From the variety of causes, and the nature of some of these, it is difficult to state the indications and method of cure. We may, with the generality of authors, propose, 1. To prevent an impending paroxysm. 2. To shorten a present one. 3. To guard against future attacks. The first of these intentions is answered in plethoric habits by suitable evacuations and antispasmodics, as nitre, opium, musk, etc.; in languid constitutions, by warm, nervous medicines, as castor, valerian, camphor, fetid gums, volatile salts, the bark, and chalybeates. Cheyne thinks that the epilepsy differs but little in degree from the hypochondriac and hysteric fits; and observes, that, when the former abate, they end in the latter, and when the latter are violent, they become epileptic: he therefore urges a free use of vomits, bitters, and steel. The second intention is supplied by sinapisms or blisters, if the fits are long; but before these are applied, or when the fits are short, if the jaws are separated by a wedge as far as they can be opened in health, the fit, it is said, will be removed; and in cases where the patient hath due notice of their approach, he may prevent them by introducing the wedge into his mouth. When the fits are preceded by a peculiar sensation in the toes, feet, or legs, a bandage applied tight below the knee will often prevent the paroxysm; or wherever these sensations are felt, a bandage may be applied there, and continued from thence upwards. Instances of perfect cures have occurred, by cutting down on the part in which those peculiar feelings were first perceived. (See an instance in the Edinb. Med. Essays, vol. iv. and the article Sesamoidea.) Coelius Aurelianus prefers the blowing of strong vinegar up the nostrils to volatile salts. The third intention requires, if possible, that the cause be known, in order to its being removed: but in some instances it cannot be discovered; and in others no remedy could be applied.

In the article Convulsions we stated what appeared to us a correct view of the subject, and this is more particularly applicable to epilepsy. We there remarked that convulsions were irregular actions, depending chiefly on debility, though generally excited by some, often almost imperceptible, irritation. To prevent the return of the fits, both objects must be combined; and we have fortunately some medicines, or combinations of medicines, which will answer both intentions.

Dissections have taught us that exostoses in the cranium, obstructions in the venous system of the brain, and various causes of irritation in that organ, frequently produce epileptic paroxysms. It will be obvious that no medicine has power over these; yet, in a very few instances, where, from venereal complaints, the external injuries of the bone lead to a strong presumption of internal ones producing the disease, long continued, gentle courses of mercury have succeeded: we say in a very few instances, for, in general, the bones are too intimately diseased to admit of very considerable relief. Yet where we find these mechanical irritations to produce epilepsy, though we cannot remove them, we can often mitigate the paroxysms. In such cases we generally find the fits increased by every circumstance which accelerates the circulation through the head; and, taking the hint from this fact, a drain from any part of the neck or head, by means of a blister or a seton; a free discharge from the bowels; a milk diet, with the utmost tranquillity of body and mind, have given very considerable relief. Indeed, in almost every case of epilepsy, except where it is connected with great debility, or has been produced by debilitating causes, these means of relief will be found highly useful.

Another cause of topical, nervous irritation occurs in those cases where the fit is preceded by a sensation of cold air, rising from some portion of either (though generally the lower) extremity. An instance of this kind is recorded where a hard body was found on the nerve, which was removed, and the fits ceased. In other cases a drain from that part, by means of a blister, has succeeded; but, as the cause is fixed and often within our reach, many remedies may be applied to the nerve, or if it be not a considerable one, it may be divided above the part whence the irritation proceeds.

These are unfortunately the very few instances on which our foundation is firm, and in which, if we cannot cure, we can often alleviate. In general, we must rest on the vague indicationsofcounteractingirritability, or any concealed source of irritation. From the stomach and bowels the latter often nnsuspectedly proceeds; and, in every instance, these organs should be kept free by occasional emetics, and the regular use of laxatives and anthelmintics, when worms, as sometimes happens, are the cause. From the observations under the article Cathartica, it will be obvious that these are means of removing many.kinds of irritation in different organs; and from their use in chorea and palpitations, it is probable that they will be found extensively useful. Convulsions do not differ so greatly as authors have generally represented. In the diagnosis, which we hastily passed over because it did not admit of any practical application, they appeared to run into each other; and it is difficult, if not impossible, to distinguish epilepsy from other convulsions but from the violence, the obstinacy, and often the regularity, of the return of paroxysms. The foaming at the mouth is occasioned only by the convulsions of the muscles of the jaws emulging the salivary glands and combining the saliva with the air; yet this is the chief distinction. The paroxysms arising from a distant aura is a good mark of distinction; but it would greatly contract our views, and exclude many cases from the share of attention which they would otherwise receive.

Another source of irritation, less obscure, arises from the suppression of the usual evacuations. The German physicians are uncommonly anxious to procure or restore the haemorrhoidal discharge; but, in this country, we do not find it such an essential evacuation. The suppression of cutaneous affections has occasioned the disease; the repulsion of gout; and sometimes the deficiency of constitutional strength, which prevents its formation, has had the same effect. In some cases, the eruption of the menses will occasion pain and convulsive paroxysms. In all these instances, the knowledge of the cause will suggest the means of relief.

When causes of debility and irritability produce epilepsy; in other words, when the irritability is so great that the slightest irritation will induce the fits; the remedy is equally obvious. Warm generous diet, which may appear at first indicated, must be used with caution, since a fulness of the vessels is, alone, in tender habits, a cause of irritability. Tonics and narcotic bitters are the best remedies in such cases, anxiously guarding, as usual, against any accumulations in the head; but not by such remedies as will weaken.

In the greater number of instances, however, we have only the vague indication formerly mentioned to direct us; and many are the nauseous disgusting remedies recommended by ancient authors, which act on the mind by exciting horror, and thus, by fixing the attention, destroy the habit; for nervous paroxysms, after their cause is removed, are frequently renewed by habit only. These we shall not stay to enumerate: they are almost forgotten, and we wish not to revive their memory. Superstition has, however, employed one remedy, not yet wholly disused, the misletoe, retained, perhaps, as a tonic from its connection with the oak. It has, however, no such power; its taste is nauseous, and it may be sedative; but its quality is almost wholly mucilaginous.

Tonics, in general, are freely employed; and, of these, the Peruvian bark is the principal remedy from the vegetable kingdom; yet alone it is seldom trusted, and would probably seldom succeed. The metals, we have said, are very generally tonic, differing only in the degree of inflammatory stimulus, most conspicuous in iron. All have, however, been employed, viz. silver (argentum nitratum); iron (flores martiales, ferrum vitriolatum, rubigoferri, squamae ferri, and chalybs pre-paratum); copper (cuprum vitriolatum and ammonia-cum); zinc (zincum vitriolatum, ustum); tin (limatura vel pulvis stanni); arsenic (kali arsenicatum). Each has been used with success; but the silver, the copper, and zinc, have been preferred. These are more effectual when combined; but as we cannot suspect any chemical union, the increased power is probably owing to their being borne by the stomach in increased quantities. (See Combination of medicines). As a tonic, the cold bath is also an excellent remedy.

The medicines which obviate irritation are the sedatives and antispasmodics. Of these the chief is opium, and the valerian: camphor is similar in its powers; and the leaves of the orange tree, the extractum hyoscyami, the peony root, flowers of the cardamine pratensis, are medicines of the same class. We have found little benefit from any except the valerian and camphor. The flowers of the cardamine have failed in every instance; the leaves of the orange tree have produced only a temporary and inconsiderable benefit. The union, however, of these with the tonics has been particularly serviceable; and their effects seem to support the opinion we have attempted to establish. The bark and valerian united have afforded relief, which neither separately could procure; and the camphor, with the zinc, been highly and deservedly commended. Opium has been combined with all the metallic preparations with advantage. If, according to this idea, such combinations are pursued, much benefit will probably result.

The tribe of antispasmodics has been employed; but not often successful. The ether, rectified animal oil of Dippel, oleum vini, musk, castor, and asafoetida, are the principal remedies of this class; but they are seldom trusted alone; and of their separate or comparative merits it is not easy to speak. We have placed them nearly in the order of their power.

Of anthelmintics we have not spoken with sufficient distinctness. Worms are not an uncommon source of irritation in the tender habits of children; and epileptic paroxysms should always, in such cases, be attacked with this remedy, unless they arise from fright, or some more obvious cause. We have nothing to add at present to what we have remarked in the article Anthelmintics, q. v.

See Hippocrates, Celsus, Coelius Aurelianus, Are-taeus, Hoffman, Boerhaave; and among the best authors on this subject, Threlfal's and Lyson's Essays on Epilepsy; Cullen's First Lines, vol. iii. edit. 4.