KlV. •.'"•■ OAvn-, > ■:..>',>tj IS is^^^ Kdfc'"^ :$l UNITED STATES OF AMERICA WASHINGTON, D. C. GPO 16—67244-1 A N INAUGURAL ESSJT ON EPILEPSY, SUBMITTED TO THE EXAMINATION OF THE Ref. JOHN EWING, S. T. P. Pzorosrj THE TRUSTEES AND MEDICAL FACULTY OF THE UNIVERSITYof PENNSYLVANIA, On the 17th day of May, 1796. FOR THE DEGREE OF DOCTOR OF MEDICINE. By yohn C. Otto, a, m. Member of the Medical and Chemical Sociai,.., o: I.ui ..kir-hia PHILADELPHIA, PRINTED BT LANG fcf USTICX, M.DCC.XCVI. 'sr >? TO Benjamin Rujh, M. Df PROFESSOR OF THE INSTITUTES AND O? CLINICAL MEDICINE, UNIVERSITY OF PENNSYLVANIA; THIS DISSERTATION IS INSCRIBED, AS A TRIBUTE OF GRATITUDE AND ESTEEM, PT HIS SINCERE FRIEND AND AFFECTIONATE PUPIL, JOHN C. OTTO, I II T1 HE fubject. of the prefent Differtation has received different names. It has been called morbus comitialis, from its occurring in crowded affem- blies; morbus herculeus, from the difficulty of cure, or perhaps from the ffrength difplayed by the refera- ble patient in a paroxyfm of this difeafe. The falling ftcknefs, however, is a name more frequently given it. This, perhaps, is as applicable as any, for the difeafed falls'down upon an attack of it. Even fuperftition has not been idle upon this fubjecl. It has afTumed the name of morbus facer, from the fuppofition that the gods punifhed men with this difeafe, as a peculiar mark of their difpleafure. And a perfon, in perfect health, falling down and appearing in the mod vio- lent agony, without any apparent caufe, was a fufrl- cient reafon to induce the ignorant to afcribe it to fome fupernatural agent.—We (hail coniider it under the mod £;rr,iii^- name cf Eplkpfy. B ( 6 ) Dr. Culien defines it to confift " in convulfions of the greater part of the mufcles of voluntary mo- tion, attended with a lofs of fenfe and ending in a ftate of infenfibility and feeming fleep." This com- prehends the prominent features of the difeafe, and is fufficient to difiinguifli it from palfy, apoplexy, catalcpfy, tetanus, and other complaints. A FIT. AS the circumfiances attending it are nearly the fame in all perfons, except with regard to violence, it will be unneceffary to be prolix. The perfon attacked falls down fuddenly with a perfect lofs of fenfe in violent cafes; but in the mild, there is fome- times a recollection of whatever has paffed during the paroxyfm. The jugulars fwell and the veifels of the head appear turgid; there is a violent contraction and alternate relaxion of the mufcles of the body or part of it: thofe of the face are particularly liable to be affected, and exhibit violent distortions. A froth- ing of the mouth attends; and the eyes are frequently turgid and turned upwards. The refpiration and pulfe are hurried and irregular; the latter fddom fhewin^ any preternatural force or foftnefs. The paroxyfms continue generally but a (hurt time, and then termi- nate in dulncfs and ftupidity, which continue in dura- tion mod commonly in proportion to the violence of thev preceding attack. After this, the patient fro ( 7 ) quently enjoys good health until he is again attacked in the manner already defcribed. REMOTE CAUSES. These are whatever have a tendency to produce debility in the animal economy in general, and parti- cularly in the nervous fydem. This is of two kinds, direct and indirect. The flrd confids in an unufual abdradtion of the dimuli that fupport life; and the latter in the exceflive application of them. Under the flrd head may be ranked fear;—the abdradtion of the dimulating padions—excef; in venery—depletion to a confiderable degree—fome poifons—odours, &c. under the latter, all the dimulating paffions—frequent intoxication—the application of particular medicines, as dramonium—intenfe dudy or continued application of the mind to any particular fubject. Thefe caufes have been known to give a difpofition to this difeafe, and their action, it is evident, is principally on the brain and nervous fydem. PREDISPOSING CAUSE. This, like all other difeafes of the nervous fydem, depends upon a debility or mobility of the nerves. This I infer, id, From thofe mod fubject to this difeafe j and, ( 8 ) 2d1y, From the time it mod frequently attacks. i The flighted retrofpect will convince us of the truth of this caufe. It is the delicate female, and tender infant, that mod frequently differ: they, whofe minds are fubject to a condant change, and upon whom every imprefEoa excites to confiderable action, are the mod frequent victims. Delicate civil- zed life has become familiar to it, while rude and favage nations fcarcely know the pang of a convulilon, The brain in children is larger and lefs firm than in advanced years: its fqftnefs caufes it to be thrown more eafily into irregular action upon the application. of any thing of an irritating nature, Plethora dif- pofes to an attack of this difeafe; and the quantity of blood font to the brain, in childhood, in propor- tion to the body, is much greater than in any fubfe- quent period of life. It needs no other proof that thefe are the real caufes, than this fingle reflection that maturity alone has fometimes redored to health, A parcxyfm of anger has no influence upon the firm nerves of a nurfe, while it will convulfe a delicate infant at her bread. 2dly, This difeafe frequently makes its attacks i11 at night, cr early in the morning; a feafoU when ( 9 ) the animal economy is the mod debilitated. The excitement or drength of the body is diminiflred, while the aptitude to receive imprefhons is increafed. From thefe circumdances, we mud conclude that debility in the whole fydem, and particularly in the nervous, difpofes to Epilepfy—I fay particularly in the nervous; for if it refides in the arterial, a fever, and not con- vulfions, is the effect of an application of an occa- sional caufe. Hence we obferve, thofe who are fub- ject to convulfions, are feldom afflicted with an inflammatory fever, and vice verfa. Nervous difeafes are the offspring of cultivated fociety; the modes of life and manners attendant upon fuch a date, give a quicknefs of perception and delicacy of feeling. The fcenes of a tragedy are too feeble to produce confiderable emotion in a favage bofom ; while the civilized and refined fair one, fometimes faints, and is occafionally convulfed. Her feelings are io eafily excited, and her imagination fo foon wrought upon that thedifferent objects of didrefs, are frequently prefented to her view, even in dreams, while the favage {lumbers undidurbed. The higher this refinement is carried, the more frequently will thefe unnatural difeafes appear. Even our own country can bear tedimony of this, by the revolution pf them that is condantly taking place. C 10 ) Happily for mankind, a predifpofition to F.pi- Iepfy may exid through life, without the difeafe actually appearing. The debility occafioned by cold difpofes to inflammatory fever; but a difeafe does not occur without the application of fome difpropor- tioned dimulus. Parallels to this are to be found in every medical author.-----A predifpofition to Epilepfy is fometimes derived from ancedors: the difeafe is not inherited, but a mere aptitude to be affected upon the application of fome occafional caufe. This is not peculiar to Epilepfy, for Gout and Confump- tion exhibit indances familiar even to the vulgar. The defendants of perfons labouring under thefe difeafes, frequently avoid them by abflinence and care. It will not appear drange, that a predifpo- fition to certain diforders is derived from ancedors, when we reflect that difpofition, faculties of the mind, features, and even form itfelf, is tranfmitted. Thus a fimilitude appears between parents and chil- dren in the flruchire and organization of every part of the fydem. Van Swieten * fays, that the difpofi- tion fometimes paffes one generation and appears in the next: the fon, by an active andfober life, fubdues it; but communicates an aptitude to his offspring. Dr. Blackmore has obferved the fame thing to take place in the gout j and has happily compared it to a river * Vol. X. P. 315. ( II ) in Africa, that runs through a great extent of country, and then difappears, but emerges again from the earth at a didance from whence it defcended. 'The fame has been obferved of Scrophula, and other dif- eafes. EXCITING CAUSES. These may be ranked under two general heads : id, Thofe that produce violent excitement; and,' 2dly, Thofe that produce debility. The flrd may be fubdivided into id, Thofe caufes that act primarily upon the brain; and, 2dly, Thofe that act primarily upon the fydem at large, and, through its medium, influence the ner- vous fydem. Under the flrd head of the fubdivifion are includ- ed fplinters of the cranium—the ends of fliarp indru- ments penetrating it—ofliflcation of the membranes, &c. Defections have fliewn that all thefe have indu- ced the Epilepfy. The paflions prove powerful exciting caufes of this difeafe. Ca?far was fubject to it, efpecially on ( >2 ) the eve of a battle.* Joy and anger have each pro- duced it. The flrd feems to act principally upon the nervous fydem ; the latter has confiderable influence upon the arterial. They act as violent flimuli, prof- trating in an indant, the nervous fydem. The death of the Roman mother at the fight of her fon, return- ed from the battle of Cannae, was occafioned by the violent impreflion of joy—it mud have acted like a powerful fliock of elearicity, producing, perhaps, a dedruction of excitability. Anger feems t© derive fome of the violence of its action from the indrumentality of the blood ; for the face is flufhed, the veffels of the head turgid, and every evidence exids of an increafed determination to the brain—Joy and anger produce indirect debility in the nervous fydem in the fame manner that fome contagions and other dimuli prodrate the arterial. Perhaps the effects of certain odors may be explained in a fimilar manner. The fight of perfons afflicted with this difeafe, has produced a like affection in the bye-danders. This circumdance has taken place fo frequently as to make it impoflible to deny it: the mod remarkable indance of this kjnd occurred at the poor-houfe in * Zimmerman's Experience, Vol. II. p. 333, ( i3 ) Hsrlcm ; where nearly all the children were affected by feeing a perfon attacked with it. The method of accounting for it fatisfadtorily, requires a more extenfive knowledge of the laws of the human frame than I poffefs. Man is faid to be an imitative animal; and to this fenfe of imitation many have afcribed this phenomenon. The horror, in- duced at the fight of a perfon labouring under this difeafe, has likewife been called in to explain it. Similar facts prefent themfelves every where; and Whyte, in his elaborate treatife upon the nerves, has mentioned many. He accounts for it by fuppofing that, " in thefe cafes, the imprefllon made upon the mind, or fenforium commune, by feeing others in a difordered date, raifes, by means of the nerves, fuch motions or changes in certain parts of the body, as to produce fimilar affections in them ; and hence it is, that the fight only of a perfon vomiting has often ex- cited the fame action in others." And fo great is the fufceptibility to action in fome perfons, that the flight- ed imprefllon will induce a difpofition to imitation. Over-didention of the blood-veffels of the brain proves a frequent exciting caufe : this is evidenced by a turgefcence of them, and a dimnefs of fight taking place previous to a paroxyfm. The precurfors, as fliall be fliewn hereafter, corroborate it; for they ( '4 ) difcover increafed excitement in the brain. Thofe effufions that appear upon diffection put the qucflion beyond the fhadow of doubt. The apparent fullnefs that occurs in the veffels previous to a fit, induces the opinion that the effufions are the effect, and not the caufe. But Epilepfy frequently fucceeds thofe difeafes that are univerfally confeffed to arife from too great a determination to the brain, fuch as mania and apo- plexy. That over-didention of the veffels of the brain, is a fruitful caufe of Epilepfy, is evidenced, by the manner of operation of feveral of the exciting caufes. Heat applied to the head—anger—fevere exercife—a furfeit, or fit of intoxication, have all a tendency to this effect. Debility was confldered as the pre-difpofing caufe of Epilepfy ; now plethora often accompanies, and is a mark of debility. This over-proportion of blood that conditutes plethora, renders the veffels of the brain, very liable to be over-didended, by the appli- cation of any fubdance or means that increafes the circulation. Bat there are other exciting caufes that feem to act primarily upon the body. In fact, the applica- tion of heat, exercife, and intoxication, already mentioned, produce over-didention of the veffels of the brain by the influence they have upon the circu- ( '5 ) lation. Convulfions fometimes occur in inflammatory fevers, from the dimulus of the blood upon increafed excitability, or from contagion, and are only to be cured by the liberal ufe of the lancet. I faw a cafe in which the convulfions, and its precurfors tremors, were gradually diminifhed by four bleedings. The mod fruitful and lead dangerous occafional caufes, in children, are dimuli acting upon particular parts, and thence communicated to the whole ner- vous fydem. Thefe are worms, teething, the irrita- tion that attends the eruption of certain contagious difeafes. To thefe may be added, the dimulus of a calculus in the kidney, or any local applications ; cantharides have proved fufliciently violent to produce this effect, and even the acrimony of the fanies of old fores has had a flmilar operation. Poifons—great pains—the ceffation or doppage of humors that ufed to be evacuated, as the drying up of old fores—the retention of the menfes, and the ceafing of the bleed- ing in piles, have all had the fame effect. Among the exciting caufes, that mud not beomitted that is accompanied with the aura erileptica. This is a fenfation of fomething, ariflng from the body or extre- mities and extending upwards, like a blad of wind, or dream of cold water; and, when it reaches the brain, a paroxyfm immediately enfues. The circumdance of ( 16 ) the fenfation going, from a particular part, directly to the brain, would induce the fuppofltion, that it origi- nated from an irritation of a nerve ; but nice obfer- vation upon this point difcovers, that the fenfation is not continued along the courfe of any nerve. Some indances, however, have been mentioned by authors, where the aura epikptica arofe from a vifible irritation of a part. A fruitful exciting caufe is dill to be mentioned ; viz. whatever makes a drong imprefllon upon the nervous fydem, occafioning great pleafure or pain. Unlefs the force of impreflion is confiderable, no remarkable change occurs, except the predifpofing caufe exids to a confiderable degree. The impreffions that induce pleafure, feern to be conveyed directly to the brain, by the nerves; while thofe that induce pain, frequently act primarily upon the mufcular fibres, producing didention and inflammation. The caufes of both being the fame, only varied in order and degree. They all feem to act by creating an exceffive excitement in the brain in particular, or in the whole fydem in combination with it. There is no neceffity for the predifpofition to exid, to a confi- derable degree, in every cafe ; for the violence of the occafional caufe is fometimes diffident of itfeif to bring en the difeafe. And, when induced, it is the fame, by whatever caufe effected. Like the plcurify, it may ( i7 ) be excited by intoxication, the heat of the fire, Sec. 5 but remains unaltered by whatever occafions it. That violent dimuli fhould produce irregular and exceflive action in a part, is no new law of the animal economy. We fee it illudrated every where, in the familiar difeafes of the arterial fydem. We might as well expect to fee a veffel ride fafely and equably in a gale of wind, as to expect the excitement of the fydem to be regular, upon the application of a violent dimulus. This law is obfervable through all nature, and political bodies give confirmation, daily, to this affertion. Whole nations have been renderedEpileptic, to ufe a new exprefllon, by hearing the exploits and victories of their armies. There is a degree of excite- ment which Dr. Brown places at 60, on his fcale, within the boundaries of regular action; but if it extends further, the weaked and mod excitable parts are thrown into irregular or convulfed action. The fame takes place with regard to diminifhed excitement: a certain quantity of dimuli and excita- bility, are neceffary to fupport the proper action of every part of the animal economy. If the excitement, in any particular part, is below 20 in Dr. Brown's fcale, this part differs ; if this happens to be the ner- vous fydem, what tire generally called convulfions, ( i8 ) and fyncope, will enfue ; if in the arterial, fevers of too little action ; and, if in the domach, dyfpepfia. Hence I conclude, that the application or abdraction of dimuli, beyond a certain degree, is incompatible with regular action, and that this irregularity occurs in the weaked part. I have ufed Dr. Brown's fcale to elucidate my idtas upon this fubject, without wifli- ing to imply my belief that the graduation is critically juft. If the debility, or tone, exids nearly equally over the whole fydem, they may be carried to a very great degree without being productive of difeafe. But there are exciting caufes of this difeafe that confid in an abdraction of dimuli ; thefe are, a great lofs of blood—the abdraction of the dimulating paflions—hunger—the ceifation of pain, and many others mentioned by medical writers. When thefe occur, there is an abdraction of a great fupport to the fydem. A feeble old man, who has been ufed to walk with a cane, might as readily hope to fupport himfelf in a firm and regular dep, after this affidance is taken from him, as a phyfician to fuppofe that regular action could be continued, in great debility. After evacuating the water from the abdomen, in the afcites, fyncope follows, unlcfs bandages are applied : the abdraction of fo great a dimulus dedroys that tone which is neceffary to regular action. ( i9 ) The influence of joy, heat, and the excefs of blood* have already been mentioned as inducing this effect. That Jaw of the fydem, that brings thefe two extremes to the fame point, has been noticed. So great an imprefllon had this fact upon Dr. Brown, that his theory falfely propofed the cure of both of them, even when acute, by the application of dimuli. It t may not be improper to evidence a few cafes, in which the fame effects obtain through oppofite caufes. Perhaps this will prevent the dartling that might enfue, upon hearing that a fit of Epilepfy may be brought on by oppofite means. A review of a few difeafes, will fhew that a fimi- larity exids among them that is feldom obferved—it will make us give thofe directions that will prevent the repetition of them—it will give us more clear ideas concerning their nature and cure. A noted medical author, much fubject to the gout, has affirm- ed, that he could produce a paroxyfm by taking a moderately dradic purge; and, who is there that knows not, that it may be produced by a fit of intox- ication? How often do we fee gangrene from excef- five action, and how frequently does it arife from deficiency. Apoplexy has been occafioned by deple- tion, as well as by intemperance. The arterial fydem will frequently fliew as few figns of aaion from the violent imprefiion of a dimulant contagion, as from C 20 ) confiderable depletion by a lancet. Mania and deli- rium, without any collateral proof, afford no certainty of their origin from excefs or deficiency of action; and Whyte has obferved a flow pulfe to arife, fometimes from a caufe directly oppofite to that which generally induces it. Thefe facts are fufficient for my purpofe. Many of the exciting caufes mentioned, act pri- primarily and principally upon the nervous fydem ; but others on the arterial. The operation of the firft would naturally fugged the idea, that whatever difeafe arofe, would, in confequence, be of the ner- vous kind ; but the latter not fo. Such would be the cafe if there was not a predifpofition in the ner- vous to be affected. "When the fufceptibility to im- prefllon exids in a great degree, difeafe may be indu- ced even when the dimulus acts through the medium of another fydem. In favage and rudic life, where employment gives a firmnefs and vigour to the con- ftitution, the paflions, excited to a high degree, pra- duce fever ; but in refined civilized fociety, their effects are often upon the vehicles of pleafure and pain. If it is the bufinefs of the nerves to convey inrprefnons to the brain, and obey, the mandates of the paflions, through the indrumentality of the will, whatever affects the mind, mud communicate a fimilar influence to them. There is no novelty in the idea that there are dimuli that act principally upon the ( 21 .) nervous" fydem ; the fame will be obferved to ta!? place with regard to every other fydem or part of the body. They are each of them induced with a dilpo- fition to be acted upon by imprefSons of a peculiar kind. But the animal economy is fo condituted, that there is a general fufceptibility to certain dimuli: befides, the different parts are called into action, by fympathy, by the violent imprefllon of a body on any particular part. Thus columbo acts upon the jtomach and bowels—bark upon thefe and the arte- rial fydem—balfam copaiba upon the urinary veffels— mercury upon the glandular and lymphatic fydems— oil of amber upon mufcuiar fibres—and opium upon the whole animal machine. But to fliew more clearly that the appearance of a difeafe depends much upon the peculiar exciting Caufe, we need but furvey difeafes in general, and their particular fituation. Contagion mod commonly affects the arterial fydem, and the /kin; but the pe- culiar one of human effluvia has influence upon the nerves in particular. The fcrophula affects the lym- phatic glands—the itch and leprofy, the fkin. When heat and cold alternate, the difeafes produced, are thofe of the arterial fydem. So that not only medi- cines have their chief effect upon particular parts of the body, but like wife the caufes of difeafe act fpecifi- cally upon particular parts. It is true, that violent ( *2 ) difeafes affect every part of the body; but it is equally true, that their principal force is upon particnlar parts or fyflems. Who has not fern convulfions attend inflammatory fevers, and increadd action in the blood veffels in nervous complaints ? Hence I would infer, not only that debility in the nervous fydem predifpofes to affections of it ; but, from analogy and facts, that particular caufes exert their chief influence upon it ; and, that it may be affected by a violent imprefllon upon the arterial, or fome other fydem. In what manner the mind adls upon the body, or the body upon the mind, is unknown to me ; but the advocates for the materiality or immateriality of the foul, all eonfefs that their connection is great. Epilepfy, affecting the faculties of the mind, fre- quently arifes from impreffions made upon the body; and it, in turn, is often affected with convulfions by a mere affociation of ideas. PROXIMATE CAUSE. This confilts in an irregular mixed action of the nervous fydem. The term irregular is ufed, to didin- guifli it from the action that exid. in health ; and mixed, to didinguifli it from the exc< fs that takes place in tonic gout, and tonic madnefs, and the defi- ciency that attends hypochondriacs. Ilaller fufpe&3 ( *3 ) that a kind of apoplexy is produced by the increafe of action in the veffels of the brain, and adduces, as a proof of it, the rednefs of the face, increafed heat, and deliqiuum animi that accompanies this date. That the energy of the brain is affected, is evident from the phenomena of the difeafe; and that in fome it is too great, and in others too fmall, is plain, from the phlogidic and antiphlogidic plan of cure being in different cafes attended with fuccefs. It holds the fame rank in nervous difeafes, that Dr. Cullen's fyno- chus and Dr. Rum's typhoid date of fever does in the in the arterial. As the fcarlet, puerperal, and hectic fevers have been confidered, by many authors, as inflammatory, and by others of equal eminence, as poffeflmg too little a&ion ; fo Epilepfy has, in like manner, undergone this variety of opinion. Since we have but little acquaintance with the nervous fydem, and few marks to diilinguifli particular grades of action in it, indications of cure, from a knowledge of the proximate caufe, will be attended with diffi- culty. A reference mud be had to the primary caufe, and the particular ones that renew the paroxyfms. I know of no other criterion, to judge of excefllve action in the nervous fydem, than the pulfe. In Dr. RufiYs practice, I have feen tremors, hiccough, faint- ing, and convulfions, attended with a teufe pulfe, cured by the proper and liberal ufe of the lancet. ( =4 ) DISSECTIONS. Upon the cranium being opened, phenomena prefent that will direct us to the true caufe of the difeafe. It requires much attention to difcriminate between caufes and effects; and we are much aflifled, in this part of the enquiry, by a review of the cir- cumftances that preceded death. Water—pus—bony excrefcences—deprefllons of the cranium—fragments or points of bones have all been obferved ; but, in fome cafes, the brain appears perfectly found.* A drift examination might perhaps have discovered pre- ternatural foftnefs or hardnefs in fome part; but, if the niceft fcrutiny fhould find neither of thefe to exid, it will: not appear drange to my mind : for, being a diteaie of the whole nervous fydem, we have no right to expect morbid appearances in the brain in every cafe—they do not always cxiil in mania ; nor do the lungs diew marks of injury or ulceration in every cafe of phthifis pulmonalis. EFFECTS OF THE DISEASE. Epilepsy being a violent difeafe, its effects, it may be prefumed, are often terrible. Palfy and apo- plexy fometimes fucceed it; and death itfelf is not unfrequently its termination. Didortions and defor- * \ViIH6' Pathology of die Brain. ( '5 J mities take place from the fame caufe that debility, in the lungs, fucceeds pneumonia, and, in the joints, rheumatifm. But however difagreeable to the eye of the afflicted, and the beholder, the want of fymmetry may appear, it is a mere nothing to what the mind differs. The iublime and difcriminating judgment, and wonderful memory, are both proftrated'. AH thofe faculties that exalt, man to the flrd grade in creation, are frequently annihilated, and happily with them a fenfe of his fituation. Although the mind has much influence upon the body, dill a date of idiotifm is not incompatible with perfect or occafional health. If it mould be afked why the body affumes an afpeft of health, and has all its functions performed with regularity, after a paroxyfm', and not the mind? I would anfwt'r, that the ffruc- ture of the brain may be (o much dedroyed as to prevent the operation: of the faculties of the mind, without receiving that degree of lefion that hinders the due performance of action in the body. There appears to be an exact and equal date of ter.uon, neceffary in every part of the brain for the proper exercife of the faculties of the mind, which is not requifite for the regular action of the functions of the body. C 26 ) REPETITION OF FITS. Upon what does the repetition of fits depend ? Some have afcribed it to habit; but this, in my mind, amounts to nothing more than a new term to expreis an ignorance of the caufe : others to a recurrence of debility. But I would object to both of them, for the following rcafons—With regard to habit, id, Becaufe the paroxyfms come on generally at very irregular periods, or when at regular ones, they may be traced to fome evident exciting caufe, as the influence of the moon, &c. in the fame manuer as the irregular attacks. 2d, Becaufe the patient can produce a paroxyfm, almod at any time, by imprudent expofure of the fun, fatigue, intoxication and other means. It is true, with refpeft to debility, that whatever increafes it, when inflammatory action does not exid, increafes the predifpofition to the difeafe ; and, if carried diffidently far, the difeafe itfelf: but I have already mentioned that an aptitude may exid, without the difeafe being ever produced. How often has the contagion of a violent fever remained dormant in the fydem for days, when no occafional caufe has been applied to bring it into action ; and, in many indan- ces, it has paffed out without injuring it. If it fliould ( *7 ) be urged in favour of 1 abit having produced a repeti- tion of fits, that the interval between them condantly decreafes ; I would reply, that the paroxyfms merely induce an increafed fufceptibility, in the fame manner that an attack of pneumonia, by debilitating the lungs, induces a difpofition to be renewed. And who has ever afcribed a recurrence of it to habit ? Nor does the idea fuggeded operate in favour of debility ; for it is but one link in the chain of caufes that pro- duce this difeafe. The inhabitants of all northern and fouthern regions are expofed to all the debilitating caufes that induce a predifpofition to pleurrf^ ; but they are very feldom fubject to it; becaufe they are not expofed to that mod common of all occafional caufes, the frequent and rapid fuccefllon of heat to cold. Hence I would afcribe the repetition of fits entirely to an application of fome exciting caufe. PRECURSORS. The Epilepfy frequently comes on ftiddenly, without the lead previous warning; but it fome- times has its harbingers. Thefe mod frequently precede attacks that come on at regular and dated, periods, and appear to be the flrd impreffions of caufes that aft more durably than violent. In this particular, it is upon the fame footing with the apo- plexy and the gout; and mod difeafes, of the violent kind, are ufhered in by marks which afford an oppor- *( 23 ) tunity of frequently preventii g any injury from being received. I have obfefveci the following precurfors; a change of difpofition and conduct—the mod uncom- mon and incontinent ideas—fupercilious looks— haughty carriage—-difdainful and obfcure exprcflions, and unaccountable malice to particular perfons and their friends—dubbornnefs and felf-govcrnment. I am acquainted with a boy, who is eafily managed in general, and difplays a great pliability of temper and vullingnefs to day in the houfe, previous to a parox- yfm, always become refractory and run away. And I am macquainted whh an elderly gentleman, whofe fervant could predict an approaching attack by his haughty conduct and impatience of contradiction. , But in many, evident fymptoms of plethora and de- termination to the brain take place, fuch as coflive- nefs, little deep, quicknefs of perception, headach, a dilated pupil, red eyes, and a flufhed countenance. j I Some perfons can foretel an attack, by an unufual take being perceived; this will often occur feveiil days, without any concomitant fymptoms. I have i mentioned the aura epileptica as accompanying the operation of one of the occafional caufes of this difeafe; hut, upon reflection, imagine that this may be confi- dered as one of the harbingers of it. For it is- of fuch a nature, that a meditated attack may be pre- vented by timely application. Befides thefe, there ( 29 ) are others that are peculiar to different patients. A A drift, enquiry fhould always be made ; for a pre- vious knowledge may direct fuch methods to be pur- fued, as will tend to the mod falutary purpofe. An advantage has been taken of thefe precurfors; and, if it fhould appear that a recurrence of fits depends partly upon habit, much will be gained ; but, if this opinion is groundlefs, it will be advantageous to prevent them, becaufe the fydem differs confiderably from every paroxyfm. In pleurify, where we do not fuppofe a repetition of attacks to depend upon habit, we bleed and ufe the antiphiogidic regimen in its various parts, to prevent that debility from taking place in the lungs, that paves the way for confump- tion, and renders every flight diforder of the fydem liable to be accompanied by an affection of this organ. PREVENTION OF A PAROXYSM. It has already been obferved, that a predifpofition may exid through life, without the difeafe taking place, and, that an occafional caufe may often be applied, without injury, if there is no predifpofition. But, when an epileptic diathefis exids, much care mud be taken to produce a firmnefs of conditution, and prevent the application of an exciting caufe; for the preventing of a paroxyfm not only relieves the feelings of the patient, but gives the nervous fydem time to regain that degree of dability, that permits actions E ( 3° ) my in proportion to the violence of the imprefllon, Thefe circumdances afford drong inducements to ob- ferve the preceding harbingers, and to take advan- tage of their flrd appearance. A review of them, will fhew that they are generally fymptoms of increafed action in the veiieis of the brain, and fometimes of plethora in the whole fydem. Hence bleeding, and the antiphlogidic plafl, will be found to be the mod rational and fuccefsful means of pre- vention. Thefe will only effect a reduction of that excitement in the arterial fydem, which would other- \x\L dim -late to excefs; and this theory and practice are powerfully fupported, by the means we ufe to obviate an approaching attack of its fider-difeafe, the apoplexy. If there is a periodical fulnefs of the veffels of the brain, or the whole fyVm, nothing can be fo efficacious, in practice, as the ufe of ihe lancet. C .aicn has mentioned the beneficial effects of this remedy, and Bonetus and others recite fome cafes, in which a perfect cure was effected by it. The pulfe fhould be one of our principal guides, in directing us to its ufe. Purgatives fhould be joined with it; for they re- duce excitement, and create a determination to the bowels, and maybe ufed when phlebot-'y is not neceffary. There is often that degree cf action, pre- ( 3i ) vious to a fit, that this remedy and emetics are jud fuited to deflroy. Van Swieten mentions an indance of a fchool- mader, who could prevent an attack by keeping his domach moderately full. Opium has proved of effential fervice, if admi- nidered when the fydem was labouring under direct debility. It prevents a fufceptibility from exiding or arifing to a great degree. When given at bed-time, it has frequently obviated an attack ; for it hinders that degree of debility from occurring, that lays the foundation of a paroxyfm. Thofe cafes that are preceded by the aura epileptica, feem particularly adapted to this remedy; for they diew a great degree of mobility in the iie-v^us fydem. Dr. D_ TTaen has given a cafe in wk:c.e. the £ts were prevented bv avoiding deep, and which finally yi~. to opium.' Should an affociation of ideas prove an exciting caufe, we mud prevent a parowfm, by producing fome violent imprefllon upon the mind, fuch as fear ; in this manner, the celebrated Boerhaave prevented it in the Poor-houfe at PIserlam. Should violent emotions occafion it, we mud be careful not to vifit thofe places, hi which there is a probability of having them excite 1. Should the influence of the moon produce a paroxyfm ( 32 ) we fhould be careful to mark the precurfors, and adt accordingly; but fhould it be excited by that caufe which is attended by the aura epileptica, we fhould examine the part from which the fenfation arifes. If an irritating fubdance is obferved, it fhould be taken out, and then the difeafe has been known to difap- pear; but, if the part has the refemblance of being perfectly found, we fhould neverthelefs, make a con- fiderable incifion into it, or in the courfe of the aura. Bliders and iffues upon the part have often had the fame effect, and even binding with a dring, the limb, above where the fenfation originates, has prevented a paroxyfm. A dedruftion of the part, from which the aura arifes, is the primary object, the manner of effecting it, whether by knife, caudic, iffue, &c. has but little influence in the cure. Should fever, and the irritation of the eruption of the fmall-pox or the meafies, be the exciting caufe, bleeding, cool air, ?zc, will prevent the repetition of paroxyfms. Should • dentition be an exciting caufe, cutting the gum upon the appearance of the tooth, will enfure returning health. Should acidity in the flomach, or an irrita- tion in the bowels, be the exciting caufe, their effects may be prevented by abforbents, cathartics, and other remedies. Should heat, violent exertion, or fatigue occaflon a paroxyfm, the exercife of reafon will prevent a return from thofe fources. If irrita- tions, from any caufe, be found to excite it, a preven- ( 33 ) tion of the difeafe confids merely in obviating and avoiding them. Crowded affemblies, and places, where there is a want of free circulation of the air, fhould not be frequented. From the previous enu- meration of the occafional caufes, it is evident, they are many, and require each of them attention. Dif- ferent perfons are more eafily affedted by fome pecu- culiar ones, and it fhould be the bufinefs of the phy- fician, to make himfelf acquainted with the influence of each, in order to prevent their effects. TREATMENT DURING A PAROXYSM. This is a period of the difeafe that is attended with the greated hazard, but one in which our exer- tions, mod commonly, are the lead. Indead of dan- ger and mifery exciting our attention in proportion to then* degree, we remain idle fpeftators, and leave the patient to his fate. Why this diould be the cafe, in this difeafe, and not in others, is unaccountable; and thofe gentlemen who look forward, with great reafon, to the perfection of medicine, will difeard an idea fo unworthy of their prcfeihon, and fo humilia- ting to the pride of human refources. A review of the fltuation and circumdances attend- ing a fit, together with the caufes and phenomena of it, will point to fomething ufeful. Since perfons are ( 34 ) liable to be attacked in crowded affemblies, a primary object will be, to remove them to a place that is pro- perly ventilated—all unneceffary attendants fhould be difnaiffed. This has often been directed, but feldom any thing elfe has been attempted, and when it has, rice has been entirely empirical, and has fhewn no regard, to the variety that is neceffary when there are many cafes. The exerting caufes, the harbingers of the difeafe, together with the fymptoms, difcover that there is commonly too much action in the arterialTyflem. Hence bleeding will fometimes be neceffary to palliate a paroxyfm, and to reduce that action that would produce effufions, fo often the effect of this difeafe. From the continuance of the diforder, the brain labours under chronic debility, and of courfe, is eafily rendered apopleftical, by a fmall increafe of action. Diffeftions fhew that this is the mod common attend- ant upon a fit that terminates in death. The quan- tity of blood taken fhould be in proportion to ther violence of the affection. Befides, this treatment permits dimulants to be ufed afterwards with lefs danger and more efficacy. When the pulfe is feeble, laudanum, when it can be given, may be adminidered with advantage. ( 35 ) The diffufibility of this dimulus renders it extremely ferviceable in many indances. It may be repeated according as occafion demands, But it fometimes terminates in coma, and then thofe remedies, diould be applied, that are in common ufe when this date fucceeds apoplexy. But as this lalt difeafe is more frequently attended with plethora, we will have lefs hefitation in ufing dimulants in Epi- lepfy than in it. Bliders, acrid cataplafms, the po- tential, and even the actual cautery, fhould be tried. TREATMENT DURING THE INTERVALS OF PAROXYSMS, Tbefuddennefs of the attack, and the violent con- vulfions attending it, throw a veil of fuperdition over the minds of the flrd practitioners of medicine. It was viewed with reverential awe, and none dared attempt the cure of a difeafe that was fuppofed to be inflicted by the hand of heaven. Accident and time, however, effected fome cures, that brought dawning and affenting reafon to try fimilar methods. Thefe have formed the only clue to the improvement of me, dicirie in favage life; and, even in our prefent date of fcience and medicine, we take advantage of thefe in perfecting the healing art. And however much the reafoning faculties of man deferve to be boaded ( 36 ) of, dill they are found infufficient of themfelves, to difcover the nature and cure of every diforder. Let us examine what accident or time has effected, and obtain whatever light, upon the nature and cure of this difeafe, thefe fources will afford. Puberty, travelling, and the vigour infpired by rudic and mi- litary life, have each cured it; hence we would infer, that tonics, in fome cafes, may prove ferviceable. Van Swieten* remarks, that Hippocrates ob- ferved, that thofe who are feized with a quartan, do not differ the Epilepfy; and that a quartan, com- ing after that difeafe, cured it. Fie quotes a cafe in which the paroxyfm returned every week, and was cured by a quartan fever ; and another, in which it returned feveral times a-day, that was cured by an epidemic fever. And all writers upon epidemics obferve, that a violent attack of them carries off complaints of a very long dandkig. From thefe lad fafts, we would conclude, that concentrating the excitement in the arterial fydem may, in fome cafes, be of advantage. But if we may judge from ana- logy, confiderable morbid excitement raifed in any part of the animal machine, except in the nervous fydem, will be of equal fervice. Willis relates the * Vol. X. p. 369. ( 37 ) cafe of a girl who was fubject to Epilepfy—fhe, in one of her fits, fell into the fire and burned her face and head exceedingly ; but, as long as the ulcers remained open, ihe was free from the difeafe. Hol- lereus furnidies us with a fimilar indance. Dr. Meade relates a cafe of Epilepfy that occurred at the fame period with the tides, and was cured by an ulcer on the head, the confequence of a blider. Thefe lad examples will ferve to fhew, that morbid excitement accumulated in any part of the animal economy, but the nervous fydem, ferves to relieve it—Some advan- tage was certainly derived, from difcharging any great excefs of excitement that might have occurred. The part affected bears the force of all impreffions, and differs the nervous fydem to regain its tone. Dr. Hodges, in his treatife upon the plague, gives a re- markable example of this. During the rage of that violent difeafe in London, he had a feton in his leg, and attributes his efcape from its deadly ravages to this caufe. Whenever his fydem became furcharged with contagion, the feton inflamed and difcharged more confiderabiy. This not only ferves to fhew the inflammatory nature of the plague ; but likewife the means and necefllty of keeping the fydem at thofe trades of excitement at which regular action or health mud neceffarily attend. Diarrhoea is often cured by bliders; and Hippocrates has pronounced ulcers in the ler;>, to be very ufeful, even in vehement diforders ( 3S ) of the lungs. Thefe facte are diffident to edablidi the pofition; and my friend Dr. A. Alexander, in his inaugural differtation on the influence of one difeafe in the cure of another, has happily taken advantage of this law of the animal economy, and taught when and how to apply it. It is true, that whatever is adminidered mud have fome operation upon the nervous fydem; but as the doctrine of particular medicines exerting their chief influence on peculiar parts is firmly edablidied, we may ufe thofe medicines that are powerful, with- out throwing the nervous fydem into irregular action. Thus, through the peculiar organization of the glan- i dular fydem, mercury and its combinations aft princi- pally upon it. Dr. Darwin has happily called, the fufceptibility of particular parts to be afted upon by peculiar dimuli, by the name of animal feleftion or appetency—it depends upon their original conforma- tion, and not upon an intelligent principle in them. From thefe facts and accidental cures, a mode may be indituted that will prove beneficial; but in every indance, it mud be varied and directed by the date of the fydem. In the end, the cafes noted amount to nearly the fame thing; for the cure in all depended upon givino- tone to the nervous fydem, and all the difcord upon ( 39,) the fubjeft may be reconciled. Thus, tonics gave flrmnefs to the whole body, and made flight impref- - fions produce correfponding actions—the fevers threw all the morbid excitement into the arteries, and g-ave time to the nerves to recover their lod tone—the ulcers acted nearly in the fame way, but prevented, by a difcharge, too great a degree of action. It is obfervable, that their violence and continuance mud be confiderable to abforb all the morbid excitement, and give time to the nerves to become firm. AH the ufual dimuli will aft confiderably upon the nerves, unlefs a part is much affefted by an acute difeafe,. and then its excitability is fo accumulated as to throw itfelf in the way of every dimulus. Should inflammatory action exid, it fhould be redu- ced ; for this alone, has cured convulfions, by giving drength to the oppreffed nervous fydem. The prac- tice, that contemplates giving tone by the abdraction of dimuli, appears abfurd at the flrd fight; but reflec- tion approves of it, and rafts confirm its propriety. The arterial fydem has fhewn too many evidences of it to leave a doubt. It has been prodrated by the excefs and dimulus of the blood ; fo has the nervous occafionally, by the excefs of action in the arteries. This law appears far from being partial or limited in its extent. The action of cold, in a fultry day, by abdrafting the fuperabundant dimulus of heat and C 40 ) giving tone, is a familiar indance of it. The impref- fion being made upon the arteries, they would fuffer the mod materially, were not the nerves poffeffed, in thofe indances, of great mobility or difpofition to be thrown into action. By attending to that great principle in medicine, to be guided " by the prefent date of the fydem," we fhall be able to effect much in the cure of this dif- eafe. Had this principle been known, or properly attended to, it would have prevented bleeding, and bark and wine, in their turns, from proving dedruc- tive in intermittent, heftic, puerperal, and fcarlatina fevers. All that obloquy, that medical writers, even f of eminent characters, have ufed fo liberally, would have been difpenfed with. I have placed Epilepfy in the fame grade in nervous difeafes that thefe dates of fevers, jud mentioned, dand in the arterial; like them, it has been the fubjeft of litigation and different practice. Reafon would approve of the latter, but change is not the charac- teridic of empiricifm. An affcftion of the nervous fydem is not diffident evidence, of itfelf, to induce the idea that the fydem at large labours under direct debility. Fainting and convulfions attend the yellow fever, and one of the C 4i ) mod violent inflammatory fevers I ever faw, was attended with tremors and fyncope. And, it is clear to me, that three cafes in four of nervous fevers, arife from not reducing inflammatory action, in the blood-veffels, and permitting it to wear itfelf down. When paroxyfms arife from plethora, depletion does not weaken the nervous fydem, but gives it time to recover a proper degree ofinfenfibility. Bleeding and purging fhould be ufed, as long as there is an excefs of aftion in the arterial fydem ; and even when there is none, they fhould be employed in the flrd dage in a fmall degree, to render the application of tonics more powerful. This was Sydenham's happy me- thod. They increafe the excitability of the fydem, without reducing it to that degree of debility that portends danger. And when a courfe of tonics is prefcribed, the date of the fydem fhould always be attended to in each vifit; for it feldom happens that it remains long in the fame fituation. The ufe of thefe remedies mud occafionally be laid afide, until the inflammatory aftion, which accident and a change of temperature in this climate will often produce, has been dedroyed. There appears to be an abfolute neceffity for this precaution; becaufe nothing but keeping it at certain grades of excitement will effect a cure. ( 42 ) It is not eafy, and perhaps may be dangerous, to imitate nature in producing fevers for the cure of this difeafe; but we may derive fome confolation during their exidence, if they fhould occur, from the reflec- tion, that they have been beneficial in this, and all others of the nervous fydem, as, mania, apo- plexy, Sec. RELIEVING BY EXCITING MORBID AC- TION IN ANOTHER PART. If there ever was fuch a thing as a panacea, it mud certainly be mercury. Dr. Rufli has emphatically called it the Sampfon of the materia medica. It has not only triumphed over fyphilis,* dyfentery,f fcarla- tina,} yellow fever,§ and hepatitis,|| been beneficial in the lad and mod dangerous dages of .pneumonia, typhus mitior, fmall-pox, tetanus, hydrocephalus and eyrrdnche trachealis, but has lately received trophies from its fubduing many cafes of nervous affections. The hypochondriac, the parajytic, and the epileptic, have each with pleafure confeffed its power. The proper application requires much fkill and attention, and it fliould never be exhibited while * Hunter, and all writers upon the fubjetf. f Clark on hot climates. % Ogden. § Dr. Rufli. § All late Eafl India writers. ( 43 ) there is much inflammatory aftion in the fydem. If it be confiderable, in vain will aptialifm be expefte4 ; and, even if it fliould take place, if inflammatory aftion is produced in the arterial, fuperior to that which the mercury induces in the glandular fydem, it will be flopped. This obfervation applies not only to Epilepfy, but likewife to all other difeafes. A paroxyfm of a moderately inflammatory fever wall dop a ptialifm ; and the aftion of the yellow fever and hydrocephalus internus is fuch, that unlefs depleting remedies have been previoufly ufed, a fpitting cannot be effefted until an effufion, which it was intende&i tQ prevent, is induced. Since mercury acts principally upon the glandular and lymphatic fydems, it will not; excite wonder, that its operation does not occafion a violent impref- flon upon the nerves. This, as likewife fome reme- dies to be mentioned hereafter, mud be continued for a confiderable time, and in a violent degree. Unlefs the inflammation and tumefaction of the glands of the fauces and the gums are fuch as to prevent fpeaking at all; or, at lead, diitinftiv for feveral weeks, little. benefit can be expected. A new aftion is produced, that renders the glandular fydem fo excitable, that it abforbs the effect of every dimulus, that might other- wife generate morbid excitement in another part of the animal economy. Befides, the difcharge prevents ( 44 ) any ftimulus from raifing the excitement to too great a degree. A falivation renders the arterial fydem fo irritable, that, after it has gone off, it, and not the nervous, receives whatever impreffions are afterwards made. Zimmerman* quotes Kaau Boerhaave, in confirmation of the efficacy of a falivation in the cure of this difeafe. Dr. Rufh, in his lectures, has likewife mentioned feveral happy terminations of it, by means of mercury ; and Dr. H. Smith, it is faid, has ufed this medicine with the fame beneficial effects. Theory would lead to the ufe of it, and practice has confirmed the propriety of exhibiting it. Iffues, fetons, and candies, may be confidered fomewhat in the fame light; their operation, how- ever, is much more feeble. They are frequently united to tonic remedies, and, to be ufeful, mud produce inflammation to a confiderable degree and duration. The cafes, already quoted from Mead, Willis, HoUereus, and many others to be found in medical writers, of cures by accidental wTounds, gave thefe remedies a repute that time has notleffened. Dr. Perfecl has effefted feveral cures by combining with a feton, fome tonic medicine. Thefe lad are not en- titled to all the credit, fince fetons, iffues and caudics have individually been of the fame fervice. * Experience, Vol. II. p. 373. ( 4$ ) There are cafes, mentioned by authors, in which the delicacy and mobility of the nervous fydem was fuch, that the lead increafed aftion in the arterial, or a fmall imprefllon upon the mind, threw the nerves into convulfions. In thefe indances, it would be mod proper not to excite morbid action in another part, but to give tonics, particularly thofe that acted chiefly upon the nervous fydem. In preventing the recurrence of the difeafe, much depends upon obviating the predifpofing Caufe—this We fixed in debility. Accidental cures confirm the truth of this idea, and gave the flrd fuggedion of the propriety of adminidering tonics. Thefe feem to be divided into two kinds; thofe that aft principally upon the nervous fydem, and thofe that operate upon the whole animal machine ; of the flrd kind are fetid gums, mufk, agreeable fenfations, garlic, &c. ; of the latter, the preparations of iron, cold bath, food, exercife, and other remedies. Whenever the violent ufe of a medicine has pro- duced the Epilepfy, it has always been religioufly withheld in a plan of cure ; but this conduct, reafon and fafts will difcard, provided the medicine has only, by its excefs, afted as a remote caufe. Cold is a principal remote caufe of the inflammatory date of fever, and yet few remedies are of more fervice G ( 46 ) in its cure. A gleet is the product of a violent inflammation in the urethra, and yet, a frefh gonor- rhoea has cured it. Wine and rich food with indo- lence, aft as remote caufes to the gout; and yet, in many indances, they are of eflential fervice in pre- venting a paroxyim. When a remote caufe produces a predifpofition, by its dimulus, it may be applied to advantage, in fmall quantities, during the predifpofi- tion, in preventing a difeafe from occurring. Many cenfures have been paffed upon dramonium and other medicines, whofe operation Dr. Cullen conceives to befedative ; but I imagine that thefe lay, the foundation of debility, in the excefs of dimulus. A fmall dofe would give gentle tone, while a larger one produces debility. Thus a gleet generally derives its origin from the irritation of veneral matter, or fome dimulating fubdance, and yet we applv rentle dimulants and adringents in curing it. Exercife in a violent degree induces a predifpofition to difeafe; but when it is gentle and acts upon debility, it redores health. As flight affections of the nervous fydem have been removed by garlic, cador, and affafcerida, I prefume they may be mentioned with propriety in this place. Nothing more being neceffary, in the admini- dration of them, thari proportioning the dofe to the violence of the diforder. They give a gentle dimulus. (. 47 ) Many others might be mentioned, whofe effect is fimilar; but it will be unneceffary to be particular on this point, fince their tendency is to give tone. Prefuming that nothing now remains but predif- pofing debility, I will notice fome remedies that are intended to correft it; but as it is fometimes derived from original damina, and at others brought on by a combination of caufes that have afted long on the fydem, it will be neceffary, in order to obviate it, to ufe them for a confiderable portion of time. The vegetable tonics confld in BARK.—This, it has been obferved, has been combined with a feton to advantage ; and, from a knowledge of its mode of operating, much has been expected from it. Dr. Cullen and others have found it ferviceable ; but this, like all other powerful me- dicines, has often failed, and even proved detrimen- tal, by not being adminidered in a proper date of the fydem. It is rendered more palatable, by being joined with an aromatic. OPIUM.—In this fituation, it has been of Angular fervice, when given in fmall and repeated dofes. By its general impreflion upon the fydem, and the dimu- C 48 ) lating quality refiding in it, one part is prevented from being thrown into exclufive action. VALERIAN.—Much has been faid with regard to the efficacy of this remedy, and fome cafes are related by authors in which it performed radical cures. OIL OF AMBER.—This has been found ufeful, as a tonic, in Epilepfy. It is one of thofe medicines that has been adminidered with fuccefs in tetanus, and ferves to fhew the relationfhip between nervous difeafes. This view will dedroy empiricifm, and difco/er fources from which we may derive much advantage. MINERAL TONICS. The preparations of Iron—Thefe arefimilar to the bark in effect; but the fimple rud or oxyd is attend- ed with this additional advantage, that it keeps the body gently open, and, of courfe, keeps up a more regular excitement. Chalybeate waters, under the direction of a fkilful phyficiau, have been of fervice. In frequenting them, we often combine travelling, amufements, and fociety, with the efficacy of the water; and from thefe being of utility in other ner- vous affections, we may indulge the hope that more ( 49 ) advantage, in the cure of Epilepfy, may be derived from them, than is yet known. But the preparations of Copper, are of ancient ufe, in the cure of this difeafe. Aretseus, long fince, mentioned their virtues, and fucceeding phyficians have fubfcribed to his opinion. The cuprum ammo- niacum is the preparation mod commonly exhibited. Dr. Sims ufed a folution of lunar codic with fuc- cefs : towards the latter part of the time, he com- bined bark with it. Flis paper is inferted in the 4th volume of the Memoirs of the Medical Society of London. The Flowers of Zinc, have been highly recom- mended by the German phyficians, in curing this and other diforders of the nervous fydem, but have not been edimated, to that great degree, by the Britifh. When combined with affafcetida I think 1 have obfer- ved them to be of ufe. In addition to thefe, white vitriol has been recom- mended by many authors ; and Dr. Kuhn obferves, it has been of fervice in his practice. ARSENIC has likewife been mentioned.* ( So ) Perhaps there are few remedies that aft more powerfully, in giving tone to the fydem, than the cold- bath. Univerfal experience confirms the utility of it, in difeafes of too little aftion. To produce invigorat- ing effects, it fhould be employed for a fhort time only, and in that date of the fydem in which the re- duction of excitement will be attended with no ill confequences; or, to ufe Dr. Cullen's exprefllon, when the fydem can re-aft. The fedative operation of cold is fuch, that a long continuance of the bath, at one time, would, in fome indances, entirely dedroy the excitement. Thh tonic h; particularly adapted to our climate in fummer ; for the heat is fometimes fo intenfe as to preclude gentle exercife. For the pre- ceding reafon the cold of w inter fhould be carefully avoided. All the difeafes of the nervous fydem run into each other ^ or rather they are different grades of the fame difeafe. From this circumdance, I would em- ploy in the cure of Epilepfy, when there is nothing but mere debility to be overcome, all thofe remedies, that have been beneficial in dyfpepfia, hypochondria- cs, tetanus, &c. A viev/ will be had principally to thofe which operate upon the fydem at large. Mer- cury has been found of advantage in thefe diforders— fo it has in Epilepfy. The cold-bath has been found ( 5< ) ufefnl in thefe diforders—fo it has in Epilepfy. A re- gard mud be had in adapting, in all cafes, the remedy to the degree of affection in the nervous fydem. Dr. Cullen, in fpeaking of apoplexy, fays, " Al- though the whole of the body is affefted with the lofs of fenfe and motion, it fometimes takes place more upon one fide of the body than the other ; and, in that cafe, the fide lead affefted with palfy, is fome- times affefted with convulfions." This would lead us to fufpeft an affinity between palfy and epilepfy ; but, the latter date of the fydem terminating in the former, removes every fliadow of doubt. Eleftricity has certainly been found ferviceable in this difeafe ; and, if we have proved a relationfliip between them, there is every reafon to hope benefit from its ufe in Epilepfy; but much circumfpeftion will be necef- fary in the adminidration of it. Experience has taught that the fhocks mould be light and frequent, in mod indances, to be of advantage; but in this they fliould more particularly be fo; for a violent one would be as injurious as a violent emotion of joy, or any other hidden and confiderable imprefllon. Ingenuity has beenexhauded in difcoverln? reme- dies for this diforder ; and even the trepan itfelf has been reforted to—but the cafes, in which it could be ( 5* ) prefumed uieful, are but few. Mr. Bell* affures us, that it has been produftive of death in two inttances, out of three, in which it was applied. Thofe, in which it could appear neceffary, arife from injuries of the cranium, and afford a prefumption of a^deprefEon or an effufion. Medical authors have furnifhed us with many fafts, in proof of the operation of the paflions being curative as well as produftive of this difeafe. Since they are but little under our controul, and as it is impoflible to excite them to the exact degree we require, it would be imprudent to roufe them.— Thefe cafes, however, have their ufe, as they teach us what ought to be done. If prudence would with- hol 1 a remedy whofe force it is impoflible to forefee, dill we are left to the application of thofe whofe effects are nearly equivalent. If we do not chufe to excite a violent paroxyfm of joy, we may create the durable and pleafing emotions of hope. The influence of fright has alfo been favourable; but perhaps this fhould have been mentioned with bleeding and purging. DIET—has much influence upon all chronic af- fections -f and directions concerning it, fhould be given * Vol. III. p. 185. ( S3 ) with as much care, and followed with as much atten- tion, as thofe relative to medicine. Many difeafes, both of the acute and chronic kind, derive their origin from irregularities in living ; abdinence, of courfe, would feem, and really is, productive of advantage. Dr. Hunter has related a cafe of dyfpepfia that was cured by a continued milk diet. A quedion will natu- rally arife, relative to the kind and quality of food that are mod proper to be taken; this experience and reflection will anfwer. If nervous affections, and of courfe Epilepfy are mod frequent in civilized and polifhed life, we mud trace the principal differences between it and uncultivated, and derive, from thefe differences, fome aid in curing thefe difeafes. Per- haps in contrading them, diet and indolence are the mod prominent features. If the food of the favage and the cultivator of the foil be fimple and have but little variety, and they are principally freed from ner- vous affections, that of the epileptic fliould likewife be fo. Whatever has a tendency to prevent the for- mation of thefe diforders, has likewife an influence in preventing the repetion of them, when only a predif- pofition exids. Intemperance in eating and drinking, attended with indolence, produces the gout, and we place our greated hopes of a radical cure in moderate and frequent exercife, joined to a regularity in lining. That diet has all the influence we have afcribed to it, is evident, fmce we can fometimes tell the mode of H ( 54 ) living, from the difeafe under which the patient la- bours. The food fliould be Ample, and not rich—in this manner, we feldom eat too much. It fliould be taken feveral times a day to keep up a regular excite- ment. Spices, fliould by all means be difufed, becaufe they dimulate without affording nourifhment. The drinks fhould confid chiefly of fimple water ; but, in a few iudances, the bed wine may be com- bined with it—ardent fpirits fhould efpecially be avoided; for they produce, when taken in a confide- rable quantity, a temporary paralyfis of the faculties of the mind ; and, in a continued ufe, a total dedruc- tion of them. The whole train of nervous difeafes, from the Ample tremor to the mod violent apoplexy, are their offspring ; and I know of no one direftion more neceffary to be given than their difufe. Dr. Rufli* has mentioned the group of terrible diforders that arife from them ; and if they are fo dedructive in originating difeafes, how much more powerful mud they be, when acting upon predifpofition ? EXERCISE.—This fliould be in kind and degree in proportion to the drength of the patient; and fatigue fliould never be induced. I have known paroxyfms excited by excefs of exercife, which, had * Medical Enquiries, Vol. I. ( 55 ) it been gentle, would have been prevented. This and diet fhould require particular directions, in a plan of cure in this, as well as in all chronic difeafes; for much may be expefted from their proper ufe and application—Travelling has particularly been recom- mended, and proved ufeful in fome cafes—it has a tendency to give vigour to the body, and that tone that will dedroy predifpofition. A choice of climate will be highly requifite, and that one preferred which is agreeably mild, and not fubjeft to great changes of temperature. From a review of the prominent ideas in this effay, fuch a choice would be fuggeded; for, we have wifhed to avoid, every thing that would make a hidden impref- fion upon the fydem. This rule is adhered to in confumptions, and, why not in this difeafe ? FINIS. M«L Hiat. W2. nn c'i 1.1 "*r ■ ■■ \ .v- ; .u-i ra*< •■'• .■♦v; ■•■< 'C ■■^..■■^ #?■•*..-:• ^-*V ■ yy :?a^,- :e^:|y^:1r#::T^V'^#^y^ •»*/■■•• •*•<•..-5 i^-Xi.iSiSBtttot .*■>■■ / ■',.;■ ; M', e,, :{ , SsPf"il