As the disease seems to originate from such a varie ty of causes, so its prognosis is extremely uncertain, and its cure has been attempted by a great variety of means. When the exciting cause is clearly ascertained, we, of course, direct our whole attention to the remo val of it ; and the success of our attempts in this way must entirely depend upon the degree in which this can be accomplished. When the c arse is not obvious, we have but little to guide us in our operations, except a reference to the general state of the functions, and some analogies which arc too often very obscure and uncertain. The state of the bowels is one of the first things to be attended to; and, in children, we are often able to remove very formidable attacks of the disease, by completely evacuating the alimentary canal. It is generally the custom to make c dotnel one of the prin cipal ingredients in the purgatives that are administer ed in Epilepsy, and it is probably used with more ad vantage when united to jalap, scammony, colocynth, or some of the drastic medicines of this description. When the digestive organs seem to suffer from acidity and flatulence, or from any other particular symptom, we are to endeavour to remove them by the appropriate remedies; and when there is a general weakness of the digestive organs,we employ,according to circumstances, stimulants, stomachics, and tonics. It has been pro posed, in those cases where the fit is preceded by the aura, to cut off the communication between the part whence the peculiar sensation proceeds and the brain, by compressing the nerve, or even dividing it ; but it is doubtful how far this practice has been attended with success, or how far we ought to expect any benefit to be derived from it. When there is no obvious ex citing cause, and when the different organic functions do not exhibit any evident irregularity, we can have but a faint prospect of removing the disease; and our practice must, for the most part, proceed entirely upon empirical principles. In this, as in all other similar cases, we find, that in proportion to the obscurity of the complaint, and the real difficulty which there is in re lieving it, so is the number of infallible remedies that are held out to the hopes and fears of the unfortunate sufferers. The remedies that have been proposed for Epilepsy, under this form of the disease, may be divided into three classes ; those that are called antispasmodics, generally possessing some property that powerfully af fects the external senses ; tonics, and a miscellaneous description of remedies, which can only be referred to their power of acting upon the imagination. Some of the principal antispasmodics are ether, valerian, castor, and musk, to which it has been the custom to add opium, and various other sedatives In certain cases of convulsions, we conceive it not impossible that benefit may have been derived From these substances ; but we have no conception that they can have any great power over proper Epilepsy. The second division of reme dies, the tonics, although of very problematical opera tion. possess more claim upon attention. Of these the most powerful are certain metallic salts, as the nitrate of silver, cuprum ammrmiatum, the oxide of zinc, and various salts of iron and arsenic. In what manner these substances act, and for what particular varieties of the disease, or states of the system, they are each of them more particularly serviceable, are points on which we have little certain knowledge. Vegetable tonics are among the remedies usually prescribed for Epilepsy ; of these cinchona may be supposed to supersede all the rest, although, by way of "giving variety to our prescrip tiens, we may substitute other articles of the same de scription, or may occasionally give them in combina tion. We have mentioned worms among the exciting causes of Epilepsy, and this appears to be the case more particulary with the tape-worm. As the oil of turpentine seems to act very powerfully upon these animals, we may be fairly allowed to try the effect of turpentine in all cases of Epilepsy that have baffled our other means, even when we have no evidence of the existence of the tmnia, more especially as the indications of its presence in the intestines are not always very ob vious.
Nearly allied to Epilepsy, and perhaps differing from it chiefly in degree, arc the convulsions with which children are so frequently attacked, more especially about the period of dentition. These affections are ge nerally removed as the exciting cause ceases to operate, and are not productive of any permanent injury to the constitution. It is, however, necessary to use the ap propriate means for facilitating the passage of the teeth through the membrane that covers them; while, at the same time, it will be desirable to evacuate the bowels completely, and to be extremely guarded with respect to the diet. The paroxysm is supposed to be shortened
or relieved by immersing the patient in the warm bath; and it is a remedy which may be always employed with safety, if not with advantage.
Hysteria is a disease of so multifarious an aspect, which exists under such a variety of forms, differs so much in its violence at different times, and is so pecu liar in its nature, and in its effeers upon the animal eco nomy, that we feel some difficulty in giving a concise and summary account of it.
It usually occurs in fits or paroxysms, which consi derably resemble those of Epilepsy, except that they are less violent, and that the consciousness is not altogether lost; but there is the same convulsive exertion of the limbs, and the sensations and mental faculties,although not entirely suspended, arc much disordered and per verted. There is likewise in Hysteria a symptom which may be conceived to bear some analogy to the aura epi leptics, which has obtained the name of the globus hys tericus. It commences with a peculiar feeling of pain and distention in some part of the abdomen, which gra dually rises up the course of the intestinal canal, until it reaches the stomach, and, finally, the upper part of the throat, where it remains stationary, and seems to threat en immediate suffocation. The convulsive affections now come on, and are attended with faintness and par tial insensibility, while the patient laughs and cries al ternately, exhibiting almost an appearance of delirium or fatuity, until the paroxysm is terminated by an eruc tation of flatus, to which succeeds a copious discharge of pale urine, and sometimes a degree of stupor and drowsiness.
The nature of the convulsions, as well as of the other symptoms, varies in all possible ways. Sometimes the limbs are rigidly fixed in one position ; at other times they are violently agitated : occasionally there is a ge neral stupor approaching to coma ; at other times pains are felt, which are so violent as to cause the patient to utter the most horrid screams.
There is something very mysterious about the excit ing causes of Hysteria. It appears, in many cases, to be merely a mental affection, induced by violent passions or strong emotions ; and so much is this the case, that the patient is certainly able, by voluntary exertion, to prevent the accession of the disease, which, if it had been suffered to proceed in its usual course, would have assumed the formidable appearance that has been de scribed above. The symptoms are frequently induced by a kind of imitation, where the sight of a patient la bouring under the disease will bring a similar discas:: on the by-standers. These facts have led sonsc per sons, both professional and unprofessional, to consider Hysteria as always a fictitious complaint; one entirely under the control of the will; which, like the expres sion of anger, may be always restrained, being assumed for the purpose of exciting sympathy, or other similar motive. To a certain extent this may be tine; but we apprehend that no one who has frequently witnessed the disease in its aggravated form, can suppose that it I: always so. Indeed, we cannot conceive how any vo luntary effort could produce the effects upon the variou; organic functions, that are so frequently observed in this disease, or that any thing, except a highly morbid condition of the animal economy, could enable the pa tient to perform the convulsive muscular exertions, which far exceed what is ever observed in the same in dividual at other times. It is well known that Hyste ria is almost entirely confined to females, and, among these, it is generally met with in those of feeble mus cular powers, but of great nervous sensibility. Sonic instances occasionally occur in the male sex, which we think are entitled to be classed with Hysteria, whose state of body and mind are most similar to the female constitution. We have already mentioned the resem blance which Hysteria bears to Epilepsy ; and we con ceive that it is often extremely difficult to distinguish between them, where the one disease appears in its mildest, and the other in its most acute form. The globus is not always present in Hysteria ; and there are certain cases which seem entitled to the appellation of Epilepsy, yet where the insensibility is not complete, and where the state of the feelings and of the nervous functions very much resemble what has been described as characterizing Hysteria ; and. besides this, the dis eases are sometimes evidently convertible into each other, what begins under the form of Hysteria finally terminating in Epilepsy.