318 PATH 
fuperior parts of the brain, which are already debilitated 
by the over-excitement of that part of the brain (the 
bafe and fpine) from which the nerves of voluntary 
motion are derived ; the phenomena of epilepfy evi¬ 
dently difplaying exaltation of one fet of nervous func¬ 
tions, with diminution or complete lofs of others. The 
appearances of diifeftion, as we have before hinted, are 
generally thofe of inflammation; rednefs of the mem¬ 
branes or fubftance of the brain, flight adhefions and af- 
fuflons in the fame part, are the moft remarkable. Irre¬ 
gularity in the bones of the cranium, fome of their pro¬ 
jecting parts prefling on the brain, tubercles and oflifl- 
cation of the inverting membranes, are fometimes met 
with. 
In the treatment of epilepfy, we have two objefts irt 
view. The firft to diminiflt the fanguineous plethora 
which is the immediate caufe of the fit: hence bleeding 
may be praftifed during the fit, or as foon after as may 
be, efpecially if fulnefs of pulfe be felt, if vertigo or 
mufcae volitantes have preceded, or if pain in the head 
lias followed it. The degree to which this evacuation is 
to be carried muft be regulated by circumftances. Cafes 
which arife from idiopathic cerebral irritation, will gene¬ 
rally allow of more copious abftraftions of blood than 
thofe which arife from fympathetic or dirtant irritations. 
Thefe cafes, of what may be called idiopathic cerebral 
irritation, are comparatively rare. The more frequent 
forms arife from irritation in the liver, bowels, or fto- 
inach. In thefe cafes, local plethora will ftill require to 
be obviated. But our attention muft chiefly be directed 
to the treatment of the malady during the remiflion, by 
means of regular and fparing diet. Free purging may 
at firft be ufed in all cafes ; but, in thofe under immediate 
confideration, this muft fhortly give way to milder lax¬ 
atives, left the over-aftion of the bowels become a freflt 
caufe of irritation. When uterine irritation occafions 
the epilepfy, (and when we confider the high importance 
of this fyftem in the female Economy, we (hall not be 
furprifed at the frequency of this caufe;) emmenagogues 
if the catamenia are fupprefled, or fedatives and tonics 
according to other circumftances, muft be reforted to. 
The main indication being ftill, as in all other cafes, to 
keep a certain balance of excitement; by diminilhing 
local plethora, and exciting the fecreting and motive 
organs. 
The infufficiency of this plan alone fuggefts the adop¬ 
tion of other meafures in addition to them. Thefe mea- 
fures, however, we have no faith iq, unlefs the digeftive 
organs and the ftate of the cerebral circulation be at the 
fame time attended to. The firft meafure is counter-ir¬ 
ritation. This may be done by fetons in the nape of the 
neck; perhaps more favourably by iflues or fetons on the 
facrum, or above the knees. If thefe applications are 
too troublefome, an iffue in one or in each arm will have 
a fimilar effeft, in a certain degree. If there are any con- 
ftitutional diforders which may aft as drains or diverfions, 
they fliould be encouraged. A feton in the fcalp has 
been found uleful. 
Among the medicines which feem to alter the aftion 
of the nervous fyftem, and which confequently do good 
in protrafted epilepfies, arfenic and the nitrate of filver 
hold the firft reputation. The former drug has often 
cured this difeafe: it is given in the ufual moderate dofe 
of ten drops of Fowler’s folution, to be gradually in- 
creafed. It is certainly not fo much to be depended on 
as the nitrate of filver, but is free from an unpleafant 
effeft which we fhall prefently note as belonging to the 
latter medicine. The nitrate of filver is a medicine of 
great power; and, given when the conftitutional treat¬ 
ment has been llriftly purfued for fome time, will, we 
believe, rarely fail. The unpleafant effeft above alluded 
to confifts in a remarkable blacknefs or difcolouration of 
the fkin which has in fome cafes followed its ufe, and 
which, when once formed, lafts for life. It is faid, how¬ 
ever, that this may be obviated by keeping out the rays 
O L O G Y. 
of the fun during the exhibition of the medicine. It is 
alfo ftated, that a period of from three to fix months’ 
continuance in the ufe of the argenti nitras has always 
preceded this difcolouration : it is therefore advifed that 
we fliould never continue the medicine for many weeks 
together ; and in faft, if its good effefts are not apparent 
in a month or fix weeks, we believe it will be found quite 
ufelefs. 
Dr. Good makes four varieties of this difeafe. 
a. E. cerebralis : attacking abruptly, without evident 
caufe, except fometimes a flight giddinefs. The remote 
caufe is external violence to, or internal injury, malfor¬ 
mation, or difeafe, of the head. 
£?. E. rigida: the limbs fixed and rigid, with agitation 
of particular organs. 
y. E. fympathetica : catenating with fome morbid ac¬ 
tion of a remote part, with a fenfe of a cold vapour af- 
cending from it to the head. 
A remarkable but authenticated faft is, that the tour¬ 
niquet applied round the limb before this auru has af- 
cended, often flops its progrefs, and wards off the dif¬ 
eafe ; but, as mental emotion has great effeft in keeping 
off epilepfy, (as the well-known ftory of Boerhaave, who 
threatened his patient out of it, teftifies,) we fhould be 
inclined to attribute this effeft to the influence of the 
imagination. 
E. irritata; from fudden emotion of the mind, or ir¬ 
ritation of the ftomach or bowels. 
Genus IX. Carus, [x«po?, deep heavy fleep; from xapas, 
the head.] Torpor. Generic charafters—Mufcular im¬ 
mobility ; mental or corporeal torpitude ; or both. There 
are fix fpecies. 
i. Carus afphyxia, fufpended animation : total fuf- 
penfion of all the mental and corporeal functions. Four 
varieties. 
a. A. fuffocationis ; from hanging or drowning ; coun¬ 
tenance turgid and livid. 
/ 3 . A. mephytica; from carbonic acid gas, or other ir- 
refpirable auras, by the miners called damps, (from the 
German dumpff, vapour, exhalation.) In afphyxy from 
this caufe, the countenance, inftead of being livid, is 
pallid. 
7. A.algida; from fevere cold : limb^rigid, counte¬ 
nance pallid and flirivelled. 
The three grand organs, the brain, lungs, and heart, 
fupport motion and fecretion by their aftion and re-ac- 
tion on each other; and the funftions of any one of them 
cannot be fufpended without the fufpenfion of the other 
two. If the aftion of the heart ceafes, the brain ceafes to 
tranfmit the nervous energies neceflary to the aftion of 
the refpiratory mufcles, neceflary perhaps alfo to the ox¬ 
ygenation of the blood. If the aftion of the nervous 
pow'er be fufpended, the heart retains its powers a fiiort 
time; but, the refpiratory procefs being fufpended, the 
exertion of thofe powers is prevented ; and fo on. 
From thefe premifes it follows, that all cafes of death 
are traceable to the fufpenfion of the ufe of thefe func¬ 
tions. In moft cafes this fufpenfion depends on aftual 
deJlruSlion of the powers or properties of the part; and 
confequently revival is impoflible. In many cafes the 
powers remain unimpaired, but latent; and are quiet only 
becaufe the ftimulus to them is abfent. The wheel of 
motion, kept up by the aftion of the heart, lungs, and 
brain, on each other, has been flopped ; but, the powers 
of aftion ftill remaining in thofe parts, if it is once fet 
going, their reciprocity of aftion will keep it up. We 
confequently find fudden death ufually from fufpenfion 
of the funftion of breathing, as from hanging, drowning, 
or the like ; or from rupture or ftoppage, or from mecha¬ 
nical impediment, of the heart; or, laftly, from fome un¬ 
known change in the brain ; preemptively, and indeed 
certainly in many cafes, from rupture of biood-veflels, or 
general preffure from diftention of veffels. To the firft of 
thefe clafles we fhall confine ourfelves; the fecond is of 
courfe 
