A manual of medicine.

  • Allchin, William Henry, 1846-1912.
Date:
1901
Catalogue details

Licence: In copyright

Credit: A manual of medicine. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    337/458
    convulsions (p. 327) and malingering; and in the case of minor attacks from fainting and vertigo (p. 295). Major fits also have to be distinguished from convulsions due to local disease of the brain, such as tumours, and from ursemic convulsions and convulsions due to drugs. A medical man is unlikely to be imposed on by a malingerer if he have an opportunity of witnessing one of the fits, and the pre- servation of the pupil reflex will further aid in distinguishing. From hysteroid attacks the character of the convulsion, tonic followed by clonic stage with groaning but no speech in epilepsy, rigidity with opisthotonos, followed by struggling purposive movements, and shouting or screaming during the fit in hysteroid convulsions, will usually enable a diagnosis to be made. But it must be borne in mind that hysteroid convulsions are often post-epileptic phenomena. From fits due to lesions of the cortex the diagnosis is by no means easy in all cases, as in the early stages the fits from a tumour may be general. Usually, however, they are one-sided, and are characterised by definite aura, slow march of the spasm, late loss of consciousness (or consciousness may be preserved), and, most important of all, paralysis of the part in which convulsion has occurred for some time after the fit. Optic neuritis is present in many cases of cerebral tumour, and should be looked for in every patient who comes for treatment of convulsions. Ursemic con- vulsions will be of recent origin, and the other signs of renal disease should prevent a false diagnosis. Convulsions may occur from time to time in those who have had some head injury or local lesion years before. Convulsions may occur temporarily as a result of an alcoholic bout. The prognosis in epilepsy involves several separate questions —(i) the danger to life; (2) the prospect of a spontaneous termination of the disease; (3) the prospect that by treatment the disease may be cured or the attacks arrested. The chief danger to life is from the exposure to accident which the attacks involve. Death from asphyxia may occur from choking if an attack should occur during a meal or if a patient vomit after the attack while still comatose. Another danger is the tendency of patients to turn on the face after an attack in bed, when suffocation may occur in the post-epileptic insensibility. Falling into the fire or on to machinery are not uncommonly the causes of death in epileptics, but by far the most common accident is drowning. The danger of such accidental death is, however, very small. Death from the severity of a single fit is very rare, and the occurrence of