ESSAY ON EPILEPSY.
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ESSAY ON EPILEPSY.
IN WHICH A new THEORY of that DISEASE is attempted, from which the proximate Cause is investigated, and Indications brought from thence; shewing clearly the Consistency of the Method of Cure.
By
W. THRELFAL,
M. D.
Nemo Mortalium omnibus horis sapit.
PLIN. Hist. vii. 40.
LONDON:
Printed for Z. STUART, Bookseller, in
Paternoster-Row.
M.DCC.LXXII.
To the Right Honourable LORD GEORGE SUTTON; A just and uncorrupt Senator, Candid and ingenuous, Highly esteemed by some, Generally respected by all: As a Testimony of Regard and Gratitude, for his Civilities and Friendship, with Diffidence and Submission, the following Sheets are most humbly inscribed.
By his LORDSHIP'S most devoted, most obedient, and humble Servant, THE AUTHOR.
ESSAY ON EPILEPSY.
THE intention of the Author, under this genus Epilepsia, is to describe that disease which has been most commonly in this island, called the
Falling Sickness:
The reason why we chuse to give it the title of Epilepsy is, it being the general Term now in use amongst the most accurate and recent Systematics: But before I attempt to enumerate the phaenomena and different symptoms accompanying it, I think it necessary, in order to avoid the danger of its being confounded with any other Genera, of the class of Neuroses of Dr. Cullen, or of the
Spasmi
of Sauvage, to which it pertains; to give it a Definition, which I shall endeavour to be as concise in as the matter will admit.
DEFINITION.
THE Epilepsy is a disease of the convulsive kind, returning periodically, affecting the extremities with various and irregular motions; every sense, as well as the faculties of the mind, for a certain time are altogether obliterated.
HISTORY OF THE DISEASE.
HAVING thus defined the disease, I shall next endeavour to illustrate its appearance more accurately in a detail of the particular symptoms attending it; but as I have before remarked that it is a periodical one, and as many circumstances shew the approach of these periods, it seems most proper to take our first observations from them. Before any one is seized with an Epileptic Fit, as it is called, he or she generally perceives the head to be in some degree affected by stupor, or a kind of swimming, which we express by the name Vertigo; the countenance is sometimes red and bloated, at other times in a collapsed state, the eyes sparkle and appear highly excited, a small inflammation or red spot is frequently perceived upon the white of them, increasing gradually till the time of accession; the circumambient parts are considerably distended; vision is diminished and vitiated in some degree, sometimes indeed altogether absent.
The Iris has very different appearances, sometimes purple, at others black; the ears tingle, and sounds are difficultly heard; disagreeable smells and tastes are also perceived.
The patient's discourse deviates much from what it is in health, being either quicker or slower, and at this time saliva is emitted from the mouth very copiously; the jugular veins are enlarged, and at last a loss of sense takes place.
Neither are the parts below these altogether free from complaint, but are affected with symptoms common to other spasmodic diseases, particularly those of hysteria and hypochondriari; but it frequently varies here, acting differently in different temperaments; sometimes a pain is felt between the shoulders, the abdomen is drawn upwards, the tendons are convulsed, the heart and extremities tremble, yawning and difficult respiration succeed, the extremities grow cold, the penis is praeternaturally distended a sense of air or warm vapour is often perceived from the hypochondria, extremities or lowest parts, ascending to the higher and to the senorium.
The eructions also are very irregular, for besides the profusion of saliva, which has been spoken of above, the digestions of the intestines are foetid and very offensive, the urine is also discharged in greater quantity than is customary, and not sufficiently elaborated.
Nocturnal emissions of semen frequently happen from salacious dreaming, a sense of inflation is also perceived at the praecordia, the abdomen begins to swell and murmur, the appetite vitiated, requiring food either in too great or small quantity, some are excited by anger, others are depressed by sorrow or fear; others again are distracted by anxious cares, some transported by joy, by foolish and intemperate laughing; others within a short space of time run through all their different affections, sleep is either too profound or disturbed with terrifying dreams; the incubus or night-mare frequently is an addition to these calamities. By the increase of these symptoms, at last the occasion appears, by which the patient is prostrated on the ground by a groan, all the senses and the faculty of the mind being abandoned.
Violent convulsions seize the whole body, the muscies of the face being differently distorted, seem to express different senses of the mind as those of grief, joy, anger, love, &c. there is also a violent grinding or grating of the teeth takes place, to such a degree as sometimes to destroy part of their extremities; it is not unusual for the tongue to protrude a little out of the mouth, and the closing of the jaws frequently cause the teeth to cut it exceedingly; a livid appearance of the lips and under parts of the eyes takes place, which, in a short time, runs over the whole face; the palpebrae of the eyes are irregularly moved, but never are so far constricted as to cover all the white; the mouth is dry, sparm prevailing in the beginning, afterwards it pours forth its saliva, the sparm not being solved; respiration is performed with the greatest difficulty and labor, as if a person was actually under efforts of strength, and the hands are clinched with great force, neither are the heart and arteries free from distress, the pulsations of which are at first quick and small, in a short time they become full and slow, not having their proper force, and can scarcely be numbered, wanting their regular order; after this the venis of the face, also the praecordia and abdomen begin to swell; the excretions are also considerably disturbed, for instead of saliva, which was before very profusely secreted, a soam arises in the mouth, also stools, urine, sweat and semen, are spontaneously evacuated, in an excited system, endued with great sensibility; vomiting also happens sometimes.
All these symptoms by degrees begin to vanish, and the Convalescent Epileptic has not the appearance of death, or a moribund state, but a more natural sleep at last returns again; but yet not so sufficiently natural but that it represents Apoplexy. The breathing at last becomes less laborious; and a short space of time intervening, the patient, not conscious of any thing that has happened, is restored to his natural state: it rarely occurs that a person recovers immediately all his faculties, upon the paroxysm subsiding; for generally there remains an inactivity to motion, in all the extremities, dullness of conception, pains of the head, and dimness of sight; all which continue some time. — The times of interval between these accessions are very different; some are attacked every day, or sometimes twice in the day; others once in the month; and others again, at a much greater distance of time; but the accessions do not observe regular periods, even in the same person; and the continuance of the accession also differs greatly, some only being distressed for a few minutes, others whole days: and here we conclude our account of the symptoms attending Epilepsy.
REMOTE CAUSES.
THE different remote causes, and the effects of those visible upon the brain of dissected Epileptics, sufficiently demonstrate, that Epilepsy most frequently depends on a turgid state of the brain; these causes, whether they act directly upon the brain, or primarily on another part of the body, are at last transferred to it, and there act
Vide
Bonetus, Morgagni, and Lieutaud.
.
Those that act within the brain may, as sar as at present we have learnt from dissections, be properly reserred to six heads: 1. Mechanical Stimuli—As a fractured cranium, and all cases of depression. 2. Chemical Stimuli—Collections of acrid fluids. 3. Matters preventing the free circulation of the blood, or proper action of the nerves, under which are comprehended tumor, ossifications, and compressions. 4. Where the vessels of the brain are preternaturally filled with blood. 5. Effusions of blood. 6. Effusions of Serum.
It is obvious, beyond a doubt, that all these causes consist in a full and turgid state of the brain, which is the fourth cause; and an increase of this, the fifth and the sixth follows either of these, when no hydropic habit is present; which may be easily detected by its symptoms, and distinguished from that state of turgiscency which we are endeavouring to investigate; an impeded circulation in the sinuses of the brain, or jugular veins, will cause the arterious blood to act with greater impetus, upon their exhalents, which will cause an effusion of serum; and a small effusion in the brain is more liable to do harm than in any other part; because here we have no absorbents, and the veins only perform this office; so that a small quantity of serum effused, must accumulate by stagnation for want of this absorbent system.
The sixth cause is therefore an effect of the two foregoing; nor does the first act immediately, unless by giving that full habit we have been discussing, or in some degree assisted by that, we are certain it does not give a more certain Epilepsy, and the cure of every Epilepsy coming from this origin, consists in a diminution of the full habit.—What pertains to the second, I agree that acrid chemical Stimuli are both obnoxious to, and capable of giving Epilepsy; but as such I deny its capability of giving one where the paroxysm is continued longer, and when the stimulus is present, and the fit has been more durable, and serous colluvies found extravasated; I contend that it is the effect of the disease, and of the impetus of the blood, which before has been elucidated.
The third cause is the only one remaining to be reconciled to our general opinion, under which are classed, hard tumors and consertions in the brain, impeding the free circulation through it: this is pretty well explained by the first and second cause; such is a compression of the softer parts into a praeternatural hardness: this cause therefore seems to me to act as a stimulus, quickening the circulation of the blood through its vessels; therefore this, as well as the first cause, if not directly, yet in effect produces the plenitude necessary for our proposition; and the same may be added with respect to the other four causes, which have been before enumerated, and properly reconciled, as terminating similarly.
These conclusions are or the greatest advantage in practice, and clearly shew us how we ought to diminish the Plethoric habit of Epileptics, and recommend abstinence: this is an excellent example of the use of dissections in investigating proximate causes of diseases, though much neglected at present by physicians.
Not that I mean to affirm, or give it as my opinion, that there is no Epilepsy but what depends on
Plethora;
many depend on inanition, others on neither cause: more are however to be referred to it than at first view we imagine.
I remember a case of Epilepsy, remarked by my most ingenious master and illustrious professor, Dr. Cullen, at Edinburgh, which was brought on by fear; and yet before every return of the paroxysm an inflammation of one of the eyes was clearly perceived.
As we have gone pretty fully through these causes, which act within the Cranium, let us endeavour, in order more certainly to establish the nature of the disease, as depending on this plethoric state of the Brain, to shew how causes originally acting elsewhere, or at a distance, produce the same effects.
Impressions of different kinds, acting upon the senses in general, give Epilepsy, according to their degree of impulse; they do not act as being of distinct or different kinds, but by force of impression, or reflect sensations, excited (as they are called) and this may be reconciled to all the senses, except that of smell, upon which odours seem to act particularly; neither have these the power of acting, unless sufficiently strong. So a considerable degree of pain, of any part—joy, and what is still more,
fear,
which is carried to a degree of terror, have produced Epilepsy.—Terror acts more powerfully as a stimulus than joy; because we are modified by nature to attend more peculiarly to those motions of the mind, which free us from danger, than those which elevate us to sudden prosperity.—And why not? when we consider, that sudden destruction is escaped in one case, and only transitory pleasure acquired in the other.—Chemical Stimuli act also in like manner; some upon the whole system, others only on a particular part, as by stimulating the stomach; and these do not act specifically, but according to their strength do they produce Epilepsy.—Odours, indeed, as we have before said, seem to have a peculiar mode of action, and some other causes produce the disease from encreased irritability of the patient; as among children, dentition, calculi, and worms. And these causes act in the same manner as those within the brain, viz. by stimulating the brain to more violent motions, and quickening the circulation of the blood through it; which, from our former observations, seems to be the most frequent cause of Epilepsy. But having before said, that Epilepsy might arise from a contrary state, we shall run over these causes, as not being of so much consequence and importance, with less precision.
Perturbations of the mind, by diminishing the action of the brain, produce a temporary Epilepsy, quickly terminating in either death or health, as is observed in the effects of great and sudden joy, or terror; but it would have been sufficient only to have mentioned these once, as they very commonly bring on death in a similar manner; as by Palsy, Apoplexy, Syncope, and Convulsions.—Some of the affections of the mind give a more continued Epilepsy, and one more pertinent to our proposition, as Fear; which, by diminishing in a certain manner the mobility of the nervous power, seems, by an inherent law in our system, to give in a certain ratio, a reaction of the efforts of the brain, which is even greater than natural; or the remembrance of this same cause of fear is often very surficient to bring back the disease.—There is a fact of a pregnant woman being fatigued with trying a new gown, which by diminishing the excitement of the Sensorium, gave that reaction necessary for the production of an Epileptic fit; the sight of which gown, for sometime after, was sufficient to renew the paroxysm. Atonia of the stomach sometimes is sufficient to give Epilepsy; such as is made by distention after eating, as is observed by Galen.—Fumes of Ipecacuana taken into the stomach, are capable of producing the same effects; also Mercury, and many other matters; the Variolous contagion, induced by inoculation; and the Aura Epileptica, and finally, compression of the brain, which produces Epilepsy, such as generally precedes Apoplexy or Palsy.
There causes, from the effects, and method of cure, are very clearly seen to act, by giving a state of the brain, contrary to excitement, which we chuse to call by the name Collapse; but then these act very rarely when compared with the former; neither do they essentially deviate from our proposition.
From innumerable dissections of Lieutaud, Morgagni, and others, of Epileptic patients; also in the opinion of the greatest characters in Physic, Albertinius and Hossman, and many others, truly honoured and esteemed for their practice, it appears, that they, for the most part, frequently treated Epilepsy as a disease strictly connected with Plethora; and this also particularly agrees with the opinions and doctrines of my late most worthy Master and Instructor, Doctor Cullen, of Edinburgh, Professor of the Institutes and Practice of Physic; whole name I am at a loss for words to adorn with that reverence, gratitude, and affection, that it demands of me; but will always endeavour to keep it in view in my practice.—I am also of opinion, that this turgescent state, which we have been endeavouring to establish, will, argued fairly, most easily investigate the nature and cure of the Epilepsy.
For the more clear and accurate elucidation of the proximate cause of this disease, let us consider those habits that are most predisposed to it.—Those Systems inclined to Epilepsy, are generally endowed with encreased mobility: by this I mean persons subject to sudden, irregular and violent motions of the mind; and is it not highly probable, that the state of the brain in these habits, which is moved by every impulse of stimuli, and every change of tension, is similar?
This mobility is encreased by repetition, and, after sometime, become habitual, and almost natural, according to the law of irritability, (by which I mean the power of contraction of muscles) it is encreased and facilitated by motion.—This explains the reason why, after one paroxysm others can be produced by less active and weaker stimuli, and seems as if they were produced even spontaneously; for which reason it has been called a voluntary and feigned disease. This mobility assists us much in the investigation of the proximate cause of every Epilepsy.—There are two causes of mobility:
1. Debility of muscular fibres.
2. Excess of tension.
The first cause is clearly elucidated in infants, who are particularly obnoxious to Epileptic fits, a debile state of muscular fibres, or of the original stamina, can give such a certain condition of the nervous power, which makes it more adapted to irregular motions, which we call encreased mobility: but perhaps this reasoning may appear too subtile; so I shall pass to the other cause of mobility, viz.
Excess of tension.—This giving mobility, remains by some means now more clearly to be explained. Stretching fibres beyond their tone, gives encrease of mobility: so fibres immoderately distended by the Potentiae Nocentes; such as exercise, heat, drunkenness, &c. especially in a Plethoric system; when the force of these is removed, they immediately relax themselves, in a certain ratio, as they have been before distended; and in like manner are their oscillations encreased; which remission, or relaxation, must frequently necessarily take place in the brain.—This tension, which depends on the quantity and impetus of the humours, frequently remits; an explanation of which, by an example of an elastic cord, may perhaps render it more easy to conceive: if such a cord is extended, by force or by any weight, to a certain length, it will require a greater force, or weight, to stretch it as much more, than was at first applied: and in a ratio, according to the degree of distension, so will be the resilition, the distending power being removed: or, I may explain the same thing by a pendulum; as far as you remove it by the hand from the center of gravity in one direction, giving it liberty, it will, in a certain ratio, go so much farther from it on the reverse side.—A full, turgid state of the brain is analogous to this; the oscillations of which are produced either spontaneously, or by faults occuring elsewhere; as Plethora always encreases itself.
But besides this cause of Epilepsy, consisting in the excitement of the brain, or in its greater oscillations, that is excess of tension connected with debility; a defect of tension, debility being present, will produce the same effects.—This is a peculiar law of our system; as excitement produces Collapse, so, in return, does sedative powers produce Excitements.—For the motions of our minds run into contrary extremes.—Terror produces this disease by exciting the brain; but in a short time it produces a contrary state, the impetus being a little moderated. Exquisite titillation brings about the same phaenomenon, as is observed by Aristotle:
Omne animal post coitum triste.
And other sedative causes act in like manner. We shall however leave these discussions, and pass to the cure of Epilepsy, depending on a turgescent state of the vessels of the brain.
METHOD OF CURE.
THE indications of Cure seem to be Two:
I. To avoid occasional causes.
II. To obviate a full habit.
I. All exciting causes are particularly to be guarded against; so every thing that induces plethora, is strictly to be forbid, as animal food, and matters that are highly nutritious; also whatever has the power of determining the blood to the head, as the rays of the sun acting upon it, heat of the bed, favoured by the horizontal position, bathing, exercise, drunkenness, and anger, and whatever is capable of inducing vertigo; as viewing of objects from eminencies, venery, strong impulses, as sudden noises, stridor of the hinge of a door, commotions of the mind, remembrance of the first cause of the disease, and sight of other patients labouring under the same paroxysm.
II. By the second indication of Cure, is intended not only to obviate the increase of a full habit, but also to diminish that which is present; for which purposes the following method seems to me most advantageous.
First, Blood letting: This is peculiarly efficacious, where the disease chiefly seems to consist in tension, and a few ounces drawn will answer the intent; but when signs of congestion appear in the head, as by acute pain, tumor, or any inflammation, then blood is to be drawn plentifully; and for this reason I advise a large quantity to be taken at once, because it is not so soon repaired; and as we know from fact that nothing more encreases plethora than frequent small bleedings, performed periodically, the system being accustomed to lose a certain quantity of blood at particular times, always provides for such a loss: therefore, from the reasons above, it is sufficienity clear, by small repeated bleedings we increase that habit we wish to obviate. And this remedy may be used with greater advantage when we are acquainted, by any symptoms, of an approaching accession; upon the appearance of which, I would very freely immediately draw blood from a vein. I should, at the same time, be very cautious of inducing a Deliquium Animi, and this for two reasons: 1st, Lest I should be frustrated in my intent as to quantity; and 2dly, As by this there is some danger to be apprehended of inducing an accession.
This then may be the rule, to bleed while the strength of the patient remains favorable. Should not this prove sufficient, which I am in hopes it would, then leeches, or cupping glasses, may be applied to the temples, as necessity requires.
Second, Purgatives: The action of these is accompanied with stimulus; and if this be a general one, often does as much harm as good: we should always, in this case, pay particular attention that this stimulus be as much confined to the alimentary canal as possible; which may have good effect in altering the determination from the head, which before we elucidated to be so generally the case with Epileptics.
These act by exciting the peristaltic motion of the intestines, and thus occasioning a discharge of their contents; also by emulging the several excretions, which is a greater evacuation than the former: hence purgatives must have a considerable power in depleting the system, and diminishing its tension, which we have shewed to abound in Epilepsy; I would, however, recommend those of the milder kind; such as neutral Salts, Senna, Manna, Rhubarb, Castor—Oil, &c. as most proper.
Third, Issues and Setons: These by discharging the coagulable lymph, are, without doubt, useful against a full habit; as this is the part of our fluids which forms Pus, that we see evacuated by these emunctories, which are generally placed in the neighbourhood of the system, where the cause of the disease acts: hence, in Epilepsy, the most proper part for an Issue or Seton, is the nape of the neck.
These remedies, in most cases, are sufficient either to cure, or, at least, to alleviate the disease: yet I would not recommend a long use of them; since the system being inured to this evacuation, from custom and habit, assimilates an increased quantity of coagulable nymph, in order to supply the discharge of pus, analogous to frequent blood lettings increasing plethora.—So the longer we continue these evacuations, the less essential are the effects.
The most proper method after the use of these means, to obviate a full habit, is,
Fourth, Abstinence: This is highly effectual against the cause of Epilepsy, consequently against a turgid state of the vessels of the brain, the cause of this disease; and certainly more Epileptics are cured by this, than all other remedies; and whatever advantages may arise from the use of the above evacuations, it is absolutely necessary that the patient observe strist regularity in the non-naturals, and adhere inviolably to the antiphlogistic regimen, for a considerable length of time, and perhaps through life.
In Epilepsy, arising from debility, the following indication of cure seems most proper.
To obviate mobility of the nervous power.
This takes place in a lax state of the system, and is relieved by tonics and antispasmodics: there is doubt in the former from the difficulty in the administration. In the vegetable kingdom, there are some plants abound peculiarly with an astringent quality, as the bark of oak, which has been thought to act specifically in this disease; perhaps commended enthusiastically, as it is very uncertain.—The vegetables where the bitter and astringent qualities are connected, are the most powerful; as in the
PERUVIAN BARK.
And this is not administered with so much propriety to a full plethoric habit, as to remove mobility of the nervous power; for it certainly is injurious to systems accompanied with the haermorrhagic or inflammatory Diathesis: And, as this disease sometimes fluctuates from the mobility arising from turgescency, to that from laxity, particularly connected with the nervous system; in this state we may admit it as a most powerful remedy, especially where the accessions observe regular periods; as we know the bark hath particular qualities of removing periodical diseases, as is clearly elucidated in the phaenomena of intermittents, and that it has very trifling powers, unless given very nigh to the approach of a paroxysm. Hence it appears, that the indiscriminate manner in which the Bark has been prescribed, is the reason of its being exploded by many in practice: It however, with some justice may be said, that the Jesuit who first shewed the use of this most noble medicine, hath sufficiently compensated for the crimes of the whole fraternity.—Now we go to
METALLIC TONICS.
Which are more powerful than all the vegetable, except the Peruvian Bark, and
1. Arsenic.—This is dangerous, although much commended.
2. Tin.—This is said to have had good effects.
3. Iron.—This is sufficiently safe; but if chalybeate waters have alleviated Epilepsies, they have done this not so much from their tonic power, as from the effects that succeed cold bathing, exercise, and cold air, in general.
4. Copper.—This is perhaps an useful medicine against Epilepsy, and it is much to be lamented, that we are not particularly acquainted with that composition of it that proved so remarkably effectual, and which is recorded by Baron Van Swieten, the form of which he himself is ignorant of; but, most probably, it may depend on this circumstance, preserving the tonic power of the Copper, and rejecting altogether its stimulating qualities, which may in some measure be obviated by joining a neutral, instead of an acid, with the Copper; which is done in the Cuprum Ammoniacale, now in use in Epileptic cases; consisting merely of Copper connected with the Sal Ammoniacum. This composition has very strong advocates.
COLD BATHING.
This alone hath frequently been recommended as a cure in Epileptic cases; and wherever it has been of service, I should imagine it to be in those systems where the mobility of the nervous power is considerably increased; but injurious in those where the inflammatory or plethoric Diathesis prevails.
The method of using the Cold Bath should be, either by the patient going in head foremost, or by cold water being first thrown upon his head; as in this manner it is most likely to be effectual.
ANTISPASMODICS.
To enter formally into a strict discussion of these would be a work of time, and require much experiment and observation, to shew with accuracy their modus operandi; but we can, in general, say of these, they scarcely merit the praise attributed to them.—We shall speak of those chiefly recommended.
PEONY and VALERIAN.
These have long been held very efficacious in the cure of Epilepsy; the former of which has been extolled even to absurdity; many having credulity enough to believe, that the root of this plant worn about the neck only, was very serviceable in this disease; but its great use, I own myself unacquainted with, therefore pass it over.
Many physicians have ascribed great praise to Valerian; but I have been informed by a most eminent professor at Edinburgh, who has been very much engaged in the practice of physick for thirty years past, who declared he had only seen it of service in one or two cases; and when that takes place, it acts merely as a purgative, destitute of any antispasmodic qualities.
ANIMAL OIL.
This has been highly celebrated amongst the Germans, which is the Empyreumatic oil of animals, highly purified by distillation, which destroys the original disagreeable odour, and renders it thin and limpid, of a subtile, penetrating, not disagreeable smell and taste; its volatility is so great, that it gives all its power to the air; for which reason, if there is any hopes of advantage in volatile medicines, it may justly be expected from this; and the testimony of many confirm the fact.
MOSCH.
This is the most subtile of all, and therefore ought to be scattered upon the whole body; if its powers are obvious in the cure of hydrophobia, it ought from similitude of reasoning to appear in Epilepsy, and its fame is every where divulged; but it is found necessary to give it in large doses to answer the intent, which may be owing to our very rarely meeting with this medicine pure, and therefore being uncertain of its efficacy.
AETHER.
This is not altogether useless, because of its volatility rendering it capable of being diffused through the whole system; and therefore it is not to be altogether rejected.
OPIUM.
This has been condemned by many in the cure of Epilepsy. Two very illustrious names in physick, De Haen and Morgagni, have commended it, but without giving any sufficient reason for their opinion. De Haen relates a particular case, where the accession used to return during sleep; and he declares that many paroxysms were obviated by the use of opium, the slowness of the pulse having sufficiently indicated their approach. This is very little to the purpose; neither is the reasoning of Morgagni sufficiently probable.—In my own opinion opium acts here as a tonic, and being given at a happy crisis before the accession, by that means obviates it.—Certainly if ever it is to be admitted in spasmodic convulsions or Epilepsies, it ought to be admitted as nearly as possible to the accession, because of its quickly losing its power; and this being over, it always leaves the system more irritable. Its inebriating quality on the one hand quickens the circulation to the head, and debilitates and irritates in consequence; so, on the other hand, its being given in such quantity, and at such a particular time, to obviate an accession by diminishing the nervous mobility, or to be more particular the mobility of the nervous power, in which spasms consist. But this power of opium does not appear so clearly in a pure idiopathic Epilepsy, where the brain itself is the seat of the disease, as in one arising from irritation of the system in general, or of a particular part.—But in fact, the rash use of it in the former case is scarcely compensated for, by the more prudent use of it in the latter.
HYOCYAMUS.
The action of this plant is not unlike that of opium, only that it does not leave the belly so constipated; this advantage alone being admitted, it is either (notwithstanding the high character given of it by Dr. Stork) not to be given at all, or with the same restrictions as opium, in Epilepsy.
This indication for the removing mobility, contains a great many remedies; the use of which in a plethoric system would be altogether absurd, and are adapted simply to mobility, accompanied with debility; but as this frequently in time succeeds the other, so must we practise accordingly.— We may add a fourth indication for the convalescent state.
To obviate altogether an habitual Disease.
This is chiefly done by avoiding occasional causes; a little fuller diet may be admitted; this disease sometimes varies in such a manner, that to those where abstinence hath been strictly commanded, a fuller diet comes in for a remedy, after a few years. I say here, a more liberal regimen, not absolutely a full regimen; for irritability of the nervous and sanguiferous system is particularly to be attended to.—A generous glass of wine may be admitted, but not in quantity to inebriate, as a little strengthens and nourishes the body without irritating it, which effect has considerable power against the very production of mobility.—Sleep ought to be enjoyed temperately, which is most adapted to corroborating the body.—Let the degree of the atmosphere, if it can be so contrived, be under 64 of Farenheit's Thermometer, rather than above.
All these may be varied discretionally, according to the state of the convalescents. This alteration being properly and skilfully managed, other remedies being less efficacious, and the disease itself not being so well investigated, is highly beneficial; which is a maxim from the time of Hippocrates down to the present.
FINIS.