Unless we are wholly to reject past records and the opinion of distinguished physicians, the nitrate has given good results in a large number of epileptic cases. Heim considered it the best of remedies, and Trousseau, who used also the chloride, places the silver salts second only to belladonna ("Traite," Ed., 1868). We need not, however, quote many authorities to the same effect: we recognize that it has relieved, sometimes even seemed to cure, cases of this disease, and may, therefore, under certain conditions, relieve others. We should not, with Krahmer, consider it most suited for the robust, with symptoms of head congestion, but rather for the delicate with morbidly irritable and susceptible nerve-system, and a languid state of the organic functions (Stille); it is in the pallid and anaemic that strychnia acts well sometimes (Tyrrell), and it is in similar cases that I should be hopeful of good results from silver. Curci considers that it does good in epilepsy connected with spinal disease, but when dependent on local lesion - as hemorrhage, softening, or tumor - the malady is not influenced by it. More definite indications we cannot at present lay down, and must acknowledge that, of any given number of cases, the majority at least will not yield to this remedy, and others, if they receive temporary benefit in the prolonging of the interval or lessened severity of the attacks, will ultimately relapse.

The greatest objection to nitrate of silver, and one which has led to its comparative disuse, is the possibility of its discoloring the patient, and this even without curing his malady - I have seen epileptics discolored by the medicine, and yet suffering as severely as ever from their convulsions. Unfortunately the nature of the disease requires a long continuance of treatment, and therefore a medicine must be preferred which shall, at least, not inflict so visible an injury, and we need seldom prescribe the silver salt until a fair trial has been made of bromides, of belladonna, etc. If, however, it be decided upon, then a purgative should be given at the commencement of, and occasionally during treatment; the remedy should be omitted for a few days at intervals, and the gums should be carefully watched for signs of systemic saturation. The use of nitrate for epilepsy in children has been objected to by Loebenstein, but I have seen it of service in chronic cases. Brenner recommends the chloride in infantile convulsions, and also in the brain-affections of typhus. Niemann found advantage from the ammonio-chloride in epilepsy and melancholia.