after the lapse of years the vigour of the system fails, and many causes act to derange the nice balance of the constitution: the bowels often become sluggish, &c. &c." A person may die in an epileptic fit, even in the first, but this is seldom the case; more generally the disorder does not immediately threaten life, but the individual goes on from year to year, suffering more or less, and still lives; even when the fits occur daily, or two or three times a-day, this is the case. When death does occur early in the disease, it is more probably due to suffocation arising from the spasm of the muscles of the throat and neck, than to the brain affection. But if life is continued to the confirmed epileptic, too often intellect becomes affected. This may not be palpable after a first seizure, not even after many seizures for many years, not throughout a tolerably long life, but these are exceptions. The generality of epileptics become feebler in intellect, the memory fails, the power of continuous exertion of the mind is lost, and perhaps, at last, the condition ends in mental fatuity.

That epilepsy is due to disease or disorder of the brain and nervous system is unquestionable; the affection either directly originating from them, or through them, in consequence of irritation in some portion of the body. It is well ascertained that hereditary predisposition gives greater effect to causes which have plainly exerted influence in the production of this distressing malady. Dating, either directly or indirectly, from the nervous system, whatever weakens that system tends to cause epilepsy. From this it is evident how well founded the observation is, that there is no more fertile source of epilepsy than the abuse of the sexual organs, particularly in the young. The subject is a painful one, but the direful consequences of vice, with which the merest children become imbued at school, is frequently coming before medical men; unaware of the sin and evil consequences of their acts, they ruin constitutions at the most critical period of life, and lay the foundations of epilepsy and other nervous diseases, which are either quickly developed, or do not show themselves till late in life. The subject is one to which parents and tutors cannot be too strongly alive. Intoxication is a cause of epilepsy, and delirium tremens may be complicated with it. Strong and prolonged mental exertion may induce epilepsy. Fright is another and very frequent existing cause. Worms and irritations in the bowels, indeed, whatever can irritate the nervous system, may induce the disease in ques

tion. Imitation, or at least the witnessing an individual in the epileptic paroxysm, has been known to give rise to the fits in others; but they were most likely predisposed, or at all events of nervous and susceptible temperament; for this reason, such persons, young females and children especially, should never if possible be permitted to witness an epileptic fit; the premonitory cry is so terrifying that it has been known to affect even the lower animals.

Of the predisposing causes there is no question that hereditary tendency is a powerful one, and especially if the constitution of the family be scrofulous. Epilepsy in the offspring has been traceable to no other cause than dissipated, and especially drunken, habits in the father. It is frequently observed to be concomitant with malformation, or at least mis-shape, of the head of the sufferer. From what has now been said, it must be evident that epilepsy is no disease for domestic management in a curative point of view, but that it affords much room for preventive and other means.

In families in which a tendency to epilepsy is known to exist, the greatest care should be taken to guard the nervous system from all causes either of irritation or exhaustion. In infancy, the period of teething, and the condition of the bowels, will require special attention, and the tone of the system to be maintained as directed in article "Children." The physical strength and health are to be cultivated in early life, even at some sacrifice of educational advancement; at puberty, the strictest eye must be kept upon the habits and tendencies, and whilst the constitution is developing, and growth going on, all exhausting exercises prevented; indeed, during life the suspicion of a tendency to so terrible an affliction as epilepsy should be a never-forgotten check upon excess in every way—a check upon the man who consumes his energies in the exertions of business or of study, as well as upon those who waste them in the pursuits of vice or sensualism. In addition to passive preventive means, all those measures which are fully laid down throughout this work for the preservation of health should be well attended to, particularly the use of cold water to the head, spine, and surface generally, if there is sufficient re-action to bear the application.

Care must be taken in the curing or suppression of accustomed or long-continued discharges, such as habitual diarrhoea, bleeding from piles, &c.; at the same time it must be borne in mind, that the discharge, by weakening the system, may be itself the cause of the disease; but this is a point

which the medical attendant must determine.

Certain precautions are always requisite with those who suffer from epilepsy, and as a general rule it may be laid down that they should never, if possible, place themselves or be placed in situations in which a sudden seizure will expose them to danger. Thus, employments which necessitate riding on horseback, ascending heights, &c., ought never to be engaged in, neither such as those in which even momentary unconsciousness may involve the lives of others in danger. Even the suspicion of epilepsy in a railway official ought to be a disqualifying circumstance. Many, it is true, have sufficient warning to enable them to prepare for the attack, and to withdraw from danger, but this is not always possible; the worst case of burning-or rather roasting-the author ever witnessed, was in consequence of a fall into the fire in an epileptic paroxysm: when means will allow of it, the epileptic ought to have an attendant constantly with them. When an individual is seized with a fit of epilepsy, but little can be done for its immediate relief; the chief thing is to prevent the patient inflicting injury upon himself, by striking against surrounding objects, and also to protect the tongue. Those who are much in attendance upon the epileptic, ought always to have at hand a piece of india rubber, or a thick india rubber ring-such as is used for children teething-to insert between the teeth. All fastening about the body, such as the neckcloth, &c., ought to be loosened, and air freely admitted; the head should be raised, and cold wet cloths may be applied to it if there is much heat. It has been advised to cram the mouth full of salt as soon as the fit comes on; Dr. Watson, who had the plan tried in hospital, thought it seemed to curtail the duration of the convulsion.

neck, or better still, a full and free eruption produced over the shaved scalp, by tartaremetic and croton-oil ointment, or down the spine, should any tenderness be detected there. It sometimes happens that accidental counter-irritating effects relieve epilepsy, at all events for as long as they are in action. In one case attended by the author, a man who was suffering from daily attacks of epileptic convulsion fractured his leg, and from that time, had no attack for five or six weeks, during the period the accident was being recovered from.

Further, it is well to draw the attention of the reader to the article "Cotyledon.” Where the plant is within reach, either of the patient or of friends, there could be no possible objection to its powers being tested, and of them the author can speak favourably. Epilepsy is often a feigned disease, particularly among soldiers and sailors, and also by mendicant impostors. The latter usually choose public places for the exhibition, throw their legs and arms about, foam at the mouth with a little soap mixed with the saliva, and continue their exertions for a much longer time, and with more expenditure of heat, but with less active power than the real epileptic. real epileptic is not susceptible to pain or sensation; where suspicion exists, therefore, some test of this kind which will not injure may well be tried. Snuff may be put up the nostrils, and if it produces sneezing there is no epilepsy; sometimes the proposal, within hearing of the person, to try some mode of treatment which involves considerable suffering is sufficient to dispel the fit.

A

Refer to Ablution-Convulsion-Cotyledon-Children, &c.

EPIPHYSIS-is the extremity of a long bone, such as of the arm or thigh, which is, in the young, connected with the shaft or main portion of the bone, by means of gristle. When such bones are boiled for some time, the epiphysis separates, as may be seen in the case of veal or chickens. In children the epiphysis is sometimes separated by accident attended with violence. Refer to- Bone.

EPISPASTICS are substances used medicinally for producing inflammation of the skin, which may be followed either by blistering or by the formation of matter. Their action is in fact that treated of under the article "Counter-irritation," which may be referred to.-See also Blister, &c., &c.

EPISTAXIS-Bleeding from the nose.See Hæmorrhage, Nose, &c.

EPITHELIUM-is the external layer of a mucous membrane.-See Mucous Mem

EPSOM SALTS-are a compound of magnesia and sulphuric acid-sulphate of magnesia-and derive their name from having been first obtained by the evaporation of the water of a spring, situated near Epsom, in Surrey, which contains the salt in large quantity. They are now prepared largely by manufacturing chemists from magnesian limestone, and also from sea-water. They are sold in the form of small, pure white, needle-like crystals, and from their cheapness are extensively, indeed too much so, used among the poor as a general aperient, and not unfrequently by all classes. Epsom salts are tolerably certain in their action, do not gripe much, and produce free watery evacuation of the bowels; on these accounts the medicine is a most valuable one in many diseases, particularly in persons of a full habit, but, as generally employed, it is not suitable for a common or frequently repeated aperient. From its being in many instances taken in a state of too concentrated solution, it induces a discharge of the watery part of the blood into the bowels, and thus seriously debilitates moreover, after the action of a dose of Epsom salts, the bowels, in those liable to habitual constipation, are very apt to be left with a greater tendency to inaction than before; nevertheless, in persons of full strong habit, an occasional dose of the medicine is, without question, beneficial, but it should be taken in smaller quantity and much more largely diluted than is usually done. The question of dilution is a very important one in the administration of this salt, and if attended to, renders it safe and efficient even for the comparatively delicate. From half a drachm, or even less, to a drachm, should be dissolved in at least six ounces or half a pint of cold or tepid water, and taken on first rising in the morning, when the dose should be followed by the fluid breakfast: many persons liable to constipation find this method a simple and effectual remedy, which may be used for weeks together. From five to ten drops of dilute sulphuric acid are often a good addition to the dose, and one which at the same time corrects in some degree the bitterness of the salt. If there is debility, either of the stomach, or generally, from a quarter to half a grain, either of quinine or of some salt of iron may be added. The quinine appears to increase the aperient power. The most convenient method of taking Epsom salts in this form is to dissolve one ounce in a pint -sixteen ounces of water, adding the acid or other ingredients in proper proportion. Of the solution, from half to a whole wine-glassful may be taken the first thing

in the morning, diluted with the proper quantity of water before taking, or if preferred, by the latter being drank immediately after the medicine.

The following method for the administration of Epsom salts has been recommended in France :-take of water about sixteen ounces, powder of roasted coffee two and ahalf drachms, Epsom salts one ounce; boil well for two minutes-not in a tinned vessel remove from the fire, and let the mixture infuse for some minutes, so as to allow time for the development of the aroma; then filter, or merely strain off: it must be sweetened to taste. This fluid does not impart the slightest taste of the bitterness of the salt. It should be observed that the simple infusion of coffee is not capable of removing the bitter taste.

The combination of Epsom salts with infusion of senna, constituting the common black draught, is one of the best forms of active occasional purgative in common use. It is well to bear in mind, that there is considerable resemblance between oxalic acid in its crystalline commercial form and Epsom salts, and that in consequence, fatal mistakes have occurred. The intensely acid taste of a single crystal of the former would at once clear up any doubt; perhaps it might be well always to use so simple a test.

Refer to Oxalic Acid-PurgativesSenna.

ERGOT OF RYE-is a peculiar diseased or fungoid growth which is developed upon the seed of the common rye. The affected grain is sometimes called " "spurred rye;" from the peculiar curvature of the growth, which varies from half an inch to an inch and a-half in length, is about a quarter of an inch thick, slightly angular in shape, and black in colour. As a remedial adjunct in the hands of the accoucheur, ergot of rye is most valuable, but is scarce likely to form part of the domestic medicine chest. It is more commonly met with on the continent, where much rye is grown, than in this country, and when the grain is largely infected with it, pestilential diseases have been ascribed to the use of the flour in which it has been mixed. It is certain that a peculiar kind of dry mortification of the extremities has followed the prolonged use of grain containing ergot.

Ergot of rye has been used in medicine in hæmorrhagic and other diseases, but chiefly on account of its undoubted action upon the womb. It can only be safely used by medical men. ERRHINES-are medicinal substances

used as snuff to excite discharge from the lining mucous membrane of the nostrils; they are, in fact, means of counter-irritation, but are not much employed by medical men. In some cases of headache they are useful, and common snuff may be used with as much effect as any of the class.

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ERUCTATION-is the rising, either of or fluid, into the mouth from the stomach. It is a constant symptom in dyspepsia. Refer to-Flatulence.

ERUPTION—a diseased appearance on the skin.-See Skin.

ERYSIPELAS, or ST. ANTHONY'S FIRE, or THE ROSE,-is an inflammatory affection of the skin, with or without vesication or blistering, sometimes extending to the cellular tissue beneath. It appears on various parts of the body, but most generally on the head and neck. Unless the attack is very slight indeed, the occurrence of erysipelas is generally ushered in by symptoms of fever, shivering, and headache, furred tongue, perhaps sickness, followed by thirst, hot skin, quick pulse, &c.; at the same time the part first affected, such as the nose, cheek, or ear, becomes stiff, painful, red and swollen, the pain being of a burning character. If unchecked, this inflammation of the skin extends with more or less rapidity, and so rapid indeed is its progress at times, that in a very few hours the whole head and face become enormously swollen. As the disease progresses, blisters resembling those raised by a scald form over the surface, which is intensely hot and red, or purplish; the pain is severe, fever runs high; sore throat is a very frequent accompaniment, and delirium is common.

So serious a disease as erysipelas ought only to be treated by a medical man; but as it is important, if possible, to check it at its first onset, the following measures should be adopted if proper assistance cannot quickly be procured; a disease present ing the symptoms above detailed, must generally be recognisable even by unprofessional persons. There is great diversity of opinion respecting bleeding from the arm in the first onset of erysipelas, but here, as in many other cases, the treatment must hinge upon the constitution of the patient, and not on the name of the disease. Under any circumstances, however, it would not be well for an unprofessional person to use so active a remedy; but if the affected individual be of very full habit, there is no objection to the application of leeches around the inflamed patch, that is, if there is no peculiar tendency to irritation of the skin after the use of leeches. If the tongue is very foul, an emetic may be given,

and the bowels freely purged with the calomel and colocynth pill, whilst eighth-of-agrain doses of tartar emetic may be administered every three or four hours; the diet being kept as low as possible. In weakly persons, a more negative plan should be pursued; the bowels must be more gently acted upon, as by five grains of grey powder, followed in a few hours by some gentle aperient such as castor-oil; effervescing saline draughts should be given—and, indeed, are useful in the former case alsoevery few hours, whilst all stimulants and animal food are cut off. With respect to local applications, quite the most certain and efficacious is nitrate of silver or lunar caustic, which, if carefully used, may be employed beneficially even by the unprofessional; indeed it is quite possible to imagine a clergyman, for instance, in the country, checking, effectually, a fast-spreading attack of erysipelas, which would, unattended to, gain a dangerous ascendancy before the services of a medical man could be obtained. The lunar caustic is used for two objects, one to check the spread of the inflammation over the skin, and the other to quell the disease for the first it is best used in the solid stick, for the latter purpose in strong solution.

Erysipelatous inflammation tending to spread may be stopped by surrounding the affected part entirely with a cauterized ring; the parts to be touched must in the first place be shaved, if covered with hair, and the skin must always be thoroughly cleansed from its natural oily secretion, by washing with soap and water; it must then be moistened all round, and the stick of caustic drawn slowly and gently over it, so as to make a line of demarcation at least a quarter of an inch broad; but this line must be entire throughout-deficiency in one spot may permit the inflammation to extend by the outlet. It is not asserted that in every case this caustic line will inevitably stop the disease, but it will do so in the majority, if care be taken that it is efficiently done, and that it includes without doubt every portion of the affected skin. When the solution of caustic is to be used to quell the disease, it should be used of the strength of forty grains to two drachms of distilled or rain water. The inflamed surface must be gently cleansed by soap and warm water, and the solution applied all over it by means of a camel-hair brush or a feather. The practice now recommended is perfectly safe, is very efficacious, both as a preventive against the extension, and as a cure of this formidable disease, and might be quite justifiably employed by an intelligent person

in the absence of medical assistance. It has, however, the inconvenience of turning the skin to which it is applied perfectly black for some time afterwards, that is, until the outer skin has peeled off, and been replaced by a fresh layer. For this reason it is better in mild cases to have recourse to some of the local remedies yet to be mentioned. It is desirable that persons should be duly impressed with the necessity of cutting or shaving off the hair whenever erysipelas in a severe form extends to parts naturally provided with the covering.

In addition to the local treatment by lunar caustic, which the author has always found the most to be depended upon, other applications are used, and may be used, when the other is not procurable, or when the cases are so very mild that it is unnecessary to incur the temporary discolouration of the skin produced by the caustic application.

Flour is a very common and often a good and comfortable local remedy in erysipelas; hot fomentations, either of simple water or decoction of poppy heads, applied continuously for many hours, by means of flannel, give much relief in some cases; or a lotion composed of twenty grains of sugar of lead, a drachm of laudanum, and sixteen ounces of distilled or rain water may be used slightly warm, and applied by means of linen cloths, with much advantage.

The remedial measures, both local and general, which have now been recommended, ought and may, under intelligent unprofessional management, do much to keep this formidable disease in check until the medical man, whose presence must be necessary, can be got. Moreover, there ought not to be much doubt as to the nature of the disease, if the distinctions pointed out in the first part of this article are attended to, and further, many attacks of erysipelas are secondary ones, as persons who have once suffered are liable to do so again.

Much confusion of ideas exists on the part of the public with regard to erysipelas, and many affections of the skin are imagined to be this disease, which do not in the least resemble it. It should be remembered that it is an affection which appears suddenly, tends to spread, and is accompanied with fever; that the affected skin is red, hot, tender, and often blistered.

The causes of erysipelas are numerous: cold and atmospheric vicissitudes, and peculiar conditions of the atmosphere, are all apt to excite an attack, and everything which tends to produce debility, predisposes to it.

Wounds and sores often appear to be the first originators of the malady, and in such cases, contagion has much to do with its diffusion through a hospital or a town; even the most trifling scratch being sufficient to become the attraction. For this reason, erysipelas is the most formidable enemy which can gain a footing in a surgical hospital, and for the same reason when the disease occurs in private houses, caution should be observed that persons suffering from wounds do not come into close contact with the affected; and, indeed, in any case, the same precautions should be adopted in erysipelas as in contagious diseases generally. This is doubly requisite in a house in which a confinement is expected, or has recently taken place, for there is an undoubted close connection between erysipelas and fatal child-bed inflammation. The head and neck are the most frequent sites attacked by this disease, but any other portion of the body may be liable to it; the throat not uncommonly suffers, and is a dangerous complication, best treated by the free application of the caustic solution to the tonsils, &c.; it ought to be quickly attended to by a medical man, for death sometimes occurs most unexpectedly from suffocation, in consequence of swelling. Hot bran poultices and mustard plasters externally would perhaps relieve the throat in some degree.

When erysipelatous inflammation extends to the tissue beneath the skin, it constitutes what medical men call "phlegmon;" purulent matter forms, and the parts slough or mortify. In such cases it is usual for the surgeon to cut through the skin to give free exit to the matter, &c., and by the proceeding much relief is afforded; this, of course, unprofessional persons cannot do, and poultices and fomentations must be their resource should it happen, which is not perhaps likely, that a case which has reached this stage has been unvisited by a medical attendant.

Refer to-Silver, Nitrate of--Skin, &c.

ERYTHEMA is a more superficial and evanescent inflammation of the skin than erysipelas. The most familiar instance of it is the inflammation produced by the chafing which occurs in stout children, or adults, between the folds of the skin, and which has a tendency to spread from its point of origin. The application of cloths dipped in tepid water, or in the sugar of lead and laudanum lotion, recommended in erysipelas, will allay the burning sensation. A few grains of grey powder should be given at bed-time, followed by castor-oil or senna in the morning, and then quinine