EPILEPSY (Gr. epi, upon, and lanthano, future, lepsi), I seize), a form of disease characterized by sudden insensibility, with convulsive movements of the voluntary muscles, and occasionally arrest of the breathing, owing to spasm of the muscles of respiration, and temporary closure of the glottis (q.v.). E. was called by the ancient Greeks the " sacred disease." Owing to the mysterious and extraordinary character of the convulsion of E., it was always, in ancient times, supposed to be due in a very special manner to the influence of the gods, or of evil spirits; Hippocrates, however, combats this idea in a special treatise, in which lie maintains that E. is no more and no less divine than all other diseases. The same idea of the specially supernatural char acter of E. is shown forth in the deeply rooted oriental notion of demoniac possession. See DEMONIACS. E. is often called, in modern language, the " falling sickness," and this name is not only descriptive of one of its most striking phenomena, but also points distinctly to the most obvious danger of the fit. The patient is seized, without refer ence to his condition or occupation at the moment, with insensibility, often so complete and sudden as to lead to serious accidents and bodily injuries; in the most aggravated cases, he has no premonitory sensations whatever, but falls down without any attempt to save himself, and usually with a wild inarticulate cry of some kind, immediately after which the face is violently distorted, the head drawn towards one or other shoulder, and the whole body convulsed. These convulsions follow in rapid succession for a few minutes, and are attended by foaming at the mouth, and by great lividity, or, in some cases, livid pallor, which, with the irregular spasmodic movements of the lips, nostrils, and eyes, give a frightfully ghastly expression to the countenance, and almost invariably lead the bystanders to an exaggerated idea of the immediate danger of the fit. The immediate danger is, in reality, not great, excepting that the sudden attack may lead to an injurious or fatal fall; the tongue, however, may be bitten if protruded during the convulsion, or the patient may be so placed as to injure himself seriously by the repeated and unconscious movements of his body, or he may suffocate himself by accidentally falling with his face in water, or otherwise closing up the mouth and nostrils, or by dragging upon a tightened neckcloth. Care should be always taken to avoid these accidents by keeping the epileptic as much as possible within view of per sons acquainted with his condition, and able to give such assistance as may he required; as well as by warning the patient himself to avoid all places in which a fall would be especially dangerous. But when an unskilled person happens to witness a fit of E., he will do well to remember that beyond the simplest and most obvious precautions against the dangers mentioned above, there is literally nothing to be done; and any attempt to rouse the patient by violent stimuli, as ammonia applied to the nostrils, or by dashing water in the face, or, still more, by administering medicines hastily recom mended by the ignorant and thoughtless, is almost certain to do more harm than good. The tongue should be looked to, a piece of cork or other gag being, if necessary, inserted between the teeth; the patient should be then placed on a mattress or other soft place near the ground; his neckcloth should be removed, and the dress loosened round the chest; the head should be, if possible, a little raised, and a free circulation of air maintained (this last precaution being very apt to be neglected in case of a crowd); with these things done, it may be safely affirmed that in the vast majority of epileptic cases has been left undone which will conduce to recovery. Me ordinary
course of the fit (which usually lasts from five to twenty minutes altogether) is as fol lows: the convulsions gradually diminish in intensity, and the patient passes into a state of deep but motionless stupor, with dilated pupils, and sometimes, but not always, with snoring or noisy breathing; the foaming at the mouth ceases, the color gradually returns, and this state leads to recovery through a more or less protracted, but appar ently natural sleep, the patient, on awaking, being often quite unconscious that he has been the subject of any anxiety, or, indeed, in any unusual condition whatever. Although in all cases of true E. there is a stage of complete coma (q.v.), or unconsciousness, yet the fit is often very transient, and but little attended by convulsion, being also less sudden than above described, and not necessarily causing a fall to the ground; in some cases, also, fits of greater intensity are preceded by certain premonitory symptoms or peculiar sensations, which act as warnings to the patient himself, and lead him to place himself in a position of safety on the approach of the parcxysm. Having in view these distinctions (which are certainly of considerable practical importance). the French language, both popular and scientific, has adopted the terms of grand mal and petit mal (i.e., great and little evil), as characterizing the more and less dangerous forms of E. respectively. The sensations which precede the fit in some epileptics have been termed in Latin the aura (i.e., breath) epileptica, from their supposed resemblance to a current of cold air passing over the body, and proceeding from the extremities towards the head. This description does not, however, hold good in all cases; and not unfre quently, as mentioned above, there is no aura, or unusual sensation of any kind, pre ceding the fit. It must be mentioned, however, as bearing on treatment, and as being quite within the bounds of popular medicine, that some of the most ancient authorities assert strongly the power of a tight bandage, placed suddenly upon the limb in which the aura begins, to cut short, or even to prevent altogether, the fit of epilepsy. Although this alleged fact has often been regarded as doubtful, it has never been altogether dis credited. and has of late years been brought into renewed notice by good observers. It is even maintained that such a bandage, placed experimentally upon one or other of the limbs, and tightened on the approach of a fit, has been found effective in some cases in which there was no distinctly local sensation; and epileptics have been repeatedly convinced of the propriety of habitually wearing a bandage loosely applied upon the arm, which they have been able, by carefully watching their own sensations, and by being watched in turn by others, to get tightened at the proper time. There is no doubt room for fallacy in these observations, but they may safely be commended to notice, as involving no possible risk of mischief, and as far more worthy of extended trial than the great majority of popular remedies in epilepsy.