plates are faithfully copied by myself from specimens I have carefully prepared, and which have been also examined by my Assistant Physicians, my pupils, and many of my colleagues.

No better opportunity will offer itself for stating my gratitude to my esteemed friend. Professor Charles Robin, of Paris, witli whom I have spent many hours of the pleasantest recollection, and to whom belongs any credit that my investigations might deserve. To the satisfaction of counting myself among his pupils, to many warm proofs of predilection and friendship, I still add the practical teaching which has served as the most secure guide in my inquiries on epilepsy and other nervous diseases.

In conclusion, I mnst own particularly the valuable aid I have derived respectively from my Assistants, Drs. F. A. Castle, L. B. Edwards, F. M. McClung, D. McEwan, J. H. Morgan, A. E. Macdonald, and W. H. Bennett. Each of them shares importantly in my work, and I am most happy to express this imqualified acknowledgment of their efficiency and talents. To Messrs. Isaac Bell, James Oweti, James B. Nicholson, O. W. Brennan, and A. Frear, of the Board of Commissioners of Public Charities and Correction, I feel also much obliged for their worthy and unabating efforts to keep the New York Hospital for Epileptics and Paralytics on a model standard, no less than for their kindness and consideration.

50 West Thirty-third Street,

New York, October, 1870.

Contents

CHAPTEE L

HODEBK DOCTRINES OF EPILEPtST.

General description of Epilepsy— Canse of the unsettled opinions on the subject — Base of modem leading doctrines of epilepsy — Marshall Hall's theory : the medulla the primary seat of epilepsy — Brown-Sequard's inyestigations and theory : peripheral origin of fits ; influence of the sympathetic in their production, upon a change in the reflex excitability of the cerebro-spinal . axis — Schroeder Van der Koikes researches : the medulla oblongata the seat of epilepsy : influence of the circulation on its production — Van Swieten and Portal's views on the part that the medulla takes in the epileptic attacks — Todd's humoral theory of epilex)sy— State of the cerebral circulation in epilepsy — Beseazches of ProTOst and Cotard — Henle's hyi>othesis — Kussmaul and Tenner's experiments — Nodus epilepticus in the medulla oblongata— Yulpian's experiment — C. B. Radcliffe's inquiries on muscular contraction : convulsions associated with depressed circulation and innervation — Falret and classical French alienists holding that the essential seat of epilepsy is in the brain, and that the aura has no influence on determining the spasms — ^Author's views as to the medulla oblongata being the original seat of epilepsy, primarily involving the vaso-motor nerves. pp. 10-45