HYSTERIA FROM THE POINT OF VIEW OF EPILEPSY.

764 number of accounts submitted by us [13 in all] was true, a series of fits. He was found on the high road having isolated fits and was carried to an auxiliary hospital. as compared with those submitted by other practiwere uninjured when they were found. tioners." So that, in addition to the time spent on the He and his bicyclewho attended the hospital not being at The medical men operations (for each of which I and my partners hope to once obtainable, I was asked to see the patient. The fits receive the magnificent sum of 3. 6d. apiece), an after- had the look of fairly heavy major epileptic fits, but I thought noon will have to be wasted in explaining to the Panel the trouble hysteria. When the series ended the patient Committee why we have done our duty; and, at the promptly returned to his normal state. His subsequent end of it all, we stand a good chance of being, what history is not known to me, but probably it would be if most workmen would call, defrauded. Needless to say, there had been further fits. Two brothers, who were said to have started to have fits we shall continue to do what we think best for our within a short time of one another, were admitted to the patients, whether we are paid the agreed fees or not. colony. The one who had begun first to have fits still has But I think you will readily see that the dignity and fits, the other brother was soon well and able to go home to work. His trouble was hysteria. good repute of the medical profession are involved. I am, Sir, yours faithfully, Probably somewhere in the world every day fits HARRY ROBERTS. Harford-street, E.,Oct. 4th, 1920. occur that are epileptic in appearance and h;rsterical in origin. But that is not the conclusion of the whole HYSTERIA FROM THE POINT OF VIEW OF matter. There seem to be fits of intermediate origin. Theoretically, such intermediate fits can be expected. EPILEPSY. call fits of conscious origin malingering, fits of subWe To the Editor of THE LANCET. conscious origin hysteria, and fits of unconscious origin And truth is this to me, and that to thee." epilepsy. It is held that the conscious joins the subSIR,-The older pathologists thought hysteria wander- conscious, I and the subconscious the unconscious, ing of the womb, and epilepsy the very devil. We with spectrum-like indefiniteness. Presumably, then. have abandoned that conception of hysteria, but without malingering flows into hysteria and hysteria into agreeing what conception to have in its room. To me epilepsy, and it may be that there are fits that are hybrids hysteria seems to be rampant egoism of the sub- of epilepsy and hysteria and fits that are hybrids of conscious self. It is as though the captain’s wife had hysteria and malingering. Such fits there are, and in mounted the bridge and taken possession of the steering- their treatment there is room for nice discrimination. wheel, the trouble ending only when he recovers his I am, Sir, yours faithfully, dignity and sends her below again. While we differ ALAN MCDOUGALL, M.D., among ourselves as to the pathology we are all agreed Director of the David Lewis Epileptic Colony. as to the definition of the complaint-hysteria is that Alderley Edge, Oct. 3rd, 1920. condition that we expect will yield to antihysterical treatment. Logically absurd though the definition may PELLAGRA AMONG THE PRISONERS IN EGYPT. be, it has life-saving value. One who lives in an epileptic colony may be struck To the Editor of THE LANCET. by a negative phenomenon : the absence there of textSIR,-In the discussions that have taken place upon book hysterical fits. A familiar sight in the accident I would suggest that too little attention has pellagra room of a general hospital, the text-book hysterical fit been paid to the possibility that the diets were deficient is not seen at a colony. This arouses the suspicion in actual calories as well as particular amino-acids. I that in people familiar with the sight of epileptic fits was in medical charge of the P.O.W. South placed hysterical fits take the form of epileptic fits. Numerous Labour Camp at Kantara in June, 1918, and shortly cases of series of fits seem to confirm the suspicion. after made for my own purposes a calculation of the A young woman after having had for years several value of the diet actually supplied, and found it to be epileptic fits a month began to have groups of four or approximately 3700 calories. My calculations were five hundred. Each of the fits in these series resembled the fairly heavy isolated epileptic fits that were usual in her admittedly imperfect in that they were based on the at other times. There was incontinence of urine and of. figures in such works of reference as I carried with me fseces. Accumulation of mucus in the air-passages with on service. Thus I had no figure for " camel," and cyanosis and difficult breathing made her state appear took it as a mean between prime and lean beef. alarming. But when the patient was told that because of Considering the camels in question had no further these series it would be necessary to discharge her from the value, the figure obtained was probably colony-a terrifying threat to most colonists-she imme- military optimistic. But the same references showed that in the diately replied that she would have no more of them. She mess we consumed daily a diet of an average value of had no more series, although the isolated attacks continued 4500 calories, and none there complained he was to occur. As the series were banished by treatment that was overfed. In view of the high rate of sickness (30 per cent per antihysterical rather than antiepileptic it may be claimed that though the individual fits in the series diem) and its evident relation with work the first duty laid on me was that of classifying the fitness of the were epileptic the condition was hysteria. A girl of 13 had 3231 discrete fits in 17 days, of which prisoners for labour. In this respect each man had fits 2258 occurred in the course of six consecutive days. been in category A 1 three months before. My inspecEach fit had the appearance of a mild major epileptic fit. tion showed that out of 3500 men 318 were now unfit The eyes and the head were twisted to the left; a tonic for any labour whatever and 559 were only fit for light stage was followed by a clonic. There was incontinence of labour. Except in the cases of an old gentleman of 70 There was little cyanosis ; there was no special urine. a mentally deficient, under-nutrition was the basis tendency to the ‘formation of bedsores ; the axilla tempera- and of my classification. Those classified by me as unfit it was ture, whenever tested, was below 100° F. The series ended almost by crisis ; one day there were 437 fits, next day for any labour whatever were " living skeletons." 41, the day after there were 3. During the occurrence of the Never before had I seen such an advanced grade of series the patient was fed with peptonised milk and at the emaciation, nor have I since. When a score of such end did not appear to have lost weight. On the third day had been segregated for registration the only pictorial after the cessation of the fits she was up and about and as parallel presented to one’s mind was that of a faminelively as ever, though instead of talking she somewhat stricken population with a relief commissioner in ostentatiously made the sounds of a baby that is still charge. The men classified as fit for light labour only wordless. On the Thursday morning she was warned that unless she was found talking on Saturday morning there were in the same state of nutrition as one can find here would be no pocket-money for her. Normal speech returned in the out-patient tuberculous or aortic subject. After classifying the men of a company on this basis to her on the Friday afternoon. In this case, too, it may be claimed that the fits were I regularly questioned the English N.C.O. supervising the work to see if it agreed with his experience. epileptic, the state hysteria, These two patients had long been subject to epilepsy. I found N.C.O.’s classified the men into willing and In the following case there was no history of previous unwilling workers, and that my classification tended to take men who had been and were willing workers, but fits. A youth visited a patient at the colony and while whose capacity for work had markedly decreased. riding back on a bicycle to the railway station began, if his story After this classification had been completed a month :

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