inculcated in people, so that both for themselves and for those about them they may seek rather than shun early treatment. The incipient cases must be discovered. In this work the psychopathic social worker and the family social worker is needed. Teachers and employers should know more about the matter, so that they can recognize the early signs of mental breakdown. Doctors and nurses especially should be taught concerning premonitory symptoms. Clergymen and others consulted by people in trouble may serve, if informed, to discover the incipient case and before it is too late get him in touch with the right person or institution. Mental hygiene societies can be of considerable assistance in securing the attention of the public. Newspapers should be used to give more information to the public on insanity and the means of its prevention and treatment. The psychiatric institution should become universal. Its results should be published abroad. Seeking out the causes of insanity, it should give its results wide publicity rather than bury them in technical reports which only the few read. Exhibits and lantern slide lectures can be used to great advantage in teaching the public on this important subject. Finally, the conditions which produce mental disease should be attacked without delay. The last few years have seen much publicity on the rôle of syphilis and alcohol in the production of insanity. Other conditions are not so well known. Fatigue, mental conflicts, depressing and debilitating conditions of life in home and factory, the stresses of puberty and the climacteric, the factor of general debility, whatever the cause, and heredity have received less attention. The education of the people as to the causes, so far as known, and as to the proved methods of treatment and prevention must proceed. Already enough has been learned as to the results of giving information to the people to justify going further. We have reduced the death rate of babies by education of the mothers. We have taught a whole people that excessive use of alcohol is destructive of human life and happiness. It is just as possible to bring to people the principles of mental hygiene. It should be done, for there is no more terrible and tragic thing in human society than a mind deranged. A body man shares with the animal. Man's most characteristic endowment is his mind, with its reason, its deeper and more expansive emotions, its social possibilities on which human society rests for its achievements and its amenities. To prevent bodily disease is impor ant; to preserve the mind, to prevent its breakdown; to promote mental health, is absolutely imperative for the happiness of the individual and the welfare of society. TOPICS FOR REPORTS I. Volunteer Patients in an Institution for the Insane. Adams, Proceedings, National Conference of Charities and Correction, 1907, P. 434. 2. Village Care of the Insane. Lathrop, Proceedings, National Conference of Charities and Correction, 1902, p. 185. 3. Family Care of the Insane in Massachusetts. Fish, Proceedings, National Conference of Charities and Correction, 1907, p. 438. 4. Relation of Mental Defect to Industrial Efficiency. Powers, Proceedings, National Conference of Social Work, 1920, p. 342. A SEIZURE NAT 1 CHAPTER XIX THE CARE OF EPILEPTICS ATURE of the Disease. For at least 25 centuries epilepsy has been recognized as such. Hippocrates, born 460 B. C., described it and said of its prognosis, "The prognosis in epilepsy is unfavorable when the disease is congenital, where it continues to manhood or where it occurs in adult. We may attempt to cure the young, but not the old." It was early named from its most characteristic manifestation, the seizure. The name the disease now bears, "epilepsy," is Greek in its derivation and means "a seizure." Mention of a case is to be found in the Gospels. A man brought his son to Jesus with the words, "Lord, have mercy on my son: for he is epileptic, and suffereth grievously; for oft-times he falleth into the fire and oft-times into the water." 2 Dr. William T. Shanahan of the Craig Colony for Epileptics at Sonyea, New York, defines epilepsy as "a chronic progressive disorder, characterized by recurrent abrupt attacks or loss or impairment of consciousness, with or without convulsions, and usually accompanied by mental and oft-times physical deterioration." " There are four forms of the disease usually recognized in medical literature-grand-mal, petit-mal, psychical epilepsy and Jacksonian or focal epilepsy. The first is the most easily recognized form, because the patient falls in a seizure, usually froths at the mouth, has convulsions, and is usually unconscious for some time. The second differs from the first rather in degree than in nature. Usually the patient does not fall because the seizure is less severe. The attack is momentary, and is manifested by a slight flush or paling of the countenance accompanied by a gasp, a sigh or a momentary loss of consciousness. The patient does not fall usually. Sometimes there may be a slight giddiness or a faintness. Usually this form progresses into the first. The third named is less frequent in its occurrence than the other forms. The convul 1 Quoted by Barr, Mental Defectives, Philadelphia, 1913, p. 211. 'From address at Illinois State Conference of Charities, Oct. 21, 1912. sions are mental rather than physical and it is sometimes mistaken for insanity. The seizure increases in force usually for hours and sometimes for days, then gradually subsides. It is not followed by coma, but usually by a period of automatism, or a state resembling absentmindedness. This is the type which often manifests itself in homicidal tendencies. In the Jacksonian form the attack begins in some extremity of the body, the leg, the hands or the face. In this type the convulsions are confined to one portion of the body. Usually consciousness is not entirely lost.1 Cause of Epilepsy. The cause of epilepsy is unknown to the medical profession. They are agreed that it is a nervous disease, that certain conditions aggravate it, that it is rather closely related to certain other diseases of the nervous system and that it may be transmitted by heredity. In some cases epilepsy seems to act as an equivalent of other nervous conditions in the stock. Thus, the epileptic may have a relative who is feeble-minded, another who is insane and still another who is only a "little queer." It is a disease which usually manifests itself in childhood. Barr says that it seldom develops after the age of 20.2 If it appears after that age, the history of the case will generally show that there were convulsions in infancy or childhood. For example, a case described by the Bureau of Analysis and Investigation of the State Board of Charities of New York shows that a sister is of normal intelligence but nervous, the father had epileptic fits when a boy and for the last 5 years has had attacks of petit-mal. He has been in prison, never supported his family, and is alcoholic. Three sisters of the father were abnormal-one having had chorea when a child, another being very high-tempered, and the other very "queer." A brother of the father is feeble-minded. In the 9 cases investigated a strain of nervous instability ran through most of the families. Epilepsy itself appeared in the family history of 4 of the cases. "Fainting spells" appear in 3 of the cases. Clear cases of feeblemindedness appear in 8 of the 9 cases. Alcoholism appears in 7 of the 9; insanity in 6 families, a total of 9 times. Many other manifestations of mental awryness appears in these families which indicate a defective stock.3 'Barr, Mental Defectives, Philadelphia, 1913, pp. 214-216. 'Barr, op. cit., pp. 212, 214. 'Eugenics and Social Welfare Bulletin, No. VII, Albany, 1916, p. 55. Barr and Spratling attribute 56 per cent of the cases coming under their notice to heredity. external Among the exciting causes of its manifestation are blows upon the laust head, worry, excitement, injuries to the mother during gestation, diffibringing cult cult dentition, acute sicknesses and malnutrition. Intemperance and irregular living has also been suggested, but it is a question whether epilepsy manifests itself because of drink and vice, or whether these are a consequence of an epileptic taint. tenden кухо light Closely connected with the question of exciting causes as well as with the question of treatment are matters of food, age, and excitement. Experience with epileptics indicates that careful attention must be given to the food eaten, as to quantity and the kinds of food and how soon after eating the patient should go to sleep. Every physician who has worked in an institution for epileptics stresses the importance of providing easily digested foods, eliminating much meat, giving vegetables instead and providing when possible an amount of exercise sufficient to keep the bodily functions in good order. Childhood is the age period when this disease appears most frequently. Says Letchworth, ". . . epilepsy is essentially a disease of the young." Nothnagel finds it most common between the ages of 7 and 17. Barr finds that 66 per cent of his cases developed epilepsy between birth and the fifth year. Hasse, Gowers, and Gray find 75 per cent developing before the twentieth year. A high death rate for epileptics would naturally cut down the number in later years. Social Relations of the Disease. The importance of the disease. is indicated by its high mortality rate, its relation to other social problems, such as dependency, crime, unemployment, vagrancy and vice. Letchworth says of the relation of the epileptic to society, "The epileptic holds an anomalous position in society. As a child he is an object of solicitude to his parents or guardians. The street to him is full of danger, and if sent to school he is liable to seizures of the way or in the classroom. At school his attacks shock his classmates. and create confusion. He cannot attend church and public entertainments, nor participate in social gatherings with those of his own age and station. Because of his infirmity the epileptic grows up in idleness and ignorance, bereft of companionship outside of the family, 1 Barr, op. cit., p. 213. Letchworth, The Care and Treatment of Epileptics, New York, 1900, p. 8. 'Barr, op. cit., p. 213. |