On some postepileptic phenomena : read in the Section of Medicine at the Annual Meeting of the British Medical Association at Liverpool, August, 1883 / by Julius Althaus.

  • Althaus, Julius, 1833-1900.
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: On some postepileptic phenomena : read in the Section of Medicine at the Annual Meeting of the British Medical Association at Liverpool, August, 1883 / by Julius Althaus. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    The cases, therefore, which form the groundwork of this paper, are only such where epilepsy was the primary event, and where some mental disturbance was observed subsequently to, and as a direct consequence of, the attacks. There are two forms of this disturbance; viz., an acute one, where mental symptoms occur soon after attacks, and disappear again after a certain time; and a chronic form, in which there is a gradual and permanent loss of mental power consequent upon attacks. The characteristic feature of the acute form of postepileptic mental affection is its periodicity. Identical, or at least highly similar, symptoms are seen to occur year after year, and gradually become intensified, unless they be checked by active treatment. They do not always occur immediately after attacks, but occasion- ally a day or two afterwards, and last a variable time, but rarely longer than a week. After such an attack is over, the patient has mostly no recollection whatever of what has occurred. I will now relate as briefiy as possible the particulars of a case which was some time ago under my care, and which I consider well suited to illustrate this pathological condition. An unmarried lady, aged 57, had for three years suffered from epileptic seizures when she came under my care. No cause could be assigned for this illness. There was no neurotic tendency in her family ; she had lost her catamenia ten years before, without any trouble; her general health had been good, and her life compara- tively uneventful, although well employed. She had had no anxiety, and her habits had always been regular and temperate. From the first, the disease had followed such a regular course that it was pos- sible to predict, with a great degree of accuracy, the time when attacks would take place, and what would be their consequences; and this course had not been influenced by the treatment which the patient had undergone. , The usual sequence of events was as follows. Having gone to bed as usual, and slept the first part of the night, she has, generally, between 3 and 5 A.M., a sort of convulsive munching and swallow- ing in the mouth and throat, which lasts one or two minutes, and which is accompanied by a rolling or rumbling noise in the stomach. There is rhythmic action of the muscles of mastication and degluti- tion, as one sees it in the ruminating of sheep. After this munching and swallowing is over, she relapses into a quiet sleep, from which she awakes in half an hour or so, in a bewildered state of mind, asking what day it is, what o’clock it is, over and over again, and being quite incapable of collecting her thoughts. Her attendants then give her some medicine, which she swallows, and then goes to sleep again, awakes in a few hours for good, quite herself again, and has not the shghtest recollection of anything that has occurred. Such attacks are followed by a slight but perceptible loss of memo^, and occur generally at intervals of from ten to twelve days. Sometimes, however, there are two or three such attacks in one night. More severe attacks take place every four to six weeks. These also begin with munching and swallowing; but then she does not awake at all, but lies, with her eyes wide open, quite unconscious for hours. After a time, a tremulous motion of the whole body is observed, and a half-suppressed noise in the throat. The tremor so on becomes intensified into convulsion; the head turns round to the left side; a moaning sound is produced, the eyes are turned upwards; and this convulsion, which is at first tonic and afterwards clonic, lasts from three to ten, twenty, and even twenty- five minutes. The head then gradually turns back, and the eyes close; and a sort of heavy puffing comes on, with a slight flow of saliva from the mouth, the face being a good deal flushed. The