may be equally compared to a state of dream." But this subject has been dwelt upon sufficiently above; and a classification of some of the varieties of this disease, although necessarily inadequate and incomplete, has been quoted from one of those who have devoted most attention and intelligence to this obscure and curious disease.

2311. As to the Mental Condition of Epileptics. That being the case, it being true that this disease may show itself simply as an involuntary pause, a momentary loss of consciousness, or in connection with convulsions, coma, and maniacal fury, it is necessary to consider the mental condition of those who are liable to epileptiform seizures, and, having arrived at some definite conclusion with regard to the mental state, a consideration of the modification which may be necessary, in the relations of epileptics to their neighbors, will naturally follow. It cannot be doubted that epilepsy is very frequently associated with insanity. As showing the kind of insanity with which it is most frequently associated, Esquirol has shown that of 339 females in Charenton, 12 were monomaniacs, 30 maniacs, 34 furious, 145 demented, 8 idiots, 50 habitually reasonable, but afflicted with frequent loss of memory, and 60 exhibited no aberration of intelligence. Now, although there is a close connection between mental disease and epilepsy, many people would argue that still the epileptic is not necessarily insane. The individual who is liable to epileptic fits is to all appearance in every respect like his fellow-men, except at the time of the seizure. He is able to conduct his business; he is able to perform his professional duties; he is able to continue his amusements and pursuits with as much zest, intelligence, and vigor as at any period before the commencement of the disease. It is not incompatible with the possession of transcendent genius, and the advocate of these views would point to Cæsar and Napoleon as 221 examples of individuals who labored under epilepsy, and were at the same time famous as no insane men could have been. We have ourselves heard medical psychologists point to the writings of some of those

Archiv. Gén. de Méd., t. xviii

Maladies Mentales, t. i., p. 274.

persons who are most popular with the reading public at the present time as full of internal evidence of the existence of epilepsy in the authors. If such statements are true, it would be absurd to regard epileptics as insane, and to deprive them of civil privileges or protect them from punishment for criminal acts.

2312. Necessary to consider the Mental Condition at the time of the Seizure.-But one thing is to be considered, and that is, the mental condition of the individual at the time of the seizure. Although an individual may be, under ordinary circumstances, perfectly sane, still when he is attacked by fever he becomes mad; and just as it is necessary to consider the legal relations of the one, it is necessary to consider the legal relations of the other. It matters very little to law whether the mental excitement and fury which led to a wrong act be the result of fever or epilepsy so that it be of such a nature as will deprive the individual of those faculties the possession of which constitutes responsibility. But besides the excitement and mania which occur in connection with epilepsy, there are other mental states that may have an important medico-legal aspect.

2313. Epilepsy is very often followed by Insanity.It is a well-established fact that epilepsy leads to insanity. That a long continuance of epileptic fits will lead to excessive mental weakness and disease amounting to dementia is well understood. But, besides being, as it were, the high road to mental disease, "all authors," says Baillarger, "are agreed in admitting the fact that epilepsy, before leading to complete insanity, produces very important modifications in the intellectual and moral condition of certain patients. These sufferers become susceptible, very irritable, and the slightest motives often induce them to commit acts of violence; all their passions acquire extreme energy;" and many of these acts of violence are to be ascribed to disease, and not to the influence of ordinary motives.

2314. Method of this Chapter.-We will consider the

Ann. Médico-Pysch., Avril, 1861.

stages of an attack of epilepsy in the order of their occurrence. We have seen that these may be roughly divided into three: 1. The conditions premonitory to the attack; 2. The attack itself with the suspension of consciousness; 3. The conditions which occur subsequently.

315. Conditions Premonitory to the Attack.-During the premonitory state there is generally considerable confusion and perplexity; the patient wanders about without any [222 purpose, and indulges in various eccentricities of conduct. In this stage the epileptic scarcely understands what he is doing, and has no internal certainty of the clearness of his perceptions. They not unfrequently have "queer feelings" which they are unable to describe. If the epilepsy is associated with insanity, it is at this period that the peculiar delusions and illusions which are found in connection with epilepsy become most prominent. We have been able to ascertain some of those insane beliefs which exist in the minds of those who are laboring under epilepsy with insanity.

1. W. Bexpresses great apprehension lest his head should fall off, and stands for hours holding it on with both his hands. He says it is so unsteady that he is afraid to move, as it would certainly be broken to pieces were it to fall on the floor.

2. A. M- fancies that he is being hung and run over by railway trains. He clutches at his throat, gasps for breath, and complains of being suffocated and drawn out. At other times he screams out that he is being cut in pieces by the wheels, that his arm is wrenched off, and that he is bruised.

3. F. McN is perpetually being beaten and abused in the most shameful way by one of her companions in the wards. She thinks that her bones are broken, and that her body is covered with bruises.

4. J. S thinks he is dead and buried, and that it is only a phantom that is filling his place.

5. T. D thinks that a little man gets into her head, and produces the fits. She feels him there, and also hears him talking.1

Dr. Schupman relates the case of a man who believed himself to be pregnant. Journal de Psychiatrie, 11 Cahi", 47; Ann. Médico-Psych., 2d series, t. i., p, 301.

6. P believes that his breath is drawn out of him, that his heart is removed from his breast for a time, squeezed, and replaced. He also maintains that he is visited during the night by God in a white robe, and by three men in smock frocks and masks, who pull his hair.

7. A. S before the fit comes on thinks that his brain is turned round.

8. J. Mimagines after fits that his body is immersed in a burning fiery furnace.

9. W. A into blood.'

after the fits declares that his brain is changed

? 316. Peculiar Character of the Insane Belief's associated with Epilepsy.-223 Now, these insane beliefs are interesting in that they are all connected with ideas of violence; and in considering the relation of epileptics to the State, the fact that all insane impressions existing in epilepsy are colored by the belief of injury done by an external cause, will be a matter for careful consideration. That this is almost the invariable drift of ideas in persons laboring under insanity and epilepsy will be proved by other cases than those above alluded to. Thus Dr. Sherlock had an epileptic patient under his care who "imagined that she was addressed by men with unbecoming freedom, and scolded with dreadful imprecations, that she was lashed with ropes, and cruelly lacerated, and that she was drawn into painful attitudes by various mechanical contrivances."2 Dr. Browne, late commissioner in lunacy for Scotland, in a paper in the Journal of Mental Science upon epilepsy, has said: "I have seen a victim rise panic-stricken from sleep, and flee from imaginary foes to imaginary friends. I have heard described strife and struggles and extravagant gestures, which might have as readily dealt death or injury to those around as been expended on the unresisting air. There are facts which show that suicide has been committed under the influence of such seizures." And with a similar tendency, it has been shown

See also an interesting paper on the Religious Sentiments of Epileptics, by Dr. Howden, Journal of Mental Science, Jan. 1873.

* Report of the Worcester Asylum, 1856.

Vol. xi., p. 336.

Sce also Dr. Maudsley's Mind and Body: London, 1870.

that the existence of epilepsy is associated with meaningless fear, and that in very many cases the epileptic attacks are produced by terror. There are one or two other insane impressions connected with epilepsy which have an interest for those who would understand the real mental phenomena of this disease. One of these is an illusion of sight or a delusion with regard to blood. In the cases above alluded to, the combination of the two beliefs, the one of personal violence and the other with regard to blood or the color red, will illustrate this point; and the story given by Mr. Warren' of the delusion which existed at the time of an epileptic seizure, that an old woman in a red cloak came and struck the patient with her crutch, is not fiction.

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317. Epileptics: Insane Feeling of Unhealth, and Desire for Cure.-One other interesting point is worthy of being noted, and that is the intense desire which exists in connection with epilepsy to be treated medically for the disease. Epileptics are not content unless something is being done to relieve them from [224their fits. In a case which came under our notice the patient had, with a view of getting rid of his fits, drunk his urine at 12 o'clock each night. He imagined that he had been better for it. But this is not peculiar to one case, it is to be found in all; and if we examine into the history of superstition in connection with disease, we will find that most of the superstitious beliefs, with regard to cures, have reference to the falling sickness. Thus, in Austria it is believed that a murderer's blood cured the disease. In Scotland, within a very few years, cocks have been sacrificed, and gold and silver water has been sprinkled in the name of the Trinity, with a view to the same desirable end. We have ourselves been able to ascertain the details of a case in which incestuous connection was determined on in family council, with a view to the removal of epilepsy which existed in a daughter of the house, and in which the connection alluded to resulted in the birth of a child, and not in the cure of the epileptic. This strange method was adopted, and this absurd superstition believed in, in a highly

L Diary of a late Physician.