Part 3

No antecedent diseases in 78 per cent. Antecedent diseases in 32 per cent.

Of these persons who, prior to the first attack of epilepsy, had suffered from illnesses, the details are as follows:--

Convulsions at dentition in 43.7 per cent. Rheumatic fever in 12.5 per cent. Chorea in 6.2 per cent. Mental derangement in 6.2 per cent. Constant headache in 6.2 per cent. Suppurating glands in 3.1 per cent. Brain fever (?) in 3.1 per cent. Small-pox in 3.1 per cent. Typhus fever in 3.1 per cent. Spinal curvature in 3.1 per cent. Somnambulism in 3.1 per cent. Scarlatina in 3.1 per cent.

The only special feature of this table is the fact that, of the cases of epilepsy under observation, convulsions at dentition were positively ascertained in 15 per cent. of the total number of cases, and in 43.7 per cent. of those having suffered from former illnesses. Here also the percentage is probably in reality greater, as it is obvious that many of the patients were ignorant as to whether or not these symptoms existed. There is no evidence that any of the other illnesses had any relation to the epilepsy.

Temperance and Intemperance.--On this head nothing definite could be ascertained. The patients either do not tell the truth, or have very elastic notions as to moderation in the use of alcoholic stimuli.

2.--EXCITING CAUSES.

To ascertain the exciting causes of epileptic seizures with exactitude is usually a matter of very great difficulty. It is simple enough when the results directly follow the cause; but this is not commonly the case. If, for example, a man, after a blow on the head (having been previously in good health) becomes suddenly seized with epileptic attacks within a few hours or days of the accident, we may fairly assume that the injury has originated or developed his illness. But should the seizure not supervene for some months or years afterwards, the external wound having in the meantime completely recovered, there remains on this question a considerable element of doubt. In the same way a patient often attributes the attacks to a fright which may have occurred weeks or months before they began; yet great care should be taken in accepting such a statement: on the other hand, it should not be utterly ignored. Again, if a person develops epilepsy after severe and prolonged domestic trouble or affliction, how are we accurately to determine the relation between the two? These difficulties render an exact method of ascertaining the exciting causes almost impossible, and this can only be approximated by a careful consideration of the entire history and circumstances of the case. Taking these into consideration, the following statements have been drawn up, in which only those conditions are recorded, where from a review of the whole case a reasonable relation was found to exist between cause and effect.

In a hundred unselected cases of epilepsy there were--

No apparent exciting cause in 43 per cent. Possible exciting cause in 57 per cent.

Of the cases where a possible exciting cause was present, the following is an analysis:--

Blow or injury to head in 28.1 per cent. Uterine disorder in 22.8 per cent. Domestic trouble in 15.7 per cent. Disease of the nervous system in 8.7 per cent. Fright in 5.2 per cent. Depression in 5.2 per cent. Pregnancy in 5.2 per cent. Mental strain in 3.5 per cent. Sunstroke in 3.5 per cent. Emotion in 1.7 per cent.

Thus, in no fewer than 16 per cent. of the total number of cases, and 28.1 of those in which a possible exciting cause was present, did epileptic seizures follow injuries to the head. Of the cases recorded under uterine disorders, it must be stated that these conditions were as much the accompaniments as the cause of epilepsy, the relations between the two being as follows:--

Attacks occurring at menstrual periods in 61.5 per cent. Attacks associated with irregular menstruation in 30.7 per cent. Attacks associated with uterine disease in 7.6 per cent.

An attempt was made in twenty-two cases to ascertain whether, in women, the age at which the epileptic attacks began had any relation to the period at which the catamenia commenced, with the following results:--

Average age at which attacks began 14.6 years Average age at which catamenia began 14.6 years

This shows singularly enough exactly the same figures, and serves to point out, that in women, the earliest manifestation of puberty is a decided exciting cause for epileptic attacks. It must however be stated that, in the female epileptics, the attacks commenced before the age of puberty in 16.9 per cent. of their numbers. Of the 8.7 per cent. of cases included under the term "diseases of the nervous system," the epilepsy was associated with hemiplegia in all.

SYMPTOMATOLOGY.

In a hundred unselected cases of epilepsy there were--

Epilepsia gravior in 62 per cent. Epilepsia mitior in 10 per cent. Epilepsia gravior and mitior in 28 per cent.

1.--EPILEPSIA GRAVIOR.

Premonitory Symptoms.--In the cases in which epilepsia gravior was present there were--

No premonitory symptoms in 34.4 per cent. Premonitory symptoms in 65.5 per cent.

Of those cases in which there were symptoms premonitory to the attack, there were--

General premonitory symptoms in 47.4 per cent. Special Auræ in 72.8 per cent.

By general premonitory symptoms are understood those morbid conditions lasting for some hours or days before each attack, and of the cases under consideration in which these were present, the following is an analysis:--

Prolonged vertigo in 46.4 per cent. Headache in 21.4 per cent. Nervousness in 14.2 per cent. Drowsiness in 3.5 per cent. Faintness in 3.5 per cent. Depression of spirits in 3.5 per cent. Cramps in 3.5 per cent. Numbness of extremities in 3.5 per cent.

Of the cases in which a special aura preceded the attack, the details are as follows (the special symptom in each case being sudden):--

Loss of sight in 2.3 per cent. Loss of speech in 13.9 per cent. Loss of hearing in 2.3 per cent. General tremor in 16.2 per cent. Tremor of one foot in 2.3 per cent. Sensation in epigastrium in 6.9 per cent. Sensation in abdomen in 4.6 per cent. Sensation in throat in 6.9 per cent. Sensation in left side in 2.3 per cent. Sensation in both hands in 2.3 per cent. Sensation in one hand in 2.3 per cent. Violent pain in head in 2.3 per cent. Pain in one foot in 2.3 per cent. Sparkling sensation in eyes in 6.9 per cent. Pumping sensation in head in 4.6 per cent. Noises in ears in 4.6 per cent. Diplopia in 2.3 per cent. Contraction of one leg in 2.3 per cent. Rotation of head in 2.3 per cent. Distortion of face in 2.3 per cent. Twitching of thumb in 2.3 per cent. Spasm of eye-balls in 2.3 per cent. Disagreeable smell in 2.3 per cent.