Epilepsy-Falling Sickness-Fits.

-RUDDOCK.E.H,

DEFINITION-Sudden and complete loss of consciousness and sensibility, with spasmodic contractions of the muscles, lasting one, two, or three minutes, recurring without any typical regularity, and followed by exhaustion and deep sleep. the greek term, from which the name is derived, means literally a sudden seizure. the exact pathology of Epilepsy is still uncertain, but epileptic seizures re seen as the result of chronic infections, arterio sclerosis, growths, etc. When the convulsive movements always begin in one particular limb or group of muscles. and are always markedly associated with that pat of the body, some pressure on the corresponding area of the brain cortex may be suspected due to tumour of meningeal thickening. These cases are known as Jacksonian Epilepsy and the question of operation should be considered for them

Epilepsy is no new disease, and was perhaps as well known ages ago as at present. Notwithstanding our views of the gravity of the malady, greater importance was anciently attacked to it from its being regarded as a direct infliction of he celestial powers, in token of their displeasure towards the individual afflicted, or towards the community of which he was a member. In the Jewish, Grecian, and Roman philosophy, it was made the foundation of the brief of possession by evil spirits.

Epileptic cerebram.

THE AURA EPILEPTICA-In the majority of cases, the premonitory symptoms are to brief to allow the patient to remove to a convenient place, or even to give an intimation of what is about to happen. In other instances an approaching seizure is clearly indicted form many minutes, or even hours, before its actual occurrence. The minutes or even hours, before its actual occurrence. The kind of warning in variable in different cases, often consisting of such symptoms as as Headache, shooting pains, giddiness, in distinctness of vision, sparks of various colours, humming noises, or loud reports, strong odours, sneezing,orange tastes, hoarseness, irritability, gloomy mood, spectral illusions, etc. But the most striking premonition is that called the aura epileptica, a sensation compared to a stream of warm or cold air, to the trickling of water, or to the creeping of an insect, which commences at the extremity of a limb, and gradually runs along the skin towards the head; or, occasionally, it gets no further than the pit of the stomach; and as soon as it stops, the fit occurs. A knowledge of these circumstances is important, as, in some instance,s tine is afforded to interpose remedies that may avert the paroxysm or at least to secure the patients safety during a fit.

A FIT-The patient utters a loud shriek or scream, and falls suddenly to the earth, convulsed and insensible. The cry is peculiar and often terrifying, not only to mankind, but also to the brute creation. The convulsive movements, especially of the head and neck, are often very extreme, one side being frequently more affected that the other; there is violent closure of the jaws; the tongue is liable to be bitten; a foam issues for the mouth, often coloured by blood; the eyes quiver and roll about,or are fixed and staring; the hands are firmly clenched, and the thumbs bent inwards upon the palms; urine, etc. sometimes escape involuntarily; the breathing is impeded by spasms of the larynx and performed with hissing sound; the cheeks and lips are of a deathly pallor, the veins of the neck and forehead are generally distended, the heart acts tumultuously and death seems inevitable. Gradually,however, the symptoms remit, and the patient is left insensible and apparently in a sound sleep. A fit rarely lasts longer than from one to three minutes, although the painful nature of the spectacle makes it appear longer to a bystander.

SYMPTOMS FOLLOWING A FIT.– Some few patients recover perfectly in a few minutes; some regain consciousness,and then sink into a profound sleep; but more frequently consciousness is not immediately recovered, the slumber succeeding the struggles without any lucid interval. On emerging from the slumber the patient may merely feel languid and inert, or like a person stunned, or in a state bordering upon idiocy, unconscious of of what has passed. Occasionally a fit is followed by an attack of insanity, in which the epileptic may commit murder, or other crimes.

GRAND MAL AND PETIT MAL.– The fit just described is le grand mal of the French; but her is also a ,milder form of the disease– le petit mal– in which there is but slight, or even unobserved, convulsion, only a transient pallor of the face, no bitten tongue, no foam, and but slight and momentary obscuration of the mental faculties. There is an endless variety in this form of the malady. But,although imperfect, it is yet real Epilepsy, and the petit mal and the grand often alternate, or the lesser grows into the greater. ( The following is an illustration from Trousseau of the petit mal– A child in the midst of his play stops, slowly turns his head to the right side, and gazes with wide open eyes. There is no spasm of the facial muscles, but insensibility is at the time so profound that a needle passed into the flesh is unfelt. in about five seconds the child regains consciousness, but looks perplexed, or as though just awakening from a distressing dream. In a quarter of a minute more the attacks is over and the child resumes his play.)

CONSEQUENCES.– These are generally most disastrous both on the physical and moral condition. oft-repeated, severe attacks tend to destroy control of the appetite and passions, enfeeble the memory, impair the intellectual faculties, and, in some instances, terminate in irremediable imbecility. These patients rarely attain old age.

CAUSES.– Whatever the actual cause, Epilepsy is associated with an instability of the nerve centres which is often hereditary. Thus two or more cases may be observed to occur in the same family far more frequently than they would as mere coincidences. Hereditary tendency may be manifested by what has been termed the convertibility of nervous disease. Thus, a choreic patient may beget an epileptic child, or vice versa. This hold good of all neurotic diseases. Intermarriage of families having a tendency to nervous disease greatly strengthens the danger to the offspring. The marriage of near relations having such proclivities magnifies the danger immensely. Injuries of the skull; local irritation,as a splinter or shot under the skin; or in some internal organ; Tumours; Inflammations; parasites in the brain; malformations of the skull, as one half being unlike the other; osseous deposits within the cranium, especially spicula of bone formed on the inside of the of the duramater. In post- mortem examinations,the bones of the head are sometimes found thickened or otherwise diseases. It is well known that Epilepsy occurs often in confirmed lunatics and idiots, as the result of some malformation of the brain. The most frequent exciting causes are — derangement of the nervous or sexual systems.– Hysteria, immoderate sexual indulgence,self-abuse,and physical and physical prostration from any cause. The age at which the attacks most frequently commence is from the tenth to the twentieth year, when the important change of puberty takes place. The other most, frequent period is from the second to the tenth year, during which the permanent teeth are cut.

Frights, fits of rage, overstraining the mind, gastric disorders, the irritation of worms– especially taenia– menstrual irregularity or suppression, and the sight of other epileptics, are also exciting causes. Chronic poisoning, especially lead-poisoning, should also be named.

TREATMENT.– During a Fit.– The patient’s tongue should be put back into his mouth, and a cork or linen pad (as a roller bandage) fixed between his molar teeth, he should be laid on a couch, or rug, fresh air freely admitted around him, his head slightly raised, and all ligatures relaxed that interfere with circulation and respiration. Throwing cold water on the face appears to do no good; and restraint should not be exercised beyond what is necessary to prevent exposure, or to guard against injury. In Epilepsy preceded by the aura a firm ligature above the part where the sensation is felt, or the immediate inhalation of the vapour of Nitrite of Amyl, is said to prevent the attack occasionally. After a fit, the patient should be allowed to pass the period of sleep which usually follows without disturbance.

Between the Fits.– in addition to the administration of any remedy indicated, an endeavour should be made to discover, and then if possible to remove, the cause of the malady. But a cure is not always possible; and their obscurity which often surrounds the etiology of Epilepsy should done down our prognosis of cure. Homoeopathy, however contrasts most favourably with Allopathy; even when cure is out of the question, the striking relief afforded is worth all that pains taken to obtain it.