Epilepsy, being a convulsion of the whole body with impairment of the
leading energies, has its cause seated sometimes in the brain itself, and
sometimes in its cavities. This is sometimes a pituitous and sometimes
a melancholic humour. The disease also sometimes arises from sympathy
with the orifice of the stomach (as happens in colic affections, as will
be stated when treating of them); and sometimes it is propagated from
other parts, when a cold aura ascends to the brain, either from the leg
or the fingers of the hand. It has also been seen to proceed from the
uterus in females, at the time they were pregnant, for after delivery it
ceased. This disorder attacks mostly the young, more especially infants,
and after them boys and adults; but least of all elderly persons and
the old. Its precursors are, an involuntary commotion, both of mind and
body, despondency, oblivion of accustomed things, terrifying visions in
dreams, headach, continued fulness of the head (especially from acute
anger), paleness of countenance, and a distorted motion of the tongue, so
that some even bite it. When it proceeds from the stomach, palpitation
thereof goes before, with rumbling and aching pain; and when fasting,
or during a delayed meal, they fall into a paroxysm. When the attack
comes on they suddenly fall down, are convulsed, and sometimes utter
inarticulate cries. The characteristic mark of these cases is foaming
at the mouth, all the other symptoms being common to other diseases. In
certain instances the urine and fæces are evacuated involuntarily, and
in some the semen also. In some cases, when the disease is very acute,
it proves fatal speedily, by the continuance of the paroxysms, or the
violence of the attack; but it is most frequently protracted, so that, if
it be not removed by the attainment of manhood, by purging, or pregnancy,
or if it invade after this period of life, it for the most part does not
leave a man until death, unless removed by a suitable cure. The following
substances are used to prove epilepsy, namely, the fumes of bitumen, or
gagate-stone, or goats’ horn, or the liver of a buck-goat when eaten, or
the smell of the roasted liver.
_The cure._ When the patient is an infant, we need not be particularly
solicitous about it; for when its age changes to a more bilious and drier
constitution, and the diet is more prudently regulated, the affection
most commonly goes off spontaneously. But we must attend to the diet not
only of the infants, but likewise of their wet-nurses. After boyhood,
those that fall into the disease ought to have the convulsed and
distorted parts freely anointed, and ligatures applied to them, when they
are to be stretched out; and then the mouth is to be opened, and one must
introduce a finger or a feather, smeared with oil of iris, in order to
bring away the phlegm. We must also rouse the senses by strong-smelling
things, such as hog’s fennel, Cyrenaic juice, bitumen, and the pitch of
cedar. But after the paroxysms, if nothing prevent, we must bleed from
the arm; and when the paroxysm does not abate, we must apply a sinapism
to the extremities, and a cupping-instrument to the hypochondria. When
after these things no remission takes place, there can be but little
hope, and yet the physician ought boldly to force castor into the
mouth, and Cyrenaic juice, with honey and vinegar; and the decoction of
centaury, or of colocynth, must be injected by the anus. Those that are
recovering from an epileptic attack are to be evacuated after recovery
by purging with hiera. This is the cure of a recent and acute attack of
epilepsy. We will next deliver the treatment of the disease when it is in
a chronic state. Wherefore the patients are to be made to persevere for
a long time in drinking cold water; and when setting about the cure, it
will be proper to bleed if nothing prevent; and after an interval of four
or five days to recruit the body, and thus evacuate with a purgative,
more especially black hellebore, colocynth, or scammony. The hellebore,
without its medullary part, is to be pounded and strained, and sprinkled
on five or six cyathi of honied water, or it may be taken in boiled honey
with some pepper. Rejecting the seeds of the colocynth, fill it, still
retaining the medullary part, with must, and allow to remain for a whole
night; in the morning dilute the must, and give to drink. Or we may use
the cathartic from white hellebore. It is this: Of cleansed bay berries,
dr. viij; of white pepper, dr. viij; of alypias, dr. viij; of euphorbium,
dr. viij; of white hellebore, dr. viij. Give these things at one dose,
with the must in the colocynth, and it will evacuate well by vomiting.
After proper purgation let them be put into the bath, and on the third
day cup the hypochondria and back with scarifications; and then, stopping
for a sufficient number of days and recruiting the body, give the hiera
from colocynth; and afterwards apply the cupping instrument to the head
and nape of the neck, and the day following a cataplasm consisting
of bread boiled in honied water, and pounded with bitter almonds,
wild thyme, mint, calamint, or rue. This must be done for three days.
Afterwards the head is to be shaven and rubbed with the juice of hog’s
fennel dissolved in vinegar, wherein cow-parsnip has been boiled; then,
after stopping and recruiting the body, nine oboli of the antidote from
colocynth are to be given in honied water; and, again, after an interval
of some days, the antidote is to be repeated, and sternutatories used.
After five or six days give castor in honied water; then stopping again
administer a clyster of centaury and colocynth; and afterwards give the
hiera again, and use masticatories and errhines in order, and apply a
sinapism to the head. Acrid food must be seasonably given. Benefit may
be obtained from oxymel of squills drunk every day, and honey in which
the squill has been softened, to the amount of a spoonful. The diet
should be of an incisive and attenuant nature; and therefore capers may
be frequently taken with pickle. But they ought to abstain from flesh,
pulse, and much wine, likewise from frequent venery, baths, mustard, and
from drinking immediately after the bath, more especially of undiluted
wine. Let them have recourse to gymnastic exercises and friction, and the
last part that is rubbed should be the head.
_On the cure of epilepsy from the stomach._ If the disorder is occasioned
by the stomach’s being primarily affected, the patient must attend to
his digestion, taking about the third hour some carefully-baked bread
that has been soaked in some diluted wine, slightly astringent, and of
a white colour. Give to such persons the medicine from aloes twice or
thrice every year. “I once knew a boy,” says Galen, “who was never seized
with epilepsy after he carried a large piece of fresh peony appended
from his neck.” Agaric is beneficial to epileptics, also hartwort, the
fruit and root of cow-parsnip, and the round birthwort drunk with water.
Scarification of the legs frequently repeated is also of great use.
_On epilepsy proceeding from some of the members._ When the attack is
threatened, and they feel a sensation in the part, whether the hand
or foot, a tight ligature ought to be applied above it, and the cure
attempted during the remissions, by applying some caustic substance to
the part, such as the garden cresses (_lepidium_), preparations from
cantharides, and the like. The Julian oxymel is also of great use to
epileptics, by expelling the offending matter from the part. After those
things which have been mentioned, the theriac and natural baths have
place. During their whole life, they must particularly guard against
indigestion, and be careful not to take food before digestion has been
performed; avoid all incrassating food, too long abstinence from food,
all vehement venereal impulse, much wine, and drinking, after the bath,
more especially of undiluted wine, as formerly mentioned, and likewise
of old and thick wines. They must avoid, also, all aromatics of an
acrid smell, and such as fill the head; must abstain from looking down
steadfastly from a high situation, from remaining long in the bath, and
exposing the head to the heat of the sun.
* * * * *
COMMENTARY. Consult Hippocrates (de Morbo Sacro); Galen (de Sympt. Diff.
3; De Loc. Affect. iii, 11; De Puero Epileptico); Oribasius (Synops.
viii, 3); Aëtius (vi, 13); Aretæus (Morb. Acut. i, 5; Morb. Chron. i,
4); Pseudo-Dioscorides (Euporist. i, 21); Alexander (i, 15); Leo (6);
Actuarius (Meth. Med. i, 16); Nonnus (36); Serenus Samonicus; Scribonius
Largus (12); Apuleius (Apologia); Celsus (iii, 23); Octavius Horatianus
(ii, 2); Isidorus (Orig. iv, 8); Pliny (H. N. xxv, 5); Avicenna (iii,
i, 5, 9); Serapion (i, 23); Haly Abbas (Theor. ix, 6; Pract. v, 21);
Alsaharavius (Pract. i, 2, 36); Avenzoar (i, 9); Mesue (de Ægr. Cap. 26);
Rhases (Div. 7, alibique.)
Our author derives his principles of treatment, more especially with
respect to regimen and diet, from Galen’s directions for the management
of an epileptic boy. Part seems also to be borrowed from Oribasius.
Hippocrates with great good sense rebuts the popular belief of his own
times, that the epileptic paroxysm is produced by demoniacal influence.
He justly remarks, that the inferior animals, such as goats, are subject
to this complaint; and that in them it is found to be occasioned by
water in the brain. It is almost certain that the _morbus sacer_ of
the ancients, and the disease under which the demoniacs laboured was
epilepsy. See Athenæus (Deipnos. vii, 33), with the notes of Casaubon and
Schweigh.; also Coray (ad Hippocrat. de Aq. &c. 12.) Leo, in fact, says
expressly, when treating of epilepsy, that the vulgar call the disease
the demon and lunacy; and in like manner Aretæus mentions that some refer
the disease to the moon. See further Galen (Introductio); Dietz (ad
Hippocrat. de Morbo Sacro); and Greenhill (Adnot. ad Theophil. v. 30, p.
340.)
Celsus lays down his rules of treatment with his usual judgment and
elegance. His practice is very similar to our author’s. He recommends
bleeding; purging with black or white hellebore; shaving the head and
applying cupping-instruments to it, and, in desperate cases, even the
actual cautery; also friction of the extremities, and bleeding in the
foot, along with attention to exercise and diet. The use of hellebore in
epilepsy is mentioned by Pliny, and by Aulus Gellius (Noct. Attic. xvii,
15.)
The poet Lucretius gives a very glowing and accurate description of the
symptoms and causes of epilepsy. (De Rerum Natura, iii, 485.)
Aretæus delivers separately the treatment of an acute attack and of the
disease when in a chronic state. For the former he recommends the general
remedies (we mean bleeding, clysters, and emetics.) Among the medicines
enumerated by him for the cure of epilepsy, he mentions copper, which,
he says, when given with cardamon, will act either upwards or downwards.
We need scarcely say that copper has been strongly eulogised in modern
practice. In the treatment of chronic cases he pays particular attention
to the head, opening the veins and arteries of it, boring the bone down
to the diploe, and applying the actual cautery to it. A more rational and
less dangerous procedure was the application of embrocations containing
cantharides and other such rubefacients to the scalp; in that case he
recommends milk to be drunk beforehand, to prevent the bladder from being
affected.
Aretæus and most of the authorities mention the gagate stone or jet as
a test of epilepsy. The smell of it was said to bring on an attack.
He exclaims in affecting terms against the abominable means often had
recourse to for the cure of this disease. And so also Pliny (H. N.
xxviii, 2.)
Aëtius, Oribasius, Actuarius, and Alexander treat the disease upon the
same principles as our author. Alexander, although otherwise a most
judicious and original writer, expresses great confidence in the use of
amulets, for the preparation of which he gives very minute directions.
Jasper is particularly commended as an efficacious amulet. One of his
amulets is the nail taken from the arm of a malefactor who had been
crucified! In his general treatment he particularly approves of giving
drastic purgatives and emetics.
Isidorus thus defines epilepsy: “Epilepsia vocabulum sumpsit quod mentem
apprehendens pariter etiam corpus possideat. Fit autem ex melancholico
humore quoties exuberaverit, et ad cerebrum adversus fuerit.”
No ancient author has treated of epilepsy more accurately than the great
Methodist Cælius; but his account is so long and minute, that it is
impossible for us to do justice to it in an abridgment. The causes of the
complaint which he enumerates are drinking too much wine, indigestion,
compression of the brain, and frights. He says that the whole nervous
system is affected, but especially the part seated in the head. When the
patient is an infant, he properly directs us either to change the nurse,
or to pay particular attention to her diet. Bloodletting he approves of
on a first attack, unless the stomach be loaded with crudities; and if
there be pain in any part of the head, he directs leeches to be applied
to it. He recommends gargles, and rubbing the skin with substances which
occasion an eruption of pustules. He enjoins great caution in the use
of hellebore. He approves of gentle exercise, a light diet, abstinence
from wine, change of scene, or a sea-voyage. With respect to the modes
of treatment pursued by the other sects, he greatly disapproves of the
application of fire and other hot things to the head, and of strong
sinapisms to the other parts of the body. Escharotics applied to the
head, he says, only increase the disorder; and the use of bull’s blood,
or that of a man recently killed, and other such ridiculous remedies,
he properly treats with contempt. He disapproves of diuretics, and of
hellebore, scammony, and the like, when administered indiscriminately. He
speaks unfavorably of chalybeates.
The Arabians follow closely the views of their Grecian masters, without
suggesting any material improvement. Haly Abbas says that epilepsy is a
convulsion which either comes on periodically, or at no stated times; and
that it either arises from the brain itself, or from sympathy with the
stomach, or with some other parts of the body. It is occasioned, he says,
either by a gross humour collected in the ventricles of the brain, or
from compression produced by fracture. He makes mention of the epileptic
aura, and, like our author, states that the disease is distinguished
by foam at the patient’s mouth. He joins Hippocrates in pronouncing
such cases as occur before puberty to be not difficult to cure, but
those which supervene after that age to be most intractable. When the
complaint occurs in an infant, he properly directs us to attend both to
the nurse’s and the infant’s diet. In cases attended with plethora he
approves of general bleeding, cupping the limbs, and opening the saphena.
When the disease is protracted he advises to apply cupping-instruments
to the neck, and to give drastic purgatives, such as black hellebore,
colocynth, &c. When it appears to proceed from the stomach he approves of
emetics. He commends peony applied as an amulet. It is worthy of remark
that Andreas Laurentius, in the 17th century, speaks confidently of this
remedy. So inveterate is the dominion of superstition and ignorance!
Alsaharavius gives a curious account of epilepsy, but mixed with some
superstitious notions. He says he had had ocular proof that epileptics
are possessed with demons; for that he had known many of them who had a
knowledge of things which he was sure they had never learned. Like the
others, he speaks of amulets; but his general treatment is sufficiently
rational and scientific.
Rhases gives the theories and practice of preceding authors along with
his own remarks, which, however, contain no very original opinions. One
of his Arabian authorities recommends bleeding at the arm, and also
by cupping and opening the occipital arteries, rubbing the head with
mustard, purging with hiera, sternutatories, &c. The application of
mustard to the head is approved of by most of his authorities.
Like our author, most of the ancient writers approve of Cyrenaic juice,
or assafœtida, in cases of epilepsy.