In old persons I have found gout to have an undoubted influence in producing the disease, there being a spasm of the cerebral vessels which usually betokens a condition of uric-acid saturation. In these cases the painful symptoms were not decided. Such epilepsies have quite often preceded serious evidence of arterial degeneration.
Malarial epilepsy is rare: Jacobi8 reports a case and Payne9 another. A young man was brought to me last year who had lived for many years in a part of Pennsylvania which was exceedingly malarious. His attacks, which were more or less periodic, were violent, and his convulsions were general and attended by very great preliminary rise of temperature and intense congestion of the face and head. The patient was unusually somnolent, and between the paroxysms frequently suffered from facial neuralgia. The influences of change of habitation and quinine determined the correctness of my diagnosis.
8 Hospital Gazette, New York, 1879, v. 41-43.
9 Indian Ann. Med. Sci., Calcutta, 1860-61, vii. 597 et seq.
Day10 and Kerr11 have both ascribed epilepsies seen by them to hepatic congestion.
10 Clin. Histories, etc., London, 1866, 143-145.
11 Med. Times and Gazette, London, 1871, i. 568.
The important etiological relation of the exanthemata to epilepsy has been the subject of much attention. The books are full of cases which owe their origin not only to scarlet fever and measles, but to whooping cough, diphtheria, and the various zymotic fevers. In 35 cases tabulated by Gowers12 (p. 28) no less than 19 were due to scarlet fever, while the first fit followed measles in 9 cases. So far as my individual experience goes, I have in 23 cases found epilepsy to be the result of scarlet fever, and this form of the disease was often associated with other manifestations of coarse brain trouble. Cerebro-spinal meningitis was the undoubted cause of epilepsy in 6 cases I examined. It is probable that just as smallpox acts upon the nervous centres, so does scarlet fever, and I agree with Gowers that the convulsions that may begin during or just after the fever are not always due to uræmia. Bright's disease may give rise to an epilepsy, but this can hardly be regarded as a distinct affection.
12 Op. cit.
There are many cases, especially in adults, which grow out of a prolonged depletion of the brain—a continued cerebral anæmia. Among these cases are some which depend upon pressure upon the great vessels of the neck, and some due to debilitating disease of a general character. Schulz13 has seen a case which followed compression of the jugular vein, and enlarged cervical glands have in other cases acted as mechanical agents. Hammond alludes to the influence of prolonged general anæmia in the production of epilepsy.