Epilepsy, Hysteria, and Neurasthenia | Page 4

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