On convulsive seizures / by J. Hughlings Jackson.

  • John Hughlings Jackson
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On convulsive seizures / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    IS Lecture II. Epileptiform (Middle Level) Fits —Varieties.—Diluted Convul- sions.—Crude Sensations.—Locality and Order of Convulsive Movements.—Degrees and Ranges of Fits.—Hyper-and Hypo- physiological States.—A Dischw ging Lesion.— l he “Buttoning Centre.”—Physiological Fulminate—The March of the Convul- sion.—Compound Order.—Cells of a Discharging Lesion Quasi- parasitical.—Nutrition of Cells.—Summary. I take for most particular consideration the second kind of fits, epileptiform seizures (middle level fits); they were first described by Brtivais in 1824. There are many reasons why we should study them first. (1) Their investigation is comparatively easy. We can, if present at a paroxysm, ascertain the place of onset and trace the March of the convulsion; and if we witness no attacks, since consciousness is not lost or is lost late in the seizures, the patient can tell us the place of onset and much more about his fits. (2) They have permanent paralytic counterparts in mono- plegias and hemiplegias from destructive lesions of the “motor region.” (3) Ttu re is after them, at least in many cases, tempo- rary paralysis of the parts first and most convulsed. (4) There is not rarely permanent paralysis of the parts which are occa- sionally convulsed, this showing—a very important thing with regard to doctrines of localisation—that in the same case there is coexistence of a destructive lesion and a discharging hsion of diffirent elements of the same centre. (5) Because there is after some seizures temporary defect of speech (“partial aphasia’). (6) Because, if we can find the condition of centres answering to paralysis and aphasia after these seizures, we shall be greatly helped in our investigation of the state of the highest centres in insanities after epileptic fits. (7) Because epileptiform seizures often depend on gross organic disease, such as tumour (syphilitic or non-syphiliric); hence, we may at post-mortem examinations obtain proof or disproof of any notions on localisation and gross pathology we had from a study of the patient’s symptomatology during his life. (8) It is in epileptiform seizures that operations have been done by Mace wen, Godlee, Horsley, Barker, and others. Hence, very precise study of fits of this kind is neces- sary. In this regard, as well as in many others, the minute investigations of the “motor region” by Beevor and Horsley are of great value. It would be very unmethodical to begin the scientific study of the more complex (epileptic) kind of fits before the study of the epileptiform kind. There are Varieties of epileptiform seizures. The convulsion begins in some part of one side of the body. Varieties are dis- tinguished by the particular place of onset (“signal symptom” of Beguin) of the convulsion. The fit may begin in some part of either right or left side of the body ; I call that on which it does begin the “first, side,” and the corresponding (opposite) half of the brain in which the discharge begins the “ first half.” If the fit begins on the left side, that is the first side, and the right half of the brain is the first half; suppose that the convulsion becomes uni- versal, then the right side of the body is the second side, and the left half of the brain (if it discharges after the right) is the second
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