Of course, even in severer forms of epilepsy, mental disturbances do not appear at once. It sometimes takes many years for the constantly recurring manifestation of explosive nerve force to produce the deterioration that gives rise to lowered rationality. Distinct mental deterioration is eventually inevitable, though modern experience with epileptic colonies, in which patients are enabled to live a quiet life, most of it in the open air and under conditions of nutrition and restfulness especially favourable for their physical well-being, shows that the development of insanity may be put off almost indefinitely.
There are many advertised cures for epilepsy. None of them is successful, and all of them may do harm. The bromides have a distinct effect in lessening the number and frequency of seizures, but if taken to excess they have a serious depressing effect upon the patient. There have been more cases of mental disturbance among epileptics, and intellectual degeneration sets in earlier, since the introduction of the bromides, than before. It is the abuse of the drug, however, not its use, that does harm. More important than any drug is the care of the patient's general health. The digestion must be kept without derangement; the bowels made regular; all sources of worry and emotional strain must be removed. Patients should as far as possible live in the country, and farm life has been found especially suitable. Relatives are often a source of irritation rather than consolation to these patients, and the life in epileptic colonies has been found eminently helpful.
JAMES J. WALSH.
XXIII
PSYCHIC EPILEPSY AND SECONDARY PERSONALITY
One of the most interesting phases of epilepsy is the type of the disease in which, without any significant motor symptoms, psychical manifestations prevail very markedly. A special manifestation in this affection is the occurrence of a more or less complete assertion of what is called a secondary personality. Apparently the individual becomes so divided in the use of the mental faculties that there are two states of consciousness. In one of these the patient knows and remembers all the ordinary acts of life, the other carries the record of only such actions as are done in a peculiarly morbid psychic or epileptic condition. It is rather easy to understand that this strange state of affairs may readily give rise to even serious complications as regards the individual's relations to others, and may make the problem of responsibility for apparently criminal acts that have been performed very difficult of solution. Undoubtedly, however, this set of phenomena constitutes a form of mental alienation that must be reckoned with in many more cases than might be thought possible. The difficulties that may have to be encountered in the proper appreciation of the actions of such individuals is best illustrated by some cases.
At a recent meeting of the New York State Medical Association a case was reported that shows how extremely difficult it may be to judge of responsibility under these pathological circumstances. The patient, a young man of about twenty-two, was the son of parents themselves of marked nervous heredity, signs of which appeared in other members of his generation. While in attendance at a public academy he had been quite severely maltreated during the [{260}] course of an initiation into a secret society of the students—the more or less familiar processes known as hazing being employed. As a result of this he had suffered from an attack of unconsciousness that lasted for several hours. No other symptoms, however, or sequelae, appeared for nearly a year. Then, while boarding with his sister, he became morose and difficult to get along with. He quarrelled with his sister several times and generally their relations were rather strained. He came home one evening very late to supper, and because things were not to suit him on the table, he grew violently angry. He went upstairs to his room in this morose state and, procuring a revolver, after a short time came down and shot at his sister.
Fortunately he missed her. He at once left the house but was followed by his brother-in-law, and, after he began to run away, by others whose attention had been attracted by the shot. He left the country road and ran across the fields. He was found at the foot of a rather high stone wall in a state of unconsciousness. From this unconsciousness he did not recover until the next morning. In the meantime he had been brought home and put to bed. The next morning he claimed that he had absolutely no remembrance of anything that happened after he became angry at the table because of his supper. The family made no further difficulty about the matter, and, as nothing serious had resulted, the boy went home to live with his father on a farm and seemed to grow much more equable in temper.
One day, when very tired and out of sorts because things had not been going as he wanted them to, he was asked to clear a potato patch of potato bugs by spreading Paris green over it. Some hours later he was found in the field suffering from severe pains in the stomach and with evident signs of having swallowed some of the poison. A doctor was called, an emetic was given and he purged, and after a time he recovered from the symptoms of poisoning. He claimed that he had no recollection of what he had done, nor did he know how he came to take the poison. After this he begged the family to watch over him carefully and not to let him be alone at times when they recognised that he was somewhat [{261}] morose in temper. He was not melancholic in the sense that he wanted to commit suicide, but something seemed to come over him in spells, and while in a state of mind of which he had no recollection afterwards, he performed actions that seemed voluntary and yet were not.
He did not have very good health on the farm, and so he was advised to try the effect of life at sea. A position as assistant steward was obtained for him on a coastwise vessel. In this position he gained rapidly in weight and seemed to have excellent health. All tendencies to moroseness of disposition disappeared. After a time he was promoted to a stewardship and later became the purser of a rather important vessel. He has given excellent satisfaction and feels in every way that he is in a much more balanced condition than ever before.