Epilepsy, Hysteria, and Neurasthenia Part 3

Epilepsy may be due to abortives. These drugs wreck the const.i.tution of the undesired children, who contract epilepsy from causes which would not so have affected them had they started fairly. In many families, the first child, who was wanted, is normal; some or all the others, who were not desired and on whom attempts were probably made to prevent birth, are neuropaths, as are many illegitimate children. It cannot too emphatically be stated that there is no drug known which will procure abortion without putting the woman's life in so grave a danger as to prevent medical men using it; legal abortion is always procured surgically. Dealing in abortifacients would be a capital offence under the laws of a rational community.

Self-abuse may perhaps play some part in epilepsy commencing or recurring after the age of ten.

The onset of menstruation often coincides with the onset of epilepsy, and in some cases irregularity of the menses seems to be a secondary or exciting cause.

Exciting Causes aggravate the trouble when present, causing more frequent and severe seizures. The chief are irritation of stomach and bowels (from decaying teeth, unchewed, unsuitable, or indigestible food, constipation, or diarrhoea), exhaustion, work immediately after a meal, pa.s.sion or excitement, fright, worry, mental work, alcoholism, s.e.xual excess, nasal growths, eye-strain; in short, anything that irritates brain or body.

Theories as to Cause. Epilepsy is usually cla.s.sed as a _functional disorder_; that is, the brain cells are physically normal, but, for some unknown reason, they act abnormally at certain times. This term is a very loose one, and there is reason to believe that the basis of epilepsy is some obscure disease of the brain which has not been detected by present methods.

The new school of psychologists regard the malady as a mental _complex_--a system of ideas strongly influenced by the emotions--the convulsions being but minor symptoms.

Fits are most frequent between 9-10 p.m. the hours of deepest repose. One school says this is due to anaemia of the brain during sleep. Clark traces the cause to lessened inhibitory powers owing to the higher brain centres being at rest, while Haig claims to have explained the high incidence at this hour by the fact that uric acid is present in the system in the greatest amount at this time.

Some doctors have thought, on the contrary, that _excess_ of blood in the head was the cause, but results of treatment so directed did not bear out the sanguine hopes built on the theory.

The fact that convulsions occur in diabetes and alcoholism, suggested that epilepsy was due to poisons circulating in the blood, and thus irritating the brain. Every act uses up cell material and leaves waste products, exactly as the production of steam uses up coal and leaves ashes. Various waste products have been found in more than normal quant.i.ties in the blood of epileptics, but it is uncertain whether acc.u.mulation of waste products causes the seizure.

A convincing theory must satisfactorily account for all the widely diverse phenomena seen in epilepsy, and the problem must remain largely a matter of speculation, until research work has given us a far deeper insight into the biochemistry of both the brain cells, and the germ-plasm than we have at present.

CHAPTER V

PREVENTION OF ATTACKS

In health matters, prevention is nine points of the law.

Some patients are obsessed by a peculiar sensation (the "aura") just before a fit. This warning takes many forms, the two most common being a "sinking"

or feeling of distress in the stomach, and giddiness. The character of the aura is very variable--terror, excitement, numbness, tingling, irritability, twitching, a feeling of something pa.s.sing up from the toes to the head, delusions of sight, smell, taste, or hearing (ringing, or buzzing, etc.), palpitation, throbbing in the head, an impulse to run or spin around--any of these may warn a victim that a fit is at hand. Some patients "lose themselves" and make curious mistakes in talking.

The warning is nearly always the same each time with the same patient, and is more common in mild than in severe cases. Rarely, the attack does not go beyond this stage.

When the patient becomes conscious of the aura he should sit in a large chair, or lie down on the floor, well away from fire, and from anything that can be capsized. He must never try to go upstairs to bed. Some one should draw the blind, as light is irritating.

If the warning lasts some minutes, the patient should carry with him, a bottle of uncoated one-hundredth-grain tabloids of

Nitroglycerin, replacing the screw cap with a cork, so that they can quickly be extracted. When the warning occurs, one--or two--should be taken, and the head bent forward. The arteries are dilated, the blood-pressure thus lowered, and the attack _may_ be averted.

The use of nitroglycerin is based on the theory that seizures are caused by anaemia due to vasomotor constriction. Success is only occasional, but this is so welcome as to justify the habitual use of the method.

If the aura be brief, buy a few "pearls" of Amyl Nitrite, crush one in your handkerchief, and sniff the vapour. This has the same affect as nitroglycerin, but the action occurs in 15 seconds and only persists 7 minutes. A headache occasionally follows the use of these drugs, and they should not be employed without professional advice.

When the warning is felt in the hand or foot, a strap should be worn round the ankle or wrist, and pulled tight when the aura commences. This sometimes aborts a fit, as biting a finger in which the aura commences may also do.

If a victim feels unwell after a meal, he must never eat the next meal at the usual time, simply because it _is_ the usual time.

Should a patient feel unwell between, say, dinner and tea, instead of eating his tea he must empty his bowels by an enema, or croton oil (see chemist), and his stomach by drinking a pint of warm water in which has been stirred a tablespoonful of mustard powder and a teaspoonful of salt.

After vomiting, drink warm water.

_Never attempt to empty the stomach at the onset of a definite aura_, for if the seizure occurs, the vomit will probably obstruct the trachea, and suffocate the victim.

After the stomach has been empty ten minutes, the patient should take a double dose of bromides (Chapter XIX) and go to bed. Next morning he will be well, whereas if he eats but a single piece of bread-and-b.u.t.ter he will probably have a fit within five minutes.

Unfortunately, in 60 per cent of cases, there is no warning at all, while in those cases which do exhibit an aura, the measures mentioned above more often fail than succeed.

CHAPTER VI

FIRST-AID TO VICTIMS

"First-aid is the a.s.sistance which can be given in case of emergency by those who, with certain easily acquired knowledge are in a position, not only to relieve the sufferer, but also to prevent further mischief being done pending the arrival of a doctor."--d.i.c.key.

_Never try to cut short a fit_. Placing smelling-salts beneath the nose, together with all other remedies for people who have "fainted", are useless in epilepsy.

Lay the patient on his back, with head slightly raised; admit air freely; remove scarf or collar and tie, unfasten waistcoat, s.h.i.+rt, stays or other tight garments, and if it be known or observed that the victim wears artificial teeth, remove them.

If five people are at hand, let two persons grasp each a leg of the victim, holding it above the ankle and above the knee; two others should each hold a hand and the shoulder; the fifth supports the head. Do not kneel opposite the feet or you may receive a severe kick. Prevent the limbs from striking the floor, but _allow them full play_. If the victim rolls on his face gently turn him on his back.

Roll a large handkerchief up _from the side_ (not diagonally) and holding one end firmly, tie a knot in the other end, and place it between the teeth to protect the tongue; or slide the handle of a spoon or a piece of smooth wood between the teeth, and thus hold the tongue down. Soft articles like cork and indiarubber should not be used, for if they are bitten through, the rear portion will fall down the throat and choke the victim.

After the fit, lower the head to one side to clear any vomitus which, if left, might be drawn into the windpipe, lift the patient on to a couch, cover him warmly, and let him sleep. An epileptic's bed should be placed on the ground floor; if his bed be upstairs, it is difficult to get him there after an attack, while he may at any time fall downstairs and be killed.

Any effort to rouse him will only make the post-epileptic stupor more severe, but whether he sleeps or not, he must carefully be watched, for patients in this state are apt to slip away, often half-clothed, and travel towards nowhere in particular at a wonderfully rapid rate.

If several fits follow one another, or if one is very long or severe, send for a doctor.

When a seizure occurs in public, a constable should be summoned, who, being a "St. John" man, will be of far more use than bystanders br.i.m.m.i.n.g over with sympathy--_and ignorance_. If some kindly householder near by will allow the victim to sleep for an hour or two--a boon usually denied more from fear of recurrence than lack of sympathy, it is better than taking him home. If not, let someone call a cab, and deliver the victim safely to his friends.

Every epileptic should carry always with him a card stating his full name and address, with a request that some one present at any seizure will escort him home.

If the victim wakes with a headache, give him a 10-grain Aspirin powder, or a 5-grain Phenalgin tablet; _never patent "cures"_.

If possible, the patient should lie abed the day after a fit, undisturbed, taking only soda-and-milk and eggs beaten up in _hot_ milk.

CHAPTER VII

NEURASTHENIA

"Some of your hurts you have cured, And the worst you still have survived; But what torments of mind you endured From evils which never arrived."

--Lowell.

To-day, the need to eat forces even sensible men to live--and die--at a feverish rate. In bygone days the world was a peaceful place, in which our forefathers were denied the chance of combining exercise with amus.e.m.e.nt dodging murderous taxis; knew not the blessings of "Bile Beans", nor the biliousness they blessed either; they did not fall victims to "advert-diseases"; and they left the waters beneath to the fishes, and the skies above to the birds.

Withal they were sound trenchermen, who called their few ailments "humours"

or "vapours" and knew what peace of mind meant. Sixty years ago there was one lunatic in every six hundred people; to-day there is one in every two hundred.