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Passing over now without further detail the characteristic physical conditions which are present during the convulsive stage, and which will be found fully described in all systematic treatises on diseases of the nervous system, we come to observe the mental states which immediately succeed the fit. These may present any one of several characters, but in nearly all cases there results a more or less marked derangement of the intellect. Generally there is present a slower mental action than is normal to the individual. The brain is in a condition of torpor, and the ideas which arise into consciousness are in a confused and half formed condition. Replies to questions come slowly and words are imperfectly enunciated. The answer may be correct, and indicate that the inquiry has reached the intellectual centres, and has been interpreted with more or less accuracy, and yet that it has failed to rouse the mind into a full state of consciousness. This dull and semi-appreciative condition may continue for a few hours only, or remain for several days. The period of time appears to bear some relation, in duration, to the severity of the attack. During the early period of this condition of mental hebetude, the patient lies with eyes closed, giving no attention to inquiries addressed to him, and yet may be frequently repeating over some words or the name of some person, while in other cases there may be no indications whatever of brain activity.

Again, instead of this condition of partial mental activity, there may suddenly appear what has been termed the “ epileptic fury.” The patient displays the greatest destructive and reckless violence in his movements. He becomes intensely homicidal or suicidal, and strikes out in every direction, utterly regardless of who or what may be near by and likely to be injured; he may throw himself

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against the walls of his room or out of the window; he may seize and break in pieces every article of furniture in his room on which he can lay hands. Persons who, in the ordinary conditions of the nervous system, are by no means powerful, when in this state become so strong as to require the assistance of several persons to control them. They are very likely to tear their own clothing and that of those who try to control them into shreds; and they may soil their clothes, beds, or rooms, in the most disgusting and filthy manner. While in this state it becomes quite impossible to determine with any degree of accuracy the state of the pulse or the temperature of the body, but the congested state of the vessels of the face and the head, the full and staring look of the eye, indicate an increased quantity of blood in the vessels of the brain.

This epileptic excitement rarely continues longer than a few hours, or at most a few days. The person gradually becomes quiet, and soon passes into his usual state of mental activity, but has little or no definite realization of what he has done while in the state of excitement.

LECTURE XXII.

EPILEPTIC INSANITY (CONCLUDED).
Tendency Toward Dementia-Loss of Memory and Judgment – Case of

Napoleon-Religious Emotions in Epileptics—Amorous Propensities,
Religious Excitement-Dancing Mania-Acts of Great Violence May or
May not be Connected with Convulsions – Two Cases-Homicidal Vio.
lence--Cases—Prognosis— Pathology-Treatment.

The general mental condition of epileptics may be regarded as one tending toward dementia. There have been, and probably are, exceptions to this rule, continuing for a long time. In cases where the convulsions occur but rarely, and with months intervening between them, in consequence of the inoperative state of the exciting cause, the mental impairment will be very inconsiderable, and perhaps not observable by those most familiar with the subjects; but the failure in mental power manifests itself sooner or later and is irremediable. It is especially observable in the faculties of perception, memory, and also the judgment, which depends so largely upon the first two. Moreover, the failure of memory relates not only to what has recently occurred, but extends also to those experiences which have been registered many years. These are recalled at first with some unusual effort, and ultimately seem to utterly fade from the mind, which in its ordinary operations is dull and apathetic. It has been stated that Napoleon was subject to epileptic attacks during or after sexual intercourse. Cæsar is reported to have been an epileptic. If these statements are true it would account for the failure of their intellectual faculties during the latter part of their lives and before they had passed into the senile period. There can be no doubt that Napoleon gave evidence of impairment of perception, rapidity of mental action, and also soundness of judgment during the last years of his reign, and at that period of life when it is common to have a higher intellectual capacity than at twenty-five or thirty years of age. Romberg goes so far as to say that many males are subject to epileptic attacks either during or after coitus. Esquirol also refers to such cases.

Many writers have drawn attention to the fact that religious emotions play a large rôle with epileptics. Dr. James C. Howden, in the Journal of Mental Science for April, 1887, has given several very interesting cases of his own. Some of these persons thought they were commissioned to save the world; others that it was their mission to kill Satan; another that he was the Almighty; and another still that at times he was Christ, and at other times that he was the Devil. While in the epileptic trance they had the experience of visions and revelations which seemed to come to them from Heaven. Dr. Howden states the case of a boy whose mother was an epileptic, who, some time after experiencing a fit, became subject to delusions, which continued for a longer or shorter period, and exhibited strong amorous propensities. Among other delusions he claimed that he was Adam ; that, of course, he could not recall all the particulars connected with his experience while living in the Garden of Eden, but that he partook of the forbidden fruit, and in so doing did as any one else would have done under the circumstances. He claimed that he

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had been in Heaven, and described the scenery there as being quite like that of some parts of Canada. His delusions were always those of a religious type, and often very extravagant. Thinks at times that he is Adam, at others that he is Christ, and again the Devil. He claims that these things have been revealed to him.

Hecker, in referring to the dancing mania of the fourteenth century, says “ that while dancing they neither saw nor heard, being insensible to external impressions through the senses, but were haunted by visions, their fancies conjuring up spirits whose names they shrieked out.” “Others, during the paroxysms, saw the heavens open, and the Saviour enthroned with the Virgin Mary, according as the religious notions of the age were strangely and variously reflected in their imaginations. When the disease was completely developed the attack commenced with epileptic convulsions; those affected fell to the ground senseless, panting and laboring for breath. They foamed at the mouth, and suddenly springing up began their dance amid strange contortions." Religious excitement and tendencies appear to be most frequently associated with the petit mal and to arise when the epilepsy has been produced by some shock to the moral sensibilities of the subject. It is also more frequently attended with hallucinations of sight and hearing, and in some cases with vertigo.

Epileptics not unfrequently exhibit acts of great violence which are not immediately connected with convulsions of either form, and these acts may be the outgrowth of premeditation and careful planning, in consequence of some imaginary insult, or the denial of a request, and, again, from the effects of hallucinations. A marked example of this was the case of the epileptic who murdered the Superintendent of the hospital for the insane at Avignon.

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