REMOTE STORAGE [Reprinted from American Medicine, Vol. X, No. 12, pages 486-487, September 16, ”1905.] EMOTIONAL SHOCK AND FRIGHT «. “AS: CAUSES OF EPILEPSY. BY WILLIAM P. SPRATLING, M.D., of, SonyedN. 26 Medical Superintendent of the orate Colony for Epileptics; President of the National Association for the Study of Epilepsy; Member New York Academy of Medicine; American Neuro- yo sya logical Association, etc. oo Se posts te: The casual student of epilepsy may hesitate to believe that epilepsy is so often due to emotional shock and fright as reliable data-conclusively show. Féré declares it is beyond doubt that in predisposed , subjects a fit may be immediately provoked by a more | or less intense. shock™to° thé*™ nervous. system, and that © such states are ciated with an overexcitability favor- * able to the evolution of convulsive phenomena. At the menstrual periods these emotions act even more power- fully by reason of the nervous susceptibility which accom panies this physiologic condition. The convul- sive discharge may gccur immediately after the emotion is experienced, or‘be delayed for some time after. The nervous depression succeeding emotional shocks ° may last a good while, and the attack may “alter thes during the asthenic state, occasionally long eae initial cause. An epilepsy which manifests connection with fright may become definitel #i lished and the fits may thereafter appear without appar- ent exciting cause. In some instances the attack invariably recurs when the same exciting influence is applied ; for instance, the sight of a corpse, of a precipice, of blood from an injury, ec. /ot all the immediate causes of epilepsy the most potent are physical fright, excitement, anxiety. To these are ascribed more than a third of those in which a definite cause is given. Of the three forms of emotion, fright takes the first place. The relation of this cause to age is very distinct. It is effective chiefly in early life, when emotion is so readily excited, and is most powerful at the transition from childhood to adult life, while after middle life it is almost inactive.’ The female sex is nctoriously the more emotional, and accordingly the disease ave & 2 results from fright in a larger proportion of women than of men, although the difference is, perhaps, less than might be ex- pected—61% of women and 39% of men. It is notorious also that this difference between the sexes increases as life advances. In childhood one sex is almost as emotional as the other, but with puberty men become far less emotional than women. The influence of fright as a cause of epilepsy is in strict harmony with this fact. Under 10 the sexes suffer equally. Between 10 and 20 the male suffers less than the female, as 3 to 4; between 20 and 30, as 3 to 13, and over 30 the only cases due to this cause occur in women. Predisposition usually exists. Hence, in speaking of fright as a cause of epilepsy, it must be remembered (as alrons stated) that its effects are only that of the exciting spark. “The exact form of fright varies, of course, in different cases, but the list is instructive. In several cases, the cause was some stupid, practical joke—a pretended ghost, children shut up in dark cupboards, an alarm of fireor burglars. Ina few cases, the patient had watched other persons in fits. Alarm - during severe thunderstorms was another cause. One case was that of a soldier, who had his first fit a few hours after being terrified, while on sentry duty at night, by the unexpected appearance of some white goats on the top of the adjacent walls of a cemetery, which he mistook for emissaries from the graves.”’ (Gowers.) In a study of 1,828 cases, I found emotional shock or fright to have been the cause in 62, or 5.56%. Of these, 22 were men, in a total of 814, and 40 were women, ina total of 509, being about 8% among the former and nearly 8% among the latter, showing such causes to be nearly three times as active among women as among men. During the first 10 years of life, there were 14 cases due to this cause among 814 men, and 15 among 509 women, which demonstrates the greater susceptibility of . females even at this early age. Some writers state there is no difference in the sexes during the earlier years, but such is not my experience. During the second 10 years, only 7 cases occurred among the same number of men, whereas there were 25 among the women. After 20 years, there was one case only in either sex. It seems, therefore, that emotional shock ‘most often leads to epilepsy in the female sex, and is “most apt to be active about the age of puberty. It is interesting to note the influence of heredity in these cases at the three age periods mentioned. Under 10 some hereditary influence was present in 5 boys and not present in 9. Between 10 and 20 it -was present in 2 and not presentin 3, while it was not present in a single case after 20, thus making it a factor in 7 cases only out of 22 among the men. Under 10 it was REMOTE STORAGE present in 10 girls and not present in 4; between 10 and —. 20 it was present in 14 and not present in 11, while it was noted in only 1 case after 20 (and that at the forty- fifth year), thus making it a factor in 20 cases out of 40 among the women. The character of the Gaetan shock of fright is indi- cated in the following: ‘‘ Fright from seeing an escaped lunatic’’; ‘‘ frightened by a Sees en father’’; ‘‘from seeing blood’’; ‘‘from a dog “bite’’; ‘‘from being chased by a cow,’’ etc. Asan illustration of the type of case in which emo- tional shock produces epilepsy, the following is a typical instance : L. L. had the first convulsion when she was a girl of 9, due ‘“to seeing an escaped lunatic.’’? She has always been ‘‘ very emotional and easily excited.’”’ She had7 or 8 attacks at first every 24 hours, which condition persisted for some years; then they dropped to4or5a day until 1896, when she was 24. At that time they began to appear several days apart. At first they were entirely petit malin character, but later changed to ‘grand mal, with no aura. She has always fallen in such a way as to injure her face, having several times fractured her nose, and more than once her lower jaw. If there ever was an ele- ment of hysteria in her attacks it disappeared completely years ago, for she is a typical epileptic at this time, bearing in her face the only physical signs pathognomonic of the disease—a mass of scars acquired through repeatedly falling and injuring the “~~ Same place—a part of the only true facies epileptica. It sometimes happens that when the disease is caused through undue excitation of the psychic centers, the “~~ reapplication of the same excitation will produce an : attack. There is now under my care a girl of 14 whose epilepsy appeared when she was 12, and was caused through fright on hearing the fire-alarm, and seeing the fire-engines go by in the night. While under my care “there have been two occasions when she has heard similar _ alarms, and each time she had an attack. This is a logical result for the unconscious association of ideas, and the results they produce are as definite in action as it is possible for memory associations to be. A man who sat in Ford’s theater in Washington the night Lincoln was assassinated saw the assassin enter the box in which the President sat; saw the flash of the pistol-shot, and witnessed the confusion that followed. Immediately in front _Sat a lady who wore a bunch of heliotrope on her dress—a flower of intense perfume. He caught the odor of this flower at the moment he saw the pistol fired and heard the noise, and for 30 years thereafter, when he told me the story, he never smelled the odor of heliotrope without seeing the whole tragic scene ; ae as distinctly as it was presented to him on that fateful night. So it is that the sensory stimulation of any center or faculty that is organized into a definite action may be produced indefinitely under the reapplication of the same or similar causes. ‘‘'There is,’? says Thomas Watson, ‘‘another very singular occasional cause of epilepsy that deserves to be mentioned, namely aie sight of a person in a fit of that disease.’ Watson asserts that this fact has been noted time and again; that patients who already have the malady will fallina convulsion at thesight of another one ; that those who were previously affected may acquire the disease in this way; and even that the disease will ‘‘ now and then run through a boarding school or through the ward of a hospital.”’ Watson speaks of the possibility of these attacks be- ing due to imitation, or to feigning, or most likely to hysteria, but finally declares they are epileptic. I dissent unreservedly from the view of this writer that epilepsy may become epidemic in schools and in hospitals. Instances of the kind that Watson mentions should unquestionably be classed as due to hysteria ; I do not for a moment doubt the power of an epileptic attack to excite a seizure in another epileptic, though it is comparatively rare. The constant association of epi- leptics, sensitive at first in this way, with other epilep- tics who have frequent seizures, causes them in time to lose such sensibility entirely. Shortly after a large number of epileptics of all types and characters had been brought together very nearly 100 of them had to eat ina common dining-room. A violent seizure occurred at one of the dinner tables one day; the table was knocked over, and crockery and chairs smashed amid great noise and confusion. In a few seconds four other epileptics were in convulsions. But it was not long before the occurrence of a fit in this room lost all power of causing attacks in others. It is the primary shock that does the damage. A nurse reported an instance in which a man had a violent attack at midnight and awakened his compan- ions about him, three of whom at once had epileptic convulsions. None of them were hysteric in any degree, the shock of sudden fright having brought on the attacks. I recall two instances in which a young woman went into convulsions at the sight of a companion so affected, the attacks in both instances having occurred at night. 5 It has also been observed that when epileptic men and women meet in the same room for religious worship, or amusement, both sexes have more attacks proportion- ately than when one or the other attends alone. The reason for this is found in the psychic stimulation of passion, a recognized exciting cause in some cases. According to Mosso, Pinel always began the examin- ation of a patient by asking him whether he had not had some fright or great vexation. The same author states that through the vivid impressions, emotions may produce, the same effects may be sustained, as, for instance, through a blow on the head or some physical shock. Fear causes the loss of consciousness, sight, and speech. Beger reports the cases of two perfectly healthy old men, one 65 the other 70, who had epileptic fits immed- iately after being frightened, though they had never suffered in that way before, nor were they predisposed to such a disease. Kohts, in his account of the maladies caused by fright during the siege of Strasburg in 1870, gives a minute description of the cases of paralysis agitans and of convulsions which he observed; while we find numerous references in Hack Tuke’s ‘ Dictionary of Psychological Medicine’”’ to the emotional state as a cause of epileptic attacks. Digitized by the Internet Archive in 2021 with funding from University of Illinois Uroana-Champaign httos://archive.org/details/emotionalshockfrOOspra d - Ky) rive . ‘ “ ve CA ~ he esa ; c2)% =i . arts sty 7 Pa Feed went a t OOOO HHOHOOOHHOHOOOHHHOHOHOHHHHHOHOHHOHHHHHHOH1 American Medicine FOUNDED, OWNED, AND CONTROLED BY THE MEDICAL PROFESSION OF AMERICA. GEORGE M. GOULD, Editor G. C. C. HOWARD, Managing Editor Subscription, $5 a year Advertisements limited to 44 pages A subscription to American Medicine ” is an endorsement of profes- sional journalism. S$6SSS5SSSS5S59SSS5SSSSSSSSSSS9SSSSSSSSSSSSS9SS9SSSSSSSSSSSSSSSSSSSSSSSES GSSsosoes SSSSSSSSSSSSSSSSS5SE SSSISSSSSSSSSSSSSSSSSISSSSSSSSS SSSSSSSSSSISE SSSSSSOSSSSSS GHIDHOOHOTSHDIGDHOD DOOD HHO OHPDDPHOTSHOOOHDOOD ef