The mild disturbances of the intellect (psychic equivalents) are not always recognised—especially when the severer types are kept in mind—because to the untrained observer the patients do not give any outward impression of being in any way mentally disturbed.
They may merely seem somewhat confused or slightly intoxicated ; and in this condition they may commit various crimes, such as arson, larceny, etc. They are in doubt as to their own mental status, and search in vain for a suitable excuse for their shortcomings. Such excuses as are finally devised are not even accepted without restrictions by themselves ; and they generally wind up their statements with the formula " I do not know how I came to do this." Patients of this kind may undertake prolonged journeys, and when they finally come to in some foreign place they are unable to explain how or why they got there.
It is important for a criminal judge to be acquainted with the tact that the recollection of any given act, such as a larceny, may not be erased for some short period of time after the crime has been committed ; but as soon as the cloud over the intellectual faculties is lifted, all memory of the act is lost. A prisoner thus afflicted will affirm what he has done while he still remains in this morbid state of mind, only to deny every recollection of the act when his normal condition of mind returns. It is possible to refer to these as instances of double consciousness, similar to those met with in other abnormal mental states, such as hysteria, sleep-walking, and hypnosis. It is scarcely necessary to call attention to the possibility of simulation in these people, but there is no doubt that many epileptics have been unjustly convicted of crimes which they committed while under the influence of the epileptic attack. It is often a most difficult matter to come to a decision in these cases, and a knowledge of insanity is necessary for proper judgment.
Intoxication in epileptic patients is a serious condition. Even a small quantity of alcohol excites them, and renders them dangerous. Some are thrown into a condition of fury and brutality by the ingestion of only a few glasses of beer. The alcoholic state is likewise followed by a loss of every
recollection of the event.
It must be expressly noted that a case of epilepsy may b2 marked only by the psychic phenomena just described, without there having been at any time any evidences of convulsive seizures. The mental disturbances of the kind described, and not the convulsive attacks, are therefore the essential characteristics of epilepsy.
Epilepsy is very often a curable disease. Sometimes it disappears without any definite method of treatment having been used ; and this accounts for the occasional " cures " by quacks. The latter have largely exploited this field of medicine, and all the nauseating remedies which characterised the pharmacopoeia of the Middle Ages have been and are still being employed by them. But only one drug has withstood the stress and storm of medical criticis n, and that is bromine and its derivatives.
These preparations should always be given under medical super vision in order to obtain the desired effects ; they should, therefore, never be recommended carelessly among the laity, who may employ them without the exercise of any discretion. Nor should any attention be paid to the statements of quacks who publish tirades against the bromides, and label them as poisons, yet incorporate them in their own secret preparations. The necessity for direct medical supervision must not only be extended to the giving of the drug, but also to the manner of living, for one is a necessary accompaniment of the other. Many an epileptic • might have been cured if these admonitions had been obeyed. Diet and open-air occupations are of even more importance than the bromides.
Epilepsy originally due to injuries to the nerves or the brain, may some times be cured by surgical procedures. The hope has been entertained that primary or idiopathic epilepsy might be similarly benefited, but thus far no results of any consequence have been secured.
Dangerous epileptics must be confined in institutions organised for this purpose, and this also applies to those who are mentally weak and helpless, unless provision can be made for them in their homes.