Major And Minor Epilepsy

(_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.

       *       *       *       *       *

  “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
hours.

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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