will be found at some period to have had a loss of consciousness, with or without convulsive movements.

Among the most peculiar of the epileptic phenomena are the so-called psychic epileptic equivalents of which the following case, taken from my case book, is a sample.

J. II., 34 years of age, son of a drunkard, married three months ago. When a baby had cholera infantum which stunted his growth, until he was five years old. At that time would have spells when he would turn pale and mutter a few unintelligible words and then go on as usual. From that time, until five years ago, his condition varied, at times being better, then worse. For the past five years has been much worse. Has been in the habit of getting intoxicated occasionally, when he felt badly. Very susceptible to liquor. Since his marriage three months ago, has been worrying about his marriage. Patient looks normal and talks intelligently, his chief complaint being about pain in the back of his head. Last night, in bed, suddenly grabbed his wife and commenced to talk to her about a wooden man having connection with her. At that time had an erection and went through the motions as if having sexual intercourse. This morning had no knowledge of the occurrence or of having said anything. While being examined the patient suddenly commenced to talk in a rambling incoherent manner for a few seconds, became pale, then gave a swallow and came to himself, but knew nothing afterwards of what he had said. Says these spells come upon him at intervals, often two or three at a time; then will have no more of them for weeks. Sexually weak, very depressed, desires to die. The patient is a salesman, and these attacks, he says, occur occasionally during his business. preventing his selling anything. Although the patient had suffered from these attacks more or less for thirty years, and been treated by numerous physicians, the nature of the disease had never been recognized until he came into my hands.

These psychic equivalents usually come on suddenly, without warning. All of the attacks somewhat resemble each other. The patient is not completely unconscious, but the consciousness is disturbed, there is a dreamlike, altered consciousness in which apparently automatic, mechanical and conscious acts seem to alternate with strange purposeless ones. In this state the patients may walk about, run away, make indecent exposures of themselves, commence complicated and apparently premeditated movements and yet afterwards have no knowledge or remembrance of anything

which they have done. Gray mentions one patient of his, a lad of fourteen, who would wander for days about the lower quarters of New York, sometimes earning wages in some light occupation, without arousing the faintest suspicion in those about him, until some fine morning he would return to his normal condition and then quietly wend his way home. Of this character are many of the sudden, mysterious disappearances of people, which are daily chronicled in the public press. While in this state many a crime has been committed, utterly motiveless, and the culprit, when restored to himself, has been as unconscious of the whole affair as if he had not been involved therein. Similar to these psychic equivalents are some of the forms of post-epileptic mental disorders which often follow the grand mal attacks. I recall one case which we had many years ago in the Middletown Hospital. This woman would have a severe attack of grand mal from which she would appar ently recover and go about the wards as usual, seemingly cognizant of all that occurred about her. A violent attack of furious mania would then ensue, during which she would have to be kept in restraint to prevent her from injuring herself and others. This state might last for days, ending in another severe convulsion from which she would recover completely, but with no remembrance of anything which had occurred from the moment of the first grand mal seizure, although often weeks had intervened.

Hammond mentions another form of epilepsy which he terms. thalmic epilepsy. This form of epilepsy is characterized by conscious hallucinations, followed by unconsciousness, but unattended by muscular spasms. He describes six cases of this variety and says that several other competent physicians have recorded similar

cases.

Sudden and severe outbreaks of perspiration, with or without unconsciousness, may also rarely appear as equivalents of epileptic attacks. A sudden sleep may also occur as an equivalent. A general tremor, combined with a clouding of consciousness, may also take the place of an attack. A great variety of auræ have been recognized as forewarnings of an attack. We may have auræ of the special senses, of the visual or organic sensations, and intellectual or psychical auræ.

Visual auræ are numerous and varied; they may appear as sparks or bright colors before the eyes, or the patient may suddenly seem to be thrust into utter darkness, or plunged into a sea of light, or a complete picture may be flashed before the eyes. The auditory

warnings, though less frequent, may be simple or elaborate in form. Hissing, singing, whistling or explosive noises, or vocal utterances may be heard. On the other hand a loss of hearing, a strange unearthly stillness may precede the loss of consciousness. Gustatory and olfactory auræ are the least frequent, but, when present, consist of peculiar tastes and smells. In vaso-motor auræ there may be a mottling of the skin, the hands may be cold and purple, the cutaneous veins may look less full than normally, and a general feeling of chilliness may pervade the patient, attended by chattering of the teeth.

The visceral and organic auræ are the most prevalent. These consist of a choking at the throat, or a feeling of weight or pain in the epigastrium, or an opening and shutting of the head, and continue until consciousness is lost. The psychic auræ are numerous and varied. Terror, shuddering, depression, gaiety or rage may seize the victim. Reminiscences of bygone days may suddenly rush into the mind, or portions of their past lives pass like a drama before them. Whatever the form of the auræ, the patients learn to recognize them as forewarnings of an attack and are thus often able to prepare for them.

Epileptics are, as a rule, undersized and constitutionally weak. Some of the physical, physiological or mental signs of degeneration are always present. According to Fèrè the physical stigmata are short stature, cranial asymmetry, short parietal or frontal arc and triangular skull; in women high prominent forehead; bad teeth badly placed; high palatal arch; facial asymmetry; prominence of occiput and lemurian hypothesis; differences in color, size, position and shape of pupils; astigmatism, badly shaped and badly placed ears; misplaced crown of scalp; low vital capacity; small genitals, atrophic uterus, greater development of left side; long fingers. Sometimes from a premature ossification of sutures we find also the steeple shaped skull, or the obliquely deformed skull.

Physiological stigmata appear in the form of lessened muscular strength, habit choreas, imperfect eyes with excessive amount of astigmatism and functional muscular weakness. The vital capacity. is diminished, the digestion weak and slow and sexual atrophy or irritability is likely to be present. The excretion of phosphoric acid is below normal as compared with urea.

Of the psychical stigmata we are likely to find mental weakness, moral insensibility, irritability, wayward and vicious impulses. lack of will power and sexual aberrations.

No forms of disease reveal more contradictory or inexplicable mental states than those which characterize the various varieties of epilepsy. The closest study and widest observation are necessary to unravel its many apparent contradictions. From time immemorial the epileptic has been associated with our criminal annals. Numerous hideous crimes, purposeless and motiveless, have been traced to his door. When we consider his violent physical contortions, and the numerous criminal acts which he has unconsciously committed when under the spell of his direful malady we can understand why the epileptic was formerly supposed to be possessed of the Devil. Although scientific research long since removed it from the realm of demonology, epilepsy remains today a blot on medical skill. No disease is more often brought under the lens of the medico-legal expert. While careful scientific research has revealed much of its mystery much still remains hidden and unknown.

THE MODUS OPERANDI OF DIPHTHERIA ANTI-TOXIN
AS A CURATIVE AGENT IN DIPHTHERIA, AND
ITS RELATION TO HOMEOPATHY *

BY ELDRIDGE C. PRICE, M.D.
Baltimore, Md.

There are, in the world of homeopathy, those who live in constant fear of a successful demonstration that some drugs, under some circumstances, do not cure in accordance with the law of similars. They profess to honestly believe that a cure can result in no other way than through homeopathy; and yet they fear. As a demonstrable fact, however, homeopathy is but one of the means by which the sick are restored to health.

In discussing the subject which has been assigned to me, there are several points to which attention must necessarily be given before we are in position to come to a definite conclusion, either as to the modus operandi of anti-diphtheritic serum as a curative agent in diphtheria, or as to the relation of this modus operandi to the law.

of similars.

Among some of these things necessary to know, are, first, the nature and cause of diphtheria; second, the origin and nature of a toxin; and third, the origin and nature of an anti-toxin, and what relation it bears to a toxin.

It is not necessary to enter into a history of diphtheria, further than to say that its antiquity certainly dates back to the time of

* Read before the American Institute of Homeopathy, 1904

Aretaus of Cappadocia, who wrote definitely of it as early as the year 50 A.D.

As the centuries rolled by much was written of the dreaded malady, but it was not until the year 1884, when Löffler confirmed. Klebs' discovery of a distinctive diphtheria bacillus, that the present apparently correct views of the disease were given definite and demonstrable foundation. The definition now generally accepted of the nature of diphtheria, is that given by Dr. William P. Northrop, in Nothnagel's "Encyclopædia of Practical Medicine." "Diphtheria is an acute infectious and communicable disease characterized by the production of false membrane on a mucous or an abraded skin surface, and due to the presence and proliferation of the Klebs-Löffler bacillus and the toxins elaborated in its growth." We find, therefore, that according to this generally accepted view, the cause of diphtheria is the toxins which are generated by the bacillus which is always found in the organism affected by diphtheria; and that the disease is infectious and communicable.

Although it is true that the Klebs-Löffler bacillus is the organism from which the poison comes that causes diphtheria, yet it is not necessary that this organism should be present continuously during the course of the disease. After its introduction into the human body and the giving off of the toxin, it may be destroyed and no successor take its place, and yet the patient may die of diphtheria, the effects of the toxin. We, therefore, find that in the treatment of the diphtheria patient it is necessary to antidote the toxin and not the bacillus, and this may be done in more than one way. (The continuous introduction of fresh bacilli should be prevented, of course, but the vital point is to neutralize the poison which the existing bacilli produce.) The toxin may be antidoted by drugs, and it may be done by what is known as anti-diphtheritic serum. The former antidotal method, however, does not here concern us, but the manner in which the antitoxin of diphtheria acts as a curative agent is for us to consider.

Diphtheria anti-toxin is one of those agents which are known as anti-bodies, and which are generated by the cells of the organism with which the toxin is brought into contact. Just how this action takes place, and just why the poison will produce its own antidote we leave such men as Ehrlich and Behring to tell us; but the fact is, that when the bacillus of diphtheria generates its poison, this poison causes the organism in which it is present to generate a substance which has the power to antidote the toxin which is the cause of its formation, and which is known as anti-toxin.

Just how the neutralizing effect of anti-diphtheritic serum upon