Page:The American Cyclopædia (1879) Volume VI.djvu/695

 EPILEPSY 683 many varieties of epilepsy that it is impossible to give a definition of the disease that will ap- ply to them all. In most cases it is charac- terized by convulsions and loss of conscious- ness, occurring at longer or shorter intervals, during which the patient is almost in good health. The absence of fever in epileptics serves to distinguish their affection from me- ningitis and other inflammations accompanied by convulsions. The complete loss of con- sciousness also distinguishes epilepsy from hys- teria. As in most nervous diseases, a heredi- tary tendency is among the most frequent pre- disposing causes of epilepsy. Epilepsy often ap- pears in the offspring of persons who have had various other nervous complaints. Bouchet and Cazauviehl say that out of 130 epileptics 30 were descendants of persons who had been either epileptic, insane, paralytic, apoplectic, or hysteric. There is no doubt that women are much more frequently attacked by epilepsy than men. We find by a comparison of the statistics given by several English and French authorities, that the most frequent periods at which epilepsy begins are early infancy and the age of puberty. It often appears also in very old age ; Delasiauve remarked that out of 285 epileptics the disease began in 10 when they were from 60 to 80 years old. In fact, no age escapes. As regards climate, nothing very positive has been established, but it seems probable that the disease is more frequent in hot and in very cold than in temperate climates. Herpin and others say that epilepsy is more com- mon in persons of low stature ; but even if this be true, Herpin is wrong in considering short- ness of stature a predisposing cause of the dis- ease, as in many of the cases on which he grounds his view it is partly the influence of epilepsy that has prevented the development of the body. Various malformations of the body, and especially of the cranium, are cer- tainly among the most frequent predisposing causes. Weak constitutions, as proved by Esquirol and Dr. C. B. Radcliffe, are favorable to the production of epilepsy. Among other predisposing causes are dentition, the first ap- pearance and the cessation of menstruation, onanism, and the abuse of alcoholic drinks. Almost all kinds of diseases may produce epi- lepsy, but among the principal we must place those affections in which the blood becomes altered or diminished, and organic affections of the membranes of the cerebro-spinal axis and of certain parts of this nervous centre. Another very powerful cause, the influence of which has been demonstrated by Marshall Hall, Kussmaul, Jenner, and Brown-Se~quard, ^ex- cessive loss of blood. Pregnancy, parturition, and menstruation frequently cause epilepsy. A tumor on a nerve, or any cause of irritation on the trunk of the terminal part of any sensitive nerve, and especially in the skin or mucous membrane, very often produces it. A wound, a burn, worms in the bowels or elsewhere, stone in the bladder or in other places, a foreign body in the ear, &c., are known to have caused epilepsy. It is quite certain that great mental excitement has originated it in many cases, but it seems probable that the disease was not introduced by those causes, but was only brought by them to manifest itself. When a complete fit is about to take place, it is usu- ally preceded by some sensation or some change in the mind of the patient. If a sensation pre- cedes the fit, it comes most frequently from some part of the skin, and especially from that of the fingers or toes. This sensation is well known under the name of aura epileptica. There is as much variation in the kind and the intensity of the sensation as in its point of starting. Most frequently the aura is a sensa- tion of cold, of burning, or that kind of sensa- tion produced by a draft of cold air on a lim- ited part of the body. Sometimes the aura starts from the eye or the ear, and then a flash of light or some other sensation comes from the retina, or peculiar sounds are heard. Some epileptics become gay, others mournful, when they are about to have a fit ; in others the attack is announced by some change in the digestive functions. A complete attack usually begins with an extreme paleness of the face, and at the same time or nearly so there are contractions of several muscles of the face, the eye, and the neck. Observers do not agree as regards the first manifestation of a fit, prob- ably because the seizure does not always begin with the same phenomenon. Not only have we known the first symptom not to be the same in different epileptics, but in the same one we have seen differences in three different attacks. Many physicians think the scream is the first symptom. It often is, but the pale- ness of the face usually precedes it. Some epileptics do not scream. As soon as these symptoms have appeared, a rigid tetanic or at least tonic spasm takes place in the limbs, and the patient falls. Respiration is suspended, and the face becomes quite injected with black blood, and assumes a hideous aspect both from the spasms of its muscles and the blackish or bluish hue. Sometimes a momentary relaxa- tion is then observed in the limbs ; but almost at once clonic convulsions occur everywhere in the trunk, the limbs, the face, and often in the various internal organs, as the bladder, the bowels, and even in the uterus. The mouth then ejects a frothy saliva, often reddened with blood from the bitten tongue. The respiratory muscles, after the first spasms which produce the scream and suffocation, causing a gurgling or hissing sound, become relaxed, and then those employed in inspiration contract, and almost as soon as air has reached the lungs thf convulsions cease or notably diminish. Ordi* narily the fit is over in a few minutes ; but it is not unfrequently the case that after a gen- eral relaxation another seizure comes on, and sometimes many occur with very short inter- missions. During the whole time the fit lasts the patient is deprived of consciousness, and