On two occasions we noticed the patient's eyes turn upward and remain fixed for a moment or two, while her expression changed to one of tranquillity and unconcern—a sign of distraction, not of ecstasy. She merely appeared to be thinking of something other than the immediate topic of conversation, and after two or three seconds resumed her ordinary ways.
These brief "absences" are trifling enough, of course, but their painstaking study is of inestimable aid in the matter of diagnosis. They began at the age of seven or eight, and at first occurred as often as sixty times in a day. What the patient did was to raise her head, and turn up the whites of her eyes; in a second or two her countenance had resumed its ordinary expression. From their onset, the "incantations"—to use her father's term—gradually increased in frequency and length, and attained a sort of maximum when she was eleven years old, slowly diminishing thereafter till at present they have become rather exceptional. They proved to be a source of great tribulation to L., seeing that she was exposed to the practical jokes of her companions, who used to seize the occasion to relieve her of any books or toys she had in her hand.
During the "absence" there is no change of colour, nor has there ever been any vertigo or sense of rotation. She has never actually fallen, though she has allowed things to drop out of her hands. Once it is over, she is aware of it, but her memory of what has just taken place is very vague, though she usually can tell what preceded it. She can be aroused from the "incantation," to sink back into it an instant later, as though she had not dreamed enough. Sometimes a series of "incantations" occurs, one following on the heels of another. Occasionally she utters such words as "yes, yes!" or "no, no!" in an impatient tone of voice, and plucks at her hair or clothes, or toys with the handkerchief which is never out of her hands.
Call these phenomena "epileptic absences" if you like, but after the reverie is over, L. knows quite well that she has had it; besides, prolonged bromide treatment has been totally inefficacious.
One of us has come across a somewhat similar condition in a ten-year-old girl:
Fifty times a day she interrupts her work or her play to retract her head and roll her eyes upward. The duration of the attack is not longer than ten seconds, and there is no cyanosis or distress of any kind. The application of tactile or painful stimuli at these times makes her shut her eyes and withdraw her head or her limbs, and she can tell afterwards what was done. She knows that she has had a "sensation," and remembers any noise that occurred while she was in that state.
Otherwise, there is little to note. For one month she presented very mild convulsive movements in the left arm and leg, but no trace remains of them to-day. Treatment with bromides has failed to effect any modification.
Examples of the same nature, but said to be of hysterical origin, have been recently published by Luzenberger:[166]
A young girl, twelve years of age, has brief attacks in which she loses consciousness, and turns her head to the right, while the angle of the mouth is drawn to the left. This sort of attack recurs forty or fifty times a day, and has been going on for three or four years.
The reporter thinks the case a difficult one to diagnose, though the trifling nature of the symptoms, and their evolution, do not suggest epilepsy. One may question, however, whether they indicate hysteria.