Chapter III: Part 3

In case of continued elevation of temperature, with heat of the head, and perversion of sensory or motor functions, meningitis may be suspected and appropriate treatment adopted.

For the prostration and weakness that is liable to follow thermic fever, mineral tonics such as the salts of iron or zinc may be resorted to.

EPILEPSY. FALLING SICKNESS.

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.

ECLAMPSIA. CONVULSIONS. SPASMS.

Definition: functional convulsions from peripheral irritation. From
dentition, helminths, uterine disease, nursing (anæmia). Treatment.
Injuries to cranial bone.

Eclampsia (convulsions) is difficult to define as distinct from epilepsy, the present tendency however appears to be to apply this term to cases in which the spasms are of a purely functional nature as far as the brain is concerned and caused by peripheral nervous irritation. Whereas in epilepsy there is some organic disease or disorder of the brain itself. Therefore the convulsions of anæmia, of teething, and of parasitism, would come under this heading being curable by the removal of the distant source of irritation, while the spasmodic seizures, that are due to central nervous lesions and are not exclusively dependent on peripheral irritation would be classed as epilepsy. In other words reflex epilepsies with no central brain disorganization would be classed as convulsions.

_Eclampsia from_ =Dentition= is seen especially in young cats, dogs and pigs when cutting-teeth, and may be obviated by lancing the gums, extracting diseased or milk teeth entangled on the crowns of their successors, and by a slight laxative with bromides.

_Eclampsia from_ =Helminthiasis= has been already referred to under epilepsy. The main object is the expulsion of the worms, after which nerve sedatives and tonics will be valuable.

_Eclampsia from_ =Uterine Disease= has been noticed by Albrecht, in cows shortly after calving, the symptoms being spasms of the neck, persistent extension or turning of the head, grinding of the teeth, loss of consciousness, convulsive movements of the legs, rolling of the eyes, and slow recovery. The same symptoms have been observed in goats and have been supposed to depend on a reflex from the irritated womb. Another supposable cause is the absorption of toxic products from the womb and vagina. Manifestly the removal of the after birth and the disinfection of the womb, should be here employed along with the ordinary nerve sedatives.

_Eclampsia in_ =Nursing Female Dogs= has long been attributed to anæmia by English veterinarians. It occurs especially in high bred bitches, when nursing a large litter and some weeks after parturition when the puppies have grown large and vigorous, with proportionately increased demands on the maternal source of supply. The dam shows an emaciated aspect, with restless anxious eyes, a wearied expression, and a generally exhausted appearance. There is weakness and swaying behind, or complete inability to use the limbs, the animal goes down, trembles violently and shows clonic spasms of the extensors of the legs, the neck, the back, the face and the eye. Breathing is accelerated, stertorous and labored, the heart beats violently the mucous membranes are congested, and the mouth is opened with convulsive movements of the jaws and throat. The attack is readily distinguished from epilepsy, by the retention of sensation, and by the absence of involuntary passages from the bowels, or kidneys. Recovery is likely to be secured if the puppies or most of them are removed early enough and the bitch sustained by nourishing food, and tonics. The spasms may be combatted by the antispasmodics and nerve sedatives employed in epilepsy. Chloroform, morphia, phenacetin, acetanilid, urethane have been specially commended. Beef teas, cod liver oil, and iron may be resorted to and free outdoor exercise and sunshine should be secured.

General convulsions are common in connection with direct injury to the brain and more particularly of its coverings, (cranial bones, meninges). In such cases the irritation which otherwise starts at a distance and reaches the brain through the afferent nerves, or the modification of the circulation acts directly on the gray matter. It is interesting to note in this connection that the evacuation of the cerebral fluid, which removes the soft support of the water cushion and allows the brain to come in contact with the hard bony walls, determines an access of convulsions. In cases of convulsions attendant on mechanical injury to the cranium surgical interference will be in order.

CHOREA. ST. VITUS DANCE.

Definition. Susceptible animals. Causes: nervous lesions inconstant,
youth, debility, anæmia, microbian toxins, cerebral embolism,
rheumatism, trophic alterations in nerve cells, fright. Lesions:
variable in seat and character, congestion of perforated space, corpus
striatum, Sylvian convolutions, gray matter at root of posterior horn
of spinal cord, etc., experiments of Chauveau and Wood. Symptoms:
=dog=, local twitching, fore limb, one or both, neck, head, maxilla,
eyelids, eyeballs, hind limbs, trunk, rhythmic, less when recumbent,
usually absent in sheep, roused by excitement: =horse=, head neck,
fore limb, trunk: =cattle=, head, neck, limbs: =swine=, hind limbs,
neck, head: severe cases lead to exhaustion, emaciation, marasmus,
paralysis. Duration: weeks, months, years. Treatment: laxative, tonic,
hygienic, arsenic zinc sulphate, strychnia, sedative, belladonna,
conium, cannabis Indica, chloral, acetanilid, trional, etc., icebags
or ether spray to spine, cold douches, outdoor life.

_Definition._ A neurosis characterized by constant twitching of muscles or of groups of muscles, and which usually ceases during sleep.

_Animals Susceptible._ This disease is especially common in the dog, but has been recognized also in the horse, ox, cat and pig.

_Causes._ Much difference of opinion exists as to the true cause of chorea. In many cases no nervous lesion has been found and therefore the disease has been pronounced purely functional. The victims are as a rule the young, weak and debilitated so that anæmia has been held to be the main causative factor. Then in dogs the affection is a common sequel of distemper and hence it has been attributed to toxic matters (microbian, etc.) in the blood. It should be added that European writers attribute the rhythmic spasms which follow distemper to eclampsia, epilepsy or tic, and claim that the contractions must be irregular or arhythmic in order to constitute chorea. English and American writers, however, have attributed less importance to this point and consider that the constancy and persistency of the contractions in the dog, differentiate an affection from both eclampsia and epilepsy and relate it rather to chorea. Tic as illustrated in cribbiting is certainly not constant nor rhythmical nor is it a habit beyond the control of the will.

Among other alleged causes of chorea is embolism of the arteries of the brain or spinal cord. Angel Money went so far as to inject a fluid containing arrowroot, starch granules and carmine into the carotids of animals, and produced movements closely resembling those of chorea. Another theory connects chorea with the rheumatic poison. Some English writers find more than 80 per cent. of all cases in man associated in some way with rheumatism, but in Philadelphia, Sinkler found that not more than 15 pet cent. showed such a relation. D. C. Wood as the result of necropsies of a number of choreic dogs reached this conclusion: “Owing to emotional disturbance, sometimes stopping of various vessels of the brain, or sometimes the presence of organic disease, there is an altered condition of the ganglionic cells throughout the nerve centres. If the cause is removed and the altered condition of the nerve cells goes only so far, it remains what we call a functional disease. If it goes so far that the cells show alteration, we have an organic disease of the nervous system.”

In man the element of sudden fright is awarded a high position in the list of causes.

_Lesions._ Constant morbid changes of structure have not been established in chorea. On the contrary in the many careful necropsies of choreic subjects some lesion of brain or spinal cord has been almost always found. Dickinson always found congestion of some part of the brain or spinal cord, but most constantly of the substantia perforata, the corpora striata and the beginning of the Sylvian fissure. In the cord the cervical and dorsal regions were the most commonly affected, and preëminently the gray matter at the root of the posterior horn. The bilateral symmetry of the contractions in cases of unilateral lesions, has been held to discredit the theory of embolic origin, yet this may be explained by mutual relation of the ganglia of the two sides and their coördination of function.

The question of the relative importance of the encephalic and spinal lesions has been also debated. Chauveau believed that by section of the cord in choreic dogs, he had proved that the spasms were of medullary origin. Wood on the other hand found that the choreic movements persisted after section of the cord, and seemed warranted in the conclusion that the movements originated in the cord. The probability is, that with the cord intact, the primary source of the morbid movement may reside either in the encephalon or the cord. In chorea, following distemper, I have found marked congestion of the encephalon and its meninges.

_Symptoms._ In the dog the twitching may be confined to one fore leg, or it may extend to both and then usually implicates the neck and head. In other cases the lower jaw, the head, the eyelids or even the eyeballs may be the seat of the twitching motions and in still others the hind limbs and trunk are also implicated. In nearly all cases the tendency is to a continuous rhythmic action, which may moderate without actually ceasing while the animal lies down, but which usually stops altogether during deep sleep. When it intermits at other times it can commonly be roused into activity by exciting the animal in any way.

In the horse the muscles affected may be those of the head and neck, of the fore limb (Hering), of head, limbs and trunk (Leblanc).

In cattle the movements have affected the neck and head and the fore or hind limbs (Anacker, Schleg).

In young pigs the hind limbs, the neck and head have been chiefly involved in the spasms (Hess, Vervey).

If the affection is slight it may not seriously impair the general health, but in proportion to its severity and the constancy and generalization of the spasms and the consequent muscular waste and exhaustion, the animal becomes gradually worn out and emaciated and dies of paralysis and marasmus.

_Duration._ In favorable cases recovery may ensue in a few weeks; in others the disease becomes chronic and will last for months or years.

_Treatment._ Among the first indications are fresh air and wholesome easily digestible food. The removal of any source of intestinal irritation should be sought by bland laxatives. As the health is usually low, a course of iron tonics is nearly always in order.

Special nervous tonics are next demanded. No agent has a better reputation than arsenious acid. Ten drops of a 1 per cent. solution of arsenite of soda may be given daily to the dog or one ounce to the horse. If gastric irritation forbids the use of this agent, sulphate of zinc may be given in 1 to 3 grain doses twice a day to the dog. In other cases strychine ¹⁄₈₀ to ¹⁄₆₀ of a grain may be given in the same manner.

Nerve sedatives often have a good effect in calming the nervous irritability and in this way belladonna, conium, cannabis Indica, chloral, chloroform, acetanilid, trional, etc., have been employed.

In the same line are ice bags or ether spray applied to the spine for ten minutes at a time, and douche baths of cold water, the animal being afterward rubbed dry. This last partakes of the nature of a stimulant and may be classed with gentle exercise which at once distracts the patients’ attention from the nervous infirmity, trains him to control the muscles, gives normal exercise and tone to the enfeebled organs and improves the general health.

CONVULSIVE TWITCHING OF THE FACE.

Nature of phenomenon, arhythmic, hyperexcitability of nerve centres or
skin. Nerve section. Head jerking: =horse=, hard bit, severe check,
internal pain, exertion, hypersensitiveness. Treatment: nerve section.
Tongue lolling, etc. Flapping of lower lip. Nasal rhythmic movements.
Weaving, from impatience, rhythmic. Rocking on hind limbs. Resting
foot on coronet. Pawing. Treatment: eliminate irritation, nerve
tonics, sedatives, hygienic measures.

This has been observed especially in the dog and may be easily confounded with chorea. The muscles on one side of the face, are twitched at more or less regular intervals, or in other cases there are sudden opening and closing of the lower jaw. The affection has not been satisfactorily connected with any special brain lesion, though as in chorea proper and epilepsy, we must invoke a special disorder or hyperexcitability of the nerve centres presiding over the affected muscles. The clonic spasm may in some cases be due only to a motor impulse from such excited nerve centre, while in others it may be traced backward along the afferent nerves to an oversensitive part of the skin or other organ. In these last purely reflex forms of the trouble it may be possible to correct it by section of the sensory nerves involved.

Convulsive Movements of the Head.

Convulsive movements of the head as a whole constitute a frequent form of chorea in the dog. It is especially common in horses and shows itself in different forms. A horse with a tender mouth, or which has been used with a hard bit, or with a heavy hand on the reins, or which has been driven with a check rein so short as to be unsuited to its conformation, is liable to indulge in annoying elevation and depression of the head when under the saddle or in harness. The same phenomenon may be shown in connection with violent internal pains, as in strangulated hernia, intussusception, or twisting of the bowels. The habit once formed is not easily corrected, so that careful treatment with the view of prevention is especially to be given.

Another more objectionable, dangerous, and less voluntary motion is the sudden jerking of the head upward, or to one side when excited under the saddle or in harness. The disorderly movements are not, as a rule, seen while the animal is at rest, but seem to be produced under the stimulus of exertion. They appear to be quite involuntary, and suggest the dread caused by the settling or buzzing of an insect about the nose or ears, but occur in the depth of winter in the absence of insect life, as well as in midsummer. The suddenness and involuntary nature of the movement is suggestive of epilepsy, but there is no indication of attendant unconsciousness. From choreic movements it is apparently distinguished, by its presence only when ridden or driven. It is unquestionably associated with hypersensitiveness of the nerve centres, and yet in many cases it appears to be a reflex originating in a specially tender or sensitive part of the skin or mucous membrane. In more than one instance in this college clinic the trouble was corrected by the section of both facial branches of the 5^{th} cranial nerves as they emerged from the infra-orbital foramina.

Abnormal Movements of the Tongue.

Some horses double the tongue downward, others upward of the bit; others protrude the tongue and give it a sinuous, serpentine motion which causes alternate protrusion and retraction.

Flapping of the Lower Lip.

This habit of rapid opening and closing of the lower lip so as to produce a disagreeable flapping noise by striking it against the upper, is seen in many horses and proves a most objectionable trait in harness or saddle animals.

Rhythmical Movements of the Nose.

Certain horses apply the protractile end of the nose against the lower lip and spend hours in succession in moving it rhythmically forward and backward, or from side to side.

Weaving. Movement like a Bear in a Cage.

This consists in a lateral rocking of the head and neck, and sometimes of the chest as well with alternate stepping on the right and left fore feet. It has been supposed to represent the movement of the weaver in working a hand loom, or still better the movement of a caged wild beast in constant turning toward the right and left of the front of his cage. The motions are as regular as a pendulum, and involve the contraction of corresponding groups of muscles on the two sides of the body.

They seem, in some cases, to begin in impatience in waiting for the feed, while other horses in the same row are being attended to first, but when the habit has been formed it may be continued most of the time in the intervals between feeds as well. Nervous horses and those that are hearty feeders are the most subject to this infirmity.

Disorderly Movements of the Limbs.

Some horses have a habit of continuously raising one hind limb, others raise the right and left alternately, rocking the hind quarters from side to side, others stand with the heel of one hind foot resting on the front of the coronet of the other, while still others paw continuously with the fore feet while standing in the stall.

_Treatment._ These various conditions even when begun as an expression of impatience, soon become fixed habits, that prove in the end virtually uncontrollable by an animal, which has no strong will and no consciousness of anything to be gained by resisting the impulse. They become virtual psychoses. In cases in which the habit can be traced to a peripheral irritation, the cutting off of this by complete section of the afferent nerves leading to the irritable nerve centre will sometimes succeed in effecting a cure. In other cases in which the source of the disorder is probably largely central in the cerebral ganglia, nerve tonics, and sedatives, and generally corroborative treatment are the most obvious means of palliation. Such measures are, however, rarely successful. Nourishing food and invigorating outdoor exercise are useful auxiliaries.

VERTIGO. MEGRIMS. BLIND STAGGERS.

Disadvantage of lack of subjective symptoms. Causes, varied,
narcotics, overloaded stomach, cerebral anæmia or hyperæmia,
degenerations, parasites, tumors, jugular obstruction, valvular heart
disease, disease of internal ear, plethora. Susceptible animals,
horse, ox, dog, pig, sheep. Direct causes: tight collar, or throat
latch, flexion of head, heart disease, pulmonary disease, embolisms,
gastric distension, hepatic disorder, optic vertigo, aural vertigo,
injections into ear, rhigolene, chloral, acariasis, seasickness,
railroad sickness, cholesteatoma, cœnurus, concussion, degeneration,
softening, œstrus, linguatula, narcotics, essential oils: essential
vertigo. Symptoms: in irritable animal, highly fed, and without
exercise, crowds pole, his mate or a wall, shakes or jerks head,
staggers, trembles, rears, plunges, falls, struggles, sweats, rolls
eyes, recovers. In gastric or hepatic cases, dullness, pendent head,
swaying gait, dull eye, dilated pupil, pendent lids and lips, leans on
adjacent object, staggers, falls. In optic cases are obvious cause in
transition to light, etc., and palliation by covering the eyes. In
aural cases, rolling eyes, constrained position of ear, deafness,
pharyngeal or Eustachian trouble, wax or acari in ear, tender or itchy
ear. Plethoric cases in spring, in overfed, etc. Brain lesions may
have fever and disordered innervation, but retained consciousness, and
no marked spasm. Duration. Sheep: parasitic vertigo. Turning.
Rotation. Treatment: according to cause: restrict ration, give
exercise, purgative, adjust collar, breast strap, check, avoid sudden
transitions of light, overdraw check, blinds, treat nasal, pharyngeal,
ocular or aural trouble; during attack, stop in shade, cold to head,
deplete, bleed, purge, shady pasture or light work, bromides,
blisters, etc.

In dealing with vertigo or giddiness in animals we are confronted by the impossibility of realizing the subjective feelings of the animal, as we can so easily ascertain by interrogation in the case of man, and thus our conclusions are largely inferences drawn from certain unsteady, reckless or uncontrollable movements, or from an apparent inability to maintain a stable equilibrium. The condition is rather a symptom of a variety of morbid conditions, functional and structural, than a disease _sui generis_. It may be due to alcoholic or other narcotic intoxication, to overloaded or otherwise deranged stomach, to shock, to a stroke of lightning, to disturbances—anæmic or hyperæmic—in the circulation in the encephalon, to degenerations, parasites or tumors in the brain, to compression of the jugular veins, to valvular or other disease of the heart, to disease of the internal ear, to the plethora of spring or early summer, to the qualms of sea sickness, to insolation.

The purely toxic cases are more clearly defined and temporary so that they may be eliminated from consideration at present, yet their possible occurrence must always be borne in mind by the practitioner especially when called to pronounce upon cases of vertigo in connection with veterinary legal questions. The cases that are due to a persistent neurosis, or to circulatory troubles may well be placed in a list by themselves, yet in their legal relations it is highly important that the practitioner should as far as possible discriminate among these as well.

_Susceptible Animals._ Vertigo undoubtedly exists among all domestic animals. The symptoms by which it is recognized have been noted especially in the horse and much less frequently in ox, dog, pig and sheep.

Among _horses_ it especially attacks the mature or aged, and family harness horses, pampered and irregularly exercised; (saddle horses rarely suffer); it is more likely to appear for the first time in spring though when established it happens at all seasons; it may come on when a horse is driven in blinders and fail to appear in the absence of these.