tor 



Kl'lLKPSY. 



EPISTAMS. 



tot 



exciting the energies of the brain, and those which act by depressing 

 the brain. Those which act by over-ittimuUting the brain are media- 

 nical, chemical, and mental stimulants, and the peculiar stimulus of 

 over-distention ; as sharp-pointed ossifications, arising either from the 

 internal surface; of the cranium or formed in the membrane* of the 

 brain ; powerful mental emotions, such a* j.v and auger ; congestion of 

 the Mood-vend* of the brain; supprwswd discharges; violent exer- 

 cise; too large a quantity of highly nutrition* fo< >d or of stimulating 

 drink. " I have observed,' says Fothergill, " that epileptics ore often 

 i-xtn-nifly incautious with rrspect to diet; that children highly in- 

 dulged are liable to the disease ; that in every other period of juve- 

 nescenoe, and in middle-aged adults, if they were attacked with the 

 dinoisn, it was when theynad fit her commuted some excesses or by 

 one meant or another were plethoric, and that in habits subject to 

 epilepsy, the rlinmnf seldom recurred without either an habitual indul- 

 gence in eating or a neglect of necessary exercise." 



But the very opposite causes, those which manifestly weaken the 

 energy of the brain, occur in epilepsy, as hemorrhage, whether spon- 

 taneous or artificial ; terror, horror, disgust ; any powerful and dis- 

 agreeable sensations, and especially certain disagreeable odours; 

 excessive evacuations, great fatigue, inanition, and sedative poisons. 



The medical treatment of a case of epilepsy must of course differ 

 essentially according as it is idiopathic or syinpathic, aud connected 

 with a plethoric and robust, or debilitated and exhausted state of the 

 system. Unless he previously ascertain .the condition of the brain 

 and spinal cord, or the nature of the affection of the remote organ in 

 sympathy with which the brain is suffering, the practitioner must 

 work entirely in the dark, and must be liable to adopt the very oppo- 

 site course of treatment to that which the case really requires. When 

 the appropriate remedies are judiciously employed, and the proper 

 regimen is strictly adhered to, epilepsy is often permanently cured, 

 and the suffering is greatly mitigated even in those forms of the 

 disease which do not admit of cure. Dr. Cheyne has laid down gome 

 excellent rules for the management of epileptic patients, of which, as 

 they are of a popular nature, and applicable to the great majority of 

 cases, we give the substance. 



In prescribing a rule of diet suitable to all epileptics, moderation in 

 quantity and simplicity in the preparation of the food are indispensable 

 points. The diet best calculated to preserve an individual liable to scro- 

 fula from an attack of that disease is best suited to a patient liable to 

 epilepsy. Fermented liquors should in general be altogether withheld. 

 Flesh-meat ought to form the principal part of one if not two meals in 

 the day ; and milk, if it do not retard digestion, which it is less liable 

 to do when fermented liquors are laid aside, is the article next in 

 value. The epileptic ought to be trained so as to be in good wind, so 

 as to put his muscles in a state of the utmost strength and firmness. 

 Epileptics should be put under a regular course of training like the 

 athletic of ancient, and the gentlemen of the fancy in modern times. 

 When the patient leaves his bed in the morning, he may have a rusk 

 or a slice of toasted bread with an egg beat up in a teacup full of 

 warm water ; then let him dress, make all needful arrangements, and 

 walk three or four miles. Two hours or more after he has left his 

 bed, let him have his second meal, milk or cream in water, or cocoa 

 with bread a day old and butter. Rest for three hours after breakfast. 

 This will be the best time to devote to business or education. Then 

 he must again walk, if an adult possessed of sufficient vigour, from 

 five to eight miles. At from five to six hours after his second meal, 

 let him have a third, consisting of meat of the best quality, mutton, 

 poultry, game, or very tender beef, roasted or boiled, of which an 

 adult must not eat more than six ounces ; bread, and one moderate 

 helping of tender well-boiled vegetables ; of drink, not more than a 

 common tumbler full of distilled water, Seltzer water, with a little 

 milk, or toast and water. Then rest for two hours ; that is, stroll in 

 a garden, read an amusing book, or engage in any occupation which 

 will not raise the pulse by one beat ; then resume more active ex- 

 ercise for an hour or two. In five or six hours after dinner, a light 

 supper may be taken, consisting of not more than four ounces of meat 

 with bread, or of a cup of milk with a water biscuit. The rest of the 

 evening may be spent in cheerful society, in a large airy room, not 

 over lighted nor over heated, but sufficiently warm to prevent that 

 chill which in the latter part of the day often follows very active 

 exercise; and every occupation by which the mind is depressed or 

 is excited, and thereby subsequently exhausted, must be avoided. 

 The patient must be in bed at eleven and up at six, nothing in 

 general being more hurtful to epileptics than sleep unnecessarily 

 prolonged. 



The scalp in all epileptics ought to be shaved once a week, and 

 daily well rubbed with a flesh-brush after the tepid shower bath, 

 or what answers nearly as well, after pouring a flagon of tepid water 

 on the head inclined over a large basin. The patient may gradually 

 bring himself to sleep without a night-cap and without curtains, 

 with the shoulders and head raised and the feet well [protected 

 from the cold, in a chamber -M large and airy as possible and without 

 afire. 



A patient liable to epilepsy must not be permitted to ride nor to 

 hold the reins in a carriage. The grates in all the apartments which he 

 frequents ought to be guarded by a deep and strong fender ; he ought 

 to avoid the streets of a crowded city, in which the whirl of carriages, 



the tide of human beings, and the multiplicity and distraction of 

 objects produce a vertiginous hurry of thought, which to him 

 dangerous. He ought not to walk near water. A fine young i, 

 twenty came to an untimely end in his own garden, by falling into a 

 runnel, in which he was drowned, although the water was not more 

 than four inches deep. 



If an attack of the disease come on while the patient is in his 

 chiu iiber, he ought immediately to be laid on his back on a bod. with 

 an attendant standing on each side to prevent him from injury during 

 the struggle. If he is much flushed, his head and shoulders ought to 

 be elevated, the warmth of his extremities supported, while at tint 

 same time air is freely admitted into the room. All attempts to make 

 him swallow or to stimulate the nostrils are improper. A mcdiual 

 practitioner ought to be sent for, and ought to remain in 

 while the struggle lasts. In a first attack, if the fit is .-w-v.-ie. l,],,,..| 

 ought to be procured from the temporal artery, a precaution which 

 will also be necessary in patients of an apoplectic diathesis when 

 they labour under a prolonged fit of apoplexy. 



(Cheyne, Cyclopaxl. of Pract. itcd. ; Copland, Diet, of Pni'!. M, !. 

 Prichard, Duetuet of the Nerroia Syttem ; Cooke, Ilitt. and Method of 

 Cure of the rariou* Speciet of Epilepsy.) 



EPILOGUE (i-*l\oyos, epilogiu) compounded of M, on or afi< 

 Xoyos, speech) signifies, in Greek, a summing up, the end or peroration 

 of a discourse. In English it is applied to the short poems or < 

 of verses, or to the short prose address which formerly were com- 

 monly subjoined to new plays, and recited on the stage at their < -'in- 

 clusion. An epilogue is usually written in a lively tone, with 

 allusions to the play, the author's circumstances, the news or fa 

 of the day, or other subjects of existing interest, as are thought liki-ly 

 to conciliate favour and send the audience away in good humour. "If 

 it be true that good wine needs no bush, 'tis true that a good play 

 needs no epilogue : yet to good wine they use good bushes, anil 

 plays prove the better by the help of good epilogues." ('As You 

 Like It.') 



EPIPHANY, from the Greek 'Eiri^ekfia (Epipfutncia), appearance, 

 or manifestation, a church festival, celebrated on the twelfth da\ 

 Christmas, in commemoration of our Saviour's being manifested to the 

 world by the appearance of a miraculous star ; likewise denominated 

 Twelfth Day. This day is said to have been first observed as a sepa- 

 rate feast in the year 813. The customs of this day, though various 

 in different countries, all agree in the same cud, namely, to do honour 

 to the eastern magi, or kings, who visited and made offerings to our 

 Saviour at his birth. 



EPIPOLIC DISPERSION OF LIGHT. [DISPERSION.] 



EPISCOPACY. [Bisnor.] 



EPISODE (iirdffoios, epdwdos). The Greek word e'aodta, the prin- 

 cipal member of this compound, when applied to the drama, means an 

 entrance of the chorus on the stage ; epewodion, that part of a play 

 which lies between two choral songs; and as these recitations had, in 

 the rude beginning of the Greek drama, no connection with the < 

 part, which they were introduced to relieve, the word, with its deriva- 

 tive Latin form, comes to signify a thing connected with, but not 

 essential to, that of which it is part, which may be taken out and 

 leave a perfect work ; as, for instance, the Catalogue of Ships, in the 

 ' Iliad,' or the War in Heaven, in ' Paradise Lost." Episodes should 

 grow naturally out of the subject ; and when judiciously used, they 

 relieve and diversify the main narration. But they should be sparingly 

 introduced, so as not to create confusion. In the ' Orlando Pui 

 for instance, or the ' Fairy Queen,' the episodes are so many and so 

 long, that the whole resembles a set of detached legends inartificially 

 patched together, rather than a single poem pervaded by one intention. 

 Episodes are commonly the most highly-finished portions, since their 

 shortness warrants a degree of elaboration and ornament which 

 hardly be maintained through a long composition, and indeed might 

 be wearisome if it could. 



EPISPACTICS. [BLISTERS.] 



EPISTAXIS (from Mara^a, a dropping, bleeding of the nose) is 

 the term used by most nosologists to indicate bleeding from tin 

 which essentially consists in an effusion of blood externally from the 

 pituitary membrane. There are few parts of the body more liable to 

 haemorrhage than the lining membrane of the nose. The blood-vessels 

 which supply this membrane are branches of the common carotid 

 arteries, and the blood is returned from the membrane by veins which 

 join the external jugular veins. Blood may flow from the now 

 very varying circumstances ; sometimes when the system is in a state 

 of plethora, and at others when in a state of debility. When it 

 in plethoric persons it is usually preceded by pain in the head, \ 

 or drowsiness, frightful dreams, increased heat of one side of the face, 

 injection of the eyes, flashes of light before the eyes, increased beating 

 of the temporal arteries, deafness, 4c. These symptoms will be present, 

 more or less intense, according to the general condition of the wiflerer. 

 This active form of the haemorrhage comes on in the course of many 

 diseases, as the inflammatory forms of fever, inflammation of the brain, 

 lungs, &c. Where the bleeding comes on in a state of debility it is 

 called passive, and may make its appearance without any premonitory 

 Symptoms. This form comes on in the course of low and malignant 

 fevers, and various diseases which come on in a cachectic state of the 

 body. 



