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Falling Sickness - Epilepsy.Symptoms,- In the majority of cases a paroxysm occurs without any warning symptom ; in others there is a certain amount of premonition. This warning usually consists in sensations which the patient describes somewhat vaguely, the descriptions varying considerably in different cases. In many there is headache, dizziness, ringing in the ears, irritability of temper and specks floating before the eyes before the attack. These sensations may be felt even a day or two before the convulsion occurs. In many there is no warning symptom until a few minutes before the fit begins. In these cases there is a feeling of tingling or pain in one of the fingers or toes ; sometimes this feeling is first experienced at the pit of the stomach. This feeling or tingling seems to rise through the body and up into the throat, when the patient falls unconscious. In other cases the patient describes the feeling as if a ball were rising from the stomach into the throat. Yet, in majority of cases, there is no sensation of this sort ; when the patient least expects it, perhaps when sitting quietly, or walking along the street, he suddenly utters a loud piercing cry, and falls unconscious. This shriek is loud, short, and from its unnatural character and suddenness, seems terrific. At the same time the face becomes extremely pale. So soon as the patient falls the convulsive movements begin. In some cases these movements seem to begin before the body falls to the ground ; in this case violent and aimless jerking movements of the arms are observed, or the head is drawn around towards one of the shoulders. In the majority of cases the first intimation is the pallor of the face, followed almost instantly by the scream, the fall, and the convulsive movements. The person usually falls forward on the face, often injuring the head and face severely. Indeed, one of the greatest dangers of epilepsy is the possibility of serious, or even fatal injury from the falls, since individuals have been known to drop onto heated stoves, into an open fireplace, or to scald them selves fatally with boiling water. The onset of the attack is so sudden and unexpected in most instances, that the patient is utterly powerless to avoid injury, if circumstances permit it. At first the entire body assumes a condition of extreme rigidity, the muscles of the head, trunk, arms and legs seem all strained to the uttermost, the body being bent sometimes in one direction, sometimes in another, but always as stiff as iron. Meanwhile the breathing is arrested, the face becomes swollen and purple ; saliva issues from the mouth, often tinged with blood from injuries received by the tongue. It occasionally happens that the tongue is caught between the teeth and deeply lacerated as the jaws close upon it. This state of rigidity lasts only from a few seconds to half a minute, and is followed by violent movements, which may involve the whole body, or may be limited to the extremities or to the head. The face is terribly distorted, the jaw opens and closes convulsively, deep violent efforts at respiration are made, the patient's body is often thrown violently from side to side, sometimes sustaining severe bruises ; sometimes, indeed, bones are dislocated, or even broken from the violence of the movements. These convulsive movements last not more than two to four minutes ; their violence then decreases, the respiration becomes more nearly natural, the face becomes less livid, and finally the patient draws a deep sigh, and the paroxysm is ended. The consciousness may be now regained at once ; the patient, however, is not aware of what has happened. He experiences a sense of fatigue, and usually falls into a heavy sleep. In most cases, however, the individual remains unconscious for some time, even half an hour after the convulsions have ceased ; during this time his breathing is heavy and labored, and his lips are puffed out during expira tion. At times the patient passes from this state into one of delirium, talking incoherently, and even becoming maniacal. This, however, is but transient, the patient finally recovering consciousness completely. He appears confused and bewildered by his own condition, and is at a loss to understand how it came to pass. After the individual has long been subject to these attacks he becomes accustomed to the situation and manifests less surprise. In most cases but one fit occurs at a time, the patient recover ing consciousness completely. In other instances a second par oxysm occurs before the patient has recovered from the first ; in fact, several fits may follow one another in rapid succession. The paroxysms of epilepsy are sure to return after the patient has had one. The intervals that elapse after the first vary extremely. Sometimes months may elapse between the first and sec ond ; in these cases the intervals become shorter as time passes. In other cases the paroxysms occur at short intervals even from the first, and, after a few months, they may recur every day, or even several times a day. In some instances the fits come on at regular intervals. In females, the paroxysms at times occur regularly with the menstrual periods. The general course of the disease is that the fits recur at constantly decreasing intervals ; in other cases, however, the intervals become longer after a time, so that the disease seems to be wearing itself out. Yet spontaneous recovery does not occur, since sooner or later the paroxysms recur, usually with the same frequency as before. The greatest diversity prevails as to the intervals which may elapse in different cases. In some instances a year or more transpires ; while in others, fifty or one hundred paroxysms occur in twenty-four hours. Dr. Flint mentions a case in which the fits occurred at intervals of a few moments during fourteen consecutive days, yet the patient recovered and remained free from the disease for several months. Sometimes paralysis, partial or complete, appears as a sequel to these series of attacks at short intervals ; yet the paralysis is usually but temporary. Another feature which often occurs after the patient has had numerous fits in rapid suecession, is a marked impairment of the mental faculties ; the individual remains childish, or even imbecile, for some hours or days, but soon recovers his usual mental condition. Epileptic fits may occur any hour of the day or night, though in many instances, there seems to be an especial disposition to their occurrence at night. In some cases, indeed, they happen only at night for a considerable time ; and inasmuch as the patient is unconscious of their occurrence, the disease may exist for a long period before it is discovered. It is further interesting that the attacks usually cease if the patient become afflicted with an acute disease. Thus during the course of typhoid fever, smallpox, pneumonia and the like, the individual usually remains free from epilepsy, which however, returns so soon as he recovers from the other disease. Cause.-The disease seems to result, in many cases at least, from abuses of alcoholic stimulants as well as from sexual excesses. Yet it is highly probable that venereal excesses and habits of masturbation are not so frequently and so directly responsible for the manifestation of epilepsy as the popular impression supposes. Indeed, it is still an open question whether the disposition to sexual excesses and the epilepsy are not to be regarded as the results of the same cause. Epilepsy has also been known to occur as the result of slow poisoning by lead, as well as by other metals ; and instances have been known to occur in persons afflicted with tapeworms, and to cease when the worms were expelled. As to what provokes a paroxysm in a person subject to epilepsy there is no definite information. In some cases it seems that unusual emotion or excitement acts as a cause in provoking a fit. Thus instances have been known in which a woman has experienced her first epileptic attack on the night of her marriage, and in which the fits have recurred with every subsequent sexual act. Yet in the majority of cases no such exciting cause is discovered. In many cases the patient feels indisposed for some time before a fit occurs, and seems to be better after the paroxysm. Hysteria seems also to exert a predisposing influence, or it may be more nearly correct to say that individuals subject to hysteria are prone to the manifestation of epilepsy. In such cases, epileptic fits are sometimes developed apparently as an act of mimicry. Thus it has been repeatedly observed that women subject to hysteria have, after association with people subject to epilepsy, become epileptic themselves. This same development of epilepsy by imitation has been witnessed also in a dog, after association with another dog already subject to the disease; for epilepsy is quite common among cats and dogs. This disease is sometimes simulated with great success by individuals who seek thereby to obtain sympathy, to arouse attention, and sometimes for purposes of gain. Not long ago it was discovered that a certain noted pickpocket of New York was in the habit of picking pockets while apparently suffering a severe fit of epilepsy, His plan was to be attacked with a severe paroxysm of epilepsy while in the midst of a crowd, and then in the excitement and commotion aroused by his " fit," he managed to insert his fingers into the pockets of those bystanders who sympathizingly assisted and protected him. In this case the deception was easily detected when subjected to medical scrutiny ; but another instance is known in which a most accomplished simulator of epilepsy deceived the medical inspector of a certain state prison, by whom he was, on account of his epilepsy, transferred from the prison to the hospital, from which he readily made his escape. Epilepsy seems to be most frequently developed in childhood and youth, and to occur more frequently among females than among males. The disease, though presenting some of the most terrifying pictures, involves no immediate danger to life. It is extremely rare that a patient dies during a paroxysm, no matter how violent this may be. Yet epilepsy conveys a certain amount of danger to the patient; danger that his mental powers will become impaired. For it is unquestioned that those who have been long subject to frequent attacks of epilepsy become, in many instances, weak of intellect, and even idiotic. This result may be, it is true, due somewhat to other causes than the epilepsy itself; thus those who in early life are subject to the disease, are not usually permitted to enjoy the same advantages of education and training as others. The above description applies to the ordinary form of epilepsy; but there is another form less violent and not marked by such characteristic symptoms, which is, nevertheless, the same disease. The attack consists in a sudden loss of consciousness, lasting usually but a few seconds. The individual, does not scream nor fall, nor do the convulsive movements occur such as have been described in connection with epilepsy. The individual's movements are suddenly arrested ; if walking he stops, if conversing he suddenly becomes quiet, and remains apparently in deep abstraction. Almost before the attention of the bystanders is attracted, the patient resumes his former occupation, walking or conversing, taking up the subject where he had dropped it and proceeding as if nothing had happened. To him indeed nothing has happened. He has no knowledge of the occurrence, and it may be long before it dawns upon the friends that the individual is at the time unconscious and not simply lost in thought. This mild form of epilepsy may last for an indefinite time without undergoing any essential modification ; while in other cases it serves merely as an introduction to the severer form, in which the patient falls and his body becomes contorted by convulsive movements. In other cases the mild form of epilepsy occurs in the in tervals between the severer attacks, the patient being subject to both varieties at the same time. Almost all degrees of severity between the two extremes narrated have been known to occur; in some cases there is loss of consciousness attended by convulsive movements of the jaws or of the face only; in other cases the patient falls to the ground but rises in a few seconds, no convulsive movements having occurred. " In other epileptic attacks sudden delirium occurs, continues for a few seconds and passes off, leaving the mind in the condition in which it was at the instant of the seizure. The delirium is manifested in different ways. Trosseau cites a case in which the patient uttered a burst of laughter, and when asked why he laughed, he looked surprised, having no knowledge of what he had done. " The same author relates instances in which individuals, who were engaged in conversation, have abruptly rushed into the street, bare-headed, as if struck by a happy thought, have walked about and then returned, and have finished the conversation, as if nothing had happened. " A female patient, quietly standing in one 'of the wards of Bellevue hospital, suddenly uttered a cry and ran from one end of the ward to the other. The urine was at the same time expelled, leaving on the floor traces of her course. Having reached the end of the ward, she stopped, looked somewhat confused, and quietly returned. The following is another example : Some years ago a young man who had been subject to ordinary epilepsy for twelve years, came to see me, accompanied by his attending physician. On the previous evening, from time to time, he had paroxysms of jumping up and down with violence for a few seconds. In walking to my residence, he stopped now and then and performed these jumping movements in the street. After sitting down and replying quietly to my questions, he began to jump violently in the chair for a few seconds, and continued to do so at short intervals. "-Flint. Treatment. - During the paroxysm the treatment is quite simple ; the patient should have plenty of air, and the bystanders, who are in the habit of crowding around out of curjosity or sympathy, should be kept back. The clothing around the neck may be loosened, and, if it can be done early, a penholder or a piece of cork may be inserted between the jaws, to prevent the patient from biting his tongue. It is quite unnecessary and undesirable to throw water upon the patient, or in any other way attempt to bring him to his senses ; this result will follow spontaneously, and cannot be hastened by any such measures. It need scarcely be said that the patient should be placed so that he cannot, during his convulsive movements, do himself any damage ; he should, therefore, be placed in an open space, in the middle of the floor, for example, or on a large bed. To break, up the paroxysm is, of course, the prime object of treatment. To accomplish this, an immense number of remedies have been employed, and success has been claimed for many of them. The largest number of cases have been benefited by the use of the bromide of potassium, with or without one of the other bromides. The following prescription has been used extensively : Bromide of potassium, - - One drachm. Bromide of ammonia, - - One-half drachm. Iodide of potassium, - - One drachm. Bicarbonate of potassium, - Forty grains. Infusion of columbo, - - Six ounces. Take a tablespoonful before meals, and two tablespoonfuls at bedtime. In most cases better results will be obtained by the following prescription : Iodide of potassium, - One drachm. Bromide of potassium, - - One ounce. Bromide of ammonium, - - Four drachms. Bicarbonate of potassium, - - Forty grains. Tincture of gentian, - Six ounces. A teaspoonful in water before meals, and three teaspoonfuls at bedtime. The bromides should not be taken for a long time without the direction of a physician, because certain ill results may follow which can be avoided by varying the remedies used. After a certain time the bromide causes mental languor and a certain degree of stupidity. If the use of the bromide causes an eruption on the face and body, as it often will, it may be combined with three or four drops of Fowler's solution at each dose. In every case the bromide should be tried first ; if this fail, after a faithful trial for six or eight months, the following prescription may be employed : Oxide of zinc, - - - - - 30 grains. Bromide of zinc, - - - 20 grains. Extract of nux vomica, - - - 8 grains. Make 30 pills ; take one morning and night before meals. An important part of the management of epilepsy is the observance of sanitary conditions. All excesses and unnecessary excitement must be avoided. Regularity in the evacuation of the bowels, the use of a nutritious diet and abundant exercise in the open air are extremely important. Within the last few years the nitrite of amyl has been somewhat employed in order to cut short the paroxysms. It has been found that in those cases in which the patient has warning of the attack, by the sensations in the thro¾t already described, the paroxysm can be often averted by the inhalation of a few drops of the nitrite of amyl. Two or three drops of this substance are placed upon the handkerchief and held to the nose. The immediate effect is a sense of dizziness, accompanied by flushing of the face. Yet this remedy is capable of causing serious effects and should not be used except under the direction of the physician. While it is in almost every case possible to improve the patient's condition materially, so that the paroxysms shall recur at much longer intervals and shall be less violent, yet it must be admitted that a permanent cure can be anticipated only in recent cases. Yet in every instance a faithful trial of the more important remedies, extending over two or three years if necessary, should be made. For it is to be remembered that the most disastrous feature in the disease is not the convulsions, but the deterioration of the intellect, which is almost sure to follow if the disease be allowed to progress without treatment ; and that although it may not be possible to arrest wholly the occurrence of the paroxysms, that if they can be checked the prospect for preventing the impairment of the mental faculties is much improved. Attention should be called to one other feature of the disease also, namely, that in some cases delirium lasting several hours or even days, succeeds a paroxysm of epilepsy ; during this time the patient is not in his right mind, and therefore not responsible for his actions. Instances have been known in which patients in this condition have been guilty of acts of violence which would, under other circumstances, have rendered them liable to severe punishment at the hands of the law. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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