The diagnosis between true epilepsy and convulsions arising from other causes is not to be regarded as a matter of merely curious investigation, for upon its just appreciation depends the correct treatment of the case. I may cite an example in which the first epileptiform seizure was accompanied by some delirium, which differed materially from the mere confusion of epilepsy; but the whole disorder seemed so transient. that its peculiarities were attri buted to manifest bad management in the commencement of the attack ; and with some misgiving it was regarded as epilepsy. The patient was dismissed as having recovered ; but the next attack was distinctly one of serous apo plexy, at an interval, indeed, of nearly two years. After death' there was found immense dilatation of one of the lateral ventricles. I cannot doubt that in this case a condition of chronic inflammation had existed throughout and that judicious treatment might possibly have prevented the fatal termi nation.
An epileptic seizure may be either feigned for the purposes of deception. or simulated by the hysterical paroxysm. One grand source of distinction in such cases is the circumstance of no corporeal injury being inflicted during the attack ; not that this necessarily happens in true epilepsy ; but while on • the one hand, a bitten and bleeding tongue or a bruised face may be taken as conclusive evidence of genuine convulsion, its avoidance in ciiicumstances which might naturally have given rise to it, leads to the suspicion that con sciousness has not been entirely lost. The determination of its nature, indeed. turns mainly on the existence of consciousness, and various methods must sometimes be had recourse to for the purpose of ascertaining it. There is generally, too, a certain method and regularity in those movements which are either partially or wholly voluntary ; and in the case of hysterical females, other characteristics may be observed from which the prevalence of hysteria may be predicated, and the consequent probability that the seizure is only part of the same disorder. But this demands experience and attention rather than book-learning.
Certain points must not be omitted in the investigation of convulsive at tacks which are not immediately connected with diagnosis. In a first seizure, it has been shown how necessary is the inquiry into the condition of other organs ; but it is no less so even in cases where periodicity is clearly estab lished. The possibility of success in the treatment of all such disorders depends upon the correctness of this information, and in proportion to its accuracy will their management be removed from the realm of empiricism, and come under the domain of legitimate medicine. Not only do the physical
condition of the cranium and all the relations of the brain to sensation, mo tion, and the intellectual faculties, demand particular study; but respiration, circulation, digestion, and elimination, have each been proved to have their influence, if not as causes of the disease, yet as special sources of irritation, and therefore must each be individually inquired into ; and if' last. not least, the reproductive organs, in their changes from disease to health, from imper fection to maturity, exercise a most unquestionable influence over its amelio ration and its cure.
§ 6. Functional Disturbance.-r-V ague as this term may be, it needs no argument to show the necessity for such a distinction in a classification of nervous diseases. Not only do our present means of investigation fail in pointing out that there is any dis ease in nerve-structure accompanying the delirium of fever, or puerperal mania ; but there are numerous slighter and more transient alterations in the relations of the brain as the recipient of sensation, the originator of motion, and the medium of intel lectual operations, the nature of which, were our means of in vestigation never so perfect, we c,annot by any possibility have the opportunity of ascertaining through the bony wall of the cranium ; and to the,se last we especially wish to limit the term functional, although it might very well include all those condi tions which, so far as our knowledge extends, are unconnected with actual disease of nerve-structure.
They divide themselves naturally into three main groups ; (a) those connected with disturbances of the circulation, whether in excess or deficiency; (b) those connected with disorder in the process of digestion and assimilation; and (c) those which are more properly called nervous. Of the two former it is to be remarked, that while coincident, and bearing some relation to each other as cause and effect, the functional disturbance of the brain is not to be regarded simply as a symptom of disorder of the circulation, or of the digestion ; for it is not a necessary or a constant effect. The same amount of disorder is not uniformly followed by similar disturbance in any two individuals, or in the same individuals at different times ; while the identical symptoms may be noticed in the same person under very different states. Hence, the term nervous might be justly applied to all ; but it is important to bear in mind that the connection exists, and that the disorder of the circulation or of the stomach being removed, the functional disturbance of the brain for the time ceases.