Dr. L.I. Kelnick
THEIR CAUSES, SYMPTOMS, & TREATMENT
ISAAC G. BRIGGS
METHUEN & CO. LTD.
36 ESSEX STREET W.C.
First Published in 1921
IN GKHAT BRITAIN
ALBERT E. WOODRUFF
OF STOKE PRIOR
PREFACE - ix
I. MAJOR AND MINOR EPILEPSY - I
II. RARER TYPES OF EPILEPSY 7
III. GENERAL REMARKS - 15
IV. CAUSES OF EPILEPSY - 20
V. PREVENTION OF ATTACKS - 25
VI. FIRST-AID TO VICTIMS - - 28
VII. NEURASTHENIA - 30
VIII. HYSTERIA - 39
IX. ADVICE TO NEUROPATHS - 46
X. FIRST STEPS TOWARD HEALTH - - 53
XI. DIGESTION - 56
XII. INDIGESTION - 60
XIII. DIETING - 63
XIV. CONSTIPATION - 67
XV. GENERAL HYGIENE - 7!
XVI. SLEEPLESSNESS - - 76
XVII. THE EFFECTS OF IMAGINATION - 79
XVIII. SUGGESTION TREATMENT - 82
XIX. MEDICINES - - - 86
viii EPILEPSY, HYSTERIA, NEURASTHENIA
XX. PATENT MEDICINES - 90
XXI. TRAINING THE NERVOUS CHILD - 98
XXII. DANGERS AT AND AFTER PUBERTY - 109
XXIII. WORK AND PLAY - 115
XXIV. HEREDITY - - - Il8
XXV. CHARACTER - - I2 $
XXVI. MARRIAGE . . j^i
XXVII. SUMMARY . _ J^Q
BIBLIOGRAPHY - - j^
INDEX - - - - 145
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
" 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
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
x EPILEPSY, HYSTERIA, NEURASTHENIA
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.
I. G. BRIGGS
" 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."
MAJOR AND MINOR EPILEPSY
(Grand and Petit Mai)
" 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.
" 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
2 EPILEPSY, HYSTERIA, NEURASTHENIA
oratory or sport, hence the Roman name : morbus
comitialis (crowd sickness).
In mediaeval 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
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,
MAJOR AND MINOR EPILEPSY 3
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 instan-
taneous ; 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
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
4 EPILEPSY, HYSTERIA, NEURASTHENIA
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. Epi-
lepsy 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
MAJOR AND MINOR EPILEPSY 5
Victims of nocturnal epilepsy may not be awakened
by the seizure, but pass into deeper sleep. Inter-
mittent 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
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 con-
vinced he has been ill, to that awful state which terri-
fies 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-
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 uncon-
6 EPILEPSY, HYSTERIA, NEURASTHENIA
scious. 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 inter-
rupted 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 sensa-
tion which he is usually quite unable to describe to
anyone else. The view in front is clear, he under-
stands 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 nal, 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.
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 delibera-
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 sum-
moned. Nearly all victims of severe, confirmed
epilepsy (25 per cent of all epileptics) die in status
Jacksonian Epilepsy, named after Hughlings Jackson,
8 EPILEPSY, HYSTERIA, NEURASTHENIA
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 conscious-
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 convul-
sions become general and bilateral, and the patient
presents exactly the same picture as if the attack were
due to grand mat.
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 develop-
ment of a man's own movements, a sudden and exces-
sive 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
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
RARER TYPES OF EPILEPSY 9
muscles in time may become totally paralysed, wasted,
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
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 embarras-
sing 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
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
10 EPILEPSY, HYSTERIA, NEURASTHENIA
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
Normally, only one set[of ideas (a complex) can hold
RARER TYPES OF EPILEPSY 11
the stage of consciousness at any one time. When
two sets get on the boards together, double-conscious-
ness 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
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
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
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 liberat-
ing memory-prisoners from its own block of cells in
the gaol of the subconscious. The writing often refers
12 EPILEPSY, HYSTERIA, NEURASTHENIA
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 " for-
gotten 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
RARER TYPES OF EPILEPSY 13
surely be excused if he murders a few of his tormentors
Epileptiform Seizures are convulsions due to causes
other than epilepsy, and only a doctor can tell if an
attack be epileptic or not and prescribe appropriate
treatment. To give " patent " medicines for " fits ",
to a man who may be suffering from lead poisoning or
heart disease, is criminal.
Convulsions in Children often occur before or after
some other ailment. Such children need careful train-
ing, but less than 10 per cent of children who have
convulsions become epileptic. Epilepsy should only
be suspected if the first attack occurs in a previously
healthy child of over two years of age. There are many