RARER TYPES OF EPILEPSY
If it be true that: "One half the world does not know how the other
half lives", how true also is it that one half the world does not know,
and does not care, what the other half suffers.
Epilepsy shows every gradation, from symptoms which cannot be described in
language, to severe _grand mal_. Gowers says: "The elements of an epileptic
attack may be extended, and thereby be made less intense, though not less
distressing. If we conceive a minor attack that is extended, and its
elements protracted, with no loss of consciousness, it would be so
different that its epileptic nature would not be suspected. Swiftness is an
essential element of ordinary epilepsy, but this does not prevent the
possibility of deliberation."
In Serial Epilepsy, a number of attacks of _grand mal_ follow one another,
with but very brief intervals between. Serial epilepsy often ends in
_Status Epilepticus_, in which a series of _grand mal_ attacks follow one
another with no conscious interval. The temperature rises slowly, the pulse
becomes rapid and feeble, the breathing rapid, shallow and irregular, and
death usually occurs from exhaustion or heart-failure. Though not
invariably fatal, the condition is so very grave that a doctor must
instantly be summoned. Nearly all victims of severe, confirmed epilepsy (25
per cent of all epileptics) die in _status epilepticus_.
Jacksonian Epilepsy, named after Hughlings Jackson, who in 1861 traced its
symptoms to their cause, is not a true epilepsy, being due to a local
irritation of the cortex (the outermost layer) of the brain.
There is usually an _aura_ before the attack, often a tingling or stabbing
pain. The chief symptoms are convulsions of certain limbs or areas of the
body, which, save in very severe cases, are confined to one side, and are
not attended by loss of consciousness.
The irritation spreads to adjacent areas, as wavelets spread from a stone
thrown into a pond, with the result that convulsions of other limbs follow
in sequence, all confined to one side.
As every part of the brain is connected to every other part by "association
fibres", in very violent attacks of Jacksonian epilepsy the irritation
spreads to the other side of the brain also, consciousness is lost, the
convulsions become general and bilateral, and the patient presents exactly
the same picture as if the attack were due to _grand mal_.
All degrees of violence are seen. The convulsions may consist only of a
rapid trembling, or the limb or limbs may be flung about like a flail.
Jackson said: "The convulsion is a brutal development of a man's own
movements, a sudden and excessive contention of many of the patient's
familiar motions, like winking, speaking, singing, moving, etc." These acts
are learned after many attempts, and leave a memory in certain groups of
brain cells; irritate those cells, and the memorized acts are performed
with convulsive violence.
The convulsions are followed by temporary paralysis of the involved
muscles, but power finally returns. As we should expect, this paralysis
lasts longest in the muscles first involved, and is slightest in the
muscles whose brain-centres were irritated by the nearly exhausted waves.
If the disease be untreated, the muscles in time may become totally
paralysed, wasted, and useless.
Friends should very carefully note exactly where and how the attack begins,
the exact part first involved, and the precise order in which the spasms
appear, as this is the only way the doctor can localize the brain injury.
The importance of this cannot be overrated.
The consulting surgeon will say if operation is, or is not, advisable, but
_operation is the sole remedy for Jacksonian epilepsy_, for the causes that
underly its symptoms cannot be reached by medicines.
Patients must consult a good surgeon; other courses are _useless_.
Psychic or Mental Epilepsy is a trance-state often occurring after attacks
of _grand_ or _petit mal_, in which the patient performs unusual acts. The
epileptic feature is the patient's inability to recall these actions. The
complaint is fortunately rare.
The face is usually pale, the eyes staring, and there may be a "dream
state". Without warning, the victim performs certain actions.
These may be automatic, and not seriously embarrassing--he may tug his
beard, scratch his head, hide things, enter into engagements, find the
presence of others annoying and hide himself, or take a long journey. Such
a journey is often reported in the papers as a "mysterious disappearance".
Yet, had he committed a crime during this time, he would probably have been
held "fully responsible" and sentenced.
The actions may be more embarrassing: breaking something, causing pain,
exhibiting the sexual organs; the patient may be transported by violent
rage, and abuse relatives, friends or even perfect strangers; he may spit
carelessly, or undress himself--possibly with a vague idea that he is
unwell, and would be better in bed.
Finally the acts may be criminal: sexual or other assault, murder, arson,
theft, or suicide.
In this state, the patient is dazed, and though he appreciates to some
extent his surroundings, and may be able to answer questions more or less
rationally, he is really in a profound reverie. The attack soon ends with
exhaustion; the victim falls asleep, and a few moments later wakes,
ignorant of having done or said anything peculiar.
We usually think of our _mind_ as the aggregate of the various emotions of
which we are actually _conscious_, when, in reality, consciousness forms
but a small portion of our mentality, the _subconscious_--which is composed
of all our past experiences filed away below consciousness--directing every
thought and act. Inconceivably delicate and intricate mind-machinery
directs us, and our idlest fancy arises, _not by chance_ as most people
surmise, but through endless associations of subconscious mental processes,
which can often be laid bare by skilful psycho-analysis.
Our subconscious mind does not let the past jar with the present, for life
would be made bitter by the eternal vivid recollection of incidents best
forgotten. Every set of ideas, as it is done with, is locked up separately
in the dungeons of subconsciousness, and these imprisoned ideas form the
basis of memory. _Nothing is ever forgotten_, though we may never again
"remember" it this side the grave.
In a few cases we can unlock the cell-door and release the prisoner--we
"remember"; in some, we mislay the key for awhile; in many, the wards of
the lock have rusted, and we cannot open the door although we have the
key--we "forget"; finally, our prisoner may pick the lock, and make us
attend to him whether we wish to or not--something "strikes us".
Normally, only one set of ideas (a complex) can hold the stage of
consciousness at any one time. When two sets get on the boards together,
double-consciousness occurs, but even then they cannot try to shout each
other down; one set plays "leading lady", the other set the "chorus belle"
and so life is rendered bearable.
This "dissociation of consciousness" occurs in all of us. A skilled pianist
plays a piece "automatically" while talking to a friend; we often read a
book and think of other things at the same time: our full attention is
devoted to neither action; neither is done perfectly, yet both are done
sufficiently well to escape comment.
Day-dreaming is dissociation carried further. "Leading lady" and "chorus
belle" change places for a while--imaginary success keeps us from worrying
about real failure. Dissociation, day-dreaming, and mental epilepsy are but
few of the many milestones on a road, the end of which is insanity, or
complete and permanent dissociation, instead of the partial and fleeting
dissociation from which we all suffer. The lunatic never "comes to", but in
a world of dreams dissociates himself forever from realities he is not
mentally strong enough to face.
The writing of "spirits" through a "medium" is an example of dissociation,
and though shown at its best in neuropaths, is common enough in normal men,
as can be proved by anyone with a planchette and some patience.
If the experimenter puts his hands on the toy, and a friend talks to him,
while another whispers questions, he may write more or less coherent
answers, though all the time he goes on talking, and does not know what his
hand is writing. His mind is split into two smaller minds, each ignorant of
the other, each busily liberating memory-prisoners from its own block of
cells in the gaol of the subconscious. The writing often refers to
long-forgotten incidents, the experiment sometimes being of real use in
cases of lost memory.
Dreams are dissociations in sleep, while the scenes conjured up by
crystal-gazing are only waking dreams, in which the dissociation is caused
by gazing at a bright surface and so tiring the brain centres, whereupon
impressions of past life emerge from the subconscious, to surprise, not
only the onlookers to whom they are related, but also the gazer herself,
who has long "forgotten them".
It is childish to attach supernatural significance to either dreams or
crystal-gazing, both of which mirror, not the future, but only the past,
the subject's own past.
It is noteworthy that women dream more frequently and vividly than men.
When a dreamer has few worries, he usually dreams but forgets his dream on
waking; when greatly worried, he often carries his problems to bed with
him, and recent "representative dreams" are merely unprofitable overtime
work done by the brain. Occasionally, dreams have a purely physical basis
as when palpitation becomes transformed in a dream into a scene wherein a
horse is struggling violently, or where an uncovered foot originates a
dream of polar-exploration; in this latter type the dream is protective, in
that it is an effort to side-track some irritation without breaking sleep.
Since Freud has traced a sex-basis in all our dreams, many worthy people
have been much worried about the things they see or do in dreams. Let them
remember that virtue is not an inability to conceive of misconduct, so much
as the determination to refrain from it, and it may well be that the
centres which so determinedly inhibit sexual or unsocial thoughts in the
day, are tired by the very vigour of their resistance, and so in sleep
allow the thoughts they have so stoutly opposed when waking to slip by. The
man who is long-suffering and slow to wrath when awake, may surely be
excused if he murders a few of his tormentors during sleep.
Epileptiform Seizures are convulsions due to causes other than epilepsy,
and only a doctor can tell if an attack be epileptic or not and prescribe
appropriate treatment. To give "patent" medicines for "fits", to a man who
may be suffering from lead poisoning or heart disease, is criminal.
Convulsions in Children often occur before or after some other ailment.
Such children need careful training, but less than 10 per cent of children
who have convulsions become epileptic. Epilepsy should only be suspected if
the first attack occurs in a previously healthy child of over two years of
age. There are many possible causes for infantile convulsions, and but one
treatment; call in a doctor _at once_, and, while waiting for him, put the
child in a warm bath (not over 100° F.) in a quiet, darkened room, and hold
a sponge wrung out of hot water to the throat at intervals of five minutes.
Never give "soothing syrups" or "teething powders".
The "soothing" portion of such preparations is some essential oil, like
aniseed, caraway or dill, and there are often present strong drugs
unsuitable for children. According to the analyses made by the British
Medical Association, the following are the _essential_ ingredients of some
well-known preparations for children:
Mrs. Winslow's Soothing Potassium Bromide,
Syrup. Aniseed, and Syrup
(sugar and water).
Woodward's Gripe Sodium Bicarbonate,
Water. Caraway, and Syrup.
Atkinson and Barker's Pot. and Magnesium
Royal Infant Bicarbonate, several
Preservative. Oils, and Syrup.
Mrs. Johnson's American Spirits of Salt, Common
Soothing Syrup. Salt, and Honey.
Convulsions During Pregnancy. Send for a doctor instantly.
Feigned Epilepsy is an all-too-common "ailment". The false fit, as a rule,
is very much overdone. The face is red from exertion instead of livid from
heart and lung embarrassment, the spasms are too vigorous but not jerky
enough, the skin is hot and dry instead of hot and clammy, the hands may be
clenched, but the thumb will be _outside_ instead of _inside_ the palm,
foam comes in volumes but is unmixed with blood, and the whole thing is
kept up far too long. Almost before a crowd can gather an epileptic seizure
is over, whereas the sham sufferer does not begin seriously to exhibit his
questionable talents until a crowd has appeared.
Pressure on the eye, which will blink while the "sufferer" will swear;
bending back the thumb and pressing in the end of the nail, when the hand
will be withdrawn in feigned but not in true epilepsy; blowing snuff up the
nose, which induces sneezing in the sham fit alone, or using a cold douche
will all expose the miserable trick.
It is, unfortunately, far easier to suggest than to apply these tests, for
anyone foolish enough to try experiments within reach of the wildly-waving
arms will probably get such a buffet as will damp his ardour for amateur
diagnosis for some time.
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