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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    lay them aside, and ever since he has been with- out an attack of epilepsy, and is now an able- bodied watchman. I have observed, says Fo- thergill, that epileptics are often extremely incau- tious with respect to diet; that children highly indulged are liable to the disease; that in every other period of juvenescence, and in middle-aged adults, if they were attacked with the disease, it was when they had cither committed some ex- cesses, or by one means or another were plethoric ; and that in habits subject to epilepsy, the disease seldom recurred without either an habitual indul- gence in eating, or a neglect of necessary exercise. The occasional causes of epilepsy may be divi- ded into two classes. 1st. Joy, anger, suppressed discbarges, repelled diseases, elevated temperature, bodily over-exertion, drunkenness, prolonged sleep, surtViting, congestion of the bowels, obstructed or painful menstruation. 2. Opposed to these are terror, grief, disgust, exhaustion of mind from in- tense application to business or study, vigilance, inanition, hypercatharsis, venereal excesses, he- morrhage. Parmi les causes excitantes de I'epilepsie la frayeur tient a-coup sur le premier rang. La colore et un chagrin profond, la mas- turbation, et les execs veneriens paraissent, apres 'a frayeur, tenir le premier rang parmi les causes Je Tepilepsie. (Diction, do Medecine, Art. Epi- lepsie.) We read of epilepsy being caused by imitation. An attack of epilepsy, when witnessed by a number of unmarried females in a church or school, has often led to convulsions spreading from one to another, till a great many are affected. Dr. Why tt describes this affection in the following words : There is a disease very common in the islands of Zetland, which is known there by the name of the convulsive fits. It begins with a vio- lent palpitation of the heart; soon after which the patients fall to the ground, unless they are sup- ported ; their arms and legs are alternately con- tracted and relaxed ; and in some cases their joints become so rigid that they cannot be bent. Their respiration seems to be difficult, and they cry ter- ribly vi'hile the fit lasts, which is generally less than a quarter of an hour. This disorder seldom attacks married women ; but young women, and even girls of ten or twelve years of age, are liable to it. Some boys and tv^'o young men in these islands have also been affected with it. In the church or other public meetings, as soon as one is seized, all such as have formerly been subject to the distemper are attacked with it, which often occasions great disturbance. These attacks, there cannot be a doubt, arc not epileptic, but, like cer- tain more recent exhibitions in churches, are clearly refcrrible to sympathetic hysteria. [A recent writer, M. Meyer, has published some cases of what he terms epidemic epilepsy, occur- ring in schools. In consequence of a girl being attacked with epilepsy, numerous others became affected. Most of the girls were approaching the age of puberty, and tliey were all of a highly ex- citable temperament. It is probable, indeed, as the writer has stated elsewhere, (^Practice of Me- dicine, ii. 230,) that these were cases of hysteria rather than of epilepsy. Many cases, however, are on record, in which the disease appears to have been produced by the sympathy of imitation from witnessing a paroxysm in another. An idea has long existed, that the paroxysms of epilepsy may be connected with the condition of the moon ; but there docs not seem to be any sufficient reason for this belief] Of the occasional causes of epilepsy, it is justly observed by Dr. Cooke, that some are stimulants producing an increased action of the brain, while others are sedatives, operating so as to diminish its energy. When there is a predisposition to epilepsy, a cause of either kind, productive either of excessive or defective action, may interrupt the equable transmission of the sensorial power by means of the nerves, and thus occasion a fit; and hence it would appear desirable to retain every patient who is subject to epilepsy in a state equally distant from plethora or from undue emptiness of the cerebral vessels. [Perhaps disorders of the digestive canal, while a predisposition to epilepsy exists, are the most common exciting causes; and, accordingly, we often find the paroxysms recur as certainly as ali- ment, improper by character or quality, is received into the stomach. In such case, the disease is eccentric epilepsy.] Diagnosis.—We have reason to think that not only eclampsia, but hysteria ; cataleptic hysteria ; sympathetic hysteria, the disease of religious sects among whom enthusiasm is permitted to usurp the place of sobriety; catalepsy; catalcpsis deli- rans; extasis, have been considered as specimens of epilepsy. The student, therefore, must acquaint himself with these diseases, as also with the his- tory of feigned epilepsy, which, not merely in the military hospital but in private practice, he may be called upon to distinguish from the genuine disease. Let him bear in mind that if a fit com- menced with a scream, if it was characterized by insensibility, convulsions, and foaming at the mouth, if it ended in sopor, and if the tongue were wounded or even gnawed at the edges, there can be but little doubt that it was epileptic. Prognosis.—The prognosis in epilepsy em- braces two heads of inquiry, viz. first, the danger to be apprehended firom the paroxysm; and se- condly, the probability of a return. As epilepsy sometimes proves suddenly fatal during a paroxysm, our opinion must be delivered with a salvo in reference to such a contingencj'. To form a judgm.ent of the amount of danger, we must, first, endeavour to asceitain the species of epilepsy to vfhich the case belongs; cerebral epilepsy being attended with more danger than nervous, nervous than gastric or hepatic, and these again than uterine: but we must not forget that the sympathic species of epilepsy may, by repeti- tion, acquire the character of the idiopathic, and be attended with equal danger. Secondly, we may oftentimes judge of the danger of the attack by the symptoms which precede it; thus, in the cerebral species, danger may be apprehended when the preceding s)'mptoms indicate a fixed disease of the brain, as intense pain, vigilance, delirium ; when inroads have been made upon any cf the mental faculties ; and when there have been threat enings of paralysis. Thirdly, we are influenced by the violence and duration of the paroxysm. Those severe paroxysms which continue many hours often terminate in fatal exhaustion, or in an apoplectic state. Hence coma, after the -onvul
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