The common origin and nature of 'blind spells,' petit mal, faintings, swoonings, coma, 'pseudo-epilepsy,' epilepsy, 'migraine,' etc. / by George M. Gould.

  • Gould, George Milbrey, 1848-1922.
Date:
1907
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Licence: In copyright

Credit: The common origin and nature of 'blind spells,' petit mal, faintings, swoonings, coma, 'pseudo-epilepsy,' epilepsy, 'migraine,' etc. / by George M. Gould. 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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    mean scotoma scintillans by the term, and that is a revelation of itself of the frequency of this symptom. Again, scintillating scotomas are of as many kinds almost as there are patients, running, in different cases, from hashes of light, central dark spots, rings, waverings, crinklings, obscurations to one side, etc., etc., up to the extreme fortifica- tion spectra, with rainbowed or aurora-bore- alis-like wavings. Sometimes these last for only a minute, sometimes for a half-hour. Sometimes there are no after-effects, and sometimes there are sequent headache, weak- ness, sickness, etc., of different intensities and periods of time. By “blind-spells” patients have explained that they mean such tiring and extreme effort to see while read- ing, writing, sewing, or otherwise working, that they must stop awhile. Sometimes they mean that an object looked at, the threads in sewing, the ball in the air, etc., disappear, and in a second or two again reappear, Sometimes, once more, they mean that they cannot go on for quite a time, must change the work, get up and walk about, or some- thing like. I have had a number of patients who, in using the term ‘ blind-spells,” meant it most literally and accurately. A recent instance was in a woman who has had such attacks for about fifteen years. In Florida, where light was more harsh, they increased alarmingly. She has been hours and days without vision, unable to walk alone, etc. Then the vision would return and nor- mally, and all go on as before. The phe- nomenon was caused by reflex eye-strain. And lastly, they mean, hiding the fact from their own minds and from yours, that they, as an individual, ‘ stop altogether,” that is, they lose consciousness for little or for long, partially or entirely. They are, if knowing it (and more know it than we or their friends suspect), secretly worried by it, and no one can guess how many bear about with them the haunting, disconcerting and tormenting grief that they have some inherited, inex- plicable, incurable malady of the brain or mind. Thus this large class of sufferers ftom blind-spells” passes on and over into the class afflicted with some of the thousand ever-variant and atypical symptoms bunglingly classed under the head of “ PETIT MAL. ” The predominant and characteristic symp- tom with these patients is temporary loss or lapse of consciousness and purposive action, but without falling or extensive muscular spasms. The bodily functions hold the or- ganism still, the psyche stops, seems discon- nected for a short time, and then the nexus is again established, when all goes on as before. SWOONINCS AND FAINTINGS, COMAS AND SEMI-COMAS, are more extensive, sometimes more inten- sive examples of the same failings and stop- pings of functions principally psychic, but not always so, the physical and physiologic losses of control varying greatly in extents, degrees and lengths of time. Extending from within this class, and occupying a great stretch of the long space between it and “typical” epilepsy, dovetailed into both classes, is that nondescript and infinitely varying class of pa- tients bunched together under the meaning- less terms— PSEUDO-EPILEPSY, HYSTERIA, HYSTERO- EPILEPSY, and dozens of others, repeated only by psychia- trists and neurologists, and understood by nobody in the world. But the roofings and beginnings of the symptoms of these pitiful ones, upon investigation, will usually be found back among phenomena which I have described, and among the functional “mi- graines,” headaches, nervous and nutritional disorders, of similar natures and origins with them. Epilepsy, of the pronounced or chronic kind, is the most extreme, the last, the most hopeless of the diseases of this general class. To the temporary loss of psychic control of all others is added only one almost accidental and not differentiating factor—an excessive and unregulated overflow of innervation to the bodily muscles during the lapse of psychic control or consciousness. Not for an instant, however, should be ignored the fact that the pseudo-epilepsies,” etc., merge into the typical” variety by innumerable and indes- cribable gradings and varieties. There is in- dividualism everywhere, and the hundred subclasses that might be made would far out- number the extreme variety. Even in the extreme, individualism is always present, and to be studied as such. Each person in the world differs, psychically, and physically, even in the chemical construction of his proto- plasm, from every other, and his disease must differ from that of every other. In passing it may be noted that the tremors of many kinds and afflicting many patients, are often, in essential nature, probably not unlike the diseases described. And, lastly, there is a class of sufferers, more numerous than all others combined, the subjects of