possible causes for infantile convulsions, and but one
treatment ; call in a doctor at once, and, while waiting
for him, put the child in a warm bath (not over 100 F.)
in a quiet, darkened room, and hold a sponge wrung out
of hot water to the throat at intervals of five minutes.
Never give " soothing syrups " or " teething powders ".
The " soothing " portion of such preparations is
some essential oil, like aniseed, caraway or dill, and
there are often present strong drugs unsuitable for
children. According to the analyses made by the
British Medical Association, the following are the
essential ingredients of some well-known preparations
for children :
Mrs. Winslow's Soothing Potassium Bromide,
Syrup. Aniseed, and Syrup
(sugar and water).
Woodward's Gripe Sodium Bicarbonate,
Water. Caraway, and Syrup.
Atkinson and Barker's Pot. and Magnesium
Royal Infant Pre- Bicarbonate, several
servative. Oils, and Syrup.
Mrs. Johnson's American Spirits of Salt, Common
Soothing Syrup. Salt, and Honey.
14 EPILEPSY, HYSTERIA, NEURASTHENIA
Convulsions During Pregnancy. Send for a doctor
Feigned Epilepsy is an all-too-common " ailment ".
The false fit, as a rule, is very much overdone. The
face is red from exertion instead of livid from heart
and lung embarrassment, the spasms are too vigorous
but not jerky enough, the skin is hot and dry instead
of hot and clammy, the hands may be clenched, but
the thumb will be outside instead of inside the palm,
foam comes in volumes but is unmixed with blood,
and the whole thing is kept up far too long. Almost
before a crowd can gather an epileptic seizure is over,
whereas the sham sufferer does not begin seriously to
exhibit his questionable talents until a crowd has
Pressure on the eye, which will blink while the
" sufferer " will swear ; bending back the thumb and
pressing in the end of the nail, when the hand will be
withdrawn in feigned but not in true epilepsy ; blow-
ing snuff up the nose, which induces sneezing in the
sham fit alone, or using a cold douche will all expose
the miserable trick.
It is, unfortunately, far easier to suggest than to
apply these tests, for anyone foolish enough to try
experiments within reach of the wildly-waving arms
will probably get such a buffet as will damp his ardour
for amateur diagnosis for some time.
Do not muse at me, my most worthy friends ;
I have a strange infirmity, which is nothing
To those that know me."
" Macbeth," Act III.
TARR'S table shows that combinations of
all types of epilepsy are possible, and that
mental epilepsy is rare :
Grand mal - - 1150 Grand mal and
Grand and petit mal 589 mental 3
Petit mal - 179 Grand mal, petit mal
Jacksonian - - 37 and mental- 6
Mental - 16 Petit mal and mental 2
Grand mal and Fits by day only - 660
Jacksonian - 10 Fits day and night - 880
Grand mal, petit mal Fits by night only - 380
and Jacksonian - 8
The majority of victims have attacks both by day
and by night. Of 115,000 seizures tabulated by Clark,
55,000 occurred during the day (6 a.m. to 6 p.m.) and
60,000 by night.
The usual course of a case of epilepsy is somewhat
as follows : the disease begins in childhood, the first
convulsion, about the age of three, being followed some
twelve months later by a second, and this again by a
third within a few months. Then attacks occur more
frequently until a regular periodicity from one a day
to one a year is reached after about five years, and
this frequently persists throughout life.
16 EPILEPSY, HYSTERIA, NEURASTHENIA
The effect of epilepsy on the general health is not
serious, but it has a more serious effect on the mind,
for epileptic children cannot go to school (though
special schools are now doing something towards
removing this serious disability), and grow up with an
imperfect mental training. They become moody,
fretful, ill-tempered, unmanageable, and at puberty
fall victims to self -abuse, which helps to lead to
neurasthenia. Then they may drift slowly into a
state of mental weakness, and often require as much
care as imbeciles. If the fits are severe from an early
age, arrest of mental development and imbecility
follow. If the disease be very mild in character, and
especially if it be petit mal, the victim may be very
precocious, get " pushed " at school, and later become
eccentric or insane.
Adult victims necessarily lead a semi-invalid life,
often cut off from wholesome work and from the
pleasures of life, and become hypersensitive, timid,
impulsive, forgetful, irritable, incapable of concentra-
tion, suspicious, show evidences of a weakened mind,
have few interests, and are difficult to manage.
About 10 per cent the very severe cases go on to
insanity ; either temporary attacks of mania, calling
for restraint, or permanent epileptic dementia with
progressive loss of mind. Some victims are accident-
ally killed in, or die as a result of a fit ; about 25 per
cent severe cases again die in status epilepticus,
but the majority after being sufferers throughout life
are finally carried off by some other disease.
There are many exceptions to this general course.
Some patients have attacks very infrequently, and
are possessed of brilliant talent, though apt to be
eccentric. Others may have a number of seizures in
youth, and then " outgrow " the complaint.
A few victims are attacked only after excessive
alcoholic or sexual indulgence, some women only during
GENERAL REMARKS 17
their menses, while other women are free from attacks
during pregnancy, which state, however (contrary to
popular belief), commonly aggravates the trouble.
Victims may be free from attacks during the duration
of, and for some time after, an infectious disease ;
while Spratling says that a consumptive epileptic may
have no fits for months, or even years.
Some epileptics are normal in appearance, but many
show signs of degeneration. This is common in the
insane, but less frequent and pronounced in neuras-
thenics. An abnormal shape of the head or curvature
of the skull, a high, arched palate, peculiarly-shaped
ears, unusually large hands and feet, irregular teeth
from narrow jaws, a small mouth, unequal length and
size of the limbs, a projecting occiput, and poor
physical development may be noted.
These are most pronounced in intractable cases,
in whom mental peculiarities are most frequently seen
either dullness, stupidity and ungovernable temper,
or very marked talent in one direction with as marked
an incapacity in others. In all epileptics, the pupils
of the eye are larger than normal, and, after contracting
to bright light soon enlarge again.
The facial expression of most epileptics indicates
abnormal mentality. When the seizures have been so
frequent and severe as to cause mental decay, the
actions are awkward, and the gait slouching and
irregular. Progressive poor memory is one of the
first signs of intellectual damage consequent upon
Though the disease may occur at any age, most
cases occur before the age of twenty, there being good
reason to look for other causes (often syphilis) in cases
which occur after that age. Of 1,450 of Gowers' cases,
30 per cent commenced before the age of ten ; 75 per
cent before twenty. In Starr's 2,000 cases, 68 per
cent commenced before the patient was twenty-one.
18 EPILEPSY, HYSTERIA, NEURASTHENIA
According to Turner, the first epoch is from birth
to the age of six, during which 25 per cent of all cases
commence, usually associated with mental backward-
ness, and some due to organic brain trouble. The
second epoch is ten to twenty-two, the time of puberty
and adolescence, during which time no less than 54
per cent of all cases commence. This is, par excellence,
the age of onset of genuine epilepsy, the mean age of
maximum onset being fourteen in men and sixteen in
women. The remaining 21 per cent of cases occur
after the age of twenty-two.
In 430 cases of epilepsy in children, Osier found that
230 were attacked before they reached the age of five,
100 between five and ten, and 100 between ten and
Epilepsy, then, is a disease of early youth, coming
on when the development and growth of the nervous
and reproductive systems is taking place. During
this period, causes, insignificant for stable people,
may light up the disease in those of unstable, nervous
constitution, a fact which explains the importance of
training the child.
Both sexes are attacked. If we consider only cases
of true idiopathic epilepsy female patients are probably
in excess, but in epilepsy in adults, from all causes,
males predominate. In females, the menopause may
arrest the disease.
In days gone by, epilepsy more rarely commenced
after the age of twenty, but in these days of nerve
stress it commences more frequently than formerly
in people of mature age. A victim who has a fit for
the first time after the age of twenty, however, should
consult a nerve specialist immediately.
In its early stages there are no changes of the brain
due to, or the cause of, epilepsy, but in long-standing,
severe cases, well-marked, morbid changes may be
found. These are the effects, not the cause, of the
GENERAL REMARKS 19
disease, and they vary in intensity according to the
manner of death and the length and severity of the
malady. They probably cause the mental decay and
slouching gait mentioned before.
Fits may suddenly cease for a long time, but they
usually recur, and most patients have them more or
less regularly through life.
The fact that recovery is rare should not be hidden
from patients and friends. Perhaps 8 per cent of all
classes recover and " recovery " may only be a long
interval but 4 per cent of these are Jacksonian,
syphilitic or accident cases. Only one victim in every
thirty recovers from true epilepsy ; and these are very
mild cases, in which the fits are infrequent, there is
no mental impairment, and bromides are well borne.
The earlier the onset, the more severe and frequent
the attacks, the deeper the coma, and the worse the
mental decay, the poorer the outlook.
Cure is exceptional, but by vigorous treatment the
severity of the malady may be much abated. Petit
mat is no more hopeful than grand, mal ; less so in cases
with severe giddiness ; in all cases, the better 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 accom-
panied 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.
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, con-
sisting of nerve strands, which act as lines of communi-
cation 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
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 ; other-
wise 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.
CAUSES OF EPILEPSY 21
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
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
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
Alcoholism is a strong secondary factor, fits often
22 EPILEPSY, HYSTERIA, NEURASTHENIA
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
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
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 com-
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
the menses seems to be a secondary or exciting
Exciting Causes aggravate the trouble when present,
causing more frequent and severe seizures. The chief
are irritation of stomach and bowels (from decaying
teeth, unchewed, unsuitable, or indigestible food,
constipation, or diarrhoea), exhaustion, work
immediately after a meal, passion or excitement, fright,
CAUSES OF EPILEPSY 23
worry, mental work, alcoholism, sexual excess, nasal
growths, eye-strain ; in short, anything that irritates
brain or body.
Theories as to Cause. Epilepsy is usually classed as
a functional disorder ; that is, the brain cells are
physically normal, but, for some unknown reason,
they act abnormally at certain times. This term is a
very loose one, and there is reason to believe that
the basis of epilepsy is some obscure disease of
the brain which has not been detected by present
The new school of psychologists regard the malady
as a mental complex a system of ideas strongly
influenced by the emotions the convulsions being
but minor symptoms.
Fits are most frequent between 9-10 p.m. the hours
of deepest repose. One school says this is due to
anaemia of the brain during sleep. Clark traces the
cause to lessened inhibitory powers owing to the higher
brain centres being at rest, while Haig claims to have
explained the high incidence at this hour by the fact
that uric acid is present in the system in the greatest
amount at this time.
Some doctors have thought, on the contrary, that
excess of blood in the head was the cause, but results
of treatment so directed did not bear out the sanguine
hopes built on the theory.
The fact that convulsions occur in diabetes and
alcoholism, suggested that epilepsy was due to poisons
circulating in the blood, and thus irritating the brain.
Every act uses up cell material and leaves waste
products, exactly as the production of steam uses up
coal and leaves ashes. Various waste products have
been found in more than normal quantities in the blood
of epileptics, but it is uncertain whether accumulation
of waste products causes the seizure.
A convincing theory must satisfactorily account for
24 EPILEPSY, HYSTERIA, NEURASTHENIA
all the widely diverse phenomena seen in epilepsy,
and the problem must remain largely a matter of
speculation, until research work has given us a far
deeper insight into the biochemistry of both the
brain cells, and the germ-plasm than we have at
PREVENTION OF ATTACKS
In health matters, prevention is nine points of the law.
SOME patients are obsessed by a peculiar
sensation (the " aura ") just before a fit.
This warning takes many forms, the two most
common being a " sinking " or feeling of distress in
the stomach, and giddiness. The character of the
aura is very variable terror, excitement, numbness,
tingling, irritability, twitching, a feeling of something
passing up from the toes to the head, delusions of sight,
smell, taste, or hearing (ringing, or buzzing, etc.),
palpitation, throbbing in the head, an impulse to run
or spin around any of these may warn a victim that
a fit is at hand. Some patients " lose themselves "
and make curious mistakes in talking.
The warning is nearly always the same each time
with the same patient, and is more common in mild
than in severe cases. Rarely, the attack does not go
beyond this stage.
When the patient becomes conscious of the aura
he should sit in a large chair, or lie down on the floor,
well away from fire, and from anything that can be
capsized. He must never try to go upstairs to bed.
Some one should draw the blind, as light is irritating.
If the warning lasts some minutes, the patient should
carry with him, a bottle of uncoated one-hundredth-
grain tabloids of
Nitroglycerin, replacing the screw cap with a cork,
so that they can quickly be extracted. When the
26 EPILEPSY, HYSTERIA, NEURASTHENIA
warning occurs, one or two should be taken, and
the head bent forward. The arteries are dilated, the
blood-pressure thus lowered, and the attack may
The use of nitroglycerin is based on the theory that
seizures are caused by anaemia due to vasomotor
constriction. Success is only occasional, but this is
so welcome as to justify the habitual use of the
If the aura be brief, buy a few " pearls " of
Amyl Nitrite, crush one in your handkerchief, and sniff
the vapour. This has the same affect as nitroglycerin,
but the action occurs in 15 seconds and only persists
7 minutes. A headache occasionally follows the use
of these drugs, and they should not be employed
without professional advice.
When the warning is felt in the hand or foot, a strap
should be worn round the ankle or wrist, and pulled
tight when the aura commences. This sometimes
aborts a fit, as biting a finger in which the aura com-
mences may also do.
If a victim feels unwell after a meal, he must never
eat the next meal at the usual time, simply because it
is the usual time.
Should a patient feel unwell between, say, dinner
and tea, instead of eating his tea he must empty his
bowels by an enema, or croton oil (see chemist), and
his stomach by drinking a pint of warm water in which
has been stirred a tablespoonful of mustard powder
and a teaspoonful of salt. After vomiting, drink warm
Never attempt to empty the stomach at the onset of a
definite aura, for if the seizure occurs, the vomit will
probably obstruct the trachea, and suffocate the victim.
After the stomach has been empty ten minutes, the
patient should take a double dose of bromides (Chapter
XIX) and go to bed. Next morning he will be well,
PREVENTION OF ATTACKS 27
whereas if he eats but a single piece of bread-and-butter
he will probably have a fit within five minutes.
Unfortunately, in 60 per cent of cases, there is no
warning at all, while in those cases which do exhibit
an aura, the measures mentioned above more often
fail than succeed.
FIRST-AID TO VICTIMS
" First-aid is the assistance which can be given in case of
emergency by those who, with certain easily acquired know-
ledge are in a position, not only to relieve the sufferer, but
also to prevent further mischief being done pending the
arrival of a doctor."
J^JEVER try to cut short a fit. Placing
l\l smelling-salts beneath the nose, together
* * with all other remedies for people who have
" fainted ", are useless in epilepsy.
Lay the patient on his back, with head slightly
raised ; admit air freely ; remove scarf or collar and
tie, unfasten waistcoat, shirt, stays or other tight
garments, and if it be known or observed that the victim
wears artificial teeth, remove them.
If five people are at hand, let two persons grasp each
a leg of the victim, holding it above the ankle and above
the knee ; two others should each hold a hand and the
shoulder ; the fifth supports the head. Do not kneel
opposite the feet or you may receive a severe kick.
Prevent the limbs from striking the floor, but allow
them full play. If the victim rolls on his face gently
turn him on his back.
Roll a large handkerchief up from the side (not diagon-
ally) and holding one end firmly, tie a knot in the other
end, and place it between the teeth to protect the
tongue ; or slide the handle of a spoon or a piece of
smooth wood between the teeth, and thus hold the
tongue down. Soft articles like cork and indiarubber
FIRST-AID TO VICTIMS 29
should not be used, for if they are bitten through, the
rear portion will fall down the throat and choke the
After the fit, lower the head to one side to clear
any vomitus which, if left, might be drawn into the
windpipe, lift the patient on to a couch, cover him
warmly, and let him sleep. An epileptic's bed should
be placed on the ground floor ; if his bed be upstairs,
it is difficult to get him there after an attack, while
he may at any time fall downstairs and be killed.
Any effort to rouse him will only make the post-
epileptic stupor more severe, but whether he sleeps or
not, he must carefully be watched, for patients in this
state are apt to slip away, often half -clothed, and travel
towards nowhere in particular at a wonderfully rapid
If several fits follow one another, or if one is very
long or severe, send for a doctor.
When a seizure occurs in public, a constable should
be summoned, who, being a " St. John " man, will be
of far more use than bystanders brimming over with
sympathy and ignorance. If some kindly house-
holder near by will allow the victim to sleep for an
hour or two a boon usually denied more from fear
of recurrence than lack of sympathy, it is better than
taking him home. If not, let someone call a cab, and
deliver the victim safely to his friends.
Every epileptic should carry always with him a card
stating his full name and address, with a request that
some one present at any seizure will escort him home.
If the victim wakes with a headache, give him a
lo-grain Aspirin powder, or a 5-grain Phenalgin
tablet ; never patent " cures " .
If possible, the patient should lie abed the day after
a fit, undisturbed, taking only soda-and-milk and eggs
beaten up in hot milk.