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A CASE OF GASTRIC EPILEPSY.
By ARTHUR WYNNE FOOT, M.D., Univ. Dubl, ;Senior Physician to the Meath Hospital;
Vice-President of the King and 'Queen's College of Physicians in Ireland.
[Read in the Section of Modicine, March 9, 1888.]
IN this communication the term gastric epilepsy is used in reference
to epilepsy whose exciting cause is apparently due to the irritation
of various kinds of food towards which the stomach exhibits an
abnormal sensibility. The propriety of the term will be discussed
by-and-by.
The subject of the case had, when three years old, an attack of
what was regarded as cerebro-spinal meningitis. This was followed
by very violent general chorea, which lasted for three weeks, after
which one of his feet was for some time in a condition of talipes
varus. There was no family history of epilepsy, but some neurotic
traits were perceptible in his immediate relatives. His mother
was of an excitable and emotional temperament, which might be
socially called fussy and medically hysterical. His father died of
paralysis, but it was induced by worry, overwork, and mental
annoyance. One of his brothers suffered from brain failure after
an attack of scarlatina. This collapse was marked by loss ofmemory, failure of power of application, and distaste for studies
formerly relished. He recovered completely after prolonged rest.
The subject of the case was physically as strong and active as
boys of his age, but was rather dull and retiring. He was not
considered very forward. His education was effected slowly, from
a disinclination to press him at lessons, because it was thought
overstudy might be injurious to his brain on account of the severe
attack he had when three years old. His tastes were quiet and
unObtrusive. He was fond of gardening and of animals. His
46 .A Case of Gastric Epilepsy.
skill in rearing plants, often under great difficulties, was only
equalled by his success in taming and training animals, over which
he seemed to exercise a kind of fascination, which appeared to be
reciprocated. These powers showed him to be possessed of much
patience and close observation, combined with kindness and gentle..
ness.
At the age of seventeen he had, in midwinter, an attack of
scarlatina, which was not marked by any feature of undue severity.
Delirium was slight and transitory. He desquamated safely, and
there were no renal sequelee. During convalescence there were
rheumatoid pains in the joints and eyeballs, and his pulse was fre..quently below 70.
On August 12th, 1874, seven months after his recovery from
the scarlatina, and when he was in his eighteenth year, he had a
fit in the store-room at 6 p.m. He called out for his father, who
was not far off, and who, on arriving, found him fallen to the
ground, unconscious, convulsed, and frothing at the mouth. When
I saw him half an hour afterwards his pulse was 60; the eyes
were swollen, and the conjunctives much ecchymosed. The ruptureof the subconjunctival vessels indicated a violent attack, as do
petechire of the skin from rupture of the blood-vessels of the
corium. It was admitted that he had been over-eating himself
lately, and the immediate cause of the attack was set down to a
surfeit of not overripe plums to which he had got access in the
store-room. It was not found out whether he had not also swal
lowed some of the plum stones. For several days subsequentlythe pulse ranged between 56 and 60. For some time before this
attack he had been liable to diplopia after reading, and one day
exclaimed, "Is there fish for dinner? I see two forks," "Thenthere was but one.
He spent the following month (September, 1874) in Wales,apparently in as good health as usual. On Sunday, October 4th,he ate a good deal of salad at dinner. That evening at lOBO,when he was in bed, reading a book before going to sleep, he felta sensation going from the fingers of his left hand upwards to,Yards
liis head. Then his head got confused. He called his mother
By DR. A. W. FOOT. 47
several times, but only recollected having done so once. When
she came to his room she found him in a fit-eyes open and turned
upwards, mouth working, face very pale. He soon came to himself
without any coma, but trembled afterwards, as if in a rigor, for 15minutes. I saw him while trembling. Pulse was 80, and tem
perature 98'7°. Next day his pulse was 60, as usual. Dr. Hudson
saw him with me in the afternoon, and it was decided to put him
on belladonna, according to Trousseau's method:-
~. Extracti belladonnre gr. tPulv, fo1. " - gr. t
Pro. pil.; mitte 100 similes.
One pill to be taken every morning for the first month, two for
the second month, and so on, according to the toleration of the
drug and its influence on the disease. His bowels were to be
cleared out beforehand with castor-oil and turpentine. This wasdone.
On Nov. 19th he got a giddiness at luncheon time, and found
himself" saying things wrong." Dec. 15th, got a queer sensation
in his head at breakfast, and afterwards his arms became cataleptic;
shortly afterwards he vomited for some time. He had eaten beef
steak at breakfast. On the evening of Saturday, Jan. 16th, 1875,he had a fit after having eaten a good deal of cream. May 12th,
1875, after an interval of four months, he bad a fit immediately
after dinner, at which he had eaten rich pudding.
Aug. 9th, 1875, Dr. Hudson saw him again. It was decided toleave off the belladonna, which had been increased up to four pills
a day, and to put him on 15-grain doses of brom, potass. ter die
with a small quantity of strychnin. His bowels have been most
obstinately costive ever since his attack of scarlatina, although
they used to be quite regular before. Sept. 10th, 1875, he had anattack at Llandudno when he had almost finished his dinner. He
had eaten a quantity of fat mutton. Dulness and hiccough after
the fit were rather prolonged. Dec. 13th, 1875, had a fit at dinner;
he had just eaten rapidly and heartily of roast mutton. He had along attack of tremor after it.
Dec. 23rd, 1875, just at midnight when in bed, he had a fit, the"
48 A Case of Gastric Epilepsy.
seventh of the haul mal. He called out for help sufficiently loud toalarm his parents, who found him convulsed and insensible whenthey got to' his room. A little wine stoppedthe tremor and chat...
tering of his teeth. N ext day his pulse was 56. Dr. Hudson saw
him a third time, and it was decided to have him dine early, totake some wine (Carlowitz), and he was ordered arsen, ferri -r2 gr.;
h hv zinci I • 1 •. ·11 • dP osp . zmci., 4 gr., ext. Due. vom., 4" gr., In pI twice a aYeHis face never got livid during or after a fit, and the most usual
introductory symptom is giddiness and confusion of mind. Up tothis he had had seven attacks of the fully marked kind.
1. 12th August, 1874, attributed to plums.
2. 4th October, " " salad.3. 16th January, 1875,,, cream.
4. 12th May, " " chancellor's pudding.5. 10th September, " " fat mutton.6. 13th December, " " eating fast and rapidly.
7. 24th " " " no cause assigned.The 2nd and 7th were taken in bed, four of the others at thedinner table, and one in a store-room. These seven attacks covertwo years-1874 and 1875.
Jan. 20th, 187·6, when half through his breakfast this morning he
had a fit. The warning was longer than usual, but the attack was
shorter-the convulsions lasting about a minute. A.t 2 p.m., thesame day he dined on fish, and before he had finished eating he had
a severe attack. While recovering from it I saw him. He wasshaking violently; in a few minutes he vomited the fish he hadbeen eating. This was the first occasion on which be had vomitedafter an attack, though he had often been given ipecacuanha wineand warm water to induce him to do so, and without success.
Feb. 5th, 1876, had a slight attack this morning before breakfast. Pulse just after it was 58. His face remained pale, indicating debility of the heart and aneemia of the brain-a constantphenomenon with him. It was thought that the occurrence of somany attacks at or after meal times might be due to digestive
processes appropriating his scanty supply of blood, to the depriva
tion of the due allowance required for the brain.
By DR. A. W. FOOT. 49
Feb. 14th, 1876, had an attack at 2 p.m. after dinner. It was
followed by vomiting of what proved to be more the porridge he
had eaten at breakfast than the food he bad just had at his dinner.
He had been given a little brandy when he felt the fit coming on.
and this attack was not followed by rigor, as had often been the
case. April 5th, had a slight attack at dinner time; he was very
hungry and was eating fast; was unconscious, but not sick after
wards. Aug. 11th, had an attack, not as severe as usual, imme
diately after dinner. Sept. 25th, a severe attack during dinner,
at which he was noticed to have eaten greedily. Oct. 10th, had
marked attack at dinner. There was an interval of what seemed
to be five minutes between the time he made his usual exclamation,
"I feel sick," and the time convulsions came on. In this interval
his father walked him up and down the room, but did not abort
the seizure. During the convulsive stage his mouth was wide open
and pulled to the right side. This fit occurred at 3 p.m, He was
quite well in the evening, and played a game of whist. There
were rather rich cutlets at dinner that day, but he had not eaten
much of them when he got ill.
Nov. 25th, 1876, he was examined by Dr. Brown-Sequard, who
was in Dublin at that time. He considered there was some anees
thesia of the left side of the face, and some diminished power of
standing on the left side of the body. He ascertained that the
sense of heal'ing in each ear was very acute, though the boy had
almost constant tinnitus in the ears. He thought there was basal
irritation in the brain, the result of the early meningitis or of the
scarlatina, or connected with both; that some weak point in the
stomach was the exciting cause of the manifestations-advised ice
to be rubbed for fifteen minutes every second night to the back of
his neck and to the Interscapular spine, and prescribed his iodide
bromide mixture, 3S8. three times a day, and 5iiss. at bedtime.
About an hour after this examination the patient got his sixteenth
attack, while at his dinner, which was of boiled chicken. The
warning stage was very long on this occasion. The application
of the ice was so- painful it was not persevered in; it made
the skin as red as if it had been scalded. The iodide-bromideD
50 A CUlJe of Gastric Epilepsy.
mixture increased his pallor very much and produced troublesome
acne.March 11th, 1877, at dinner-time, after eating a few mouthfuls,
he "got sick" as usual, was laid on the floor, but no convulsions
ensued, nor did he completely lose his consciousness. The full
development of the attack appeared to be warded off either by the
horizontal position or by keeping his attention awake by talking tohim, shaking him, and rubbing his hands and feet.
March 30th, had an attack like the previous one, but even milder.
He is in such dread of eating that at times he almost starves himself.
A suggestion was now acted on of giving him, just before his
dinner, five or ten drops of chloroform in a glass of wine, with the
object of lessening the irritability of the gastric mucous membrane.
In the middle of April, 1877, he got a sudden febrile attack,
which, though it subsided in two or three days, caused some alarm
(before it had been judged of by its disappearance), lest it shouldbe of a meningitic nature. He wakened at 2 a.m., with very
violent headache, and intolerance of artificial light. He could not
stand, his eyes were injected, and he had osteal pains in the legs.
Temperature was 102-2°, and pulse 108, which, considering the
habitual slowness of his pulse (averaging 60), was for him a con
siderable increase in rate. There was no reason to regard it as
due to iodism. The attack subsided under the hourly use of drop
doses of tincture of aconite and some powders of calomel and pulv.
Jacobi. Later on in this year (1877) the attacks assumed a milder
character, taking more the type of the petit mal ; thus, 15th July,he had an attack of giddiness after rising, which lasted only a
short time; 11th Sept., had a more severe attack in the morning,
with convulsions; they did not last long, and he was soon roused;
2nd Oct., a slight attack of giddiness, which soon passed off; 3rd
Nov., an attack of giddiness at breakfast, which soon passed off
while he was being rubbed smartly. It was found that during this
year (1877) the attacks could be abbreviated by tickling, slapping,
pinching, walking him up and down, talking loudly to him, giving
him snuff, and in any way keeping his attention excited.In Midsummer of 1878 a seton was put in the back of the neck.
By DR. A. W. FOOT. 51
His handwriting had become very unsteady and his face was quitedisfigured with acne, which had assumed the shape of dull red
tuberosities. The bromide of calcium was substituted for that ofpotassium, and, arsenical solution was added, without modifying
the irritation of the skin.He had attacks in August, September, October; and" November of
1878. As the·warning was- now so long he had recourse-to a bottle
of nitrite of amyl, which he carried about him or had within reach,
but for some reason or other it did not prove effectual" His hand
writing improved immensely during the course of this year. The
acne eruption resembled a crop of boils. In the year 1819' he hadeight attacks-seven of the petit mal, one of the haut mal. In
January, 1880, he had two attacks, both of a severe kind. After
this there- was a very marked diminution in the frequency and
severity of the seizures, which, as is often said in reference to
chronic cases, wore gradually away. In this year,. 1880, which
may be called the final year of the disease, he took nitrate of silver
for some time, and also pills .of phosphorus and valerianate of zinc,
but it was evident the disease had been upon the wane beforethese remedies had been employed.
In reference to the title which I have given this case, 1 wish to
remark that I have called it gastric epilepsy entirely from a
clinical point of view. The first nine attacks occurred at or
immediately after" meals, and appeared to be connected either with
the use of unsuitable articles of diet or with an injudicious methodof eating ordinary food. The earlier attacks ensued after eating
such things. as half-ripe plums, salad, cream, chancellor's pudding,
rich mutton. The greater number of the subsequent fits wereeither during or soon after dinner. The dining-room was theplace in which he was generally taken ill. On some occasions
vomiting indicated a desire on the part of the stomach to rid itselfof something noxious; yet it was found that emetics often failed
to unload the stomach. The term Gastric Epilepsy has the sanc
tion of Sir George Paget,a who, in a lecture thus headed, delivered
at Addenbrooke's Hospital, observes that "in no organ is the
a Lancet, 1868. Vol. I., 459.
52 A. Case of Gast'ric Epilepsy.
immediate exciting cause of epileptic fits more frequently found
than in the stomach.' He reports the case of a hospital patient
of his whose head bad been injured in early boyhood by the kick
of a horse, and who may thus have acquired some predisposition
to the disease. No symptom of it, however, appeared until one
day, when he was fifteen years old, he ate an enormous number
of cherries, including many of the stones. An epileptic fit was the
consequence. Several fits followed-at first at intervals of a few
months, then -of one month, and then more frequently. They
were preceded by an aura from the epigastrium to the head. At
the age of twenty-four he was found drowned in a shallow ditch,
into which he was supposed to have fallen in a fit.
The occurrence of the first fit in my patient within a few
months of recovery fr-om scarlatina might suggest the possibility
of a ureemic attack, only that it had been ascertained that at the
time of its occurrence, and for a long time previous, his kidneys
had been acting healthily, and that the urine was perfectly normal.
Scarlatina had been frequently noted as a disease precursory to
epilepsy. In 19 out of 37 cases collated by Dr. Gowers,s. in which
an acute illness was the apparent cause of the first fit, that illness
was scarlatina; and these cases of epilepsy subsequent to scarlatina
all commenced during early life-under seventeen.
In another place b it is stated by Gowers that more cases of
epilepsy are consecutive to scarlatina (apart from the influence of
nephritis) than to all the other acute diseases put together. It
may appear to some that the case which I have detailed under the
Dame of gastrie epilepsy might have been more properly named as
a case of epilepsy in one whose gastric arrangements were in a
morbid state, and I would not object to such a change of title.
It may, I think, be taken as a fair statement of the case to say
that probably the early attack of meningitis, and the violent
chorea which followed it, so impaired the nutrition of the motor
centres as to have left a predisposition to further disturbance
under the action of another exciting cause.
s. Gulstonian Lectures. British Medical Journal. 1880. Vol. I., p. 356.b Diseases of the Nervous System. VoL II., p. 679.
By DR. A. W. FOOT. 53
However, as to the use of the name which I have adopted-that
of Gastric Epilepsy-it is a very old notion that many cases of
epilepsy were directly connected with gastric irritation; and hence,
perhaps, the stress which used be laid upon regimen in the treat
ment of such cases. We have the epilepsia stomachica of Sauvages,
Cheyne, &c., and the epilepsia gastrica of Frank and others.
Cheyne relates the case of a celebrated physician who had suffered
from epilepsy for a considerable time, and had used numerous
remedies without benefit. As he perceived the attacks occurred
less frequently, the fewer and the more digestible the articles of
food he consumed, he confined himself entirely to milk. He took
a pint of milk in the morning, another in the evening, and two in
the middle of the day, taking nothing besides but water. He
continued this diet for fourteen years, and entirely recovered from
his epileptic attacks-an instance of abstemiousness which, Rom
berg remarks, is not often to be met with.
The dietary of epileptic patients has been regarded by many as
a matter of cardinal importance. Dr. Gowers does not attach 80
much weight to this matter as do many of the older authorities.
In some observations which he made, by keeping a patient under
unaltered medical treatment for alternate periods, on a diet with
and without animal food, he could observe no difference in the
attacks, except that in one patient they were slightly more frequent
in the periods when animal food was excluded, and in one patient
hystero-epileptic attacks on ordinary diet became, when meat was
excluded, severe epileptic fits, and again became hystero..epileptic
when animal food was restored,v
The frequency of an epigastric aura as a subjective commence
ment of a fit may have fixed attention on the stomach as the
starting-point, more than would have been the case had visceral
aurar in the region of the pneumogastric nerve been less common.
In former days the aura was regarded as a change in the nerves of
the part to which it was referred, exciting the fit, whereas now it
is known to be merely the impression made upon the consciousnessby the commencing action in the brain, or by the effect of this on
a British Medical Journal. 1880. Vol. I., p. 549.
54 A Oase -of 'Gastric Epilepsy.
the periphery. The fact that an aura commencing in a limb maybe arrested by a ligature around the limb, above the part te which
the sensation is referred, was once thought to constitute evidence
that the process of ,the cenvulsion originated at the periphery, and
extended thence to the cerebrum. It is now well known that the
ligature will arrest a .fit which. is due to It cerebral tumour as
effectually, and more frequently, than one of any other kind.s In
the case whieh I .have reported improvement set in after persever
ance in Brown-Sequard's mixture. The frequency as wen as the
violence of the attacks diminished under its continued use. Great
personal disfigurement was the result of -the large doses of the
iodide and bromide of potassium, and the combination of either
arsenic or strychnin did not seem to lessen .the .amount or size ofthe acne. The patient is now able to discharge the duties of an
official post with complete efficiency..
• Gowers. British Medical Journul. 1880. Vol. I" p. 394.
