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Full text of "Medical Jurisprudence And Toxicology"

380                                               MEDICAL JURISPRUDENCE

there is usually feeble-mindedness leading to progressive dementia of the
most degraded character.

True epileptic insanity is that which is associated with epileptic fits.
This may occur before or after the fits, or may replace them, and is known
as pre-epileptic insanity, post-epileptic insanity and masked or psychic
insanity.

I.    Pre-Epileptic Insanity.—This is very common and may replace the
epileptic aura, lasting in some cases for hours or even days.    It is charac-
terized by violent fits of maniacal excitement or by depression, fussiness,
suspiciousness  and  general malaise.   Hallucinations   of  various  kinds are
experienced   and,   owing  to   delusions,   the   patient   may   commit   violent
assaults, or may bring false charges against innocent persons.   Sometimes,
the patient may refuse to take any food.

II.    Post-Epileptic   Insanity.—In   this   condition   stupor   following   the
epileptic fit is replaced by automatic acts  of which the patient has no
recollections.   The patient is confused, fails to recognize his own relatives,
and wanders aimlessly about.   He is terrified by visual and auditory hallu-
cinations   of   a   religious   character   and   delusions   of   persecution,   and
consequently  may  commit  crimes  of  a  horrible  nature,   such  as   thefts,
incendiarism,    sexual   assaults    and   brutal   murders.   Such    crimes    are
motiveless   and  unpremeditated.   The   patient   never   attempts   to   conceal
them at the time of perpetration but, on regaining consciousness, may try to
conceal them out of fear.

In a murder trial at Lancashire Assizes on October 30, 1928, evidence was given by
mental specialists who suggested that the accused had killed his wife in a condition of
post-epileptic automatism. He fired shots at his wife and killed her outright. There
was evidence that at the time his manner was calm and deliberate and he appeared to'
know perfectly well what he was doing. In 1922, he had suffered from petit mal and
he was suffering from a condition of post-epileptic automatism in which a man might
do- things about which he seemed quite able to reason though entirely unconscious of
what he had done. The jury found that the accused was guilty of the act charged but
insane at the time.9

A case is recorded in which the accused murdered his mother and wounded his
step-father in a fit of epilepsy without any apparent cause and then hid himself in a
ravine. The medical evidence showed that the accused was subject to epileptic fits and
he used to be completely unconscious during such time. It was, therefore, held that the
evidence of this unprovoked attack upon his mother and step-father with whom he had
no quarrel or trouble, and his hiding in the ravine were certainly consistent with the
attack upon the deceased having taken place during or whilst recovering from an epi-
leptic fit and that any other theory of the events was really untenable. It was found
that the accused was guilty of the acts charged but not so as to be responsible in law
for his actions. He was detained during His Majesty's pleasure.10

In some cases violent gesticulations or fits of mania may develop after
sleep usually following the epileptic seizures. This condition is quite
transitory, lasting for a few hours. In a very small number of cases mental
depression may follow the epileptic fits, and may be accompanied by
delusions of persecution leading to suicidal or homicidal tendencies.

III.    Masked or Psychic Epilepsy.—In this variety the epileptic seizure
is replaced by the transitory loss of consciousness and maniacal excitement.
It is interesting from a medico-legal point of view, for a patient suffering
from this condition is apt to commit a criminal offence without any con-
sciousness or premeditation and without any subsequent remembrance of
the act.

Lastly, it should be remembered that epilepsy in childhood may arrest
the growth of the mental faculties, and lead to idiocy and imbecility.

9.   Lancet, Nov. 10, 1928, p. 990,

10.   Rangoon H. C. Cr. App. -No. 1397 of 1936, NGA ANT BWE v. K. E., 38 Cr. Law
Jour., 1937, p. 667.