THE
MEDICAL EXAMINER.
AND
RECORD OF MEDICAL SCIENCE.
NEW SERIES. —NO. CL—APRIL, 18 53.
ORIGINAL COMMUNICATIONS.
Experimental Researches applied to Physiology and Pathology.
By E. Brown-Sequard, M. D., of Paris.
(Continued.)
XXV.—ON THE TREATMENT OF EPILEPSY.
I have made numerous experiments with regard to the treatment
of this dreadful affection, and I intend to publish them, in extenso,
when some points that are still obscure, have become clear to my
mind. Here I will merely relate some of the most important results
of my researches. As I have had the opportunity during the last
three or four years of observing every day a great many animals
(more than a hundred) which had a convulsive affection resembling
epilepsy very much, I have been able to discover some very in-
teresting facts, among which are the following :
1st. For each epileptic animal, the number of fits, in a given
time, is generally in a direct proportion with the quantity of food
taken.
2d. There is an inverse proportion between the amount of exer-
cise and the number of fits.
3d. Cauterisation of the mucous membrane of the larynx is
able either to cure or to relieve these epileptic animals.
The convulsive affection existing in almost all these animals
was the consequence of a transversal section of a lateral half of
the spinal cord, in the dorsal or in the lumbar region.
I have already published the results of my experiments on
epilepsy, in my lectures before large classes of Physicians and
Medical students, both in France in 1851 and in this country in
1852.
These results are in perfect accordance with the views of Dr.
Marshall Hall in relation to epilepsy. As the views of this emi-
nent biologist are generally known, I need not expose them, and
I will merely remind my readers of the three following points :
1st. The first muscles that contract spasmodically in almost
all, if not in all, the cases of epileptic fits, are those of the larynx
and the neck: 2d, spasm of the glottis taking place then,
produces suffocation, in consequence of which convulsions are
produced in the trunk and the limbs; 3d, tracheotomy may pre-
vent these convulsions by preventing suffocation, and it is known
that in some cases tracheotomy has cured epilepsy.
It has been objected to Marshall Hall that in cases of poison-
ing by strychnine, convulsions take place even when a tracheal
tube renders respiration perfectly free. This objection has no
value, because the state of the spinal cord in epileptics is not
the same as in men or animals poisoned by strychnine. Cer-
tainly the excitability of the spinal cord is greater in epileptics
than in healthy persons, but the degree of excitability of that
nervous centre is much greater in persons poisoned by strych-
nine than in epileptics; and, therefore, it is easy to understand
that certain excitations are able to produce general convulsions
in one case and not in the other.
If we give a very slight dose of strychnine to an animal, so as
not to poison it, but merely to increase slightly the excitability of
the spinal cord, there are no convulsions when we touch or
pinch or burn the skin, but if we prevent breathing for a few
seconds only, general convulsions take place, exactly as in epi-
leptic men or animals.
It has been said also, in opposition to Marshall Hall, that a
spasm of the glottis of the severest kind occurs in cases of hoop-
ing cough, of spasmodic croup and even of apoplexy, without the
occurrence of any other convulsions. The answer to this objec-
tion is, that in epilepsy the spinal cord is more excitable than in
these other diseases, so that the same kind of excitation does not
produce the same effects.
A great many facts, that I will publish elsewhere, prove that
black blood, very probably by its carbonic acid, is an excitant of
the spinal cord and of the medulla oblongata. When, as is
the case in asphyxia, the blood is not oxygenated and deprived of
the carbonic acid constantly produced in it, or received by it
from different tissues, then the excitation made on these nervous
centres becomes so powerful that convulsions are produced. This
is found in men and animals, even in perfect health. If the as-
phyxia is incomplete, convulsions are not produced, unless the
excitability of the spinal cord is greater than usual, and this is
the case in epileptics.
In November, 1851, at the Ecole Pratique, of Paris, I pub-
lished for the first time, before a class of about forty young
Physicians and Medical students, the results of my experiments
as regards the cauterization of the larynx in epilepsy. About
eight months after, Dr. Eben Watson published a paper* in
which he says : “ The treatment I would now propose instead of
tracheotomy is simply the application of a solution of nitrate of
silver, varying in strength with the requirements of the case, to
the glottis of the patient, with the view of diminishing the
nervous excitability of the part in question. A similar treat-
ment has been found by me remarkably successful in alleviating
and removing, in a short time, the susceptibility of the patient
to laryngysmus, in cases of hooping cough, and of spasmodic
croup [laryngysmus stridulus,') nor can I see any reason why a
similar result should not ensue in chronic cases of epilepsy.”
* Remarks on Dr. M. Hall’s theory of the relation of Laryngysmus to
Epilepsy. In London Journal of Medicine, July, 1852, pp. 641-43.
The reasons given by Dr. E. Watson are partly the same by
which I had been led long before him to perform the operation
he suggests. But I had also some other reasons. It is perfectly
known, in the actual state of Medical Science, that the great-
est changes may be produced in the nervous centres, as well as
in the nerves, by a very strong excitation of the termination of
the nervous fibres in the skin or the mucous membranes. On
this principle are founded many modes of treatment of some dis-
eases of the spinal cord and of neuralgia. The application of
caustics, blisters; cupping, hot iron, etc., is based on this princi-
ple. In accordance with it I am inclined to believe that epilepsy
might be cured by a mere application of a hot iron to the skin
of the neck ; at least I have had two guinea-pigs cured after such
an application, repeated three or four times.
The operation of tracheotomy proposed by Marshall Hall has
proved successful in some cases. But it is a dangerous operation,
and if it is proved that another one much slighter can produce
the same good effects, it ought not to be practised.
That other operation is the cauterization of the larynx; it
prevents the closure of the glottis, and thus is able to cure
or to relieve epileptic patients as well as it cures some other
diseases. Every learned physician knows that it is sufficient to
cauterize the larynx once or twice to cure hooping cough in
almost every case.
When the cause of the epileptic fits is excessive, and when the
spinal cord is very excitable, to allow free breathing merely
will not be sufficient to prevent the general convulsions. But
their violence, if respiration is free, will be deprived of all the
effect that would be produced by the excitation of black blood
if breathing did not take place.
The distinction made between organic and inorganic epilepsy has
not the importance that some writers seem to admit. There
are alterations in the nervous system in both cases, and the only
difference is that these alterations can be easily seen with the
naked eye in one case and not in the other. I ought to point
out that the cases of epilepsy in animals, which I have cured,
were cases of organic epilepsy. These animals have been cured,
although the apparent and primitive cause of the disease, i. e. a
section of a lateral half of the spinal cord, continued to exist.
The cauterisation of the larynx on these animals was made
every day, or every other day, and sometimes during two or three
months. In some cases, the relief having been immediate, the
cauterisation was made only twice a week. One of the
animals experimented on was cured after three or four cau-
terisations; but the number of cauterisations necessary has been
generally very much greater. When I left France in February,
1852, I had cured about a third of the animals treated by this
method; and all the others, except two or three, had been very
much relieved, and certainly many of them would have been cured
if the treatment had been prolonged.
I knew that an animal was cured, not only by the absence of
spontaneous fits, but when I could not produce a fit by giving
great pain. I had found that on any epileptic animal, except im-
mediately after a paroxysm, I could very easily produce a fit by ex-
citing pain and more particularly by pinching or burning the skin
of the face or neck. So that I am authorised to believe that when
a fit was not produced by pinching or burning the face, it was
because epilepsy had ceased to exist.
Some Physicians in this country have already tried on man
the mode of treatment that I have found so successful on animals.
From what I know of the results of their attempt, it seems to
me that man is like animals in this respect. There has not been
yet a complete curation: but, except in one case, there has been
a very considerable diminution in the frequency and the intensity
of the fits.
As Physicians 'who have to treat epileptics, have not to
make experiments, but to cure by making use of all the best
means together, I think that the treatment of epilepsy ought
not to consist merely of the cauterisation of the larynx. The
plan of treatment I should suggest is the following:
1st. A cauterisation of the larynx with a strong solution of
nitrate of silver, (at least 60 grains to the ounce,) every day, for
at least five or six weeks.
2d. A cauterisation of the skin of the neck over the spine,
with a hot iron, once a fortnight, for about two or three months.
3d. Exercise and gymnastics.
4th. Make use of oxide of zinc or ammoniated copper, remedies
which a very respectable Physician of Geneva, (Switzerland,)
Dr. Herpin, has found successful in many cases, when their dose
has been considerable.*
* See his admirable work: Du Pronostic et du Traitement de TEpilepsie.
Paris, 1852. Oavrage couronne par l’lnstitut de France.
5th. If in a fit of epilepsy, the suffocation is very considerable;
the operation of tracheotomy ought then to be performed imme-
diately.
XXVI. CURE OF EPILEPSY BY SECTION OF A NERVE.
It is a well known fact that epilepsy may be produced by injury
to a nerve. Dr. John Cooke, in his Treatise on Nervous Diseases,
says on this subject: “ From the writings of Forestus, Van Swie-
ten and Tissot, it appears that injury done to the nerves, or that
a morbid state of them, has in many instances given occasion to
epilepsy. In the Edinburgh Medical Essays and Observ., a
case is related of a violent epilepsy, which frequently occurred,
which was produced by a hard cartilaginous substance, of the
size of a large pea, situated upon a nerve. That this was the
cause was evident, as the disease ceased on the extirpation of the
tumor. In the same we have an account of epilepsy depending
upon a calculus of an irregular figure, about the size of a nut,
pressing on a branch of the sciatic nerve; and another in which
the par vagurn was compressed by a concretion of a similar
kind.” Darwin, in his Zoonomia, says, “ I once saw a child
about ten years old, who frequently fell down in convulsions, as
she was running about in play. On examining, a wart was
found on one ankle, which was ragged and inflamed, which was
cut off, and the fits never recurred.”
Van Swieten relates a case of curation of epilepsy by the ex-
tirpation of a hard cartilaginous body, somewhat larger than a
pea, situated on a nerve of the leg.
A case is related in the Medical and Physical Journal, (vol.
x. p. 52,) in which a cure of epilepsy was effected by the
application of caustic to the nerve which accompanies the vena
saphena.
Many other analogous cases are on record. Jacques Carron,
(Recueilperiodique de la Soc. de Medecine de Paris, t. xviii. p.
422,) cured a child by the extirpation of a small sebaceous
tumor which existed on one of the fingers. Portal, [Observations
sur I'epilepsie, Paris, 1827, p. 159,) cites a case observed by
Fabos, in w’hich the fits were preceded by a pain in one of the
fingers. During a violent fit Fabos put a ligature around the
radial nerve, and the patient was completely cured. Portal
[Anatomie Medicale, vol. iv. p. 247,) relates that one of his
pupils, Mr. Leduc, cured an epileptic by the extirpation of
a hard tumor which was on one of the fingers. Joseph Frank
cured by castration a patient in whom epilepsy had appeared
after an injury to the scrotum. Henricus ab Heer, cited by
Sennert (Opera omnia, vol. ii. p. 489,) having observed that
during her fits, a girl used to rub her two big toes, cured her
by the application of caustic to these toes. Similar cases have
been related by Alexander, of Tralles, and by Wepfer.
I have cured a guinea-pig of a very violent convulsive affec-
tion, much resembling epilepsy, by a section of the sciatic nerve.
This animal had been bitten by another on the toes of one of the
posterior limbs. A considerable slough appeared on the wounded
part, and after two or three weeks fits appeared, and the animal
shortly afterwards had many very violent fits every day. I laid
bare the sciatic nerve and cut it transversely. After this opera-
tion I kept the animal many months, and never saw it have a
fit. From this fact, and from those observed by many physi-
cians above related, it appears clearly that in cases of
epilepsy it is necessary to examine if there is no injury whatever
to some nerve, and more particularly when the aura epileptica
exists. If there is such an injury, the treatment ought to be
either the section of th injured nerve or the removal of the
tumor, if there is one, and sometimes the application of a caustic
or a blister.
XXVI.—LAWS OF THE DYNAMICAL ACTIONS IN MAN AND ANIMALS.*
* I ought to say that these laws and the facts upon which they are esta-
blished, have been the subject of many communications that I have made to
the Society de Biologic, at Paris, in the year 1848.
The following laws are based upon a very considerable number
of facts which I have observed or found on record in many books,
pamphlets and journals. I have collected these facts and I in-
tend to publish them in a special paper.
I ought to say that many Physiologists, and more particularly
Fontana, Delaroche, Adamucci, Broussais, Buchez, R6veill€-
Parise, J. Mueller, J. Paget and Carpenter, have pointed out the
existence of some parts of some of these laws.
1. Nervous actions, muscular contraction, contraction of the
cellular tissue, the discharge of the electrical apparatus of some
fishes, the galvanic current of certain organs, the galvanic dis-
charge which accompanies the muscular contraction, and probably
also the phosphorescence of certain animals and the ciliary move-
ments, are phenomena which cannot exist without being attended
with an organic waste which nutrition alone can provide for.
2.	The faculty of originating these phenomena has a tendency
to increase in direct ratio to the rapidity of the circulation of
blood, to its abundance, and to the amount of its nutritive ma-
terials, both general and special.
3.	During rest, i. e. at the time of the non-existence of these
phenomena, the tendency of such a faculty towards augmenta-
tion meeting with no obstacle, augmentation actually takes
place.
4.	The increase is much more rapidly effected when an action
has just been performed, than it is after a prolonged rest.
5.	Nutrition becoming altered in the tissues which remain in-
active for a long time, the faculty of producing the above-men-
tioned phenomena diminishes by degrees, and even finally
disappears when the structure of the tissues has been deeply
modified.
6.	The faculty of originating these phenomena increases in
direct ratio with the length of the rest, within certain limits;
and when the latter are overleaped, there is a period when no
change takes place; but afterwards the faculty decreases, on
the contrary, in direct ratio with the length of the rest.
7.	For many tissues which produce these phenomena a com-
plete rest is scarcely possible. The phenomena take place, in
appearance, spontaneously, and with as much energy as the
temperature is higher.
8.	The faculty of producing these phenomena decreases at the
time they are going on, in proportion to their intensity and
duration, and in inverse ratio to the nutritive reparation which
simultaneously takes place.
9.	Reparation thus incessantly supplying for expenditure, it
is not possible, with regard to most of these phenomena, and as
long as circulation goes on, to destroy entirely the faculty of
originating them; or rather, as soon as we have succeeded in
destroying that faculty, it is reproduced by nutrition.
10.	Expenditure dependent upon action, being followed by a
great activity in the nutrition, it happens that, if the action be
frequently renewed, there is an excess of nutrition and a consi-
derable increase of the faculty of acting.
11.	When the faculty of acting has been increased in virtue
of the preceding reasons, within a certain limit, an equilibrium
exists between the expenditure and the reparation, and the in-
crease no longer takes place.
12.	As it is possible for nutrition to take place in the tissues,
although the nutritive fluid is not actually circulating in them,
and provided that a certain amount of it exists in them, the
faculty of acting may be increased in parts where circulation is
stopped.
13.	Although circulation and consequently reparation, are
more active in summer than in winter time, at least in cold-
blooded animals, the faculty of acting becomes more consider-
able in winter than in summer time, because the spontaneous
expenditures abovementioned, and those due to external stimuli,
or dependent upon the will, are by far less considerable.
All the preceding laws may be summed up in the following:
The intensity of the faculty which animal tissues possess, of
producing the vital phenomena, seems to be in a direct ratio to
the intensity and duration of the nutritive reparation, and in an
inverse ratio to the intensity and duration of the existence of
these phenomena.