marked. It is necessary, however, to bear in mind the point so forcibly insisted on by Trousseau in relation to epilepsy, that hereditary transmission may be either direct or indirect, that is to say, that what is epilepsy in one generation may be some other form of neurosis in the next, and conversely, nervous diseases being remarkable for their tendency to transformation in their descent in families. Where epilepsy is hereditary, it generally manifests itself at an unusually early period of life. A singular fact, which also bears to some extent upon the pathology of this disease, was brought to light by Dr Brown Séquard in his experiments, namely, that the young of animals which had been artificially rendered epileptic were liable to similar seizures. In connexion with the hereditary transmission of epilepsy it must be observed that all authorities concur in the opinion that this disease is one among the baneful effects that often follow marriages of consanguinity. Further, there is reason to believe that intemperance, apart altogether from its direct effect in favouring the occurrence of epilepsy, has an evil influence in the hereditary transmission of this as of other nervous diseases. A want of symmetry in the formation of the skull and defective cerebral development are not infrequently observed where epilepsy is hereditarily transmitted.
Age is of importance in reference to the production of epilepsy. The disease may come on at any period of life, but it appears from the statistics of Reynolds and others, that it most frequently first manifests itself between the ages of ten and twenty years, the period of second dentition and puberty, and again at or about the age of forty.
Among other causes which are influential in the development of epilepsy may be mentioned sudden fright, prolonged mental anxiety, over-work and debauchery. Epileptic fits also occur in connexion with a depraved stage of the general health, and with irritations in distant organs, as seen in the fits occurring in dentition, in kidney disease, and as a result of worms in the intestines. The symptoms traceable to these causes are sometimes termed sympathetic or eccentric epilepsy; these are but rarely epileptic in the strictest sense of the word, but rather epileptiform.
Epilepsy is occasionally feigned for the purpose of extortion, but an experienced medical practitioner will rarely be deceived; and when it is stated that although many of the phenomena of an attack, particularly the convulsive movements, can be readily simulated, yet that the condition of the pupils, which are dilated during the fit, cannot be feigned, and that the impostor seldom bites his tongue or injures himself, deception is not likely to succeed even with non-medical persons of intelligence.
The medical treatment of epilepsy can only be briefly alluded to here. During the fit little can be done beyond preventing as far as possible the patient from injuring himself while unconsciousness continues. Tight clothing should be loosened, and a cork or pad inserted between the teeth. When the fit is of long continuance, the dashing of cold water on the face and chest, or the inhalation of chloroform, or of nitrite of amyl, may be useful; in general, however, the fit terminates independently of any such measures. When the fit is over the patient should be allowed to sleep, and have the head and shoulders well raised.
In the intervals of the attack, the general health of the patient is one of the most important points to be attended to. The strictest hygienic and dietetic rules should be observed, and all such causes as have been referred to as favouring the development of the disease should, as far as possible, be avoided. In the case of children, parents must be made to realize that epilepsy is a chronic disease, and that therefore the seizures must not be allowed to interfere unnecessarily with the child’s training. The patient must be treated as such only during the attack; between times, though being carefully watched, must be made to follow a child’s normal pursuits, and no distinction must be made from other children. The same applies to adults: it is far better for them to have some definite occupation, preferably one that keeps them in the open air. If such patients become irritable, then they should be placed under supervision. As regards those who cannot be looked after at home, colonies on a self-supporting basis have been tried, and where the supervision has been intelligent the success has been proved, a fairly high level of health and happiness being attained.
The various bromides are the only medical drugs that have produced any beneficial results. They require to be given in large doses which are carefully regulated for every individual patient, as the quantities required vary enormously. Children take far larger doses in proportion than adults. They are best given in a very diluted form, and after meals, to diminish the chances of gastric disturbance. Belladonna seems also to have some influence on the disease, and forms a useful addition; arsenic should also be prescribed at times, both as a tonic, and for the sake of the improvement it effects in those patients who develop a tendency to acne, which is one of the troublesome results of bromism. The administration of the bromides should be maintained until three years after the cessation of the fits. The occurrence of gastric pain, palpitations and loss of the palate reflex are indications to stop, or to decrease the quantity of the drug. In very severe cases opium may be required.
Surgical treatment for epilepsy is yet in its infancy, and it is too early to judge of its results. This does not apply, however, to cases of Jacksonian epilepsy, where a very large number have been operated on with marked benefit. Here the lesion of the brain is, in a very large percentage of the patients, caused by pressure from outside, from the presence of a tumour or a depressed fracture; the removal of the one, or the elevation of the other is the obvious procedure, and it is usually followed by the complete disappearance of the seizures.
EPILOGUE. The appendix or supplement to a literary work,
and in particular to a drama in verse, is called an epilogue,
from ἐπίλογος, the name given by the Greeks to the peroration
of a speech. As we read in Shakespeare’s Midsummer Night’s
Dream, the epilogue was generally treated as the apology for a
play; it was a final appeal made to encourage the good-nature of
the audiences, and to deprecate attack. The epilogue should
form no part of the work to which it is attached, but should be
independent of it; it should be treated as a sort of commentary.
Sometimes it adds further information with regard to what has
been left imperfectly concluded in the work itself. For instance,
in the case of a play, the epilogue will occasionally tell us what
became of the characters after the action closed; but this is
irregular and unusual, and the epilogue is usually no more than
a graceful way of dismissing the audience. Among the ancients
the form was not cultivated, further than that the leader of
the chorus or the last speaker advanced and said “Vos valete,
et plaudite, cives”—“Good-bye, citizens, and we hope you are
pleased.” Sometimes this formula was reduced to the one
word, “Plaudite!” The epilogue as a literary species is
almost entirely confined to England, and it does not occur in the
earliest English plays. It is rare in Shakespeare, but Ben Jonson
made it a particular feature of his drama, and may almost be
said to have invented the tradition of its regular use. He
employed the epilogue for two purposes, either to assert the
merit of the play or to deprecate censure of its defects. In the
former case, as in Cynthia’s Revels (1600), the actor went off,
and immediately came on again saying:—
| “Gentles, be’t known to you, since I went in I am turned rhymer, and do thus begin:— The author (jealous how your sense doth take His travails) hath enjoined me to make Some short and ceremonious epilogue,”— |
and then explained to the audience what an extremely interesting play it had been. In the second case, when the author was less confident, his epilogue took a humbler form, as in the comedy of Volpone (1605), where the actor said:—
| “The seasoning of a play is the applause. Now, as the Fox be punished by the laws, He yet doth hope, there is no suffering due For any fact which he hath done ’gainst you. If there be, censure him; here he doubtful stands: If not, fare jovially and clap your hands.” |
Beaumont and Fletcher used the epilogue sparingly, but after
