Tag Archives: epilepsy

Interesting Cases

2 Replies
Alienists Could Be Prominent Public Figures

Alienists Could Be Prominent Public Figures

Alienists (psychiatrists) wanted to provide good care for the insane in their midst, and in the early years offered assistance primarily  through therapeutic stays at insane asylums. These doctors’ favored regimens of rest, occupational therapy, and structured time probably served many patients well, but such programs could not help everyone. Alienists were still exploring the causes and treatments of insanity, and some of their thoughts missed the mark widely.

In an 1871 paper on mental disease (reported in the Transactions of the Medical Society of the State of North Carolina), the author described a “case of violent cerebral excitement” in a 5-year-old, which had been relieved by an oral dose of bromide of potassium. This case of “mental disease” seems to be clearly a case of epilepsy, and we can only wonder if the child was tagged for life as insane.

Another paper in the same publication discussed “Mania Transitoria,” or insanity of very short duration. During this type of mania, people could be fully aware of their surroundings (or not) and actions. It was brought on by such things as physical disease or the “accumulation of harbored feelings over a number of years.” The author seems to be describing explosions of temper or momentary passionate outbursts, but he attributed this type of insanity’s cause–or attributed it at least in part–to masturbation and petit mal epilepsy.

Craig Colony for Epileptics, courtesy museumofdisability.org

Craig Colony for Epileptics, courtesy museumofdisability.org

Cures For Epilepsy Were Plentiful

Cures For Epilepsy Were Plentiful

Misunderstanding Convulsions

Leave a reply

Treatment of Insanity, 1846

Doctors didn’t understand what caused many psychological problems or mental illnesses, and usually relied on a “best guess” approach to anything without an immediate cause and effect. A doctor at the neurological unit of Boston City Hospital discussed the case of a boy experiencing convulsions. He had shown signs of a cerebral injury at birth, and later developed grand mal seizures. He was also bitten by a dog as a child, and began to have convulsions that usually occurred when he saw a dog. The doctor felt that emotion (in this case, fear of a dog), was the precipitating factor in the patient’s attacks.

The doctor brought up other instances of an emotional cause for convulsions. A 17-year-old girl suffered her first grand mal attack within two hours of being forced to break off an engagement. The doctor also described another physician’s initial treatment for a 12-year-old girl  who had had cranial trauma and then seizures earlier in life: a regime of high enemas. Later, when the girl was 18, the doctors tried a “nine months trial of dehydration” which made her condition worse.

 

________________________________________________________________________

Insanity Diagnosis

Leave a reply

Insane Epileptic Patient Eliza Whitfield, age 28 in 1889

Epilepsy always puzzled alienists (early psychiatrists) because of the strange behavior victims exhibited in contrast to the rationality they often also displayed between episodes. The American Journal of Insanity was full of articles about epilepsy, and continued to explore the topic after it became the American Journal of Psychiatry. One article in 1923 explored the question of psychotic symptoms in epilepsy.

The writers noted that patients were often described as having a “typical epileptic disposition.” An author they referenced described this disposition: “The whole life of the epileptic shows hatred. It bursts forth in all its brutality on the slightest provocation; the horrid the brutal, and all that is evil…”

It is no wonder that with this prejudice against them, many epileptics were confined to insane asylums based on their behavior during and after convulsions.

 

Admission Notes Showing Epilepsy, courtesy Gutenberg.org

An Epileptic Boy, courtesy Gutenberg.org

________________________________________________________________________

And The Flip Side

Leave a reply
Bromide Advertisement

Bromide Advertisement

Patients who came in malnourished or otherwise neglected often needed building up. However, doctors often had plenty of patients that they needed to settle down rather than energize. Sedatives like bromides (usually potassium or sodium bromide) were very popular for excitable patients.

Many patients at the Canton Asylum for Insane Indians were epileptics. Sodium bromide and potassium bromide were also used as anti-seizure medicines. At the time, bromides had a secondary (though related) use.  Many doctors thought epilepsy was caused by masturbation, and the drug calmed sexual excitement. There is no evidence that any of the doctors at Canton Asylum believed this theory, but they did rely heavily on bromides for their epileptic patients.

Bromide doses were difficult to adjust, since the drug stayed in the body a long time. Chronic overdoses could lead to a toxic condition called bromism, which itself presented neurological and psychiatric symptoms like confusion, emotional instability, hallucinations, and psychotic behavior.

Bromide Eruption Resembling Small-Pox from Materia Medica, 1918

Bromide Eruption Resembling Small-Pox from Materia Medica, 1918

________________________________________________________