The common origin and nature of 'blind spells,' petit mal, faintings, swoonings, coma, 'pseudo-epilepsy,' epilepsy, 'migraine,' etc. / by George M. Gould.

  • Gould, George Milbrey, 1848-1922.
Date:
1907
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Licence: In copyright

Credit: The common origin and nature of 'blind spells,' petit mal, faintings, swoonings, coma, 'pseudo-epilepsy,' epilepsy, 'migraine,' etc. / by George M. Gould. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [Reprinted from The Lancet-Clinic, October 19, 1907. THE COMMON ORIGIN AND NATURE OF “BLIND SPELLS,” PETIT MAL, FAINTINGS, SWOONINGS, COMA, “PSEUDO-EPILEPSY,” EPILEPSY, “MIGRAINE,” ETC. BY GEORGE M. GOULD, M.D., PHILADELPHIA, PA. I am told that, observed and studied with care and precision, there is no case of organic or infectious disease that is truly “typical,” or exactly like that of another. Let it be admitted, however, that many run a course so roughly resembling others that they may, in a general and crude way, be called typical. Immediately that we turn to functional dis- eases the case is absolutely different, and instead of classifying any two cases as alike or typical, we are compelled to acknowledge that, with any observation to be named scien- tific, the symptomatologies and courses tend to differ as much as possible instead of re- sembling each other. But despite the diver- gences and variations, it is becoming recog- nized by analytic and studious minds that large groups of seemingly most unrelated diseases may have a common origin, and are essen- tially of the same nature. T hat this intimate relationship has not been discovered and traced out by medical men supposedly scien- tific is due primarily, of course, to their unscience —that is, their want of the closely- observant and philosophic, or analytic type of mind. Secondarily, it arises from the amazingly morbid non-interest of the profes- sion in the origin of functional diseases. Thirdly, and specifically, it comes from the almost universal neglect of thoroughness in taking histories of patients and in finding out the facts they conceal, have not thought of, or that they suppose not connected with their chief complaint of the day. The common history-taking and symptomatology existing in the books and case-records of hospitals and private practitioners is usually meaningless and worthless. In truth, it does not generally exist at all. Do one-half of those now prac- ticing medicine take notes at all, and properly classify, index, and keep track of their cases? No. Do one-half of the remainder do so in any way serviceable to themselves or another? Certainly not. It is generally only a few questions, a quickly made diagnosis, a few orders, and then the rest is left to memory, which, for science, is absolutely non-memory. I had been in practice for years before I began recognizing that patients did not tell the most of their related symptoms willingly, and that my history-taking was as much of a farce as that of my teachers. The vast importance of slowly, softly, patiently, cun- ningly, thoroughly working into the details of the past history, of getting at the biographic clinic, of eliciting the confession of symptoms long past and seemingly at present unrelated, is a great art; and it is a greater necessity, if we would understand all, and if we shall cure all. Often, and often again, I have been able to get at the facts only after years have passed, and by requestioning I have learned of the symptoms existing prior to the prescription of glasses, and which disappeared with the continued wearing of glasses. Thus slowly and by studying over the old records, and by massing together the indications from large numbers of similar cases, have 1 reached uni- fying conclusions, and found that many of the most apparently divergent and unrelated symptom-complexes of different cases have a common origin and nature. For instance: “ BLIND-SPELLS.” T his is a term that is every day repeated by patients in the oculist’s office — what, exactly, are they, and what causes them? By the term, if one is careful to inquire narrowly, every patient means an individual, peculiar, ever-variant happening. Under cross-ques- tioning most patients will admit that they are not at the time and for the instant really blind. It is not an absolute blackness or total inability to see anything or something, it is only a temporary obscuration, dimming, or clouding. T hings “ waver,” are hard to see, or rubbing or batting” the eyes is necessary to see clearly, etc. Perhaps 25 per cent, of patients