Isaac G. Briggs.

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_First Published in 1921_

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I hope this book will meet a real need, for when one considers how
prevalent epilepsy, hysteria and neurasthenia are, among all ranks and ages
of both sexes, it seems remarkable some such popular book was not written
long ago.

I add nothing to our knowledge of these ills, my object being to put what
we know into simple words, and to insist on the necessity for personal
discipline being allied to expert aid. The book aims at helping, not
ousting, the doctor, who may find it of use in getting his patient to
see - and to act on - the obvious.

"Nervous Disease", as here used, includes only the three diseases treated
of; "Neuropath" - victims of them.

"Advice" to a neuropath is usually a very depressing decalogue of "Thou
Shalt Nots!" If it be made clear _why_ he must _not_ do so-and-so, the
patient endeavours to obey; peremptorily ordered to obey, he rebels. Much
sound advice is wasted for lack of an interesting, convincing, "Reason
Why!" which would ensure the hearty and very helpful co-operation of a
patient who had been taught that writing prescriptions is not the limit of
a doctor's activities.

Many folk, with touching belief in his own claims, regard the quack as a
hoary-headed sage, who from disinterested motives devotes his life to
curing ailments, by methods of which he alone has the secret, at low fees.
To fight this dangerous idea I have tried to show in an interesting way how
science deals with nerve ills, and to prove that qualified aid is needed.
Suggestions and criticisms will be welcomed.

_June_, 1921

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"Lette than clerkes enditen in Latin, for they have the propertie of
science, and the knowing in that facultie: and lette Frenchmen in their
Frenche also enditen their queinte termes, for it is kyndely to their
mouthes; and let us showe our fantasies in soche wordes as we lerneden of
our dames tongue."

- Chaucer.

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(_Grand and Petit Mal_)

"My son is sore vexed, for ofttimes he falleth into the fire, and ofttimes
into the water." - Matthew xvii, 15.

"Oft, too, some wretch before our startled sight,
Struck as with lightning with some keen disease,
Drops sudden: By the dread attack o'erpowered
He foams, he groans, he trembles, and he faints;
Now rigid, now convuls'd, his labouring lungs
Heave quick, and quivers each exhausted limb.

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"He raves, since Soul and Spirit are alike
Disturbed throughout, and severed each from each
As urged above, distracted by the bane;
But when at length the morbid cause declines,
And the fermenting humours from the heart
Flow back - with staggering foot first treads
Led gradual on to intellect and strength." - Lucretius.

Epilepsy, or "Falling Sickness", is a chronic abnormality of the nervous
system, evinced by attacks of _alteration of consciousness_, usually
accompanied by convulsions.

It attacks men of every race, as well as domesticated animals, and has been
known since the earliest times, the ancients imputing it to demons, the
anger of the gods, or a blow from a star.

It often attacks men in crowds, when excited by oratory or sport, hence the
Roman name: _morbus comitialis_ (crowd sickness).

In mediæval times, sufferers were regarded with awe, as being possessed by
a spirit. Witch doctors among savages, and founders and expounders of
differing creeds among more civilized peoples, have taken advantage of this
infirmity to claim divine inspiration, and the power of "seeing visions"
and prophesying.

Epilepsy has always interested medical men because of its frequency, the
difficulty of tracing its cause, and its obstinacy to treatment, while it
has appealed to popular imagination by the appalling picture of bodily
overthrow it presents, so that many gross superstitions have grown up
around it.

The description in Mark ix. 17-29, is interesting:

"Master, I have brought Thee my son, which hath a dumb spirit. And
wheresoever he taketh him, he teareth him: and he foameth, and gnasheth
with his teeth, and pineth away: ... straightway the spirit tare him;
and he fell on the ground, and wallowed foaming.

"And He asked his father, How long is it ago since this came unto him?
And he said, Of a child. And ofttimes it hath cast him into the fire,
and into the waters, to destroy him.

"And he said unto them, This kind can come forth by nothing, but by
prayer and fasting."

Up to the present, epilepsy can be ascribed to no specific disease of the
brain, the symptoms being due to some morbid disturbance in its action.
Epilepsy is a "functional" disease.

GRAND MAL ("_Great Evil_")

An unusual feeling called an _aura_ (Latin - vapour), sometimes warns a
patient of an impending fit, commonly lasting long enough to permit him to
sit or lie down. This is followed by giddiness, a roaring in the ears, or
some unusual sensation, and merciful unconsciousness. In many cases this
stage is instantaneous; in others it lasts some seconds - but an eternity to
the sufferer. This stage is all that victims can recall (and this only
after painful effort) of an attack.

As unconsciousness supervenes, the patient becomes pale, and gives a cry,
which varies from a low moan to a loud, inhuman shriek. The head and eyes
turn to one side, or up or down, the pupils of the eyes enlarge and become
fixed in a set stare, and the patient drops as if shot, making no effort to
guard his fall, being often slightly and sometimes severely injured.

The whole body then becomes stiff. The hands are clenched, with thumbs
inside the palms, the legs are extended, the arms stiffly bent, and the
head thrown back, or twisted to one side. The muscles of the chest and
heart are impeded in their action, breathing ceases, the heart is slowed,
and the face becomes pale, and then a livid, dusky blue.

The skin is cold and clammy, the eyebrows knit; the tongue may be
protruded, and bitten between the teeth. The eyeballs seem starting from
their sockets, the eyes are fixed or turned up, so that only the sclerotic
("whites") can be seen, and they may be touched or pressed without causing
blinking. The stomach, bladder, and bowels may involuntarily be emptied.

This _tonic_ stage only lasts a few seconds, and is followed by
convulsions. The head turns from side to side, the jaws snap, the eyes
roll, saliva and blood mingle as foam on the lips, the face is contorted in
frightful grimaces, the arms and legs are twisted and jerked about, the
breathing is deep and irregular, the whole body writhes violently, and is
bathed in sweat.

The spasms become gradually less severe, and finally cease. Deep breathing
continues for some seconds; then the victim becomes semi-conscious, looks
around bewildered, and sinks into coma or deep sleep.

"...As one that falls,
He knows not how, by force demoniac dragg'd
To earth, and through obstruction fettering up
In chains invisible the powers of Man;
Who, risen from his trance, gazeth around
Bewilder'd with the monstrous agony
He hath indured, and, wildly staring, sighs:

In a few hours he wakes, with headache and mental confusion, not knowing he
has been ill until told, and having no recollection of events just
preceding the seizure, until reminded of them when they are slowly, and
with painful effort, brought to mind. He is exhausted, and often vomits. In
severe cases he may be deaf, dumb, blind, or paralysed for some hours,
while purple spots (the result of internal hemorrhage) may appear on the
head and neck. Victims often pass large quantities of colourless urine
after an attack, and, as a rule, are quite well again within twenty-four

This is the usual type, but seizures vary in different patients, and in the
same sufferer 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.

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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, 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 psycho-analysis.

Our subconscious mind does not let the past jar with the present, for life
would be made bitter by the eternal vivid recollection of incidents best
forgotten. Every set of ideas, as it is done with, is locked up separately
in the dungeons of subconsciousness, and these imprisoned ideas form the
basis of memory. _Nothing is ever forgotten_, though we may never again
"remember" it this side the grave.

In a few cases we can unlock the cell-door and release the prisoner - we
"remember"; in some, we mislay the key for awhile; in many, the wards of
the lock have rusted, and we cannot open the door although we have the
key - we "forget"; finally, our prisoner may pick the lock, and make us
attend to him whether we wish to or not - something "strikes us".

Normally, only one set of ideas (a complex) can hold the stage of
consciousness at any one time. When two sets get on the boards together,
double-consciousness occurs, but even then they cannot try to shout each
other down; one set plays "leading lady", the other set the "chorus belle"
and so life is rendered bearable.

This "dissociation of consciousness" occurs in all of us. A skilled pianist
plays a piece "automatically" while talking to a friend; we often read a
book and think of other things at the same time: our full attention is
devoted to neither action; neither is done perfectly, yet both are done
sufficiently well to escape comment.

Day-dreaming is dissociation carried further. "Leading lady" and "chorus
belle" change places for a while - imaginary success keeps us from worrying
about real failure. Dissociation, day-dreaming, and mental epilepsy are but
few of the many milestones on a road, the end of which is insanity, or
complete and permanent dissociation, instead of the partial and fleeting
dissociation from which we all suffer. The lunatic never "comes to", but in
a world of dreams dissociates himself forever from realities he is not
mentally strong enough to face.

The writing of "spirits" through a "medium" is an example of dissociation,
and though shown at its best in neuropaths, is common enough in normal men,
as can be proved by anyone with a planchette and some patience.

If the experimenter puts his hands on the toy, and a friend talks to him,
while another whispers questions, he may write more or less coherent
answers, though all the time he goes on talking, and does not know what his
hand is writing. His mind is split into two smaller minds, each ignorant of
the other, each busily liberating memory-prisoners from its own block of
cells in the gaol of the subconscious. The writing often refers to
long-forgotten incidents, the experiment sometimes being of real use in
cases of lost memory.

Dreams are dissociations in sleep, while the scenes conjured up by
crystal-gazing are only waking dreams, in which the dissociation is caused
by gazing at a bright surface and so tiring the brain centres, whereupon
impressions of past life emerge from the subconscious, to surprise, not
only the onlookers to whom they are related, but also the gazer herself,
who has long "forgotten them".

It is childish to attach supernatural significance to either dreams or
crystal-gazing, both of which mirror, not the future, but only the past,
the subject's own past.

It is noteworthy that women dream more frequently and vividly than men.
When a dreamer has few worries, he usually dreams but forgets his dream on
waking; when greatly worried, he often carries his problems to bed with
him, and recent "representative dreams" are merely unprofitable overtime
work done by the brain. Occasionally, dreams have a purely physical basis
as when palpitation becomes transformed in a dream into a scene wherein a
horse is struggling violently, or where an uncovered foot originates a
dream of polar-exploration; in this latter type the dream is protective, in
that it is an effort to side-track some irritation without breaking sleep.

Since Freud has traced a sex-basis in all our dreams, many worthy people
have been much worried about the things they see or do in dreams. Let them
remember that virtue is not an inability to conceive of misconduct, so much
as the determination to refrain from it, and it may well be that the
centres which so determinedly inhibit sexual or unsocial thoughts in the
day, are tired by the very vigour of their resistance, and so in sleep
allow the thoughts they have so stoutly opposed when waking to slip by. The
man who is long-suffering and slow to wrath when awake, may surely be
excused if he murders a few of his tormentors during sleep.

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