Definition. Frequency. Susceptibility: dogs, pigs, cattle, horses,
parrots, sparrows. Divisions: slight and severe: Jacksonian (partial):
symptomatic; idiopathic. Lesions: inconstant: of brain, cranium,
cerebral circulation, myelon, poisons in blood, dentition, cortical
and ganglionic lesions, cerebral asymmetry, stenosis of vertebral
canal. Medullar asymmetry, traumas of cranium, anæmia, bleeding,
carotid ligation, spinal reflexes, irritation of skin, creatinin,
cinchonoidin, lead, ergot, nitro-pentan, nitro-benzol, ptomaines,
toxins, parasites, nerve lesions, local hyperæsthesia (withers of
horse, recurrent ophthalmia), indigestion, constipation, sciatic
neuritis. Causes: nervous predisposition, heredity (man, cat, dog,
ox), sexual excitement, fear, sudden strong visual impression, uric
acid in blood, meat diet. Symptoms: =horse=, sudden seizure, bracing
feet and limbs, swaying, fall, convulsive rigidity, jaws working or
clenched, eyes rolling, salivation, stertor, dyspnœa, sensation
absent. Duration. Symptoms of localized epilepsy. =Cattle=, bellow,
stertor, rolling eyes, jerking, rigidity, fall. =Sheep.= =Swine=
premonitory malaise, jerking, champing jaws, fall, trembling,
rigidity, involuntary discharges. =Dog= trembles, cries, falls,
rigidity, clonic contractions, stertor, sequelæ. Diagnosis: sudden
attack, unconsciousness, spasms, quick recovery, no spasms in syncope,
vertigo has no spasms, thrombosis has symptoms developed by exercise.
Jurisprudence: animal returnable after twenty-eight days (Wurtenberg,
etc.,) thirty days (France). Treatment: of susceptible brain, and
peripheral irritant. Correct all irritation or disease, or expel
parasites. Nerve sedations: bromides, opium, valerian, belladonna,
hyoscine, duboisine. Tonics: zinc, arsenic, silver, baths,
electricity. Borax. Vegetable diet. Castration. Avoidance of
excitement. Surgical operations. Trephining. Excision of cortex.
Outdoor life. _During a fit_: amyle nitrite, chloroform, ether,
chloral, warm bath, cold or warmth to head, quiet secluded place.
_Epilepsy_ is the name given to a class of cases characterized by a
sudden and transient loss of consciousness with a convulsive seizure,
partial or general. It appears to be due to a sudden explosive discharge
of convulsive nervous energy, which may be generated by a great number
of causes of morbid irritation—pathological, traumatic, or toxic. As a
rule the epileptic seizure is but the symptomatic expression of a
complex derangement which may be extremely varied as to its nature and
origin.
_Frequency in different animals._ The affection is far less frequent in
the domestic animals than in man, doubtless because of the absence of
the special susceptibility which attends on the more highly specialized
brain, the disturbing conditions of civilization, and the attendant
vices.
Among domestic animals, dogs are the most frequent victims in keeping
with their relatively large cerebral development, their emotional and
impressionable nature and the unnatural and artificial conditions in
which as house pets they are often kept. Their animal food and the
consequent uric acid diathesis is a probable cause, as it is in man. In
ten years of the dog clinic at Alfort they made an average of 3 per
cent. of all cases. Next to the dog the pig kept in confinement is the
most frequent victim, while cattle and horses come last. At the Alfort
clinic epileptic horses were not more than 1 per 1000 patients. It is
not at all infrequent in birds, especially canaries and parrots. Reynal
has seen it in sparrows.
_Divisions._ The disease has long been divided into _petit mal_ and
_grand mal_ (_haut mal_). The =petit mal= (slight attack) is usually a
transient seizure affecting a group of muscles only and associated with
only a momentary or very transient loss of consciousness. The loss of
consciousness is uncertain as to many cases. Under partial epilepsies
must be included the hemi-epilepsy, or Jacksonian epilepsy, which is
confined to one side of the body.
The =grand mal= (severe attack) is one in which the loss of
consciousness is complete, and the convulsions are general in the
muscles of animal life.
Another division is into =symptomatic= and =idiopathic= cases, and if
this distinction could always be made it would be of immense value in
the matters of prognosis and treatment as the removal of the morbid
state of which epilepsy is the symptom will usually restore the patient
to health. Thus the removal of worms from the alimentary canal, of
indigestible matters from the stomach, of a depressed bone or tumor from
the surface of the brain may in different cases be the essential
condition of a successful treatment.
_Morbid Anatomy and Pathology._ The literature of epilepsy is very rich
and extensive and yet no constant lesions of the nervous system can be
fixed on as the local cause of the disease. A review of the whole
literature leads rather to the conclusion that irritations coming from
lesions of the most varied kind, acting on a specially susceptible brain
will rouse the cerebral centres to an epileptic explosion. Thus epilepsy
has been found to be associated with lesions of the following kinds:
1st. Brain lesions of almost every kind, including malformations.
2nd. Lesions of the walls of the cranium.
3d. Disorders of the cerebral circulation.
4th. Lesions of the spinal cord.
5th. Morbid states of the circulating blood (excess of urea, uric acid,
creatinin, lead poisoning).
6th. Reflected irritation, as from dentition, worms, sexual excesses,
injuries to certain nerves, notably the sciatic, or to particular parts
of the skin.
1st. =Brain lesions.= Those which affect the medulla and the cortical
convolutions around the fissure of Rolando would be expected to be
implicated because these centres preside over the principal motor
actions of the body and limbs. Yet though these parts are found to be
affected with various morbid lesions in a certain number of cases of
epilepsy, such lesions are exceptional, rather than the rule. In 20
cases of epilepsy in man, 15 showed no lesion whatever of the brain.
Blocq and Marinesco, pupils of Charcot, recently made a critical
examination of the medulla and Rolandic cortex in nine cases that died
during the fit. All showed granular bodies (degenerated myelin or blood
pigment) in the perivascular sheaths but they found these in
disseminated sclerosis and even in healthy brains as well. The neuroglia
cells of the first cortical layer contained black granules. Otherwise
four cases had no change, while five showed sclerosis of the cortex. The
medulla was sound in all cases excepting one which showed punctiform
hæmorrhages. Visible lesions may be present in other parts of the brain;
Wenzel long ago claimed constant lesion of the pituitary body. Beside
the cerebral cortex, lesions have been found in the bulb, the
hypoglossal nucleus, the olivary body, the hippocampi, the thalamus, the
corpus striatum, the quadrigemini, the cerebellum, etc.
Hughlings-Jackson who made an extended investigation of the subject
concludes that any part of the gray matter of the encephalon may become
over-excitable and give rise to a convulsive attack. Not only may the
lesion be in any part of the brain, but it may be of any kind:
meningitis, cerebritis, softening, tubercle, tumor, hydatid, embolism,
or dropsy. Marie Bra found an extreme asymmetry of the cerebral lobes in
epileptics. Kussmaul and others found stenosis of the vertebral canal
and asymmetry of the two lateral halves of the medulla.
2nd. =Cranial lesions.= These consist largely in blows or falls upon the
head, with osteitis, periostitis, fractures with depressions, fibrous
neoplasia implicating or not the meninges and pressing on the brain,
hæmorrhages from minute arteries, etc. The diagnosis of such lesions
will often open a way to a successful treatment. Baker found most of the
severe cases from head injuries.
3d. =Disorders of the cerebral circulation.= Burrows, Kussmaul and
Turner showed that in animals, loss of consciousness and epileptiform
convulsions followed on cerebral anæmia caused by profuse bleeding or by
compression of the carotids. The same has been observed in surgical
cases after ligation of one common carotid. Hermann caused convulsions
in a rabbit by ligating both anterior and posterior venæ cavæ.
4th. =Lesions of the Spinal Cord.= Brown-Sequard determined epileptiform
convulsions by transverse section of one-half of the spinal cord, or of
its superior, lateral or inferior columns. The later development of the
doctrine of interrupted spinal inhibition, suggests that, many of the
seizures in question are but exaggerated spinal reflexes, which are no
longer restrained by cerebral inhibition. That all are not of this
spurious kind may be fairly inferred from his further demonstration that
bruising of the great sciatic in animals tended to produce epilepsy. In
such cases., the irritation of certain areas by pinching the skin,
served to produce a seizure. Not only so, but the animals in which such
artificial epilepsy had been induced tended to transmit the infirmity to
their progeny. The prevailing view of epilepsy however, would consider
such lesions as sources of peripheral irritation by which the brain is
affected sympathetically, while the real explosion is the result of the
sudden discharge of the pent up excitement caused in the encephalic
centres by the irritation at such distant points.
5th. =Morbid States of the Circulating Blood.= Certain poisons, when
brought in contact with encephalic nerve centres produce epileptic
seizures. Gallerani and Lussana applied creatinin directly to the
cerebral cortex and quickly induced epileptiform convulsions and
choreiform movements. Injected subcutaneously it failed to produce the
same effect. Cinchonoidin acted on the basal ganglia of the brain
producing convulsions but no choreiform movement. Poisoning with lead,
ergot, nitro-pentan, nitro-benzol and a number of other poisons brings
about intermittent convulsive seizures. The same may be inferred of
ptomaines and toxins, in the convulsions that appear in the advanced
stages of infectious diseases (canine distemper, hog cholera, etc.).
6th. =Reflex Irritation.= Perhaps no peripheral irritation more
frequently causes epilepsy, than parasites. In young dogs worms in the
intestines (tænia cœnurus, tænia tenuicollis, tænia serrata, tænia
echinococcus, and ascarides) have been especially incriminated. Also
linguatula tænioides in the nasal sinuses. In young pigs the
echinorrhynchus gigas, ascarides and trichocephalus. In horses ascarides
have been principally blamed.
Wounds implicating nerves, and tumors pressing on nerves, have served as
sources of nervous excitement which accumulates in the cerebral ganglia
and bursts forth as an epileptic explosion. Bourgelat mentions the case
of a horse which fell in a fit the moment he was touched on his tender
withers, also a case in which a seizure coincided with an attack of
recurrent ophthalmia. Gerlach saw a horse which had an epileptic fit the
instant he was touched on his sensitive withers. In kittens and puppies
the irritation attendant on dentition is a common cause of attacks. In
nervous dogs and pigs indigestion or constipation may serve as the
occasion of an explosion. In the experimental cases of Brown-Sequard,
not only did the injury to the sciatic nerve develop in the brain a
latent tendency to epilepsy, but the subsequent pinching of the skin in
certain areas (epileptigenous zones) promptly brought about a seizure.
=Causes.= Most of the causes of epilepsy have been given above under the
head of pathology and morbid anatomy. The nervous predisposition may,
like any other peculiarity or function, become hereditary. In the human
race nothing is more certain than the tendency to some form of nervous
disorder (insanity, dementia, alcoholism, morphinism, epilepsy, chorea,
etc.) in a special family line. Reynal records the case of an epileptic
cat (belonging to an employe of the Alfort veterinary school) the
progeny of which for three generations, became affected with epilepsy
and mostly died before they were a year old. Also four epileptic dogs (3
males and 1 female) which produced a number of epileptic puppies.
LaNotte records the cases of two bulls affected with epilepsy, in the
progeny of which numerous cases of epilepsy appeared; the cows being
attacked after the first calving, and the oxen soon after they were
first put to work. Breeding stallions are particularly liable to
attacks, the high feeding, lack of muscular work in the open air, and
above all the oft repeated nervous excitement attendant on copulation
being directly exciting causes. The heredity of the artificial epilepsy
induced by Brown-Sequard in Guinea pigs, serves to strengthen the
doctrine of heredity in ordinary forms.
Among emotional causes fear easily heads the list. Bernard states that a
horse became epileptic in connection with the terror caused by the
giving way of a wooden bridge over which he was passing. Bourgelat and
Reynal adduce instances, in cavalry horses when first put under fire.
Reynal records the case of another which had his first attack when
facing a moving locomotive, and which never again could see an engine in
motion without suffering another attack. La Notte mentions the case of a
horse attacked when frightened by a sky rocket; Romer, the case of a
horse scared by the sudden display of a white sheet in front of him, and
Friedberger and Fröhner relate cases of attacks caused by intense rays
of light, as in racing toward the declining sun, or the dazzling
reflection from the surface of water. Liedesdorf saw it in a dog scared
by a locomotive.
A strong impression like that caused by transition from bright light
into darkness, by seeing shadows of trees crossing the road, or violent
suffering caused by severe forms of constraint have been named as
causes.
Speaking in “Brain,” of epilepsy in man, Alexander Haig attributes the
fits to the fluctuations of uric acid in the blood. Headache (migraine)
he finds to be very closely allied to epilepsy and convulsions and to be
a result in a susceptible system of a liberal flesh diet. By a vegetable
and fruit diet he reduces the ingestion and formation of uric acid, so
that the largest quantity which a patient is likely to get into his
blood, shall never or only very rarely, affect the blood pressure and
increase the intracranial circulation to a dangerous extent. In
predisposed subjects, all flesh food, soup, and meat extracts must be
avoided, while even tea, coffee, cocoa and other vegetable articles
containing xanthin compounds are to be regarded as producing uric acid,
and to be denied, or employed only as the merest flavoring.
This position is greatly strengthened by the fact that epilepsy is so
much more frequent in the carnivora (dog, cat, bird) than in the
herbivora. It also suggests very strongly a light vegetable diet for
both prophylactic and curative purposes in our domestic animals. In the
same line the frequent and liberal drinking of warm water, the use of
diuretics and the flushing of the large intestine are indicated.
For other causes see under pathology.
_Symptoms in the_ =Horse=. It has been claimed that premonitory
symptoms, such as dullness, lack of energy and quick, nervous or
startled movements herald an attack, but in animals as in man, the
disease usually attacks suddenly without any antecedent indication.
If at work the horse stops suddenly, or if in the stable he ceases
eating, seems frightened, stands for an instant immovable, braces his
feet, sways, trembles, and falls heavily to the ground. Or he may remain
for an instant supported on his rigid limbs, the jaws moving or firmly
closed, the eyes rolling, and the facial muscles drawn or twitching.
When down there are convulsive movements of the limbs, so that the
animal may kick out violently, and tense contractions or twitchings may
occur in the muscles of the croup, chest and abdomen. There is usually
an increase of the salivary secretion with frothy accumulation about the
angles of the mouth. The respiration is stertorous, dyspnœic, and
interrupted, the nostrils widely dilated, the nasal mucosa of a dark
brownish red, and the superficial veins distended. The pulse is weak,
slow, irregular, intermittent and sometimes imperceptible. Sensation
seems to be in abeyance. No attention is paid to loud sounds, nor to
pinching, pricking, or even cauterizing the skin. Perspirations may
break out on the flank or over the whole surface of the body.
The duration of the attack may be from one to four minutes, or
exceptionally ten or fifteen, after which the muscles relax, the
twitching ceases, the horse raises his head, extends his fore limbs and
finally rises.
After rising some are dull and stupid for an hour or so, and may
continue to perspire, some move the limbs, jaws or head automatically,
turn in a circle, or seek seclusion and darkness, while some take at
once to eating and seem as if nothing had happened.
In _partial_ or _localized_ epilepsy the spasms are confined to a
limited group of muscles like those of the jaws, neck, or fore limbs.
These may alternately contract and relax, or they may remain rigid for a
minute or less, the mouth being held open or firmly closed with grinding
of the teeth, the eyes rolled backward and upward, or affected with
strabismus, the face drawn and distorted, the head turned to one side or
downward, or the limbs fixed and immovable.
At the conclusion of an attack it is not uncommon to see a discharge of
urine or fæces, or in stallions, of semen.
The horse often contracts a fear of the place where the attack occurred,
and this contributes, with the re-appearance of the former object of
dread (car, locomotive, rifles, cannon, etc.) to precipitate a new
attack if he is compelled to go to such a place.
_Symptoms in_ =Cattle=. In cattle the animal is attacked without
premonition, bellows, breathes hard and with effort, has dilatation of
the nostrils, and squinting or rolling upward and backward of the eyes
and falls to the ground rigid and trembling. There may be violent
succussions of the limbs, head or neck, movements of the jaws, grinding
of the teeth, and the appearance of frothy saliva and elements of food
about the lips. The beats of the heart are violent, the pulse slow and
small, and sometimes intermittent. Involuntary micturition, defecation,
or discharge of semen may occur. In slight cases one or more of these
symptoms may be absent, and the victim may not even fall to the ground
but support himself against a wall or other object.
The duration of the attack may be from one to five minutes, rarely more,
and there is often a slow and progressive subsidence of the spasms. When
recovered the animal may get up and go to eating or rumination as in
health.
_Symptoms in_ =Sheep=. In sheep the attack is sudden. The animal ceases
eating or stops in its walking, and after turning or other involuntary
movement falls to the ground, head extended, mouth open, eyes rolling or
squinting, and with rigidity or twitching of the muscles of the neck or
limbs. There is the same loss of sensation, frothing from the mouth, and
grinding of the teeth as in the larger animals. The attack may last 40
to 50 seconds.
_Symptoms in_ =Swine=. In pigs a state of discomfort and restlessness
often marks the approach of an attack, referable probably to the
digestive disturbance or to parasites which furnish the occasion of the
disease. Uneasy, wandering movements, jerkings of head or limbs, rolling
of the eyes, and champing of the jaws may first appear. Then the animal
falls, extending its limbs and head, with open mouth, retracted lips,
and a free flow of saliva. Trembling and jerking of the head, neck and
limbs, hurried, short, difficult breathing, and complete loss of
sensation may be noted. Discharges of urine, semen, and prostatic fluid
are not uncommon. The attack usually lasts 2 or 3 minutes, and
exceptionally 10 to 15. In the shorter seizures, frequent repetition is
not uncommon, Delafond having observed 5 or 6 attacks in the course of
an hour.
_Symptoms in_ =Dogs=. The attack is sudden and unheralded by prodromata.
The animal stops, trembles, cries plaintively and falls; he may manage
to rise or to do so in part but instantly falls anew. The limbs stiffen,
tremble or twitch, the head is extended or flexed, or jerked, violently
striking the ground, the mouth open, with abundant saliva, or firmly
closed though the tongue may be between the teeth. The trunk may be firm
and rigid or alternately twisted in one direction or the other. The eyes
roll or squint, and the breathing is stertorous and difficult.
Insensibility is complete. Toward the end of the attack there may be a
discharge of urine, fæces or semen, the stools often containing worms.
The body is often wet with perspiration during or after an attack.
The attack usually lasts for two or three minutes, then the convulsions
gradually lessen in intensity and finally cease, the dog raises his
head, opens his eyes, and gazes inquiringly around. Then he gets on his
feet shakes himself and may at once resume his customary habits. In
other cases the restoration is less sudden. The dog remains for 30 to 60
minutes dull and stupid, or seems to have little power of control over
its muscles and staggers as if intoxicated, or as if the muscles were
benumbed. It may drop on its knees and then fall with the head on the
ground and repeat this several times. In other cases the dog wanders
around, or trots off and may snap at any one interfering with him, so
that the case is often mistaken for one of rabies. Finally the animal
may remain prostrate and fall into a deep sleep marked by stertorous
breathing.
_Diagnosis._ The diagnosis of epilepsy is usually easy. The suddenness
of the attack, the loss of consciousness, the muscular spasms, the
complete temporary recovery and the tendency to recur, form a _toute
ensemble_, which is pathognomonic. The danger of confounding this with
other nervous disorders is on the whole greatest in the slight cases in
which the symptoms are less typical.
From =Syncope= it is easily distinguished by the spasms which are not
present in syncope.
From =eclampsia= it is not so easy to diagnose, but the line between
eclampsia and epilepsy has not been accurately drawn, and some have even
shown a disposition to drop eclampsia from medical nomenclature.
Eclampsia may be defined as general convulsions dependent on some
eccentric irritation, and which do not recur after such irritation has
been removed. This would remove from the category of epileptic attacks
the cases of convulsions in which the attacks were due to intestinal or
nasal parasites, dentition irritation, tumors pressing on nerves, canine
distemper and other infectious diseases. So far the distinction might be
made by the diagnosis of the particular disease on which the convulsions
depend. There remains however a class of cases in which the centric
nervous disorder on which the epileptic seizure depends is present, and
also the peripheral source of irritation (worms, etc.). In such a case
the presence of the worms or other eccentric source of irritation, even
if added to the fact that this was the immediate exciting cause of the
epileptic explosion, could not do away with the fact that the essential
conditions of epilepsy are permanently present in the nervous centres.
The difficulty therefore of making an accurate differential diagnosis,
resides largely in the impossibility of drawing a definite line of
pathological separation between eclampsia and epilepsy.
From =Vertigo= epilepsy is distinguished by the absence in the former of
marked spasmodic contractions. It is only in the milder forms of
epilepsy those in which the spasmodic action is so slight as to be
overlooked, that this disease can be confounded with vertigo.
From =Thrombosis= or =embolism= of the iliac or femoral arteries
epilepsy is easily distinguished by the absence of exercise as the
essential cause in the development of the latter. In thrombosis on the
other hand, the loss of control over the hind limbs is developed at will
by active motion (walking, trotting). In thrombosis too the absence of
pulsation at the fetlocks or at any point below the seat of obstruction
is conclusive.
=Question of Soundness and Jurisprudence.= Manifestly a horse or bull
subject to attacks of epilepsy is _not sound_. It is moreover a disease,
the symptoms of which are only shown for a very short period at one
time, after a long interval of apparently perfect health. It is,
therefore, a disease against which a purchaser cannot be expected to
protect himself and he should have the right to annul the sale and
return the animal in case the infirmity should appear within a
reasonable period after purchase. This is provided for in the laws of
different countries of Europe, thus in Wurtenberg, Baden and Hesse, a
purchased animal may be returned within 28 days; in France within 30
days, and in Bavaria within 40 days. The greatest difficulty arises from
the frequent impossibility of obtaining expert testimony on a seizure
which is likely to occur at any moment, without premonition, and in
which the testimony of a non-expert may easily be misleading. It seems
as if complaint having been made within the specified legal time, an
extension of guarantee should be given by the court, the animal to be
meanwhile kept under the supervision of a veterinarian.
Another question has arisen as to the position of an animal suffering
from reflex epilepsy. If the attacks are caused by intestinal worms or
nasal acarina which are easily removed, it is quite evident that this
cannot be considered as a permanent unsoundness, and one for which a
contract of sale can be justly annulled. But on the other hand, while
the eccentric source of irritation which is easily curable may have been
the active agent in developing the seizures, it may be none the less
true that the central infirmity which determines the abnormal
susceptibility, to excessive generation and epileptic explosion of
nervous force, may also be present and the animal cannot be considered
as _sound_ until a sufficient length of time has elapsed after the
removal of the peripheral irritation and no new seizure has taken place.
_Treatment of Symptomatic Epilepsy._ In cases due to an eccentric
irritant the first step must be the removal of such irritant. In case of
intestinal worms the various vermicides and tæniacides must be resorted
to. (See Intestinal Parasites). For the linguatula tænioides the
injection of benzine or tobacco water into the nose, or into the
sinuses, with or without trephining may be resorted to. In diseased
teeth extraction or filling may be demanded. In dentition irritation,
lancing of the gums. In all other cases in which a peripheral nervous
irritation can be traced every available means should be taken to remove
it.
_Treatment of Central Epilepsy._ Bearing in mind that peripheral
irritation is a frequent exciting cause of a seizure, too much care
cannot be given to the conservation of the general health and especially
to make the diet wholesome in quantity, quality and time of feeding and
watering, and to guard against constipation and indigestion. In dogs a
too stimulating meat diet is to be avoided.
The medicinal agents employed have been mainly such as are sedative, or
tonic to the nervous system. Valerian was long extolled as a valuable
remedy (Gohier, Delafond, Delwart), and this has been improved upon more
lately by substituting valerianate of zinc. Belladonna and its alkaloid
atropia have been strongly advocated (Tisserant, Bernard, Williams,
Friedberger) and it has the recommendation that it causes vaso-motor
contraction and tends to lessen cerebral congestion. Hyoscine or
duboisine may be used as a substitute. Cyanide of iron has been lauded
by Jourdier and Tabourin, as far superior to valerian. Of late years the
nerve tonics, zinc compounds (oxide, sulphate, chloride) and silver
salts (nitrate) and arsenic have been used, often with excellent
results. Borax strongly recommended for man (1 to 1¾ drachm daily) by
Pastena is worthy of a trial for dogs. It is given largely diluted in
syrup to avoid gastric irritation.
Of all agents employed up to the present the bromides still claim a
foremost place. They should be given in a large dose, on an empty
stomach and at such a time as to occupy the system at the hour when the
seizure is expected to recur. Thus for morning attacks the dose may be
given at night, while for night attacks it may be given in the
afternoon. Müller uses sodium bromide in the dog as least liable to
disturb the stomach, while Peterson, for man, advises the potassium salt
for the same reason. For man, McLane Hamilton advocates a combination of
the sodium and ammonium salts, Eulenberg adds the potassium compound,
while Berkley uses strontium bromide, and Bourneville camphor
monobromide.
Given at night in full dose (30 grs. for dog) the bromides tend to
secure a quiet sleep, with brain rest and recuperation. If beneficial
they should be repeated daily until a cure or other sign of bromism
appears. This may be somewhat checked by arsenic or chloral hydrate.
Wesley Mills finds potassium iodide useful in some dogs when bromides
fail. Bromohydrate is advocated by Müller. Flechsig and others have had
excellent results in man from the opium bromide treatment. Full doses of
opium are given three times a day for six weeks, when they are replaced
by full doses of bromides four times a day.
Improvement should be shown in the shortening of the convulsions and the
lengthening of the intervals between them. Should the bromides fail in
this, resort may be had to other treatment.
Toulouse, Clark and others find that privation of salt, in man, allows
the bromine salt to replace the chlorine one in the tissues, and the
hydrobromic acid the hydrochloric in the gastric juice, and in this way
the bromine can be introduced safely in larger amount into the tissues
and is longer retained, though given in half the doses.
A most important element in the treatment is a vegetable diet with or
without milk, to obviate excessive production of uric acid. Anything
which will disagree and produce gastric or intestinal fermentations with
toxins must be carefully guarded against and these will differ in
different individuals.
Stallions and other excitable males, and females may often be cured by
castration. Patients should be very carefully guarded against all
sources of excitement, reports of guns, sight of locomotives or
automobiles, waving flags, instrumental music, sudden exposure to
sunshine or other bright light, reflection from water, snow, or ice, the
contrast of dark shadows, as of trees, alternating with bright light,
etc. Dogs, becoming excited at a show, may have a convulsion if not
removed, and much more so in presence of another dog in a fit.
A surgical operation often places the disease in abeyance for many
months, but, unless in the case of the removal of a diseased organ which
has acted as a factor, this is not permanent. Hence in man transient
benefit has been secured from operations on the eyes, the brain, the
testicles, the ovaries, etc. In local (Jacksonian) epilepsy, which can
be traced to a definite cortical area in the brain, the trephining of
the skull and the excision of the cortex at that point, has given
temporary relief, with a local palsy, but too often the irritation from
the resulting cicatrix has in time aroused the disorder anew. Even
independently of the removal of the cortex, the trephining has been
successfully resorted to, by savage as well as civilized peoples,
securing a temporary relief. Though not in practice in veterinary
medicine it seems as if this were even more applicable than in man. It
would be fully justified if it preserved for a year or more an animal in
usefulness which must otherwise be destroyed, even if the disease should
return at the end of this time.
Plunge or douche baths (60° to 70° F.) and rubbing dry will often tone
up the nervous system, and a course of bitters, or iron, or both, may
prove valuable. An outdoor life and moderate muscular exercise are
important.
=During a convulsion= the animal should be freed from all harness,
halters, girths, etc., that would impair respiration, the jaws may be
kept apart with a cloth to prevent biting the tongue, and the animal
held with head and neck in natural position. To arrest the spasms the
best agent is amyle nitrite inhaled from a handkerchief. It may be
replaced by a mixture in equal parts of chloroform and ether. Or rectal
injections may be given of chloral. Nitro-glycerine will sometimes cut
short an attack or prevent it. Small animals may have the body immersed
in a warm bath, and cold applied to the head. Congested buccal and
conjunctival mucosæ would indicate cold to the head, while pallor would
suggest warm fomentations.
When the fit is over the animal should be kept in a quiet, dark place
until the excitement or stupor has completely passed.