Hospital Social Service
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Hospital Social Service PUBLISHED MONTHLY BY YHB HOSPITAL SOCIAL SERVICE ASSOCIATION OF NEW YORK CITY INCORPORATED 9 EAST THIRTY-SEVENTH STREET, NEW YORK, N. Y. DR. E. G. STILLMAN, Editor 1 lk* \ , 'Yv o - ^ SUBSCRIPTION PRICE Domestic $2.00 Canadian $2.50 Foreign $4.00 Single Copies, 35 cents Advertising Rates may be had on application HOSPITAL SOCIAL SERVICE Editorial Notice to Contributors \ --------------------- S cope of Papers.— This Magazine is published in the interest of Social Service and deals with the many problems of the Hospital Superintendent, Doctor, Nurse, Auxiliary Committee and Volunteer in relation to Medical Social Service. Priority of P ublication.— Papers accepted for publication will be printed as far as possible in the order of their receipt. M anuscripts.— Contributors should prepare their manuscripts with the greatest attention to detail. Manuscripts should be type written, double-spaced, and the original, not the carbon copy sub mitted. Manuscripts should not be typed on thin paper, should be packed flat, not rolled, and should be sent registered. Illustrations and charts will be accepted for publication, but if, in the opinion of the Editor, they are not required to increase the clarity o f the paper they may be omitted. R eferences.— Authors are requested to prepare their references lystematically. They should be numbered consecutively in their text and collected at the end o f the paper in the same order under "References.” References to literature cited should contain: (a) if a book, the name (including initials) o f the author or authors, the title o f the book, the place of publication, the publisher, and the date of publication; (b) if a n artical in a periodical, the name (in cluding initials) o f the author or authors, the title of the article, the name of the journal, the year of publication (in Arabic numbers), the volume number (in Roman numerals) and the page (in Arabic numerals) should be given. Reprints.—At present the high cost of printing prevents our furnishing more than fifty (50) free reprints to contributors. i . Price of R eprints Additional reprints of articles published in H O S P IT A L SOCIAL SERVICE may be obtained at the following rates for one hundred (100) copies without covers: 4 pp. 8 pp. 12 pp. 16 pp. 20 pp. 24 pp. 28 pp. 32 pp. $3.25 $6.00 $8.25 $10.00 $12.25 $14.00 $15.75 $17.00 For orders in excess of 100 copies the rates (at cost) are less. Covers $4.00 per 100 copies. Additional 100 covers $2.00. For each plate accompanying the article, add $.02 to the cost of each reprint. These prices are based on reprint pages being the same size as the H O S P IT A L SO CIAL SERVICE; for special sizes there will be an addi tional charge for imposition and make-ready. IDIOPATHIC EPILEPSY AND ENDOCRINE IMBALANCE MAXIMILIAN KERN, M.D. Assistant Professor, General Medical Foundation; Medical College, Chicago, Illinois The history of epilepsy is the history of medicine. As far back as history penetrates we find recognition and an attempt to treat the dread condition. Its symptomatology was accurately described by Hippocrates. Like other nervous and mental diseases it was for long ages regarded with a kind of superstitious awe as a special affliction and a mark of the wrath of God. The epileptic was possessed by a devil and his treatment was by prayer and exorcism. Barbaric and untutored man is everywhere inclined to superstition and to fear the supernatural. It was only to be expected that he should refer to higher powers than his own what his intelligence failed to understand and his arts to relieve. The Riddle of Epilepsy It is practically only within the past quarter century that any real progress has been made toward solving the mystery of the etiology of epilepsy. More progress has been made during this period than in the twenty preceding centuries. Not that we are now arrived at a full knowledge o f the disease and its causation, but at least we have a very fair comprehension of the factors involved in epilepsy, of the mechanism by which the epileptic syndrome is produced, and of measures which either restrict its ravages or entirely cure it. Our knowledge o f the causation, pathology and therapeutics o f epilepsy today stands upon a rational scientific basis, and each day is bringing new facts to light which narrows the field by excluding factors not directly concerned with the production of the epileptic symptom- complex or by the discovery of new facts and processes which bear directly on some phase o f the evolution of the malady. W e are bring ing histology, chemistry, pathologic physiology and other modern scientific laboratory methods to our aid, we collate facts and con crete observations which explain many doubtful and obscure phenom ena, and the general result is that we are gradually clarifying the picture o f the exact nature of epilepsy and the organic structural 265 266 Epilepsy and Endocrines bases which are affected, and are therefore enabled in a logical way to devise a system of rational therapeutics. While our knowledge is not yet exact, it may be safely said that it is constantly tending to become exact, and that the medical aspect of epilepsy will soon be on the same level as that o f disease in any part o f the human organism. The innumerable hypotheses regarding epilepsy, remnants of the older philosophical and even theologic views, have been ruthlessly swept away in the light of modern research; we are guided only by the facts as we find them and the logical deductions from these facts. Epilepsy and the Internal Secretions The study of the internal secretions in man has especially thrown a flood of light on the nature of many diseases and especially of idiopathic epilepsy. By clinical observation and experimental inves tigation we have found how epilepsy can be produced, and that in man there can be no doubt that derangement of the internal secre tions is one of the most important factors, if not the basic factor it self, in the production of the condition and in its maintenance. In deed, I am convinced and do not hesitate to say that it will ultimate ly be proved that every case of true idiopathic epilepsy will show an endocrine imbalance. This assertion is somewhat strong, yet I think it is quite justified when we regard the entire failure o f treatment based upon the assumption that idiopathic epilepsy was due to some anatomical lesion in the brain or other distinctive pathological changes. More has been accomplished in the cure and amelioration of epilepsy since the introduction of organo-therapy than by decades of empirical drug administrations. The most that can be said in favor o f drugs is that they were sedatives, which while they calmed the unfortunate sufferer, did not only fail to cure him but rather added to his malady. The endocrine basis of epilepsy is sound and scientific; it rests upon observed facts; its proofs are each day being multiplied and its general acceptance is only delayed by the professional obstinacy which has always been evident in dis carding time-honored conceptions. For real progress it is essential that we should be agreed on the conception of epilepsy in order to prevent misunderstanding. I speak here, of course, not of traumatic epileptic seizures or those caused by some definitely established pathological condition, such as a brain tumor, but of what is commonly known and accepted as idiopathic or essential epilepsy. M. Kern 267 The Newer Views on the Causes of Epilepsy Time will not permit of my discussing many of the modern views put forward as a pathogenetic basis for idiopathic epilepsy, but there is at the present time almost a consensus of opinion, based upon modern research methods, that idiopathic epilepsy is a syndrome due to various factors which develop upon a constitutional basis of in fection or a toxic state, or to glandular dyscrasia as predisposing or participating causes. The tendency to implicate the internal secret ing glands has recently culminated in treatment by adrenalectomy. The general basis beneath these views is that toxins in the blood pro duce high vascular tension leading to excessive hyperemia of the cor tex, which is a recognized cause o f epileptic seizures. Toxemia and the Internal Secretions I am willing to admit that idiopathic epilepsy is a toxemia which acts upon the nervous system, but I think that the toxemia itself re sults from endocrine malfunctioning or discrepancy. The thyroid gland and adrenals, if not other glands, are well known to be regula tors of metabolism and elimination. The parathyroids seem to control or at least to play an important role in the destruction o f toxic sub stances which have a special predilection for attacking the nervous system, and with the pituitary they are also specially connected with the metabolism of calcium and phosphorus, both of which seem to be concerned in the production of epilepsy. Enough is known to prove that various metabolic abnormalities resulting in definite organic manifestations are associated either with excessive or defective func tional activity of different glands. It is quite evident that defective metabolism must result if the hormonic balance is not maintained, and that oxidation and catabolism o f waste materials is interfered with. Toxic wastes are retained in the organism. If it be admitted that epileptic seizures are connected with metabolic defects and that the exciting cause is some toxic element in the blood, then it follows that there is no more fertile source for such a pathogenesis than constantly defective glandular functioning.