Epilepsy, Hysteria, and Neurasthenia Part 1

Epilepsy, Hysteria, and Neurasthenia.

by Isaac G. Briggs.

PREFACE

I hope this book will meet a real need, for when one considers how prevalent epilepsy, hysteria and neurasthenia are, among all ranks and ages of both s.e.xes, it seems remarkable some such popular book was not written long ago.

I add nothing to our knowledge of these ills, my object being to put what we know into simple words, and to insist on the necessity for personal discipline being allied to expert aid. The book aims at helping, not ousting, the doctor, who may find it of use in getting his patient to see--and to act on--the obvious.

"Nervous Disease", as here used, includes only the three diseases treated of; "Neuropath"--victims of them.

"Advice" to a neuropath is usually a very depressing decalogue of "Thou Shalt Nots!" If it be made clear _why_ he must _not_ do so-and-so, the patient endeavours to obey; peremptorily ordered to obey, he rebels. Much sound advice is wasted for lack of an interesting, convincing, "Reason Why!" which would ensure the hearty and very helpful co-operation of a patient who had been taught that writing prescriptions is not the limit of a doctor's activities.

Many folk, with touching belief in his own claims, regard the quack as a h.o.a.ry-headed sage, who from disinterested motives devotes his life to curing ailments, by methods of which he alone has the secret, at low fees.

To fight this dangerous idea I have tried to show in an interesting way how science deals with nerve ills, and to prove that qualified aid is needed.

Suggestions and criticisms will be welcomed.

I. G. BRIGGS THE UNIVERSITY, BIRMINGHAM, _June_, 1921

"Lette than clerkes enditen in Latin, for they have the propertie of science, and the knowing in that facultie: and lette Frenchmen in their Frenche also enditen their queinte termes, for it is kyndely to their mouthes; and let us showe our fantasies in soche wordes as we lerneden of our dames tongue."

--Chaucer.

EPILEPSY, HYSTERIA, AND NEURASTHENIA

CHAPTER I

MAJOR AND MINOR EPILEPSY

(_Grand and Pet.i.t Mal_)

"My son is sore vexed, for ofttimes he falleth into the fire, and ofttimes into the water."--Matthew xvii, 15.

"Oft, too, some wretch before our startled sight, Struck as with lightning with some keen disease, Drops sudden: By the dread attack o'erpowered He foams, he groans, he trembles, and he faints; Now rigid, now convuls'd, his labouring lungs Heave quick, and quivers each exhausted limb.

"He raves, since Soul and Spirit are alike Disturbed throughout, and severed each from each As urged above, distracted by the bane; But when at length the morbid cause declines, And the fermenting humours from the heart Flow back--with staggering foot first treads Led gradual on to intellect and strength."--Lucretius.

Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervous system, evinced by attacks of _alteration of consciousness_, usually accompanied by convulsions.

It attacks men of every race, as well as domesticated animals, and has been known since the earliest times, the ancients imputing it to demons, the anger of the G.o.ds, or a blow from a star.

It often attacks men in crowds, when excited by oratory or sport, hence the Roman name: _morbus comitialis_ (crowd sickness).

In mediaeval times, sufferers were regarded with awe, as being possessed by a spirit. Witch doctors among savages, and founders and expounders of differing creeds among more civilized peoples, have taken advantage of this infirmity to claim divine inspiration, and the power of "seeing visions"

and prophesying.

Epilepsy has always interested medical men because of its frequency, the difficulty of tracing its cause, and its obstinacy to treatment, while it has appealed to popular imagination by the appalling picture of bodily overthrow it presents, so that many gross superst.i.tions have grown up around it.

The description in Mark ix. 17-29, is interesting:

"Master, I have brought Thee my son, which hath a dumb spirit. And wheresoever he taketh him, he teareth him: and he foameth, and gnasheth with his teeth, and pineth away: ... straightway the spirit tare him; and he fell on the ground, and wallowed foaming.

"And He asked his father, How long is it ago since this came unto him?

And he said, Of a child. And ofttimes it hath cast him into the fire, and into the waters, to destroy him.

"And he said unto them, This kind can come forth by nothing, but by prayer and fasting."

Up to the present, epilepsy can be ascribed to no specific disease of the brain, the symptoms being due to some morbid disturbance in its action.

Epilepsy is a "functional" disease.

GRAND MAL ("_Great Evil_")

An unusual feeling called an _aura_ (Latin--vapour), sometimes warns a patient of an impending fit, commonly lasting long enough to permit him to sit or lie down. This is followed by giddiness, a roaring in the ears, or some unusual sensation, and merciful unconsciousness. In many cases this stage is instantaneous; in others it lasts some seconds--but an eternity to the sufferer. This stage is all that victims can recall (and this only after painful effort) of an attack.

As unconsciousness supervenes, the patient becomes pale, and gives a cry, which varies from a low moan to a loud, inhuman shriek. The head and eyes turn to one side, or up or down, the pupils of the eyes enlarge and become fixed in a set stare, and the patient drops as if shot, making no effort to guard his fall, being often slightly and sometimes severely injured.

The whole body then becomes stiff. The hands are clenched, with thumbs inside the palms, the legs are extended, the arms stiffly bent, and the head thrown back, or twisted to one side. The muscles of the chest and heart are impeded in their action, breathing ceases, the heart is slowed, and the face becomes pale, and then a livid, dusky blue.

The skin is cold and clammy, the eyebrows knit; the tongue may be protruded, and bitten between the teeth. The eyeb.a.l.l.s seem starting from their sockets, the eyes are fixed or turned up, so that only the sclerotic ("whites") can be seen, and they may be touched or pressed without causing blinking. The stomach, bladder, and bowels may involuntarily be emptied.

This _tonic_ stage only lasts a few seconds, and is followed by convulsions. The head turns from side to side, the jaws snap, the eyes roll, saliva and blood mingle as foam on the lips, the face is contorted in frightful grimaces, the arms and legs are twisted and jerked about, the breathing is deep and irregular, the whole body writhes violently, and is bathed in sweat.

The spasms become gradually less severe, and finally cease. Deep breathing continues for some seconds; then the victim becomes semi-conscious, looks around bewildered, and sinks into coma or deep sleep.

"...As one that falls, He knows not how, by force demoniac dragg'd To earth, and through obstruction fettering up In chains invisible the powers of Man; Who, risen from his trance, gazeth around Bewilder'd with the monstrous agony He hath indured, and, wildly staring, sighs: ..."

In a few hours he wakes, with headache and mental confusion, not knowing he has been ill until told, and having no recollection of events just preceding the seizure, until reminded of them when they are slowly, and with painful effort, brought to mind. He is exhausted, and often vomits. In severe cases he may be deaf, dumb, blind, or paralysed for some hours, while purple spots (the result of internal hemorrhage) may appear on the head and neck. Victims often pa.s.s large quant.i.ties of colourless urine after an attack, and, as a rule, are quite well again within twenty-four hours.

This is the usual type, but seizures vary in different patients, and in the same sufferer at different times. The cry and the biting of the tongue may be absent, the first spasm brief, and the convulsions mild. Epilepsy of all kinds is characterized by an _alteration_ (not necessarily a _loss_) of consciousness, followed by loss of memory for events that occurred during the time that alteration of consciousness lasted.

Attacks may occur by day only, by day and by night, or by night only, though in so-called nocturnal epilepsy, it is _sleep_ and not night that induces the fit, for night-workers have fits when they go to sleep during the day.

Victims of nocturnal epilepsy may not be awakened by the seizure, but pa.s.s into deeper sleep. Intermittent wetting of the bed, occasional temporary mental stupor in the morning, irritability, temporary but well-marked lapses of memory, sleep-walking, and causeless outbursts of ungovernable temper all suggest nocturnal epilepsy.

Such a victim awakes confused, but imputes his mental sluggishness to a hearty supper or "a bad night". A swollen tongue, blood-stained pillow, and urinated bed arouse suspicion as to the real cause, suspicion which is confirmed by a seizure during the day. He is more fortunate (if such a term can rightly be used of any sufferer from this malady) than his fellow victim whose attacks occur during the day, often under circ.u.mstances which, to a sensitive nature, are very mortifying.

Epileptic attacks are of every degree of violence, varying from a moment's unconsciousness, from which the patient recovers so quickly that he cannot be convinced he has been ill, to that awful state which terrifies every beholder, and seems to menace the hapless victim with instant death. Every degree of frequency, too, is known, from one attack in a lifetime, down through one in a year, a month, a week, or a day; several in the same periods, to _hundreds_ in four-and-twenty hours.

PEt.i.t MAL ("_Little Evil_")