Epilepsy, Hysteria, and Neurasthenia | Page 3

when they go to sleep during the day.
Victims of nocturnal epilepsy may not be awakened by the seizure, but pass 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 circumstances 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.
PETIT MAL ("_Little Evil_")
This is incomplete grand mal, the starting stages only of a fit, recovery occurring before convulsions.
Petit mal often occurs in people who do not suffer from grand mal, the symptoms consisting of a loss of consciousness for a few seconds, the seizure being so brief that the victim never realizes he has been unconscious. He suddenly stops what he is doing, turns pale, and his eyes become fixed in a glassy stare. He may give a slight jerk, sway, and make some slight sound, smack his lips, try to speak, or moan. He recovers with a start, and is confused, the attack usually being over ere he has had time to fall.
If talking when attacked, he hesitates, stares in an absent-minded manner, and then completes his interrupted sentence, unaware that he has acted strangely. Whatever act he is engaged in is interrupted for a second or two, and then resumed.
A mild type of petit mal consists of a temporary blurring of consciousness, with muscular weakness. The victim drops what he is holding, and is conscious of a strange, extremely unpleasant sensation, a sensation which he is usually quite unable to describe to anyone else. The view in front is clear, he understands what it is--a house here, a tree there, and so on--yet he does not grasp the vista as usual. Other victims have short spells of giddiness, while some are unable to realize "where they are" for a few moments.
Frequent petit mal impairs the intellect more than grand mal, for convulsions calm the patient as a good cry calms hysterical people. After a number of attacks of _petit mal, grand mal_ usually supervenes, and most epileptics suffer from attacks of both types. Some precocious, perverse children are victims of unrecognized petit mal, and when pushed at school run grave risks of developing symptoms of true epilepsy. The "Little Evil" is a serious complaint.
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CHAPTER II
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,