of violence is often rapid. This distinction is generally an excellent one. But it will not apply so well to some cases of epilepsy in which the convulsions are trivial. Esquirol says an epileptic fit may consist of nothing more than coma, with convulsive movements of the eyes, or lips, or chest, or a single finger.[1] Still even then the coma generally begins abruptly, so that if the case is seen from the beginning, it can hardly be mistaken for narcotic poisoning. Some forms of epilepsy, in which the fit is constituted merely by giddiness, staring, wandering of the mind, and imperfect loss of recollection,[2] might be confounded with the milder forms of narcotic poisoning. But collateral circumstances will scarcely ever be wanting to distinguish such cases from one another.
The varieties of narcotic poisoning which, in the violence and abruptness of their commencement, bear the closest resemblance to an epileptic attack, are some cases of poisoning with hydrocyanic acid or with the deleterious gases. Both of these varieties, however, when they begin so abruptly, are distinguished from a fatal paroxysm of epilepsy by the fourth characteristic to be mentioned presently; and besides, in abrupt cases of poisoning with hydrocyanic acid, the poison under certain conditions will be found in the body; while in sudden poisoning with the narcotic gases, the nature of the accident is rendered obvious to a cautious inquirer by the collateral circumstances.
3. As in apoplexy, so in epilepsy the patient in general cannot be roused by external stimuli. This, as already observed, is often, although certainly not always, practicable in cases of poisoning with narcotics. Sometimes, too, in the epileptic fit a partial restoration of consciousness may be effected by loud speaking, so that in reply to questions the patient will roll his eyes or move his lips. It is therefore to be understood in applying the present criterion, that it is only a safe guide when, as in many cases of poisoning with opium, the individual can be roused to a state of tolerably perfect consciousness.
4. When a person dies in a fit of epilepsy, the paroxysm generally lasts long, sometimes more than a day. So far as I have been able to ascertain (though on this point it must be confessed authors are singularly silent), it never proves fatal in a shorter time than several hours, unless there have been many previous fits; and even then it rarely proves fatal more rapidly. I have met with a case which, after many previous fits, proved fatal in little more than an hour.[3] In an instance mentioned by Mr. Clifton of irregularly recurring epilepsy, the patient after being exempt for four months was attacked twice a day for four days, and during an interval of ease fell down in the street and died. General congestion and excessive softening of the brain were found.[4] I have met with a case very like this, where death was owing to enormous extravasation of blood into the ventricles.
