PATHOLOGY. 
verted to. This difeafe is without clanger, except when 
it terminates in epilepfy, a termination by no means un¬ 
common to this and other nervous maladies. This re¬ 
mark naturally leads us to, 
3. Syfpafia epilepfia, the epilepfy, or falling ficknefs : 
general mufcular agitation, without fenfation orcon- 
i'cioufnefs; recurring at regular or irregular periods. 
Of the two firft: proportions contained in the above 
definition, we have to remark, that they are liable to 
much uncertainty. The mufcular agitation is. of va¬ 
rious kinds. In the more common form, in which the 
attack of the difeafe is l'udden, it confifts in a convulfive 
or twitching agitation ; in another form of the difeafe, 
the mufcles are in a Hate of fixed rigidity, like tetanus. 
The limbs are ftretched, and the whole trunk extended 
and fixed by a rigid fpafm ; the eyes are widely open ; 
not reverted, but flaring frightfully; the pupils con¬ 
tracted, and quite infenfible to theflimulus of thellrong- 
ell light: “Erigitur quoque penis in infantilnis ; in 
adolelcentibus femen ejicitur, et ftepiusurina ad magnam 
diftantiam prorumpit.” In other cafes, again, the muf¬ 
cular fyflem is perfedlly relaxed throughout the epi¬ 
leptic fit. Sometimes one fide of the body is more con- 
vulfed than the other; fometimes irregularity is obferved. 
Some of the mufcles of the face being more affedled than 
others, exhibit various and violent difcortions of the 
countenance. The tongue is often affedled, and thruft 
out of the mouth, while the mufcles of the lower jaw 
are alfo affedled, and, (hutting the mouth with violence, 
often wound the tongue grievoufly. A fymptom much 
lefs variable than the mufcular agitation before adverted 
to, is the date of ftupor or infenlibility during the pa- 
roxyfm. In a very great majority of cafes this amounts 
to complete coma ; but, in others, a flight degree of 
f'enfibility or confcioufnefs remains during the paroxyfm. 
This ftupor generally comes on fuddenly, and without 
any premonitory fymptoms. Sometimes dizzinefs and 
pain in the head, and vifual deceptions, are felt before 
the attack. Sometimes the remarkable fenfation called 
aura epileplica precedes the attack : this is a fenfation of 
fomething moving in fome part of the limbs or trunk of 
the body, and from thence creeping upwards to the head ; 
and, when it arrives there, the perfon is immediately de¬ 
prived of fenfe, and falls into a fit. It is defcribed fome¬ 
times as refenibling that of a cold vapour, fometimes 
as like a fluid gliding, and fometimes like the fenfation 
of a frnall infedt creeping, along the body ; and very of¬ 
ten the patients can give no other diftindl idea of their 
fenfation, than as in genera! of fomething moving along. 
It might be fuppofed that this fenfation arofe from fome 
afteCtion of the extremity or other part of a nerve, aCted 
upon by fome irritating caufe; and that the fenfation, 
therefore, followed the courfe of fuch nerve. But it 
is not found to follow the courfe of any nerve diftinCily, 
and it generally feems to pafs along the integuments. 
During the epileptic convulfions, the face becomes 
red, then livid and fwelled, from the interruption to 
the circulation through the head ; and there is common¬ 
ly at the fame time a frothy moifture ifluing from the 
mouth ; and in the moll fevere cafes the urine and al- 
vine excrements are involuntarily difcharged. In fome 
inftances a hiding or ftertorous noife is emitted. The 
■convulfions have for a few moments fome remiflions, but- 
are fuddenly again renewed with great violence. Gene¬ 
rally, after no long time, this terrible ftruggle ceales al¬ 
together, and the patient remains for fome time without 
motion, in a (late of abfolute infenfibiiity, and under 
the appearance of a profound deep. After fome conti¬ 
nuance of this feeming deep, he fometimes fuddenly, 
but for the mod part by degrees only, recovers his fenfes 
and power of motion, but without any memory of what 
had palled from the firft feizure of the fit; and complain¬ 
ing of head-ache, and exceflive pain in all the limbs, as 
if from fevere fatigue. During the convulfions, the pulfe 
and refpiration are hurried and irregular; but, when they 
317 
ceafe, thefe return to their ufual regularity and healthy 
date. 
It is a remarkable and diflreffing faCl, that epileptic 
attacks happen much more frequently during deep than 
in waking hours. The difeafe pretty equally affefts 
males and females; nor are there any temperaments, 
habits, or conftitutions, exempt from its attacks. There 
are periods of life at which epilepfy is more prone to oc¬ 
cur than at others. Infants are fubjeCt to the difeafe ; 
but in them it generally arifes from irritation in the 
bowels, and difappears with the exciting caufe. The fil'd 
dentition alfo is a critical period ; but, if the difeafe ap¬ 
pear then, it generally goes off when the dentition is 
completed. Epilepfy often appears, for the fil'd time, 
about the eighth, tenth, or twelfth, year ; in which cafe 
there is danger of its becoming habitual. Still there is a 
profpedl of its fubfiding at puberty ; but, if this period 
pafs without amendment, there is little hope afterwards. 
In females, the coming forth of the catamenia fome¬ 
times affids the conffitution in getting rid of the difor- 
der; but it much more frequently gives rife to it; at 
lead there is no period of life in which females are fo fre¬ 
quently attacked with epilepfy as the period of fird men- 
ffruation. The intimate connexion between epilepfy 
and other nervous diforders we have before adverted to. 
The pathology of this difeafe is obfcure. Many emi¬ 
nent writers have contended that epilepfy confids in an 
unufual fulnefs of the veffels ; and they indance the 
flufliingand turgidity of the countenance, the puliation 
of the carotids, the dilatation of the pupils, the relief 
afforded by blood-letting, the appearances on difl'edtion, 
&c. in proof of their opinion. We may remark, how¬ 
ever, that while we admit that plethora of the head is a 
very frequent condition of epilepfy, and that it is alrnod 
always the foie caufe of its fatal termination, we cannot 
allow that epilepfy arifes from plethora of the brain. If 
that date were indeed the caufe of epilepfy, how happens 
it that epilepfy is not a frequent occurrence in fever, 
where there is evident cranial plethora ? How happens 
it that it is not more obfervable in cafes in which a me¬ 
chanical hindrance is oppofed to the return of blood from 
the head ? How happens it that the fymptoms of epi¬ 
lepfy vary from thofe of apoplexy, which is evidently a 
difeafe of fulnefs of the head ? 
To the appearances on diffedlion we fay, that thefe ap¬ 
pearances are not uniform ; that frequently no turgef- 
cence of veflels is found on necrotomy, efpecially if the 
fubjedl be young. If, on the contrary, plethora were the 
caufe of epilepfy, (hould we not always find it on dif- 
fedlion ? Granting that fome part only of the brain was 
affedled with vufcular fulnefs, fliould we not find that 
part always and undeviatingly the feat of turgefcence on 
difledlion ? But we do not find this. We find a fulnels 
of blood in the head; but we do not perceive it more re¬ 
markable on the bafe than on the top of the brain, nor do 
we find it in all cafes any-where. The fact that bleed¬ 
ing does good in epilepfy, is no proof of the inflamma¬ 
tory origin of the difeafe, becaufe bleeding may do good 
by diminishing nervous excitability generally, or by di- 
minilhing the adtion of the fecernents; in which cafe 
they may fecrete lefs of the fluid ; which, it may be pre¬ 
fumed, irritates fome part of the nervous fyltem. In a 
word, fo many are the effects of bleeding on the fyftem, 
that we cannot found any theory on its effedls ; and if 
we were to do fo, the event wouid not bear us out in it. 
Bleeding often fails in epilepfy, efpecially in protradled 
cafes; and we fcarcely have heard of a cafe in which 
bleeding alone was fuccefsful. 
For our own part, w'e (hall attempt no theory of this 
difeafe. We believe that the (late called irritation (a 
Hate we are ignorant of the nature of, but which is ma- 
nifefted to us by exaltation of the cerebral fundlions) is 
the firft dileafe of the brain ; that the intenfity of this 
gives rife to cerebral plethora, a (late which, by over-dif- 
tending the capillaries, paralyzes the movements of the 
fuperior 
