Читать книгу Epilepsy, Hysteria, and Neurasthenia: Their Causes, Symptoms, & Treatment - Isaac George Briggs - Страница 6

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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.

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 training, 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 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 Syrup.	Potassium Bromide, Aniseed, and Syrup (sugar and water).
Woodward's Gripe Water.	Sodium Bicarbonate, Caraway, and Syrup.
Atkinson and Barker's Royal Infant Preservative.	Pot. and Magnesium Bicarbonate, several Oils, and Syrup.
Mrs. Johnson's American Soothing Syrup.	Spirits of Salt, Common Salt, and Honey.

Convulsions During Pregnancy. Send for a doctor instantly.

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 appeared.

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; blowing 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.

CHAPTER III