There are two classes of Epilepsy: 1st. The general form, with a convulsion that usually involves all the muscles of the body simultaneously. It begins suddenly with little or no warning, commonly with a cry or scream. The convulsion may last several minutes and is followed by a deep sleep for some hours.
2nd. The local or Jacksonian form in which the attack begins with a peculiar sensation in some particular region of the body, either in one extremity or one half of the face. This sensation is followed by a twitching of the muscles of the part. The sensation and spasm extend or advance gradually to other parts. Consciousness is not usually lost, though it may be when the spasms culminate in a general convulsion.
Great weakness generally follows in the parts convulsed, gradually passing away. When the attack begins on the right side of the face it is associated with an immediate inability to speak.
Symptoms. In the severe forms of the disease, the subject suddenly loses consciousness and falls; there is rigidity of the muscles, which causes a twitching of the face and limbs; the eyes are turned up, and there is foaming at the mouth. In the severe form of the disease, the respiration is arrested, while in the milder attacks, the breathing is difficult, slow, deep, and snoring. With the commencement of the spasm, the tongue is sometimes caught between the teeth and severely bitten. During the paroxysm, the countenance changes from a livid hue to dark purple. The convulsion continues from one to three minutes, and is followed by a deep, sighing inspiration; the subject then sinks into a deep sleep, which continues for half an hour or longer. When consciousness is first regained, the subject appears confused, stupid, and usually complains of headache. He has no recollection of what has occurred during the attack, he pronounces words indistinctly, and if he attempts to walk, he staggers like a drunken man. Sometimes, several attacks occur so closely together that there is no interval of consciousness between them.
In some cases, there are premonitory symptoms, such as giddiness, drowsiness, headache, and irritability of temper, which warn the subject of an approaching paroxysm. Occasionally, a wave of cold commencing at the feet and proceeding to the head, is experienced. This is called an aura. When it reaches the brain, the subject becomes unconscious, falls, and the convulsion commences. If the disease be allowed to proceed unchecked, it almost invariably leads to great impairment of mind, insanity, or paralysis.
Causes. The predisposing causes are an hereditary tendency to the disease, and everything which impairs the constitution and produces nervous prostration and irritability. Syphilis, phimosis, sexual abuses, uterine disease, and the use of alcoholic liquors are prominent predisposing causes. Many of the causes treated by us have been brought on by masturbation. Others are the results of injury to the head. Often fracture of the skull is followed by epileptic attacks.
The exciting causes include everything which disturbs the equilibrium of the nervous system. Indigestible articles of food, intestinal worms, loss of sleep, great exhaustion, grief, anger, constipation of the bowels, piles, and uterine irritation may be enumerated among such causes. Convulsions of an epileptic character may also be induced by a poisoned condition of the blood, from malaria and disease of the kidneys or liver.
Treatment. When the time of an expected paroxysm approaches, great care should be exercised that the patient be not suddenly attacked while carrying a lighted lamp, or that he does not fall in some dangerous place, strike upon a heated stove, or in some similar way inflict great injury. If there be warning symptoms before the attack, the subject should carry a vial of the nitrite of amyl in the pocket, and, when the premonitory symptoms are felt, two or three drops should be poured on a handkerchief and held about an inch from the nose and inhaled, until flushing is produced, or a burning sensation is felt in the face.
During the paroxysm, the subject should be laid on the back, with the head slightly elevated, and the clothing about the neck and waist, if tight, should be loosened. If there be sufficient warning, a folded napkin, or a soft pine stick covered with a handkerchief or cloth, should be placed between the double teeth, to prevent the tongue from being bitten. During the fit, the head may be bathed with cold water.
A person who suffers from this disease should avoid everything which tends to excite the nervous system, or increase to any great extent the action of the heart. The sufferer should go to bed at regular hours, and take at least eight hours sleep. The sleeping-room should be large and well ventilated, and the patient should lie with the head elevated. All indigestible articles of food should be avoided and the diet should consist principally of bread, vegetables, milk, and fruits. Meat should be taken but once a day, and then in very small quantities. The use of alcoholic liquors and coffee should be avoided, and tea only taken in small quantities. The bowels should be regulated with Dr. Pierce's Pleasant Pellets and injections, if necessary. A thorough bath should be taken once or twice a week. If the attacks occur at night, the body should be sponged before going to bed with tepid water, to which should be added sufficient tincture or infusion of capsicum, or red-pepper, to render it stimulating to the skin.