Dec. 9th. His countenance is brighter; he is less nervous; his head less oppressed; his appetite still good; and he digests his food better; he walks with greater ease, and begins to enjoy the exercise. The pills seem to give him vigour, and he feels stronger. His pulse is decidedly more firm; the tongue cleaner. Two days since, not feeling so well, with irritation about the nose and rectum, the turpentine enema was administered, and he “soon felt warm all over, and decidedly relieved." He has not taken the cotyledon umbilicus, but as this was about the time for his usual attacks, I was particularly anxious, and therefore recommended him to take, every morning before breakfast, one teaspoonful of Hooper's fluid cotyledon umbilicus, and ordered sulphate of zinc, twenty-four grains; extract of camomiles, half a drachm; divide into twelve pills, one to be taken twice a day. To watch narrowly for the coldness of the nose; for the nasal and anal irritation; for the pale and livid countenance; and on the first approach of these symptoms, to rouse the system by the turpentine enema. In diet as before, with the same systematic exercise.

Jan. 11th, 1853. He has been taking his medicines regularly as prescribed; walks daily two or three miles before breakfast, and the same distance in the afternoon; has no attack whatever; has had recourse to the enema once since I last saw him. He complains of the expense of Hooper's cotyledon umbilicus. I believe he paid £1 4s. 6d. for the last medicines ordered by me! I therefore recommended him to go to Davenport's, in Great Russell-street, who has given great attention to the preparation of vegetable juices and extracts; and I at first ordered two drachms of extract of cotyledon umbilicus, divided into twenty-four pills, two to be taken daily before breakfast. But from a subsequent communication with Mr. Davenport, at the next visit, on the 2nd of February, I substituted for the pills the following: juice of the cotyledon umbilicus, a pound, as prepared by Davenport; a teaspoonful to be taken every day before breakfast, in a wine-glass of water; persisting, twice daily, with the zinc pills, and taking occasionally one or two of the aperient pills, not neglecting the turpentine injection.

June 13th. Since the last visit, I have seen Mr. P. several times, and the change is indeed most remarkable. He is active, happy, cheerful; his whiskers, before neglected, now well trimmed; his gait erect and firm; his eye intelligent; and, having had no attack since last October, he now considers himself cured. He has, however, not relaxed in regularly adhering to the prescribed rules up to this period, and has never allowed more than a fortnight to elapse without using the turpentine injection.

Nov. 21st. I have this day received a letter from him, stating that he is quite well, and wishing to know if he may leave off all remedial means. He has had no return whatever of the fits. He takes two of the aperient pills once a week; the cotyledon, one teaspoonful twice a week before breakfast, with a zinc pill on the same day.

He has only used the turpentine injection twice or three times since July.

Previously to being placed under my care, the fits had been gradually augmenting in number and severity; the paroxysmal attacks being of the most destructive and violent character, with suffocative respiration and horrible convulsions, continuing, with but slight intermissions, for six, fourteen, and even twenty-four hours; the disease evidently gaining ground, devastating his system, and shattering his intellect; absorbing five, six, and even seven days, to partially recover from the consequent prostration; his very memory and judgment being continuously impaired.

I was requested by some medical friends, in this, as in some other cases, to try the effects of one remedy at a time; but when a cure is actually progressing, I should do so with much reluctance. The cotyledon, for instance, given alone, often fails; but when coincidentally exhibited with zinc, succeeds, even when zinc, previously administered alone, had also failed, as instanced in this case. I would invite attention particularly to such points; also to the continuous and systematic use of large doses of the mineral acids, thereby altering the very character of the urine and the blood; recommending, also, in many cases, to try the full effects of producing a reflex action by stimulating the rectum.

Epilepsy does not depend upon one specific cause, and consequently no specific can ever be expected for its cure. A rational investigation must be made as to whether there is exalted sensibility or atonic lethargy; whether there is congestion or repletion; whether each organ regulates its function; and it is only by properly appreciating and by minutely attending to each symptom, that a cure can reasonably be expected.

This case is highly instructive. I would not place too much confidence in any one of the remedial means employed, but I would strongly refer to the sulphate of zinc, to the aperient with the mild mercurial, to the turpentine enema, to the nutritious but not over-stimulating diet, to the diminished evening meal, and to the systematic exercise. -Lancet, Feb. 4, 1854, p. 128.

[The following additional information on this subject, is given us by DR. WILLIAMS in the subjoined case.

Case. A young man thought he had worms, and took a wine-glassful of spirits of turpentine. This was followed in due time by repeated attacks of epilepsy.]

He has been subjected to a great deal of prolonged treatment, both at home and abroad, and the nitrate of silver has been largely given, but without any benefit.

His exercise is irregular, at one time excessive, and then again neglected. He lives well, as most young gentlemen do who can command the luxuries of life. He is, however, to live by rule, and to take the exact amount of daily exercise prescribed by me; he is to

act gently on the bowels, with the following pill, and for the present to have two daily evacuations. Mercurial pill, one scruple; compound colocynth pill, two scruples; make into twelve pills, one to be taken occasionally, as may be necessary; and take of the juice of the cotyledon umbilicus (Davenport's), one teaspoonful daily before breakfast. Avoid stimulants, suppers, balls, theatres, &c., for the present; eat a little less, and take a proper proportion of vegetable diet.

[This treatment was soon of use. The dose was raised to two teaspoonfuls daily, with one aperient pill occasionally. The attacks seem to have been completely averted. After this Dr. Williams goes on to remark:]

When once epilepsy has occurred, an individual is more or less predisposed to its recurrence, and any physical or metaphysical excitement, not sufficient of itself to primarily produce the disease, may reinduce it, when it has been once developed. An interval of ten, fifteen, and even twenty years may occur, but then the attack may generally be clearly traced to some very obvious cause, or to some dietetic or hygienic error, as clearly shown in several cases which have come under my notice.

The prophylactic and curative effect of the cotyledon in this indidual case must be taken as the exception rather than as the rule, and practitioners will be very much disappointed if they expect it to be uniformly successful. I have just received a letter from the country evidencing how useless it and all other remedies have hitherto proved in controlling the more severe paroxysms; still the cotyledon is a remedy which does undoubtedly occasionally effect a cure, and especially in the milder forms of epilepsy.—Lancet, March 25, 1854, p. 331.

[DR. W. H. RANKING, of Norwich, does not at all agree with Dr. Williams in his faith in this medicine. He says:]

As far as my own experience goes, I should pronounce it utterly worthless. I have given Hooper's preparation, carefully and perseveringly, in more than thirty cases, public and private, in patients of all ages, and in not a single instance could I trace the smallest benefit to its operation. Many cases certainly were of an unmanageable character, and derived no benefit from any other medicine; but I have notes of three or four in which a most marked improvement has followed the use of the oxide of zinc in increasing doses, after several weeks had been, as I consider, wasted in the employment of cotyledon. -Med. Times and Gazette, April 1, 1854, p. 328.

[MR. HOOPER remarks on this subject, that many cases equally successful have been related to him; but he thinks Dr. Williams has evidently been misled about the comparative strength and value of the preparations of the drug. He says:]

When patients get better they mostly complain of the doctor, or give up the physic, or grumble grievously at paying for it. The last

was the case in this instance. The consequence was, that a preparation professedly cheaper than mine was prescribed. It invariably happens that if a chemist introduces an useful preparation, he is sure to be honoured by plenty of imitations, especially in the cheap way. All are of course prepared after Mr. So-and-so, when in point of fact all are as different as possible. The preparation of cotyledon umbilicus which Dr. Williams prescribed was supposed to cost considerably less than mine; whereas, if concentrated to the same extent, it would be just the reverse. The patient, however, was not quite straightforward in his representations to the doctor. He complained of the difference of price, but said nothing of the difference of quality; for whilst the preparation I supplied was thicker than treacle, of a dark green hue, and very highly concentrated, the lesser priced was as fluid as sherry, and of as light a colour. The druggist who sold it advertises the "solid and fluid extracts, and also the preserved juice, as recommended by Mr. Salter." I wrote to Mr. Salter on the subject, and in reply, he assured me that he knew nothing whatever of the party or of his preparations.

When I first gave my attention to the inspissated juice of cotyledon umbilicus, I sent to Mr. Salter the following minute:-Six pounds of the plant yielded two pints and a quarter of the fresh juice, and this was reduced by the process of inspissation to two ounces and six drachms. Mr. Salter in consequence published the doses thus:-Fresh juice, one ounce, twice daily; Hooper's inspissated juice, half a drachm twice daily. This appeared in the Medical Gazette' for March 2nd, 1849. It will be observed that the inspissated juice is sixteen times stronger than the fresh juice. I note this particularly; for upon its concentration, as well as on that of all analogous preparations, such as sarsaparilla, taraxacum, &c., the price must of necessity depend.—Lancet, Feb. 11, 1854, p. 176.

6

22.-ON THE EFFICACY OF SMALL DOSES OF STRYCHNIA IN NEURALGIA, AGUE, DYSPEPSIA, &c.

By DR. F. E. WILKINSON.

[Dr. Wilkinson corroborates Dr. Marshall Hall's statement of the value of strychnia, dissolved in acetic acid, in the treatment of epilepsy. He observes]

My method has been to dissolve two grains of strychnia in one ounce of phosphoric acid of the London Pharmacopoeia-a very speedy and certain solvent, and also possessing, doubtless, the additional excellent property of assisting the good effect of the strychnia upon the brain and nervous system. Of this solution, in cases of prolonged dyspepsia, in neuralgia, indeed in many states of the nervous system requiring tone, it has been usual with me to administer, after the state of the secretions has been attended to, a dose, consisting of five minims

of the above solution, three or four times daily, either alone or combined with some other appropriate remedy, according to the nature and complication of the case. This medicine has also a remarkable effect in ague. During a four years' residence at Cambridge, I had opportunities of seeing the treatment of a vast number of cases of intermittent fever, but in no one instance, as far as my memory serves me, was recovery nearly so rapid as I have seen it after administration of this powerful remedy.

I have had early this year several cases of quotidian occurring among the poorer workmen of the crystal palace, who, during the wet weather, were in the habit of pursuing their labours at night, and in places where they were much exposed to the damp, and in all these cases the disease has succumbed to doses of strychnia, of about onetwenty-fifth to one-fiftieth of a grain, and this without the use of any other medicine, excepting a dose of calomel and opium, followed by a purge of compound jalap powder to commence the treatment of the

case.

I cannot help being strongly of opinion that this medicine would be of extreme value in cholera, from the great power it has over the nervous system; more especially if combined with the sulphuric acid treatment, which has been recommended so frequently in the pages of 'The Lancet.' Nothing would be so likely to relieve as the combination of the astringent with the nervine tonic. I know that obstinate cases of serous diarrhoea, which resist almost every other remedy, yield to this combination; but I have had no opportunity of trying its effects in cholera, which I should, however, not fail to do, if, unfortunately, the disease again presented itself.

As a substitute for quinine, as a general tonic in most cases that present themselves, this solution of strychnia is to be recommended, as it does not produce the oppression and inconvenience that persons are liable to whilst taking quinine, but, on the contrary, generally produces a slight feeling of exhilaration which is not rapidly transient; at the same time, by improving the nervous tone, improving the state of the secretory apparatus.

I subjoin a few cases illustrating these remarks, whilst I know many friends who could readily corroborate these facts from cases occurring in their practices.

Neuralgia.-July 11, 1851. Mrs. P., married, aged thirty-two; pale and emaciated. She has been for some years the subject of neuralgia, which attacks her whenever she takes cold, and occasionally quite incapacitates her from attending to the duties of her family. She is now suffering acutely from pain and the loss of rest. The bowels being confined, the following was ordered:-Calomel, three grains; conserve of roses, sufficient quantity to make into a pill. Liquor of strychnia, (two grains to an ounce), twenty minims; sulphate of magnesia, one ounce; spearmint water, six ounces. To take one-fourth three times a day.