Page:Encyclopædia Britannica, Ninth Edition, v. 8.djvu/501

Rh E P I E P I 481 in epilepsy ; and it is supposed that a condition of irritability or over-action of the ganglionic nerve cells in these parts, which are concerned in controlling the vaso- inotor nerves, the muscles of respiration, and the mus cular system generally, is the immediate cause of a fit. The fact, however, of the loss of consciousness and other sensorial phenomena being the earliest occurrences in the attack, preceding the convulsions, and in not a few in stances, as has already been observed, being the only indi cations present, is regarded by some as pointing to other parts of the cerebral centres as being implicated in the origination of the fit. The whole subject, however, is still involved in obscurity. There are, nevertheless, certain facts which have been brought to light in the investigation of this disease which are of interest and importance as re gards its causation. The influence of hereditary predisposition in epilepsy is very marked. It is necessary, however, to bear in mind the point so forcibly insisted on by Trousseau in relation to epilepsy, that hereditary transmission may be either direct or indirect, that is to say, that what is epilepsy in one generation may be some other form of neurosis in the next, and conversely, nervous diseases being remarkable for their tendency to transformation in their descent in families. Where epilepsy is hereditary, it generally manifests itself at an unusually early period of life. A singular fact, which also bears to some extent upon the pathology of this disease, was brought to light by Dr Brown Sequard in his experi ments, namely, that the young of animals which had been artificially rendered epileptic were liable to similar seizures. In connexion with the hereditary transmission of epilepsy it must bo observed that all authorities concur in the opinion that this disease is one among the baneful effects that often follow marriages of consanguinity. Further, there is reason to belie ve that intemperance, apart altogether from its direct effect in favouring the occurrence of epilepsy, has an evil influence in the hereditary transmission of this as of other nervous diseases. A want of symmetry in the formation of the skull and defective cerebral development are not unfrequently observed where epilepsy is hereditarily transmitted. Age is of importance in reference to the production of epilepsy. The disease may come on at any period of life, but it appears from the statistics of Dr Reynolds and others, that it most frequently first manifests itself between the ages of ten and twenty years, the period of second dentition and puberty, and again at or about the age of forty. Among other causes which are influential in the development of epilepsy may be mentioned sudden fright, prolonged mental anxiety, over-work, and debauchery. Epileptic fits also occur in connexion with injuries of the head and organic disease of the brain, as well as with a depraved state of the general health, and with irritations in distant organs, as seen in the fits occurring in dentition, in kidney disease, and as the result of worms in the intestines. The epileptic symptoms traceable to these causes are some times termed sympathetic or eccentric epilepsy ; while, on the other hand, many authorities refuse to designate attacks thus brought about by the name epilepsy, unless the symptoms exhibit a liability to return even after their cause has been removed, which would seem to be sometimes the caae. Epilepsy is occasionally feigned for the purpose of extortion, but an experienced medical practitioner will rarely be deceived ; and when it is stated that although many of the phenomena of an attack, particularly the con vulsive movements, can be readily simulated, yet that the condition of the pupils, which are dilated during the fit, cannot be feigned, and that the impostor seldom bites his tongue or injures himself, deception is not likely to succeed even with non-medical persons of intelligence. The treatment of epilepsy can only be briefly alluded to here. During the fit little can be done beyond preventing as far as possible the patient from injuring himself while unconsciousness continues. Tight clothing should be loosened, and a cork or pad inserted between the teeth. When the fit is of long continuance, the dashing of cold water on the face and chest, or the inhalation of chloro form, or, as has been recently proposed, of nitrite of amyl, may bo useful ; and in some cases, where there is great congestion of the face and threatening asphyxia, blood letting may be called for ; in general, however, the fit ter minates independently of any such measures. When the fit is over the patient should be allowed to sleep, and have the head and shoulders well raised. In the intervals of the attacks the general health of the patient is one of the most important points to be attended to. The strictest hygienic rules should be observed, and all such causes as have been referred to as favouring tho development of the disease should as far as possible be avoided. Of medicinal remedies for epilepsy there are innumerable varieties, but only a few deserve mention as possessing any efficacy in controlling or curing the disease. For no disease has a greater number of specifics been vaunted and found to be useless. The metallic salts, especially those of zinc, silver, and arsenic, are much employed, and apparently with benefit in some cases, but they seldom can be continued for any great length of time, owing to their liability to produce evil effects upon tho health. The two remedies which have been found most serviceable are belladonna and bromide of potassium. Tho former of these has the strong recommendation of Trousseau, who advises its administration either as a pill composed of the extract and powdered leaves, or in the form of atropia in gradually increased doses, and continued for a length of time. This drug certainly succeeds in many cases in diminishing the number of the attacks, but it has not yielded such encouraging results as have been attained by the other substance above mentioned, the bromide of potassium, which is the remedy now generally employed in the treatment of epilepsy. This salt, given in from 10 to 30 grain doses three times a day, ia generally followed with some amelioration of the symptoms either in regard to the severity or frequency of the attacks, and in a few instances with apparent cure. Its employment, more over, can be persevered with for a long time with little inconvenience. Some physicians combine with it an equal proportion of the analogous salt, the bromide of ammonium, while others employ belladonna along with the bromides, and apparently with good effect. As adjuvants to these measures, counter-irritation to the nape of the neck by blisters or setons is sometimes attended with benefit. (j. o. A.) EPIMENIDES, a poet and prophet of Crete, was born at Phasstus, or according to others at Gnossus, in the 7th century before the Christian era. In the account of his life as given by Diogenes Laertius (i. 12), it is impossible to distinguish between what may be true and what is obviously fabulous. W r heu keeping his father s sheep one day, he is said to have retired into a cave, where ho fell into a profound sleep which lasted fifty-seven years. Returning home to the altered abodes of his family, he was hailed as the especial favourite of the gods, and venerated as the possessor of superhuman wisdom. He was invited by Solon to Athens (about 596 B.C.), in order to give the sanction of his sacred presence to the purification of the city previous to the promulgation of the political code of the great lawgiver. Having accomplished the desired lustration by the performance of certain religious rites, Epimenides was loaded by the Athenians with wealth aud VIII. 6 1