The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).

Date:
1849-59
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Licence: Public Domain Mark

Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    breath, and gives mc an inclination to sigh. From my head K- my fi-et I am at times in pain, and I feel as if there were a heart be-itinj in every part of my body. A numbness comes in my hands, particularly at night, and then I have no feeling in my Angers, till by rubbing I get it back. Ocea- sionally I have had numbness and coldness in my tongue. A lump came in the outside of my throat, which often returns with violent throbbing. This I have every evening.* In this patient there was great irregularity in the uterine function. In truth, this was a specimen of uterine epilepsy in- termingled with hysteria, which was aggravated by continued anxiety of mind and a diet much too stimulating. In the much greater number of patients parox- }'sm of ejjilepsy occurs without warning,-}- but some are admonished of its approach by symptoms rc- ferrible to a disturbed state of the brain or of the external senses, similar to those which are premo- nitory of apoplexy ; as for instance, excitement of the mind ; throbbing in the temples ; turgescence of the veins of the neck ; flushing of the face, with cold extremities; giddiness, weight, headach, drow- siness, forgetfulness; disturbed rest, frightful dreams; irritability of temper, despondency; in- articulate speech; flashes of light or sparks of fire seen in the dark; tadpoles, motes, flies, chains, or cobwebs, appearing before the eyes; coloured areolae around the candle, or any other luminous body ; dimness of sight, or, only one portion of an object distinctly visible ; hissing, ringing of bells, roaring of the sea, or other discordant noises heard ; strange and unpleasant odours smelt; dis- agreeable tastes occurring; numbness in the course of a nerve, or tremblings or convulsions in a limb mounting upwards. Watching or delirium some- times precede a fit, during which ghosts and appa- ritions are supposed to appear; and as the fit does not always follow the illusion, many of our ghost stories and supposed visions doubtless have arisen from threatenings of epilepsy or of apoplexy. We knew an individual subject to epilepsy who be- lieved that his mother had visited him after her death. Disorders of the digestive organs fre- quently precede epilepsy, as pain in the abdomen, salivation, sickness, vomiting, looseness. Some- times the paroxysm follows hysteric symptoms, sometimes obstructed or painful menstruation; or, lastly, the attack follows the aura epileptica, which is a sensation as if a current of air, stream of water, or slight convulsive tremor ascended from a part of the body, or of the extremities to the head ; when the aura reaches the head, the patient falls dowTi in convulsions. This sensation has first been felt in, and seemingly has arisen from, various parts of the body ; from the toe, foot, leg, groin; from the finger, hand, arm ; from the bot- tom of the spine, uterus, loins, abdomen, and chest. * Perhaps we may be allowed to observe that a swell- ing of the thyroid gland, which is often a symptani of hysteria, has not, as far as we know, been sufficiently attended to. 'Jliis swelling sometimes disappears and returns, but is more conunonly permanent; in its ex- •ernal character it is not dislinguishat)le from broncho- cele. t Sur cent malades, on en trouve a peine quatre ou cniij tlont les aitaques soient pretedees<t ariiioncccs par des symptom(?s precurseurs. Chez les qnatre vinL't qiiinze, 'III qualru vingt seize autres, rinvasion de I'aitaque e!?t moite. Gcorget, Did. de Medecine, Art, F.jiileysie. Here wc would observe, that the epileptic fit does not always take place when the patient is thus menaced with it [and, very frequently, it is wholly absent]. Premonitory symptoms of epi- lepsy often occur; not only vertigo, headach, false perceptions, but convulsions in a limb, or in one side of the face, similar to those spasms to which Burserius alludes, with weakness, headach, and a degree of stupor; after which the patient recovers, without the convulsions becoming universal, or insensibihty being complete. Dr. Prichard con- siders these as attacks of partial epilepsy, under which head they are described by that eminent pathologist. To us it would rather appear that, like the aura, they are mere threatenings of a fit. In some patients epilepsy is congenitc, in others it commences in childhood, in others in youth, manhood, and even in age. Sometimes, when previously established, it subsides at puberty ; and sometimes, especially in females, the disease com- mences at that important epoch. There is much variety and uncertainty with respect to the return of the paroxysms. The attacks have been peri- odic, but much more generally they are irregular in their recurrence. Months, nay years, may in- tervene between the severer attacks; while the slighter may return daily.-(- We have preserved no list of the epileptic patients by whom we have been consulted, and cannot state the proportion of males to females, but our impression is that we have seen many more of the former than of the latter ; hence the oliservation of Heberden, distin- guished for his accuracy, is, we presume, true with respect to epilepsy as it occurs in the upper and middle ranks of society, Feminae tamen rarius quam viri in earn incidunt. (Heberden, Comm. cap. xxxiii.) We have known individuals subject to epilepsy preserve their intellect unimpaired in old age. A very dear friend who was liable to epilepsy, died a few months ago in the seventy-fourth year of his age, whose comprehensive, well-st(n-ed, and active mind rcm.ained unclouded till within a few weeks of his death. But it is often otherwise; many become corpulent, indolent, dyspeptic; others are aflected v^ith paralysis, apoplexy, or veternus, or sustain gradual inroads on the intel- lect, which lead to amentia, the relations of things being no longer perceived or recollected by them: like mere machines, they act as they are induced to do by external influence; no longer able to originate anything, when they receive an impulse they are carried on as it were by mere habitual training, the power of modifying their conduct by circumstances as they arise being lost. They generally sit all day long staring and drivelling, inattentive to the calls of nature; so that at last their most sanguine and aflectionate relatives, des- pairing of their recovery, become anxious for their death as a release from suffering and degradation. The change which takes place in tiie c^xpression of the countenance cannot be better described than in the words of M. Esquirol. Les traits de la face grossissent, les paupieres infc-rieures se gon- flent, les l^vres deviennent epaisses ; les plus iolies visages enlaidissent, il y a dans le regard quclque t Heberden relates a case in which therp wa« an in lerval of thirlt-en years bciwccn the first ami second paroxysm. ' N»^«m
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