The differential diagnosis of a case of epileptiform convulsions / by Byrom Bramwell.

  • Bramwell, Byrom, Sir, 1847-1931.
Date:
[1880?]
Catalogue details

Licence: Public Domain Mark

Credit: The differential diagnosis of a case of epileptiform convulsions / by Byrom Bramwell. Source: Wellcome Collection.

    2/14 (page 180)
    THE DIFFERENTIAL DIAGNOSIS OF A CASE OF EPILEPTIFORM CONVULSIONS. By BYROM BRAMWELL, M.D., F.R.C.P., Edin., Lecturer on the Principles and Practice of Medicine, and on Practical Medi¬ cine and Medical Diagnosis in the Extra-Academical School of Medicine, Edinburgh ; late Physician and Pathologist to the Newcastle-on-Tyne Infirmary; formerly Lecturer on Clinical Medicine and on Pathology in the University of Durham College of Medicine, Newcastle-on-Tyne. (Being a Lecture delivered in the Extra-Academical School of Medicine, Edinburgh, during the Summer Session, 1880.) Gentlemen,—Having decided that the convulsions are general (i. e., bilateral) and epileptiform in character, we have now to determine:— I. If the attack is genuine. II. If genuine, what is its cause. The Differential Diagnosis of Genuine and Sham Epilepsy. Impostors frequently feign epileptic fits in order to get admission to hospital, to obtain alms, or to give a confederate a convenient opportunity of abstracting the purses and watches of the sympathising crowd that gathers round them. If the impostor is a clever artist, and well coached, the detection of the deceit is often very difficult; indeed, the detection of feigned or simulated disease is always difficult, and requires both acumen and a profound knowledge of the true affection. The points of differential diagnosis are the following:— Sham epilepsy is to be suspected when— 1. The fit occurs in a suitable place, and at a convenient time to collect a crowd of sympathising observers. In hospital practice a favourite time is the hour of visit of the physician or house surgeon. The occurrence of fits at such, and at such times only, is very suggestive of the feigned affection. 2. The patient receives no injury during the attack. Im¬ postors do not hurt themselves as they fall; do not bite their tongues; do not soil their clothes by evacuating the contents of the bladder or rectum A If, in addition to these suspicious circumstances, any positive facts, inconsistent with the genuine affection, are detected, a positive diagnosis may then, but then only, be ventured upon. * Genuine epileptics may not hurt themselves, and may not discharge urine and faeces. These negative facts, therefore, are not conclusive.