DR. MORTON PRINCE, Boston, read by title a paper entitled
"The Theory of `Settings' and the Psychoneuroses."
DR. L. PIERCE CLARK, New York, N. Y., read a paper
entitled, `The Mechanism of Essential
Epilepsy."[3]
DISCUSSION
DR. E. E. SOUTHARD, Boston: Idiopathic epilepsy as
found in Massachusetts material and estimated from the
appearances in the gross anatomy of the brain occurs in
about one of every three cases. There are accordingly more
idiopathic epilepsies than there are idiopathic or "functional"
psychoses, if the data of gross anatomy form a reliable
index.
It was a somewhat curious thing that in a series of
cases investigated by Dr. Thom and myself, that the more
frequent the attacks of epilepsy the less there seemed to be
to show for them in the autopsied brains. In certain cases
with daily attacks the brains were strictly normal in gross
appearances. It was the frankly organic cases with large
focal lesions that had the occasional attacks. These frankly
organic cases rarely had high frequency attacks.
DR. TOM A. WILLIAMS, Washington, D. C.: Will Dr.
Clark explain the eccentric convulsions such as when there
is uraemia, on similar grounds? Also, if he will postulate
in such cases as recover with metabolic treatment. I have
published cases in which recurrent attacks of some years
duration were removed by means which considered only the
metebolesia. (See Journal of Neurology and Psychiatry,
March, 1915.)
DR. JOHN T. MACCURDY, New York: I have held the
opinion for some years that the study of epilepsy was going
to be of greater psychiatric moment than that of any other
condition. I feel that this promise has been very largely
fulfilled by the work Dr. Clark has been doing for the last
two years. We have found, I think, from that work that
we can really shell out what we may term an epileptic
reaction, which is really the most primitive of all psychiatric
reaction. It corresponds to a flight from reality. It is a
return to the subjective phase, which, in the psychoses, is
no vague but a very real thing. In epilepsy we get it in pure
culture as a lapse of consciousness, expressed either in
completeness as in a grand mal attack or partially when
consciousness is merely clouded. Sleep probably represents
an analogous condition. We go to sleep to repair the body
while psychologically we are seeking that flight from reality
which we all long for. The convulsion may be a secondary
affair, and a physiological sequel to the loss of consciousness,
which is psychologically determined.
L. PIERCE CLARK: For the time being I am anxious to
limit my remarks to the mechanism of essential epilepsy, and,
not to convulsive disorders in general, however closely allied
to idiopathic epilepsy. At some future time I hope to take
up the epileptoid convulsions and show their relationship
and variation from that of the mechanism of essential
epilepsy. I may say, however, that I have some data already
at hand in which certain types of epileptic phenomena connected
with infantile cerebral hemiplegia would show that
the so-called epileptic constitution is much less marked in
these cases, but is present, however, to a certain degree.
As has been well known for a number of years and commented
upon by such observers as Gowers, Jackson and Binswanger,
the so-called hemiplegic epilepsies sooner or later develop
the epileptic alteration in a character analogous to that
seen in idiopathic epilepsy. I hope to show that the main
roots of the so-called epileptic alteration in general necessarily
lie in the primary make-up of such individuals, and
that the seizure phenomena of epilepsy only intensify and
make more marked the fundamental make-up when the
disease has definitely fastened itself upon the individual.
My next paper on this whole subject will attempt to show
more conclusively that the epileptic seizures are but an
unfoldment of that which has already been existent in
the biological make-up of the individual epileptic.
[[3]]
Reserved for publication.
