Epilepsy, Hysteria, and Neurasthenia | Page 8

the physical condition and digestive powers of the patient, the brighter the outlook.
To sum up, epilepsy is a chronic abnormality of the higher nervous system, characterized by periodic attacks of alteration of consciousness, often accompanied by spasms of varying violence, affecting primarily the brain and secondarily the body, based on an abnormal readiness for action of the motor cells, occurring in persons with congenital nerve weakness, and leading to mental decay of various types and degrees of severity.
* * * * *

CHAPTER IV
CAUSES OF EPILEPSY
"Find out the cause of this effect, Or rather say, the cause of this defect, For this effect defective comes by cause." "Hamlet," Act II.
THE MECHANISM OF THE FIT
The brain consists of cells of grey matter, grouped together to form centres for thought, action or sensation, and white matter, consisting of nerve strands, which act as lines of communication between different parts of brain and body. The wrinkled surface (_cortex_) of the brain, is covered with grey matter, which dips into the fissures. There are also islands of grey matter embedded in the white.
The front part of the brain is supposed, with some probability, to be the seat of intelligence, while a ribbon three inches wide stretched over the head from ear to ear would roughly cover the Rolandic area, in which are contained the motor cells through which impulse is translated to action. These motor cells are controlled by inhibitory cells, which act as brakes and release nerve energy in a gentle stream; otherwise our movements would be convulsive in their violence, and life would be impossible through inability usefully to direct our energy.
That is how inhibition acts physically; mentally it is the power to restrain impulses until reason has suggested the wisest course.
Irritation of the cortex, especially the motor area, causes convulsions, and experiment has shown that epilepsy may be due to a disease or instability of certain inhibitory cells of the cortex. The motor cells of epileptics are restrained, with some difficulty, by these cells in normal times. When irritation from any cause throws additional strain on the motor cells, the defective brakes fail, and the uncontrolled energy, instead of flowing in a gentle stream through the usual channels, bursts forth in a tidal wave through other areas of the brain, causes unconsciousness, and exhausts itself in those violent convulsions of the limbs which we term a fit.
The Primary Cause of epilepsy is an inherent instability of the nervous system.
Secondary Causes are factors which cause the first fit in a person with predisposing nervous instability; later, the brain gets the fit habit, and attacks recur independently of the secondary cause. In most cases no secondary causes can be discovered, and the disease is then termed idiopathic, for want of an explanation.
Injuries to the brain may cause epilepsy, and many cases date from birth, a difficult labour having caused a minute injury to the brain.
Some accident is often wrongly alleged as the cause of fits, for most victims come of a bad stock, and when the first fit occurs, their relatives recollect an injury or a fright in the past, which is said to be the cause.
Great fright may cause epilepsy, as in the case of a nervous girl whose brother entered her room, covered with a sheet, as a "ghost", a "joke" that was followed by a fit within an hour.
Sunstroke may cause fits, and a few cases follow infectious diseases.
Alcoholism is a strong secondary factor, fits often occurring during a drinking-bout and in topers, but in many cases, drunkenness, instead of being the cause, is only the result of a lack of self-control following epilepsy.
Pregnancy may be a secondary cause of the malady: it may lead to more frequent and severe seizures in women who are already victims; bring on a recurrence of the malady after it has apparently been cured; or, very rarely, induce a temporary or permanent cure.
Epilepsy may be due to abortives. These drugs wreck the constitution 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