DR. E. E. SOUTHARD, Boston: Idiopathic epilepsy as found in Massachusetts
material and estimated from the appearances in the gross anatomy of the
brain occurs in about one of every three cases. There are accordingly more
idiopathic epilepsies than there are idiopathic or "functional" psychoses,
if the data of gross anatomy form a reliable index.
It was a somewhat curious thing that in a series of cases investigated by
Dr. Thom and myself, that the more frequent the attacks of epilepsy the less
there seemed to be to show for them in the autopsied brains. In certain
cases with daily attacks the brains were strictly normal in gross
appearances. It was the frankly organic cases with large focal lesions that
had the occasional attacks. These frankly organic cases rarely had high
frequency attacks.
DR. TOM A. WILLIAMS, Washington, D. C.: Will Dr. Clark explain the eccentric
convulsions such as when there is uraemia, on similar grounds? Also, if he
will postulate in such cases as recover with metabolic treatment. I have
published cases in which recurrent attacks of some years duration were
removed by means which considered only the metebolesia. (See Journal of
Neurology and Psychiatry, March, 1915.)
DR. JOHN T. MACCURDY, New York: I have held the opinion for some years that
the study of epilepsy was going to be of greater psychiatric moment than
that of any other condition. I feel that this promise has been very largely
fulfilled by the work Dr. Clark has been doing for the last two years. We
have found, I think, from that work that we can really shell out what we may
term an epileptic reaction, which is really the most primitive of all
psychiatric reaction. It corresponds to a flight from reality. It is a
return to the subjective phase, which, in the psychoses, is no vague but a
very real thing. In epilepsy we get it in pure culture as a lapse of
consciousness, expressed either in completeness as in a grand mal attack or
partially when consciousness is merely clouded. Sleep probably represents an
analogous condition. We go to sleep to repair the body while psychologically
we are seeking that flight from reality which we all long for. The
convulsion may be a secondary affair, and a physiological sequel to the loss
of consciousness, which is psychologically determined.
L. PIERCE CLARK: For the time being I am anxious to limit my remarks to the
mechanism of ESSENTIAL epilepsy, and, not to convulsive disorders in
general, however closely allied to idiopathic epilepsy. At some future time
I hope to take up the epileptoid convulsions and show their relationship and
variation from that of the mechanism of essential epilepsy. I may say,
however, that I have some data already at hand in which certain types of
epileptic phenomena connected with infantile cerebral hemiplegia would show
that the so-called epileptic constitution is much less marked in these
cases, but is present, however, to a certain degree. As has been well known
for a number of years and commented upon by such observers as Gowers,
Jackson and Binswanger, the so-called hemiplegic epilepsies sooner or later
develop the epileptic alteration in a character analogous to that seen in
idiopathic epilepsy. I hope to show that the main roots of the so-called
epileptic alteration in general necessarily lie in the primary make-up of
such individuals, and that the seizure phenomena of epilepsy only intensify
and make more marked the fundamental make-up when the disease has definitely
fastened itself upon the individual. My next paper on this whole subject
will attempt to show more conclusively that the epileptic seizures are but
an unfoldment of that which has already been existent in the biological
make-up of the individual epileptic.
DR. TRIGANT BURROW, Baltimore, Md., read a paper entitled "Material
Illustrative of the 'principle of Primary Identification.' "[*]
[*] Reserved for publication.