Essay on epilepsy. In which a new theory of that disease is attempted, from which the proximate cause is investigated, and indications brought from thence; shewing clearly the consistency of the method of cure. By W. Threlfal,

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ESSAY ON EPILEPSY.

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ESSAY ON EPILEPSY.

IN WHICH A new THEORY of that DISEASE is attempted, from which the proximate Cauſe is inveſtigated, and Indications brought from thence; ſhewing clearly the Conſiſtency of the Method of Cure.

By W. THRELFAL, M. D.

Nemo Mortalium omnibus horis ſapit.

PLIN. Hiſt. vii. 40.

LONDON: Printed for Z. STUART, Bookſeller, in Paternoſter-Row.

M.DCC.LXXII.

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To the Right Honourable LORD GEORGE SUTTON; A juſt and uncorrupt Senator, Candid and ingenuous, Highly eſteemed by ſome, Generally reſpected by all: As a Teſtimony of Regard and Gratitude, for his Civilities and Friendſhip, with Diffidence and Submiſſion, the following Sheets are moſt humbly inſcribed.

By his LORDSHIP'S moſt devoted, moſt obedient, and humble Servant, THE AUTHOR.

1. ESSAY ON EPILEPSY.

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THE intention of the Author, under this genus Epilepſia, is to deſcribe that diſeaſe which has been moſt commonly in this iſland, called the Falling Sickneſs: The reaſon why we chuſe to give it the title of Epilepſy is, it being the general Term now in uſe amongſt the moſt accurate and recent Syſtematics: But before I attempt to enumerate the phaenomena and different ſymptoms accompanying it, I think it neceſſary, in order to avoid the danger of its being confounded with any other Genera, of the claſs of Neuroſes of Dr. Cullen, or of the Spaſmi of Sauvage, to which it pertains; to give it a Definition, which I ſhall endeavour to be as conciſe in as the matter will admit.

1.1. DEFINITION.

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THE Epilepſy is a diſeaſe of the convulſive kind, returning periodically, affecting the extremities with various and irregular motions; every ſenſe, as well as the faculties of the mind, for a certain time are altogether obliterated.

1.2. HISTORY OF THE DISEASE.

HAVING thus defined the diſeaſe, I ſhall next endeavour to illuſtrate its appearance more accurately in a detail of the particular ſymptoms attending it; but as I have before remarked that it is a periodical one, and as many circumſtances ſhew the approach of theſe periods, it ſeems moſt proper to take our firſt obſervations from them. Before any one is ſeized with an Epileptic Fit, as it is called, he or ſhe generally perceives the head to be in ſome degree affected by ſtupor, or a kind of ſwimming, which we expreſs by the name Vertigo; the countenance is ſometimes red and bloated, at other times in a collapſed ſtate, the eyes ſparkle and appear highly excited, a ſmall inflammation or red ſpot is frequently perceived upon the white of them, increaſing gradually till the time of acceſſion; the circumambient parts are conſiderably diſtended; [Page 7] viſion is diminiſhed and vitiated in ſome degree, ſometimes indeed altogether abſent.

The Iris has very different appearances, ſometimes purple, at others black; the ears tingle, and ſounds are difficultly heard; diſagreeable ſmells and taſtes are alſo perceived.

The patient's diſcourſe deviates much from what it is in health, being either quicker or ſlower, and at this time ſaliva is emitted from the mouth very copiouſly; the jugular veins are enlarged, and at laſt a loſs of ſenſe takes place.

Neither are the parts below theſe altogether free from complaint, but are affected with ſymptoms common to other ſpaſmodic diſeaſes, particularly thoſe of hyſteria and hypochondriari; but it frequently varies here, acting differently in different temperaments; ſometimes a pain is felt between the ſhoulders, the abdomen is drawn upwards, the tendons are convulſed, the heart and extremities tremble, yawning and difficult reſpiration ſucceed, the extremities grow cold, the penis is praeternaturally diſtended a ſenſe of air or warm vapour is often perceived from the hypochondria, extremities or loweſt parts, aſcending to the higher and to the ſenorium.

The eructions alſo are very irregular, for beſides the profuſion of ſaliva, which has been ſpoken of above, the digeſtions of the inteſtines are foetid and very offenſive, the urine [Page 8] is alſo diſcharged in greater quantity than is cuſtomary, and not ſufficiently elaborated.

Nocturnal emiſſions of ſemen frequently happen from ſalacious dreaming, a ſenſe of inflation is alſo perceived at the praecordia, the abdomen begins to ſwell and murmur, the appetite vitiated, requiring food either in too great or ſmall quantity, ſome are excited by anger, others are depreſſed by ſorrow or fear; others again are diſtracted by anxious cares, ſome tranſported by joy, by fooliſh and intemperate laughing; others within a ſhort ſpace of time run through all their different affections, ſleep is either too profound or diſturbed with terrifying dreams; the incubus or night-mare frequently is an addition to theſe calamities. By the increaſe of theſe ſymptoms, at laſt the occaſion appears, by which the patient is proſtrated on the ground by a groan, all the ſenſes and the faculty of the mind being abandoned.

Violent convulſions ſeize the whole body, the muſcies of the face being differently diſtorted, ſeem to expreſs different ſenſes of the mind as thoſe of grief, joy, anger, love, &c. there is alſo a violent grinding or grating of the teeth takes place, to ſuch a degree as ſometimes to deſtroy part of their extremities; it is not unuſual for the tongue to protrude a little out of the mouth, and the cloſing of the jaws frequently cauſe the teeth to cut it exceedingly; [Page 9] a livid appearance of the lips and under parts of the eyes takes place, which, in a ſhort time, runs over the whole face; the palpebrae of the eyes are irregularly moved, but never are ſo far conſtricted as to cover all the white; the mouth is dry, ſparm prevailing in the beginning, afterwards it pours forth its ſaliva, the ſparm not being ſolved; reſpiration is performed with the greateſt difficulty and labor, as if a perſon was actually under efforts of ſtrength, and the hands are clinched with great force, neither are the heart and arteries free from diſtreſs, the pulſations of which are at firſt quick and ſmall, in a ſhort time they become full and ſlow, not having their proper force, and can ſcarcely be numbered, wanting their regular order; after this the venis of the face, alſo the praecordia and abdomen begin to ſwell; the excretions are alſo conſiderably diſturbed, for inſtead of ſaliva, which was before very profuſely ſecreted, a ſoam ariſes in the mouth, alſo ſtools, urine, ſweat and ſemen, are ſpontaneouſly evacuated, in an excited ſyſtem, endued with great ſenſibility; vomiting alſo happens ſometimes.

All theſe ſymptoms by degrees begin to vaniſh, and the Convaleſcent Epileptic has not the appearance of death, or a moribund ſtate, but a more natural ſleep at laſt returns again; but yet not ſo ſufficiently natural but that it [Page 10] repreſents Apoplexy. The breathing at laſt becomes leſs laborious; and a ſhort ſpace of time intervening, the patient, not conſcious of any thing that has happened, is reſtored to his natural ſtate: it rarely occurs that a perſon recovers immediately all his faculties, upon the paroxyſm ſubſiding; for generally there remains an inactivity to motion, in all the extremities, dullneſs of conception, pains of the head, and dimneſs of ſight; all which continue ſome time. — The times of interval between theſe acceſſions are very different; ſome are attacked every day, or ſometimes twice in the day; others once in the month; and others again, at a much greater diſtance of time; but the acceſſions do not obſerve regular periods, even in the ſame perſon; and the continuance of the acceſſion alſo differs greatly, ſome only being diſtreſſed for a few minutes, others whole days: and here we conclude our account of the ſymptoms attending Epilepſy.

1.3. REMOTE CAUSES.

THE different remote cauſes, and the effects of thoſe viſible upon the brain of diſſected Epileptics, ſufficiently demonſtrate, that Epilepſy moſt frequently depends on a turgid ſtate of the brain; theſe cauſes, whether they [Page 11] act directly upon the brain, or primarily on another part of the body, are at laſt transferred to it, and there act*.

Thoſe that act within the brain may, as ſar as at preſent we have learnt from diſſections, be properly reſerred to ſix heads: 1. Mechanical Stimuli—As a fractured cranium, and all caſes of depreſſion. 2. Chemical Stimuli—Collections of acrid fluids. 3. Matters preventing the free circulation of the blood, or proper action of the nerves, under which are comprehended tumor, oſſifications, and compreſſions. 4. Where the veſſels of the brain are preternaturally filled with blood. 5. Effuſions of blood. 6. Effuſions of Serum.

It is obvious, beyond a doubt, that all theſe cauſes conſiſt in a full and turgid ſtate of the brain, which is the fourth cauſe; and an increaſe of this, the fifth and the ſixth follows either of theſe, when no hydropic habit is preſent; which may be eaſily detected by its ſymptoms, and diſtinguiſhed from that ſtate of turgiſcency which we are endeavouring to inveſtigate; an impeded circulation in the ſinuſes of the brain, or jugular veins, will cauſe the arterious blood to act with greater impetus, upon their exhalents, which will cauſe an effuſion of ſerum; and a ſmall effuſion in the [Page 12] brain is more liable to do harm than in any other part; becauſe here we have no abſorbents, and the veins only perform this office; ſo that a ſmall quantity of ſerum effuſed, muſt accumulate by ſtagnation for want of this abſorbent ſyſtem.

The ſixth cauſe is therefore an effect of the two foregoing; nor does the firſt act immediately, unleſs by giving that full habit we have been diſcuſſing, or in ſome degree aſſiſted by that, we are certain it does not give a more certain Epilepſy, and the cure of every Epilepſy coming from this origin, conſiſts in a diminution of the full habit.—What pertains to the ſecond, I agree that acrid chemical Stimuli are both obnoxious to, and capable of giving Epilepſy; but as ſuch I deny its capability of giving one where the paroxyſm is continued longer, and when the ſtimulus is preſent, and the fit has been more durable, and ſerous colluvies found extravaſated; I contend that it is the effect of the diſeaſe, and of the impetus of the blood, which before has been elucidated.

The third cauſe is the only one remaining to be reconciled to our general opinion, under which are claſſed, hard tumors and conſertions in the brain, impeding the free circulation through it: this is pretty well explained by the firſt and ſecond cauſe; ſuch is a compreſſion of the ſofter parts into a praeternatural [Page 13] hardneſs: this cauſe therefore ſeems to me to act as a ſtimulus, quickening the circulation of the blood through its veſſels; therefore this, as well as the firſt cauſe, if not directly, yet in effect produces the plenitude neceſſary for our propoſition; and the ſame may be added with reſpect to the other four cauſes, which have been before enumerated, and properly reconciled, as terminating ſimilarly.

Theſe concluſions are or the greateſt advantage in practice, and clearly ſhew us how we ought to diminiſh the Plethoric habit of Epileptics, and recommend abſtinence: this is an excellent example of the uſe of diſſections in inveſtigating proximate cauſes of diſeaſes, though much neglected at preſent by phyſicians.

Not that I mean to affirm, or give it as my opinion, that there is no Epilepſy but what depends on Plethora; many depend on inanition, others on neither cauſe: more are however to be referred to it than at firſt view we imagine.

I remember a caſe of Epilepſy, remarked by my moſt ingenious maſter and illuſtrious profeſſor, Dr. Cullen, at Edinburgh, which was brought on by fear; and yet before every return of the paroxyſm an inflammation of one of the eyes was clearly perceived.

As we have gone pretty fully through theſe cauſes, which act within the Cranium, let us [Page 14] endeavour, in order more certainly to eſtabliſh the nature of the diſeaſe, as depending on this plethoric ſtate of the Brain, to ſhew how cauſes originally acting elſewhere, or at a diſtance, produce the ſame effects.

Impreſſions of different kinds, acting upon the ſenſes in general, give Epilepſy, according to their degree of impulſe; they do not act as being of diſtinct or different kinds, but by force of impreſſion, or reflect ſenſations, excited (as they are called) and this may be reconciled to all the ſenſes, except that of ſmell, upon which odours ſeem to act particularly; neither have theſe the power of acting, unleſs ſufficiently ſtrong. So a conſiderable degree of pain, of any part—joy, and what is ſtill more, fear, which is carried to a degree of terror, have produced Epilepſy.—Terror acts more powerfully as a ſtimulus than joy; becauſe we are modified by nature to attend more peculiarly to thoſe motions of the mind, which free us from danger, than thoſe which elevate us to ſudden proſperity.—And why not? when we conſider, that ſudden deſtruction is eſcaped in one caſe, and only tranſitory pleaſure acquired in the other.—Chemical Stimuli act alſo in like manner; ſome upon the whole ſyſtem, others only on a particular part, as by ſtimulating the ſtomach; and theſe do not act ſpecifically, but according to their ſtrength do they produce [Page 15] Epilepſy.—Odours, indeed, as we have before ſaid, ſeem to have a peculiar mode of action, and ſome other cauſes produce the diſeaſe from encreaſed irritability of the patient; as among children, dentition, calculi, and worms. And theſe cauſes act in the ſame manner as thoſe within the brain, viz. by ſtimulating the brain to more violent motions, and quickening the circulation of the blood through it; which, from our former obſervations, ſeems to be the moſt frequent cauſe of Epilepſy. But having before ſaid, that Epilepſy might ariſe from a contrary ſtate, we ſhall run over theſe cauſes, as not being of ſo much conſequence and importance, with leſs preciſion.

Perturbations of the mind, by diminiſhing the action of the brain, produce a temporary Epilepſy, quickly terminating in either death or health, as is obſerved in the effects of great and ſudden joy, or terror; but it would have been ſufficient only to have mentioned theſe once, as they very commonly bring on death in a ſimilar manner; as by Palſy, Apoplexy, Syncope, and Convulſions.—Some of the affections of the mind give a more continued Epilepſy, and one more pertinent to our propoſition, as Fear; which, by diminiſhing in a certain manner the mobility of the nervous power, ſeems, by an inherent law in our ſyſtem, to give in a certain ratio, a reaction [Page 16] of the efforts of the brain, which is even greater than natural; or the remembrance of this ſame cauſe of fear is often very ſurficient to bring back the diſeaſe.—There is a fact of a pregnant woman being fatigued with trying a new gown, which by diminiſhing the excitement of the Senſorium, gave that reaction neceſſary for the production of an Epileptic fit; the ſight of which gown, for ſometime after, was ſufficient to renew the paroxyſm. Atonia of the ſtomach ſometimes is ſufficient to give Epilepſy; ſuch as is made by diſtention after eating, as is obſerved by Galen.—Fumes of Ipecacuana taken into the ſtomach, are capable of producing the ſame effects; alſo Mercury, and many other matters; the Variolous contagion, induced by inoculation; and the Aura Epileptica, and finally, compreſſion of the brain, which produces Epilepſy, ſuch as generally precedes Apoplexy or Palſy.

There cauſes, from the effects, and method of cure, are very clearly ſeen to act, by giving a ſtate of the brain, contrary to excitement, which we chuſe to call by the name Collapſe; but then theſe act very rarely when compared with the former; neither do they eſſentially deviate from our propoſition.

From innumerable diſſections of Lieutaud, Morgagni, and others, of Epileptic patients; alſo in the opinion of the greateſt characters in [Page 17] Phyſic, Albertinius and Hoſſman, and many others, truly honoured and eſteemed for their practice, it appears, that they, for the moſt part, frequently treated Epilepſy as a diſeaſe ſtrictly connected with Plethora; and this alſo particularly agrees with the opinions and doctrines of my late moſt worthy Maſter and Inſtructor, Doctor Cullen, of Edinburgh, Profeſſor of the Inſtitutes and Practice of Phyſic; whole name I am at a loſs for words to adorn with that reverence, gratitude, and affection, that it demands of me; but will always endeavour to keep it in view in my practice.—I am alſo of opinion, that this turgeſcent ſtate, which we have been endeavouring to eſtabliſh, will, argued fairly, moſt eaſily inveſtigate the nature and cure of the Epilepſy.

For the more clear and accurate elucidation of the proximate cauſe of this diſeaſe, let us conſider thoſe habits that are moſt prediſpoſed to it.—Thoſe Syſtems inclined to Epilepſy, are generally endowed with encreaſed mobility: by this I mean perſons ſubject to ſudden, irregular and violent motions of the mind; and is it not highly probable, that the ſtate of the brain in theſe habits, which is moved by every impulſe of ſtimuli, and every change of tenſion, is ſimilar?

This mobility is encreaſed by repetition, and, after ſometime, become habitual, and almoſt natural, according to the law of irritability, [Page 18] (by which I mean the power of contraction of muſcles) it is encreaſed and facilitated by motion.—This explains the reaſon why, after one paroxyſm others can be produced by leſs active and weaker ſtimuli, and ſeems as if they were produced even ſpontaneouſly; for which reaſon it has been called a voluntary and feigned diſeaſe. This mobility aſſiſts us much in the inveſtigation of the proximate cauſe of every Epilepſy.—There are two cauſes of mobility:
  • 1. Debility of muſcular fibres.
  • 2. Exceſs of tenſion.

The firſt cauſe is clearly elucidated in infants, who are particularly obnoxious to Epileptic fits, a debile ſtate of muſcular fibres, or of the original ſtamina, can give ſuch a certain condition of the nervous power, which makes it more adapted to irregular motions, which we call encreaſed mobility: but perhaps this reaſoning may appear too ſubtile; ſo I ſhall paſs to the other cauſe of mobility, viz.

Exceſs of tenſion.—This giving mobility, remains by ſome means now more clearly to be explained. Stretching fibres beyond their tone, gives encreaſe of mobility: ſo fibres immoderately diſtended by the Potentiae Nocentes; [Page 19] ſuch as exerciſe, heat, drunkenneſs, &c. eſpecially in a Plethoric ſyſtem; when the force of theſe is removed, they immediately relax themſelves, in a certain ratio, as they have been before diſtended; and in like manner are their oſcillations encreaſed; which remiſſion, or relaxation, muſt frequently neceſſarily take place in the brain.—This tenſion, which depends on the quantity and impetus of the humours, frequently remits; an explanation of which, by an example of an elaſtic cord, may perhaps render it more eaſy to conceive: if ſuch a cord is extended, by force or by any weight, to a certain length, it will require a greater force, or weight, to ſtretch it as much more, than was at firſt applied: and in a ratio, according to the degree of diſtenſion, ſo will be the reſilition, the diſtending power being removed: or, I may explain the ſame thing by a pendulum; as far as you remove it by the hand from the center of gravity in one direction, giving it liberty, it will, in a certain ratio, go ſo much farther from it on the reverſe ſide.—A full, turgid ſtate of the brain is analogous to this; the oſcillations of which are produced either ſpontaneouſly, or by faults occuring elſewhere; as Plethora always encreaſes itſelf.

But beſides this cauſe of Epilepſy, conſiſting in the excitement of the brain, or in its greater oſcillations, that is exceſs of tenſion [Page 20] connected with debility; a defect of tenſion, debility being preſent, will produce the ſame effects.—This is a peculiar law of our ſyſtem; as excitement produces Collapſe, ſo, in return, does ſedative powers produce Excitements.—For the motions of our minds run into contrary extremes.—Terror produces this diſeaſe by exciting the brain; but in a ſhort time it produces a contrary ſtate, the impetus being a little moderated. Exquiſite titillation brings about the ſame phaenomenon, as is obſerved by Ariſtotle: ‘Omne animal poſt coitum triſte.’

And other ſedative cauſes act in like manner. We ſhall however leave theſe diſcuſſions, and paſs to the cure of Epilepſy, depending on a turgeſcent ſtate of the veſſels of the brain.

2. METHOD OF CURE.

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THE indications of Cure ſeem to be Two:
  • I. To avoid occaſional cauſes.
  • II. To obviate a full habit.

I. All exciting cauſes are particularly to be guarded againſt; ſo every thing that induces plethora, is ſtrictly to be forbid, as animal food, and matters that are highly nutritious; alſo whatever has the power of determining the blood to the head, as the rays of the ſun acting upon it, heat of the bed, favoured by the horizontal poſition, bathing, exerciſe, drunkenneſs, and anger, and whatever is capable of inducing vertigo; as viewing of objects from eminencies, venery, ſtrong impulſes, [Page 22] as ſudden noiſes, ſtridor of the hinge of a door, commotions of the mind, remembrance of the firſt cauſe of the diſeaſe, and ſight of other patients labouring under the ſame paroxyſm.

II. By the ſecond indication of Cure, is intended not only to obviate the increaſe of a full habit, but alſo to diminiſh that which is preſent; for which purpoſes the following method ſeems to me moſt advantageous.

Firſt, Blood letting: This is peculiarly efficacious, where the diſeaſe chiefly ſeems to conſiſt in tenſion, and a few ounces drawn will anſwer the intent; but when ſigns of congeſtion appear in the head, as by acute pain, tumor, or any inflammation, then blood is to be drawn plentifully; and for this reaſon I adviſe a large quantity to be taken at once, becauſe it is not ſo ſoon repaired; and as we know from fact that nothing more encreaſes plethora than frequent ſmall bleedings, performed periodically, the ſyſtem being accuſtomed to loſe a certain quantity of blood at particular times, always provides for ſuch a loſs: therefore, from the reaſons above, it is ſufficienity clear, by ſmall repeated bleedings we increaſe that habit we wiſh to obviate. And this remedy may be uſed with greater advantage when we are acquainted, by any [Page 23] ſymptoms, of an approaching acceſſion; upon the appearance of which, I would very freely immediately draw blood from a vein. I ſhould, at the ſame time, be very cautious of inducing a Deliquium Animi, and this for two reaſons: 1ſt, Leſt I ſhould be fruſtrated in my intent as to quantity; and 2dly, As by this there is ſome danger to be apprehended of inducing an acceſſion.

This then may be the rule, to bleed while the ſtrength of the patient remains favorable. Should not this prove ſufficient, which I am in hopes it would, then leeches, or cupping glaſſes, may be applied to the temples, as neceſſity requires.

Second, Purgatives: The action of theſe is accompanied with ſtimulus; and if this be a general one, often does as much harm as good: we ſhould always, in this caſe, pay particular attention that this ſtimulus be as much confined to the alimentary canal as poſſible; which may have good effect in altering the determination from the head, which before we elucidated to be ſo generally the caſe with Epileptics.

Theſe act by exciting the periſtaltic motion of the inteſtines, and thus occaſioning a diſcharge of their contents; alſo by emulging the ſeveral excretions, which is a greater evacuation than the former: hence purgatives [Page 24] muſt have a conſiderable power in depleting the ſyſtem, and diminiſhing its tenſion, which we have ſhewed to abound in Epilepſy; I would, however, recommend thoſe of the milder kind; ſuch as neutral Salts, Senna, Manna, Rhubarb, Caſtor—Oil, &c. as moſt proper.

Third, Iſſues and Setons: Theſe by diſcharging the coagulable lymph, are, without doubt, uſeful againſt a full habit; as this is the part of our fluids which forms Pus, that we ſee evacuated by theſe emunctories, which are generally placed in the neighbourhood of the ſyſtem, where the cauſe of the diſeaſe acts: hence, in Epilepſy, the moſt proper part for an Iſſue or Seton, is the nape of the neck.

Theſe remedies, in moſt caſes, are ſufficient either to cure, or, at leaſt, to alleviate the diſeaſe: yet I would not recommend a long uſe of them; ſince the ſyſtem being inured to this evacuation, from cuſtom and habit, aſſimilates an increaſed quantity of coagulable nymph, in order to ſupply the diſcharge of pus, analogous to frequent blood lettings increaſing plethora.—So the longer we continue theſe evacuations, the leſs eſſential are the effects.

The moſt proper method after the uſe of theſe means, to obviate a full habit, is,

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Fourth, Abſtinence: This is highly effectual againſt the cauſe of Epilepſy, conſequently againſt a turgid ſtate of the veſſels of the brain, the cauſe of this diſeaſe; and certainly more Epileptics are cured by this, than all other remedies; and whatever advantages may ariſe from the uſe of the above evacuations, it is abſolutely neceſſary that the patient obſerve ſtriſt regularity in the non-naturals, and adhere inviolably to the antiphlogiſtic regimen, for a conſiderable length of time, and perhaps through life.

In Epilepſy, ariſing from debility, the following indication of cure ſeems moſt proper.

To obviate mobility of the nervous power.

This takes place in a lax ſtate of the ſyſtem, and is relieved by tonics and antiſpaſmodics: there is doubt in the former from the difficulty in the adminiſtration. In the vegetable kingdom, there are ſome plants abound peculiarly with an aſtringent quality, as the bark of oak, which has been thought to act ſpecifically in this diſeaſe; perhaps commended enthuſiaſtically, as it is very uncertain.—The vegetables where the bitter and aſtringent qualities are connected, are the moſt powerful; as in the

2.1. PERUVIAN BARK.

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And this is not adminiſtered with ſo much propriety to a full plethoric habit, as to remove mobility of the nervous power; for it certainly is injurious to ſyſtems accompanied with the haermorrhagic or inflammatory Diatheſis: And, as this diſeaſe ſometimes fluctuates from the mobility ariſing from turgeſcency, to that from laxity, particularly connected with the nervous ſyſtem; in this ſtate we may admit it as a moſt powerful remedy, eſpecially where the acceſſions obſerve regular periods; as we know the bark hath particular qualities of removing periodical diſeaſes, as is clearly elucidated in the phaenomena of intermittents, and that it has very trifling powers, unleſs given very nigh to the approach of a paroxyſm. Hence it appears, that the indiſcriminate manner in which the Bark has been preſcribed, is the reaſon of its being exploded by many in practice: It however, with ſome juſtice may be ſaid, that the Jeſuit who firſt ſhewed the uſe of this moſt noble medicine, hath ſufficiently compenſated for the crimes of the whole fraternity.—Now we go to

2.2. METALLIC TONICS.

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Which are more powerful than all the vegetable, except the Peruvian Bark, and
  • 1. Arſenic.—This is dangerous, although much commended.
  • 2. Tin.—This is ſaid to have had good effects.
  • 3. Iron.—This is ſufficiently ſafe; but if chalybeate waters have alleviated Epilepſies, they have done this not ſo much from their tonic power, as from the effects that ſucceed cold bathing, exerciſe, and cold air, in general.
  • 4. Copper.—This is perhaps an uſeful medicine againſt Epilepſy, and it is much to be lamented, that we are not particularly acquainted with that compoſition of it that proved ſo remarkably effectual, and which is recorded by Baron Van Swieten, the form of which he himſelf is ignorant of; but, moſt probably, it may depend on this circumſtance, preſerving the tonic power of the Copper, and rejecting altogether its ſtimulating qualities, which may in ſome meaſure be obviated by joining a neutral, inſtead of an acid, with the Copper; which is done in the Cuprum Ammoniacale, now in uſe in Epileptic caſes; conſiſting merely of Copper connected with the Sal Ammoniacum. This compoſition has very ſtrong advocates.

2.3. COLD BATHING.

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This alone hath frequently been recommended as a cure in Epileptic caſes; and wherever it has been of ſervice, I ſhould imagine it to be in thoſe ſyſtems where the mobility of the nervous power is conſiderably increaſed; but injurious in thoſe where the inflammatory or plethoric Diatheſis prevails.

The method of uſing the Cold Bath ſhould be, either by the patient going in head foremoſt, or by cold water being firſt thrown upon his head; as in this manner it is moſt likely to be effectual.

2.4. ANTISPASMODICS.

To enter formally into a ſtrict diſcuſſion of theſe would be a work of time, and require much experiment and obſervation, to ſhew with accuracy their modus operandi; but we can, in general, ſay of theſe, they ſcarcely merit the praiſe attributed to them.—We ſhall ſpeak of thoſe chiefly recommended.

2.5. PEONY and VALERIAN.

Theſe have long been held very efficacious in the cure of Epilepſy; the former of which has been extolled even to abſurdity; many having credulity enough to believe, that the [Page 29] root of this plant worn about the neck only, was very ſerviceable in this diſeaſe; but its great uſe, I own myſelf unacquainted with, therefore paſs it over.

Many phyſicians have aſcribed great praiſe to Valerian; but I have been informed by a moſt eminent profeſſor at Edinburgh, who has been very much engaged in the practice of phyſick for thirty years paſt, who declared he had only ſeen it of ſervice in one or two caſes; and when that takes place, it acts merely as a purgative, deſtitute of any antiſpaſmodic qualities.

2.6. ANIMAL OIL.

This has been highly celebrated amongſt the Germans, which is the Empyreumatic oil of animals, highly purified by diſtillation, which deſtroys the original diſagreeable odour, and renders it thin and limpid, of a ſubtile, penetrating, not diſagreeable ſmell and taſte; its volatility is ſo great, that it gives all its power to the air; for which reaſon, if there is any hopes of advantage in volatile medicines, it may juſtly be expected from this; and the teſtimony of many confirm the fact.

2.7. MOSCH.

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This is the moſt ſubtile of all, and therefore ought to be ſcattered upon the whole body; if its powers are obvious in the cure of hydrophobia, it ought from ſimilitude of reaſoning to appear in Epilepſy, and its fame is every where divulged; but it is found neceſſary to give it in large doſes to anſwer the intent, which may be owing to our very rarely meeting with this medicine pure, and therefore being uncertain of its efficacy.

2.8. AETHER.

This is not altogether uſeleſs, becauſe of its volatility rendering it capable of being diffuſed through the whole ſyſtem; and therefore it is not to be altogether rejected.

2.9. OPIUM.

This has been condemned by many in the cure of Epilepſy. Two very illuſtrious names in phyſick, De Haen and Morgagni, have commended it, but without giving any ſufficient reaſon for their opinion. De Haen relates a particular caſe, where the acceſſion uſed to return during ſleep; and he declares that many paroxyſms were obviated by the uſe of [Page 31] opium, the ſlowneſs of the pulſe having ſufficiently indicated their approach. This is very little to the purpoſe; neither is the reaſoning of Morgagni ſufficiently probable.—In my own opinion opium acts here as a tonic, and being given at a happy criſis before the acceſſion, by that means obviates it.—Certainly if ever it is to be admitted in ſpaſmodic convulſions or Epilepſies, it ought to be admitted as nearly as poſſible to the acceſſion, becauſe of its quickly loſing its power; and this being over, it always leaves the ſyſtem more irritable. Its inebriating quality on the one hand quickens the circulation to the head, and debilitates and irritates in conſequence; ſo, on the other hand, its being given in ſuch quantity, and at ſuch a particular time, to obviate an acceſſion by diminiſhing the nervous mobility, or to be more particular the mobility of the nervous power, in which ſpaſms conſiſt. But this power of opium does not appear ſo clearly in a pure idiopathic Epilepſy, where the brain itſelf is the ſeat of the diſeaſe, as in one ariſing from irritation of the ſyſtem in general, or of a particular part.—But in fact, the raſh uſe of it in the former caſe is ſcarcely compenſated for, by the more prudent uſe of it in the latter.

2.10. HYOCYAMUS.

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The action of this plant is not unlike that of opium, only that it does not leave the belly ſo conſtipated; this advantage alone being admitted, it is either (notwithſtanding the high character given of it by Dr. Stork) not to be given at all, or with the ſame reſtrictions as opium, in Epilepſy.

This indication for the removing mobility, contains a great many remedies; the uſe of which in a plethoric ſyſtem would be altogether abſurd, and are adapted ſimply to mobility, accompanied with debility; but as this frequently in time ſucceeds the other, ſo muſt we practiſe accordingly.— We may add a fourth indication for the convaleſcent ſtate.

To obviate altogether an habitual Diſeaſe.

This is chiefly done by avoiding occaſional cauſes; a little fuller diet may be admitted; this diſeaſe ſometimes varies in ſuch a manner, that to thoſe where abſtinence hath been ſtrictly commanded, a fuller diet comes in for a remedy, after a few years. I ſay here, a more liberal regimen, not abſolutely a full regimen; for irritability of the nervous and ſanguiferous ſyſtem is particularly to be attended to.—A generous glaſs of wine may be [Page 33] admitted, but not in quantity to inebriate, as a little ſtrengthens and nouriſhes the body without irritating it, which effect has conſiderable power againſt the very production of mobility.—Sleep ought to be enjoyed temperately, which is moſt adapted to corroborating the body.—Let the degree of the atmoſphere, if it can be ſo contrived, be under 64 of Farenheit's Thermometer, rather than above.

All theſe may be varied diſcretionally, according to the ſtate of the convaleſcents. This alteration being properly and ſkilfully managed, other remedies being leſs efficacious, and the diſeaſe itſelf not being ſo well inveſtigated, is highly beneficial; which is a maxim from the time of Hippocrates down to the preſent.

FINIS.
Notes
*.
Vide Bonetus, Morgagni, and Lieutaud.