Volume 1

Clinical lectures on the diseases of the nervous system : delivered at the infirmary of La Saltpêtrière / by J.M. Charcot ; translated by Thomas Savill.

Charcot, J. M. (Jean Martin), 1825-1893.

Date:: 1889

Credit: Clinical lectures on the diseases of the nervous system : delivered at the infirmary of La Saltpêtrière / by J.M. Charcot ; translated by Thomas Savill. Source: Wellcome Collection.

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

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$we have received^ on inquiries made, do not permit the survival of any doubt as regards this fact. In short, in cases of this kind, the prognosis is nothing different from that of intense hysteria. Such is likewise the opinion of M. Briquet. Erom this consideration a practical conclusion is deducible^ well calculated to command your attention. There is, lastly, another characteristic on which I beg leave to dwell at some length, because it has not hitherto been noted, so far as I am aware, and because, in my judgment, it is decisive. This charac- teristic is yielded by thermometrical exploration; and I hasten to seize the opportunity which presents itself now of showing you, by a new example, the advantage which may be derived from this mode of in- vestigation in the clinical treatment of diseases of the nervous system. It is not, gentlemen, that the tonic epileptiform convulsions of hys- terical patients differ, in any respect, from the convulsions of the epi- leptic attack, so far as changes of central temperature are concerned. The tonic hysterical seizure, if it have but a certain intensity, raises the temperature by i° C. (=i-8° E.), nay, by a degree and some tenths (38°, 38-5° C.,= 100*4° '^•> ioi*3° exactly as we find to result from an attack of true epilepsy. This is a fact the accuracy of which we have had many opportunities of testing in these wards.^ But if, as regards thermic elevation, the attack of epileptiform hysteria and the attack of true epilepsy be identical, it is quite otherwise when we have to deal with those fast-following fits that constitute what, as regards epilepsy, have been called in France les series or etat de mal (= status epilepticus,—which we may translate by the term epileptic acme). Of this epileptic acme we can distinguish two kinds: the minor acme, (les petites series), constituted by from to 6 fits, and the major acme, {les grandes series), in which from 20 to 30, or even more fits, have been reckoned in the twenty-four hours. I address myself ex- clusively to the latter, because the phenomenon, on which I wish to lay stress, then manifests itself in its typical state of full develop- ment. In such cases, gentlemen, that is to say, when a great number of true epileptic fits succeed each other, within a brief space, the central temperature becomes remarkably augmented; and, most assuredly, this thermic increase cannot be attributed exclusively to the repetition, any more than to the intensity, of tonic muscular contrac- ^ Bourneville, ' Etudes Cliniques et Thermometriques sur les Maladies du Systeme Nerveux.'$