Nervous and mental diseases / by Archibald Church and Frederick Peterson.

  • Church, Archibald, 1861-1952.
Date:
1908
Catalogue details

Licence: Public Domain Mark

Credit: Nervous and mental diseases / by Archibald Church and Frederick Peterson. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    Table of Differential Characters of Epileptic and Hysterical Attacks (Continued). The Fit. Epilepsy. Hysteria. Eyes. Pupils dilated and rigid. Pupils generally mobile and active. Tongue. Usually bitten. Bitten very exceptionally. Mouth. Frothing common. Relaxed, usually. Frothing absent. Sphincters. Usually continent. Pulse. Accelerated greatly and ten- sion increased. Rate and tension not much changed. Temperature. Elevated 1° or 2° F. Normal. Termination. In hebetude; gradual. Rather prompt ending and little discomfort. Urine. Increased nitrogenous and phosphatic elements. Increased acidity and toxic- ity. Urea reduced, phosphates de- creased, and changed phos- phatic formula ; often large quantity, but of low specific gravity. Postparoxysmal con- ditions. Petechial ecchymoses, re- duced muscular strength, diminished knee-jerks, mental obscuration ; no memory of attack. No motor or reflex changes ; some recollection of phases of attack; usual mental condi- tion at once regained ; pres- ence of various stigmata. Prognosis.—As an exception, but proving the rule of gravity in the prognosis of epilepsy, rare cases recover spontaneously. In a general way there is little hope for cure, if the disease, with repeated attacks, has lasted over two years, or been intense in its manifestations for even a shorter period. There is some tendency for it to appear, subside, reappear, or increase at the developmental epochs of dentition, puberty, adolescence, and the climacteric. Any inciting cause that is controllable is a favorable consideration. Epilepsy as a manifestation of degeneracy is of bad import. If there is any reason to suppose that organic cortical changes have occurred, or if dementia has appeared, the outlook is unfavorable. Grand mal cases offer a slightly better prognosis than petit nial or psychic cases. A single attack is almost never fatal of itself, but a condition of status is very likely to terminate fatally, and every attack undoubtedly leaves some harmful trace. Rarely a severe attack owing to some cardiac weakness terminates fatally through pulmonary edema.-^ The natural tendency of epilepsy is to dementia. The oftener the attacks occur, the worse the mental prospects. Death by status, or through vascular acci- dent, or by suffocation, or other physical mishap attending a fit, is not so very rare. Tuberculosis is a frequent cause of death. Epilepsy, with fits at long intervals, particularly if first appearing after twenty years of age, is not inconsistent with mental ciualities of a high order, and may not shorten life or abridge usefulness. The majority of epileptics, under 1 Shanahan, N. Y. Med. Jour., Jan. 11, 1908. 40