On Epilepsy

through most of these stages before admission, was presented to us in the little girl Catherine Bates, aged 12. In her we had universal dulness; faint and rapid action of the heart; a pulse of 120; anasarca, both of the legs and face; and respirations to the number of not less than 58 in the minute, yet all these were happily subdued by the antimonial treatment, as beautifully indicated in the descent of the respirations from day to day, first to 50, then to 40, and to 20, 18, and 16 successively. In the case of Eliza Sleuth we witnessed the total disappearance of the left lung under phthisis, the greater part of the right involved in it, and the remaining portion rendered useless by a concluding attack of inflammation. Also, in the instance of Ann West, whose left lung was likewise reduced, by tubercle, to a mere pouch at the top, the same as Sleuth's, we found the right one intensely inflamed, even after the patient seemed to have improved a good deal under the cod-liver oil. The latter onset was very sudden; she had little stamina to bear much active treatment, and would have sunk very soon under depressants. The chief features here, during the termination of life were,-blueness of the countenance, anasarca, small pulse, cold feet, and large universal mucous rattles. Most of the phthisical cases that terminate abruptly, prove fatal from the supersention of pneumonia in the remaining sound portions of lung, and therefore it becomes of great consequence to watch for its approaches throughout the whole treatment. In the remarkably favourable case of Hannah Lewis, decided measures were resorted to, even under all the weakness of phthisis, and the successful termination of that case must strengthen this view of the subject. In the first stage of engorgement, although the lung is found of a brilliant scarlet colour, and exuding blood at every cut of the knife, yet it is not altogether deprived of air, for, upon being squeezed, numerous bubbles make their appearance, along with the blood; but in the latter stage of consolidation there is a complete closure of the proper spongy structure of the organ, at first from excess of blood, compared to the structure of liver, and so named the red hepatization, afterwards, from a disappearance of the red particles, becoming grey, and, lastly, quite a pale pink, like the simple fibrinous organization. If such exudations be rapidly enough broken down, and absorbed, before the proper texture be obliterated, then the lung may be restored almost to its pristine condition; but, if permitted to press on the delicate walls so long as to have caused them, on the contrary, to be absorbed or atrophied, the adventitious tissue will remain as a fixture through life, and deprive the individual of a certain proportion of air at each inspiration The respirations will, therefore, become habitually increased in number, while local dulness will be apparent. As already remarked, this dulness will sometimes lead, under other acute attacks, to sundry mistakes as to the presence of tubercle or actually existing inflammation. Such mistakes are chiefly to be avoided by a consideration of the general history and constitution of the patient; yet the certain fact can never be demonstrated until death reveals the existence of some ancient solidification of the above kind. Thus, in the case of John Schofield, who was admitted with flushed and puffy countenance; much heat of skin, especially on the chest; great dyspnoea, so as to require propping up in bed, with pain on inspiration; anasarca, rusty sputum, and a pulse of 120; we had dulness, much more extensive than seemed consistent with the recentness of the attack. Pleuropneumonia was at once diagnosticated, and for that he was treated with blisters and antimony, but, though the more positive symptoms of acute inflammation were soon thereby subdued, the same dulness remained. It was now a questioiu whether this dulness arose from a deposit of tubercle or plastic lymph. The general feebleness and flabbiness of the body seemed to plead, in some degree, for the first, but at the same time the absence of emaciation rather pointed to the second. After having rallied from the pleuro-pneumonia, however, he imprudently exposed himself, half naked, to the cold air; this induced a return of the malady, under which he very rapidly sank, and, on examining the lungs, a most beautiful and interesting spectacle was displayed of pneumonia in all its stages, from the brilliant scarlet of the recent attack, to the red, the grey, and the tawny hepatization of former ones. It was obvious that he had had the disease in past times, again and again, and that, being not arrested, it had run on to its natural result of consolidation. As, however, he could give no definite history of his former ailments, a doubt necessarily existed as to the precise natuire of the solid matter; fortunately this doubt was not of a nature to interfere with the course of treatment. The management of these disorders will be the subject of another lecture.