VALUE OF OCCASIONAL CONVULSION IN CERTAIN CASES 263 It is probable that the statute, as we feel obliged to construe it, will work considerable mischief; in testamentary cases where the contest relates to the competency of the testator it will exclude evidence of physicians, which is generally the most decisive and important. In cases upon policies of life insurance, where the inquiry relates to the health and physical condition of the insured, it will exclude the most reliable and vital evidence which is absolutely needed for the ends of justice. But the remedy is with the Legislature and not with the courts. The amendments of 1891 and 1899 should be promptly repealed, and section 836 should be restored in this particular, as it was amended in 1877, so as to enable the parties to waive the physician's privilege when and as they please, and to give due effect to their contracts as made. To enforce the amendments referred to enables the beneficiary to repudiate a material part of his contract unfavorable to himself, while retaining the benefit of that part which is to his advantage. This is unconscionable and immoral, for he has obtained a better contract by reason of the waiver which it contains than he otherwise would have had, and the law should give effect to all parts of the contract. The amendments do away by an arbitrary statute, having no sound reason to uphold it, with an inherent right which existed independent of any statute. The amendment made to the section in 1892 as to attorneys who are witnesses to a will, and that made in 1893 as to evidence in damage cases, seem to be unobjectionable. This paper is not intended as a special plea for the life insurance companies. They are quite capable of taking care of themselves. I have aimed simply to call attention to what seems to me to be a gross and senseless injustice in the present provisions of the Code on this subject, as I have found it to exist in my own practice. For the ANNALS. THE VALUE OF AN OCCASIONAL CONVULSION IN CERTAIN CASES. BY WILLIAM P. SPRATLING, M. D., Medical Superintendent of the Craig Colony for Epileptics, Secretary of the National It is hard to imagine anything more contradictory on its face than to say that a convulsion could ever be of value; yet I am Convinced that such is sometimes the case, for two classes of indi viduals have come under my observation in which occasional convulsions were productive of good. The first includes epileptics in which prolonged periods of mental disturbance or insanity are prevented through the occurrence of a fit; the second, selected cases of insipient alcoholism in which a persistence in the drinking habit would probably lead to confirmed epilepsy, were it not for the emphatic warning given by the convulsion. Epileptics of a certain type make up the first class, and includes those in which the disease seems dependent on fluctuating internal causes; on the action of certain toxines as yet unisolated, and but little understood, and which grow in intensity until a limit is reached, when their toxicity is in some manner neutralized or destroyed by a convulsion, only to repeat again and again the same process of development, growth and decadence, the latter occur ring each time as the result of one or more epileptic convulsions. These periods of exacerbation are not, as a rule, fixed in time, although I have seen a few cases in which there seemed to be some evidence of periodicity. Epilepsy generally manifests itself by a sudden and more or less appreciable discharge of nervous energy in some part of the brain, and we know that experimental epilepsy may be produced in the lower animals in various ways, as, for instance, by the application of electricity to the brain cortex, and by introducing certain substances into the circulation, such as ammonium carbammate, alcohol and other toxic fluids. Now the action of toxic substances introduced from without is not essentially different from those produced within, and, relatively, they are of importance to the individual only in so far as he may or may not have power of control over them. In the former cases, those in which toxic agencies are introduced from without, his control over them may reasonably be assumed to be absolute, i. e., he may introduce them or not, just as he chooses; while in the latter, in the case of agencies having a like action and generated within, he may or may not be able to prevent their origin. When a man who is well along in years begins to drink and has a convulsion as the result, he had better let alcohol alone at once, for that convulsion meant an emphatic protest on the part of the brain that it cannot be subjected to such evil influences without the risk of pronounced injury to the general welfare of All amateur alcoholics would not have such a the individual. warning, and only those who suffer a constitutional loss of resistance on the part of the nervous system to the action of alcohol, especially need it, and such individuals ought to admire the wisdom of Nature in providing it. In some cases, perhaps in most of them, a convulsion, after all, may be regarded as only a protest on the part of Nature against the presence of an irritant of some kind in a part of the body where it ought not to be, and it only remains for science to locate and determine the nature of the irritant. A man of 40-the exponent of an eminent calling-an athlete in proportion, strong, vigorous, robust, and in every respect the picture of health, consulted me some five years ago for what he called "fainting spells." A thorough examination of his condition left me at a loss at first to account for his convulsions, but on close questioning he shortly admitted occasional over-indulgence in strong drink at times when "good fellowship'was being put to the test." I warned him earnestly; told him that as often as he applied the match, just so often would the powder probably explode; but he was unable at first to quit the practice, and about every two months, for a period of two years, he would have one and sometimes two well marked convulsions after his periods of dissipation. Finally-being a man who often spoke in public-he had a very marked convulsion in a place and manner that embarrassed him exceedingly, but which had the salutary effect of bringing him to his senses, for after that he submitted to proper treatment, abstained from further indulgence in alcoholic drink, and for three years now has not had a convulsion. This man stood in danger of sooner or later becoming a confirmed epileptic; not because there was any distinctive cause in his condition capable in itself of producing epilepsy; but because there was in him an inherent tendency to convulsions which would only appear under proper excitation, and which being forced to appear a sufficient number of times would give rise to a condition that might continue to create them independent of the action of an immediate excitant. Such convulsions, once established, are termed "Habit Epilepsy," and they express conclusively the power of education possessed by the central nervous system. In the second class of cases in which an occasional convulsion helps to preserve the mental life of the patient, it is far more diffi cult to determine and remove the cause. In many of them the convulsion seems to come as the termination of an obscure autotoxic cycle that varies in duration in different individuals and that bears some similarity, in its upward period, at least, to the "Folie Circulaire" or the Circular Insanity of the French. It seems evident that the specific cause of the fit in these cases is something that permeates the entire organism; something that comes and goes, causing a sort of Psychic tide that rises and falls; that grows and develops in intensity, exerting a pernicious influence on the daily life of the patient by making him do and say things not in harmony with his normal state, which abnormalities the patient will exhibit in proportion to his powers of inhibition, until the limit is reached and the mind loses its direction and control. The powers of further inhibition finally being destroyed, the nervous storm breaks with great force and violence, the poison is neutralized or destroyed, equilibrium is restored, and all is quiet and serene once more. A fairly typical illustration of this class, in her own language by E. M., an intelligent woman of 43, and now a patient at the Craig Colony, is of interest. "This is now the 22nd of February, 1902. I had four very severe attacks on the 31st of last January. I felt the attacks coming for a long time before they came. I was exceedingly nervous and irritable; things did not go right. I scolded about everything and was unable to hold things in a proper manner. When I picked up my brush and comb I would drop them, and when I walked I stepped crooked-one foot would keep making mistakes, and I didn't know which foot it was. They said it was the left. I could not sleep at all. I lay thinking of things that had happened and that were not pleasant. I tried to put them out of my mind by thinking of what I had read. I like history and I tried to think of some character in English history about which I had read. I have a strong will and feel that I can control my thought at most times, but for days before the attacks come on I am unable to do so. They go off about everything and I try to make them come back but they won't. They get worse every day and night and finally they all get jumbled up together and I don't know anything. Then the attacks come on and after that I am all right-everything clears up and I see things as they really are. I lose all my nervousness and can act naturally." The same psychic phenomena are witnessed in insane epileptics, who are prone to show indications of an approaching seizure. "In asylum life," says Bevan Lewis, "amongst the intelligent class of nurses the fact is universally recognized that a premonitory stage of great irritability is often seen, and the effect of a convulsive attack will be to clear up the mental atmosphere." In our experience, delusions, hallucinations and illusions are very rare in the average epileptic, sane or insane, during the inter-paroxysmal period, but are more common during the pre-paroxysmal stage, nearly always disappearing with the fit. Personally, I come in contact with large numbers of epileptics at regular times each week, and it is easy to detect psychic evidences of an oncoming attack, in many cases days and even weeks before the attack occurs. Such cases would seem to offer an inviting field in which the comparative study of living matter in the most comprehensive manner, during, as well as between, the periods of disturbance that culminate in convulsions, might be pursued to advantage; and especially do they emphasize the necessity for studying and treating the epileptic strictly on an individual basis. Nor is it enough now to speak simply of epilepsy, for our knowledge of its manifold types and causes would seem to require that we make every effort to be more specific, and define which one of the epilepsies we may have under consideration. Editorial In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen. Autobiography. New York State BENJAMIN FRANKLIN. This laboratory was authorized under Chapter 345, Laws of 1901, for "the manufacture and standardization of tetanus, streptococcus and diphtheria antitoxin, and for further investigations of serum therapy in tuberculosis, typhoid fever and kindred diseases." Dr. H. S. Pease was appointed Director |