144 PRACTICE OF MEDICINE. 



EPILEPSY. 



Causes. — Epilepsy appears to be occasionally hereditary, but it is 

 more frequently an acquired disease. It generally arises from ex- 

 cessive nervous irritation, either induced by sympathetic influences, 

 or by direct causes. As examples of the former, may be enumerated, 

 gastro-intestinal disturbance from indigestible food, worms, &c. ; 

 difficult dentition ; uterine irritation ; excessive sexual intercourse 

 and masturbation ; the abuse of spirituous and fermented liquors ; 

 the presence of calculi in the kidney, ureter, or bladder, or of gall 

 stones in the excretory duct of the liver. The direct causes are-r- 

 injuries of the head or spine ; diseases of the cranial bones or of the 

 vertebrse ; tumours growing on the bones, or spiculce of bone pro- 

 truding into the brain ; ossific deposition in the dura mater or its 

 processes ; ossification of the arteries of the brain ; concussions of 

 the brain or spinal cord ; and metastasis of gout or rheumatism to 

 the encephalon. Dr. Meade is convinced that the relative frequency 

 of disease of the spinal cord and its membranes in this affection is 

 underrated; and that much may be done for the patient in many 

 instances by attending to the state of this part of the nervous system. 

 The other causes which have been enumerated are — fright, fits of 

 passion, distress of mind, appalling sights, seeing others in the pa- 

 roxysm, excessive hemorrhage, immoderate depletion, hypercathar- 

 sis, the suppression of eruptions, irritation of remote nerves, and 

 the syphilitic and mercurial poisons. Its causes may be divided into, 

 1st, the centric, consisting of disease, or causes of irritation in the 

 nervous centres ; 2d, the eccentric or peripheral, consisting in causes 

 of irritation in the viscera or external parts. 



Symptoms. — Epilepsy is generally a chronic disease, and fre- 

 quently ends in insanity ; it sometimes, however, proves fatal during 

 a paroxysm. It consists in fits of imconsciousness and convulsions. 

 The epileptic fit is occasionally preceded by certain warnings, such 

 as stupor, a sense of coldness, or creeping, or of a gentle breeze 

 {aura epileptica) proceeding from* "a particular part of the body 

 towards the head. M. Georget states, " that warnings do not occur 

 in more than five cases in a hundred ;" this is, however, underrating 

 their frequency. 



In most cases, the patient utters a cry and suddenly falls sense- 

 less ; the eyes are opened widely, the pupils are fixed, the face is 

 drawn to one side, and the jaws are firmly closed; after some minutes, 

 the muscles of the neck. become rigid, the jugular veins distended, 

 and the face is in a state of livid turgescence ; the muscles of the 

 face are now seized with frequent spasmodic contractions ; there are 

 convulsive movements of the extremities, particularly the superior; 

 the thorax is fixed, and the respiration is exceedingly difficult. The 



