28. There is one author, Ballard, who has actually propounded a theory of Shell-shock as epileptic, pointing out the occurrence of epilepsy long after the early symptoms of Shell-shock have disappeared.[10] There does not appear to have been any increase in epileptics as the result of the war, either from the standpoint of Shell-shock or from the standpoint of brain injury, so far as the records of the National Hospital for the Paralyzed and Epileptic in London are able to show.
[10] In one instance, fugue and other minor symptoms were later replaced by epilepsy; in another, an epileptic confusion developed eight months after an explosion, and in a third, a case of mine explosion, stammering resolved into mutism and mutism finally into epilepsy. Of course there is a so-called general resemblance among all forms of hyperkinesis or irritative discharge of the nervous system. If we term epileptic all the things that various authors have termed epileptoid, we may be doing nothing more than to say that we believe these cases all subject to epileptic hyperkinesis. In that direction, of course, it has long been said that dipsomania was really a form of epilepsy. Whether Shell-shock is ordinarily subject to recurrence in such wise as to imitate the recurrence of attacks of dipsomania, of manic-depressive psychosis or of epilepsy, is, to say the least, doubtful at this time.
29. As in all other instances of mental or nervous disease, when an epileptic returns from the war, whether or not he was potentially or actually an epileptic before the war, his relatives are bound to term him a case of Shell-shock. I am familiar with a case in a hospital in a certain Atlantic port, a case of pronounced and obvious epilepsy. In the wards he is treated as the hero of every occasion. Not only the nurses and attendants, but the other patients and often the physicians can hardly resist thinking of him as somehow a case of Shell-shock. It is a comment upon the status of mental hygiene in general that this self-same epileptic, had there been no war, would have been, as it were, a common or garden epileptic, mute and inglorious on some sunny hillside.
30. In passing I may note how many instances in the medicolegal part of the war literature there are of epileptics who come up for courtmartial or for medical examination pending courtmartial. We may suspect that many a case of epileptic fugue has been regarded as a case of desertion. There is the case of an epileptic who left camp one morning and got drunk. Investigation showed that he left camp before anything epileptoid had happened. He developed in his drunkenness a pretty clearly epileptic crisis with great violence, for which he had a complete loss of memory. The French Council condemned him to five years of labor, not admitting in this instance that responsibility was diminished by reason of the man’s being epileptic. In short, from the military point of view, he should, so to say, have known enough not to have gotten drunk, and so have avoided getting his epileptic crisis. Of course the decision was here very close, and a like decision would not always be rendered. To add to the complication of this particular case, the very first epileptoid crisis which caused it to be known that the man fell into the epileptic group was due to Shell-shock, or at least developed immediately after the bursting of a shell nearby. On the whole, however, the relation between epilepsy and Shell-shock is not a close one.
31. The question of epilepsy in the war is considered in a series of 33 cases ([Cases 53-85]). The considerations range from banal cases developing quite incidentally, up to cases regarded by one author (Ballard) as illustrating a theory of Shell-shock as epileptic ([Cases 82-84]). First are considered two cases actually syphilitic. In the first ([Case 53]), the diagnosis had to be revised from epilepsy to neurosyphilis (the convulsions of this neurosyphilitic were brought out by alcohol, and the reporter, Hewat, remarks that the serum of any patient developing epileptiform seizures between 35 and 50 years of age should be subject to test). In [Case 54], the soldier got his syphilis in wartime and the syphilis acted to bring out an epilepsy with which the patient was hereditarily tainted (epilepsy syphilogenic, i.e., reactive to syphilis).
[Case 55] might perhaps better have been considered in the group of hypophrenoses, as he was epileptic and imbecile. He was at first condemned by court martial to five years’ imprisonment for leaving his post in the presence of the enemy.
Another mixed case is [Case 57], in which another feeble-minded subject showed seizures of a psychogenic nature, which he was able eventually to stop by clenching his teeth.
Seven cases ([Cases 58-64]) are cases of a disciplinary nature, amongst which attention may be called to [Case 62], the “specialist in escapes.” The medicolegal questions of responsibility in the drunken epileptic ([Case 58]) are particularly perplexing.
32. [Case 64] is one of epilepsy following antityphoid inoculation one-half hour. There were five attacks during a fortnight and then no others. The antityphoid inoculation came eight weeks after a shell wound of the thigh, which had not served to bring out the epilepsy in this patient. Bonhoeffer had three other instances of the sort: one in a severely tainted subject, and the others in alcoholics.
33. The next group of cases, [66-77], yields a series of the most interesting medical problems, some of which scarcely belong in an account of psychoses incidental in the war. [Case 66] is one with recovery from Jacksonian seizures after decompression of the upper Rolandic region, which was edematous following an (apparently very slight) scalp wound and shell-shock.