Epilepsy, Hysteria, and Neurasthenia | Page 3

at different times. The cry and the biting of the tongue
may be absent, the first spasm brief, and the convulsions mild. Epilepsy
of all kinds is characterized by an alteration (not necessarily a _loss_)
of consciousness, followed by loss of memory for events that occurred
during the time that alteration of consciousness lasted.
Attacks may occur by day only, by day and by night, or by night only,
though in so-called nocturnal epilepsy, it is sleep and not night that
induces the fit, for night-workers have fits 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.
* * * * *

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