It has throughout been my endeavour not to lose sight of those for whom this little book has been written, and with reference to epilepsy, as with reference to many other things, I pass over much that would be important to the practitioner of medicine, to dwell on those points which mainly interest the parents, and which they are perfectly able to appreciate.
The question is often put as to the probability of fits terminating in epilepsy; or, on the other hand, as to the ground for hope in any case that epileptic attacks, which have already often recurred, will eventually cease. In the first place, no conclusion can safely be drawn from the severity of a convulsion, nor from its general character, as to the probability of its frequent recurrence, or of its passing into permanent epilepsy. The severity of a fit certainly affords no reason for this apprehension, nor does its recurrence, so long as a distinct exciting cause can be discovered for each return. The fits, which cease in the teething child when the gum is lanced, and which, on each succeeding return are equally relieved by the same proceeding, do not imply that there is any great tendency on their part to become habitual. In the same way, the attacks which follow on constipation, or on indigestion, or on some other definite exciting cause, may probably with care be guarded against, and their return prevented. It is not the violence of a single fit, nor even the frequent return of fits for a limited time, which warrants the gravest apprehension; but it is their recurrence when all observable causes of irritation have passed away; it is their return when the child is otherwise apparently in perfect health.
If, on the one hand, the violence of a convulsion does not by any means imply the greater proportionate risk of its recurrence, so neither can any hopeful conclusion be drawn from the slightness of an attack, or from its momentary duration. In childhood, such attacks are at least as common preludes to confirmed epilepsy as in the adult, and are the more deserving of attention from their very liability to be overlooked. I believe, too, that an imperfect suspension of consciousness, the child knowing what passes, though unable to speak, is not very uncommon, and further, that it is far from unusual to have the early stage of epilepsy in childhood announced by sudden incoherent talking for a few seconds, or by a wild look; a cry of surprise, or a short fit of sobbing, announcing as in a hysterical girl, the close of the paroxysm. The early symptoms of epilepsy in childhood are also the more likely to be misinterpreted from the circumstance that they are frequently accompanied by a moral perversion much more striking than any loss of mental power. It is true that in early life there are alternations of intellectual activity and mental indolence, of quickness and comparative dulness, which all who have had much to do with education are well aware of, and which are perfectly compatible with health of body and health of mind. But changes in the moral character of a child who is still under the same influences, have a far deeper meaning than is often attached to them; a child does not suddenly become wayward, fretful, passionate, or mischievous, except under the pressure of some grave cause.
One other point there is also to be borne in mind; namely, that the child is compelled by the vague sensation of hitherto unknown dread, not to conceal the early symptoms of epilepsy as the grown person would do; longing as the child does for love and sympathy, and weakened in its moral force, it craves for more love, more sympathy, it exaggerates its symptoms, it assumes some which do not exist at all. The conclusion is a natural one, but none the less mistaken, that the child who is discovered to be shamming has nothing the matter with it—is simply a naughty child. This is a fact of much importance, on which I shall have occasion to insist further on.
In the child, as in the adult, epilepsy blunts the intellect as well as weakens the moral powers; and does both more speedily and more effectually in proportion as the child is younger, and its mind and will are less developed. And yet this has its compensation; for as the powers fade quickly, so, if the attacks cease, they recover with surprising rapidity, and as the moral powers are the first to suffer, so they are the first to regain—I will not say full vigour, but at least a degree which raises the children to be objects of specially tender affection, rather than of pity and compassion.
The conditions which justify the most hopeful view of any case of epilepsy are then, first, the absence of any history of frequently recurring convulsions in early infancy; secondly, the existence of a distinct exciting cause for the attacks; thirdly, the rarity of their return far more than their slight severity; and lastly, the more the attacks approach in character to what one knows as hysteria, the less profound the insensibility in the fit, the shorter its duration afterwards, the greater are the grounds for hope that the seizures will eventually cease.
Cases of this last class are to some degree, at any rate, under the child's control. I have several times seen a fit warded off by the threat of the shower bath, or even by calling to the child, and sending it to fetch something in another room. Such cases may indeed pass into ordinary epilepsy, but often, under judicious management, moral rather than medical, they cease, so that one can venture on taking a more hopeful view of them than of others.
And this brings me to the question of what can be done, or rather what can parents do to promote recovery from epilepsy. First of all, do not listen to what you may hear about this medicine or the other being a specific for it. There is no specific whatever for epilepsy, but there are certain remedies which in skilful hands do have a real though limited power to control the frequency and lessen the severity of the attacks. Next, there are cases in which the attacks depend on some definite cause; it may be indigestion, or constipation, or the cutting of the second set of teeth, and on the irritation produced by those teeth being too crowded. Thus, I remember a boy twelve years old, in whom two severe epileptic fits occurred apparently without cause. He was cutting his back grinding teeth, and in the lower jaw the teeth seemed overcrowded. I had a tooth extracted on either side, the fits ceased, and when I last heard of him many years afterwards they had not returned.
Epilepsy often lasts for many years, and no one's memory is retentive enough to be trusted with all the details between the different attacks, the causes which seemed to produce them, the measures which appeared at different times to be of service. I am therefore accustomed to advise people, any of whose children have the misfortune to be epileptic, to write as brief an account as possible of the child's previous history, and to supplement it by a daily record kept in parallel columns of date, food, state of bowels, sleep, medicine, attacks, specifying their character and duration; and general remarks, which would bear on the child's temper and general condition, and in which column any probable exciting cause of an attack would be recorded. It is surprising how much important information is gathered in a few months from such a record kept faithfully.
The diet should be mild, nutritious, but as a general rule unstimulating; and should include meat comparatively seldom, and in small quantities. Some fifty years ago, a very distinguished American physician, Dr. Jackson of Boston, in the United States, insisted very strongly on the importance of a diet exclusively of milk and vegetables in greatly lessening the frequency and severity of epileptic attacks. I believe in the great majority of cases of epilepsy in childhood Dr. Jackson's advice is worth following. And I may add that, while I have little faith in the influence of mere drugs, I have a yearly increasing confidence in that of judicious management, mental and moral, as well as physical.