DEFINITION.

THE Epilepſy is a diſeaſe of the convulſive kind, returning periodically, affecting the ex⯑tremities with various and irregular motions; every ſenſe, as well as the faculties of the mind, for a certain time are altogether obli⯑terated.

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 ſymp⯑toms attending it; but as I have before re⯑marked that it is a periodical one, and as many circumſtances ſhew the approach of theſe pe⯑riods, 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 cir⯑cumambient parts are conſiderably diſtended; [7]viſion is diminiſhed and vitiated in ſome de⯑gree, ſometimes indeed altogether abſent.

The Iris has very different appearances, ſometimes purple, at others black; the ears tingle, and ſounds are difficultly heard; diſ⯑agreeable 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 diſ⯑eaſes, particularly thoſe of hyſteria and hypo⯑chondriari; but it frequently varies here, act⯑ing 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 trem⯑ble, yawning and difficult reſpiration ſucceed, the extremities grow cold, the penis is prae⯑ternaturally diſtended a ſenſe of air or warm vapour is often perceived from the hypochon⯑dria, 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 in⯑teſtines are foetid and very offenſive, the urine [8]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 diſ⯑turbed 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 diſ⯑torted, 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 ſome⯑times 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 ex⯑ceedingly; [9]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 prevail⯑ing in the beginning, afterwards it pours forth its ſaliva, the ſparm not being ſolved; reſpi⯑ration is performed with the greateſt difficul⯑ty 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 ar⯑teries 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 ſa⯑liva, 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 ſen⯑ſibility; 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 [10]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 per⯑ſon 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 in⯑terval between theſe acceſſions are very diffe⯑rent; ſome are attacked every day, or ſome⯑times 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 per⯑ſon; 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 attend⯑ing Epilepſy.

REMOTE CAUSES.

THE different remote cauſes, and the ef⯑fects of thoſe viſible upon the brain of diſ⯑ſected Epileptics, ſufficiently demonſtrate, that Epilepſy moſt frequently depends on a turgid ſtate of the brain; theſe cauſes, whether they [11]act directly upon the brain, or primarily on another part of the body, are at laſt transfer⯑red to it, and there act^*.

Thoſe that act within the brain may, as ſar as at preſent we have learnt from diſſections, be properly reſerred to ſix heads: 1. Mecha⯑nical Stimuli—As a fractured cranium, and all caſes of depreſſion. 2. Chemical Sti⯑muli—Collections of acrid fluids. 3. Mat⯑ters 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 Se⯑rum.

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 in⯑creaſe 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 in⯑veſtigate; an impeded circulation in the ſinu⯑ſes of the brain, or jugular veins, will cauſe the arterious blood to act with greater impe⯑tus, upon their exhalents, which will cauſe an effuſion of ſerum; and a ſmall effuſion in the [12]brain is more liable to do harm than in any other part; becauſe here we have no abſorb⯑ents, and the veins only perform this office; ſo that a ſmall quantity of ſerum effuſed, muſt accumulate by ſtagnation for want of this ab⯑ſorbent ſyſtem.

The ſixth cauſe is therefore an effect of the two foregoing; nor does the firſt act imme⯑diately, unleſs by giving that full habit we have been diſcuſſing, or in ſome degree aſſiſt⯑ed 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 per⯑tains to the ſecond, I agree that acrid chemi⯑cal Stimuli are both obnoxious to, and capable of giving Epilepſy; but as ſuch I deny its ca⯑pability 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 compreſ⯑ſion of the ſofter parts into a praeternatural [13]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 advan⯑tage in practice, and clearly ſhew us how we ought to diminiſh the Plethoric habit of Epi⯑leptics, 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 phy⯑ſicians.

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 inani⯑tion, others on neither cauſe: more are how⯑ever 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 pro⯑feſſor, Dr. Cullen, at Edinburgh, which was brought on by fear; and yet before every re⯑turn 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 [14]endeavour, in order more certainly to eſtab⯑liſh 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, ex⯑cited (as they are called) and this may be re⯑conciled to all the ſenſes, except that of ſmell, upon which odours ſeem to act parti⯑cularly; neither have theſe the power of act⯑ing, unleſs ſufficiently ſtrong. So a conſider⯑able 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 ſud⯑den 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 ſto⯑mach; and theſe do not act ſpecifically, but according to their ſtrength do they produce [15]Epilepſy.—Odours, indeed, as we have be⯑fore ſaid, ſeem to have a peculiar mode of action, and ſome other cauſes produce the diſ⯑eaſe 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 ob⯑ſervations, 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 impor⯑tance, with leſs preciſion.

Perturbations of the mind, by diminiſhing the action of the brain, produce a tempora⯑ry 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 men⯑tioned 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 con⯑tinued Epilepſy, and one more pertinent to our propoſition, as Fear; which, by diminiſh⯑ing 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 re⯑action [16]of the efforts of the brain, which is even greater than natural; or the remem⯑brance 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 diminiſh⯑ing 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 ſome⯑times is ſufficient to give Epilepſy; ſuch as is made by diſtention after eating, as is ob⯑ſerved 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 pro⯑duces Epilepſy, ſuch as generally precedes Apoplexy or Palſy.

There cauſes, from the effects, and method of cure, are very clearly ſeen to act, by giv⯑ing a ſtate of the brain, contrary to excite⯑ment, 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 [17]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, Pro⯑feſſor 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 en⯑deavour 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 in⯑veſtigate the nature and cure of the Epilepſy.

For the more clear and accurate elucida⯑tion of the proximate cauſe of this diſeaſe, let us conſider thoſe habits that are moſt pre⯑diſpoſed to it.—Thoſe Syſtems inclined to Epilepſy, are generally endowed with encreaſ⯑ed 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 al⯑moſt natural, according to the law of irrita⯑bility, [18](by which I mean the power of con⯑traction of muſcles) it is encreaſed and fa⯑cilitated by motion.—This explains the rea⯑ſon why, after one paroxyſm others can be produced by leſs active and weaker ſtimuli, and ſeems as if they were produced even ſpon⯑taneouſly; for which reaſon it has been called a voluntary and feigned diſeaſe. This mobi⯑lity 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 in⯑fants, who are particularly obnoxious to Epi⯑leptic fits, a debile ſtate of muſcular fibres, or of the original ſtamina, can give ſuch a cer⯑tain condition of the nervous power, which makes it more adapted to irregular motions, which we call encreaſed mobility: but per⯑haps this reaſoning may appear too ſubtile; ſo I ſhall paſs to the other cauſe of mobi⯑lity, 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 No⯑centes; [19]ſuch as exerciſe, heat, drunkenneſs, &c. eſpecially in a Plethoric ſyſtem; when the force of theſe is removed, they immediate⯑ly relax themſelves, in a certain ratio, as they have been before diſtended; and in like man⯑ner are their oſcillations encreaſed; which re⯑miſſion, or relaxation, muſt frequently neceſ⯑ſarily take place in the brain.—This tenſion, which depends on the quantity and impetus of the humours, frequently remits; an ex⯑planation of which, by an example of an elaſ⯑tic 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 diſten⯑ſion, ſo will be the reſilition, the diſtending power being removed: or, I may explain the ſame thing by a pendulum; as far as you re⯑move it by the hand from the center of gra⯑vity 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 al⯑ways encreaſes itſelf.

But beſides this cauſe of Epilepſy, conſiſt⯑ing in the excitement of the brain, or in its greater oſcillations, that is exceſs of tenſion [20]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 con⯑trary 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.