31 Traité de l'Épilepsie, etc., Paris, 1845, p. 55 et seq.
When the attacks occur in alarming frequency, as they sometimes do, the condition is known as the status epilepticus. Leuret had a patient who had eighty in two hours, and Delasiauve reports the case of a young man fifteen years old who had twenty-five hundred in one month. They may be so numerous as to be apparently continuous. The patient remains in a state of coma (the status epilepticus), with very high temperature. If he be not restored, he sinks into a deeper coma, and all the signs of collapse manifest themselves. Bed-sores form, œdema of the lungs ensues, and the patient dies. Happily, this condition of affairs is rare.
Delasiauve calls attention to the fact that the first two or three attacks that usher in this state do not usually attract much attention, but the succeeding ones are so violent as to immediately suggest violent consequences. In one of my cases the attacks, when they had once become numerous, were readily excited by the least jarring, noise, or handling, just as we find in strychnine-poisoning or tetanus.
Irregular Forms.—There are occasional cases of psychical or masked epilepsy, the study of which is intensely interesting. Such forms are characterized by perverted consciousness and a low degree of volitional direction which may vary from automatism to the undoubted exercise of complex functions of the mind, though badly co-ordinated. Mesnet's soldier, when subject to a paroxysm and apparently unconscious, would perform a number of suggested acts in a rhythmical manner and with no subsequent knowledge of the previous event: when started off by the word of command to march, he would blindly go on, marking time when he met with an obstruction until stopped, or when a paper and tobacco were placed in his hands he would proceed to roll an unlimited number of cigarettes.
Two cases of a more complex exercise of certain intellectual powers, while others were dormant, came under my observation some time ago. One of them was a young man of twenty-three, who had had irregular epileptic seizures for some years. He went to bed one evening as usual, arose, and breakfasted with his family without creating any suspicion that he was at all unwell. He then went down to his place of business, and after his arrival was sent to a distant part of the city for some tool. On his return down town he stopped at a tobacconist's and became involved in a quarrel with one of the persons in the shop. A policeman was called, who, more intelligent than many of his class, immediately detected something queer about the man, arrested him, and afterward took him to Bellevue Hospital. There he remained three days, and suddenly returned to consciousness and a knowledge of his surroundings, but was entirely ignorant of his unfortunate experience. It is unnecessary to say his habits were perfectly good and he was not drunk at the time of the quarrel or arrest. His last recollection was that of going to bed the night before the day of his arrest.
Another case of unusual interest which came under my care, illustrating a phase of sensory epilepsy, is worthy of reproduction:
C. O——, aged twenty-two, is a reporter attached to one of the New York afternoon papers, who received a severe injury of the head when but three years old. He fell from the second story of an unfinished building to the cellar, striking the upper and back part of his head upon a beam. He was rendered unconscious, and remained so for a day or more. He recovered from the immediate bad effect, but has suffered from severe general headaches, which recur every week or so, with an increase in the amount of urine excreted. About six months ago he began to have epileptic convulsions of a violent character almost every day, and sometimes more often. These were precipitated by excitement, and he had a great many when worried about his wife at the time of her delivery. Upon one occasion he fell down stairs and injured himself quite severely. The attacks were, as a rule, preceded by an epigastric aura of long duration, and occasionally by a visual aura, and, according to the testimony of his associates, he became strange and queer. When in such a dazed condition he would restlessly wander about his office, and suddenly, without any cry, become convulsed. After the attack he slept soundly. The bromides of sodium and ammonium and digitalis did little or no good, but the bromide of nickel appeared to have some influence. During the past month he has had only two or three attacks, but these have been of a quite irregular character. He told me that there were times when he felt like doing himself an injury, and that he had impulses to kill some one else. His companions said he was irritable, pugnacious, and easily thwarted, and his brother-in-law stated that upon several occasions he had queer turns, when he would raise his hand to strike some member of the family—that he subsequently knew nothing of his conduct, and when it was detailed to him he appeared greatly astonished.
Mr. O—— came to my office in company with a friend at ten o'clock in the morning of December 27, 1883. He had had one of his attacks at the newspaper office, of rather more severe character than usual, at eight o'clock, with a psychical aura, during the existence of which he was very morose and sullen. Upon recovery he was speechless, though he could communicate by signs. Upon his arrival at my office his manner was composed and he appeared somewhat dazed. His pupils were dilated, but contracted readily to light. I asked him one or more questions regarding his inability to speak, which he perfectly understood, and when I gave him a pencil and a piece of paper he replied without difficulty in writing. When told to make a great effort to speak he did so, and I thought I detected the word ‘To day,’ but he could not repeat it, though he tried and expressed great annoyance. He was unable to utter any sound except a sort of groan, which could not in any way be taken as an element of speech. I examined his larynx, but found nothing which could explain his impaired phonation, and I sent him to Dr. Asch, who found absolutely no abnormal appearances to account for the speech difficulty. The patient could not phonate, and though he made attempts to enunciate the vowel-sounds, and the vocal cords were approximated, he made no orderly sound. Asch found a slight laryngitis of no importance.
The patient went home, and remained speechless all day, and was seen by my associate, G. de Forrest Smith, in the evening. What occurred during and after that gentleman's visit is contained in his notes: “I was called to see patient about 8.15 P.M. He was lying upon the bed, but had not slept; recognized me and motioned that he could not speak, and I found that he could only say one or two words, and this with the greatest effort, and so all my questions were put so that he could answer them by nodding or shaking his head. He knew that he had had an attack in the morning, that he had seen Hamilton and Asch, and recalled various incidents of the day, answering intelligently my questions in regard to them. He indicated by motions that his inability to speak was due to a lump in his throat. When asked if he had any trouble to think of the word he wanted, he shook his head, but shortly afterward hesitated in an answer, and when asked if this was due to his inability to think of the word, said ‘Yes.’ Was asked if he had any loss of power in either side, and he motioned to his right arm and leg, and said that he felt a numbness and pricking on that side. On his grasping my hands with his, the right was perceptibly weaker.
“At one time he seemed confused as to which was his right or left side, and put up both hands, and after looking at first one and then the other in a puzzled manner, at last decided correctly, then smiled apparently at his confusion.