EPILEPSY. 149 EPILEPSY. n rubber cork, or ink-eraser, or other gag being, if necessary, inserted between the teeth; the pa- tient should then be placed on a mattress <ir other soft place near the ground; his neckcloth should be removed, and the clothing loosened round the chest; the head should be, if possible, a little raised, and a free circulation of air maintained. The ordinary course of the fit (which usually lasts from five to twenty minutes altogether) is as follows: The convulsions gradually diminish in intensity, and the patient passes into a state of deep but motionless stupor, with dilated pupils, and sometimes, but not always, with snoring or noisy breathing; the foaming at the mouth ceases, the color gradually returns, and this state leads to recovery through a more or less protracted but apparently natural sleep, the patient, on awaken- ing, feeling fatigued or tender in the muscles which have been convulsed. The sensations which precede the fit in some epileptics have been termed the aura epileptica, from their supposed resem- blance to a current of cold air passing over the body, and proceeding from the extremities toward the head. In some cases the aura consists of noise in the ears, or a black cloud appearing above the head, or a feeling of nausea or faint- ness, or loss of breath. In some, the premonitory symptoms allow 7 of time enough for the patient to lie or sit down, and thus avoid falling. In most eases a peculiar inspiratory noise or a moan or scream is emitted, called the cry, as the fit be- gins. Not infrequently there is no aura or un- usual sensation of any kind, preceding the fit. A tight bandage placed suddenly upon the limb in which the aura begins may cut short the fit, or even prevent it altogether. In petit mal, the loss of consciousness lasts two or three seconds, and the patient does not fall, but simply suspends operations, stares fixedly be- fore him, gasps, and resumes consciousness, gen- erally without knowing that he had experienced the attack. No treatment is necessary during the attack. In psychic epilepsy there are the usual premonitory conditions noticed. After a period of despondency, irritability, restlessness, dread, giddiness, or, in some patients, intense ela- tion, in others an exhibition of voracious appe- tite, instead of a fit the patient experiences a sudden attack of laughing, weeping, or shouting, with extravagant gesture and maniacal appear- ance, and even in some examples with uncontrol- lable homicidal impulse devoid of motive. This is the psychic equivalent. In Jacksonian epilepsy, there is no loss of con- sciousness ; the spasmodic movements are con- fined to a limited area or to one extremity. It is generally due to tumor of the brain in the part of that organ which the 'signal symptom,' or part convulsed, indicates ; it may be due to ab- scess of the brain, injury, or meningitis. The ultimate danger of the disease has little relation to the severity of the individual fits, except in the modified sense explained above; the frequency of the attacks being apparently much more apt to influence the duration of life than their character. Indeed, although epileptics may survive several severe paroxysms at distant inter- vals, and recover in the end with an apparently unbroken constitution, it rarely happens that very frequently repeated attacks, especially of the l>i lil mal, are unattended by some permanent de- preciation of the powers of mind or of body. The most frequent, perhaps, of all the more consequences i-- insanity (q.v.). Sometimes the development of epileptic insanity i> attended by palsy, ainl rjthcr indications of structural dis- order of the brain; in other instances, no Buch consequences occur, and the brain after death may be- found to have very little tangible disease, or "iily such disease as is found in numerous other cases of functional derangement, Very often there is loss of memory. Yet. history fur- nishes several examples of epileptics who win- men of unusual mental ability and intellectuality, as e.g. Julius t'a'sar. Petrarch. IVtcr the (Jreat, Mohammed, and Napoleon. Disorders of the diges- tion are also not uncommon, and there is fre- quently a want of tone or vigor in all the bodily functions, which communicates an habitual ex pression of languor and reserve to the epileptic. In some cases of grand mal, the patient has a succession of fits, one after another, without re- gaining consciousness for several hours. This is termed status epileptious, and is a grave condi- tion, as the patient may die in it. After an at- tack of grand or petit mal a patient may experi- ence a condition of reduced consciousness, during which he wanders off for a day or a week, enter- ing shops, talking with people, eating in restau- rants, and otherwise acting as if conscious; on awakening he forgets entirely all that has hap- pened. Or there may be a post-paroxysmal psy- chic manifestation in which the patient is furious and homicidal. Masked epilepsy, or epilepsia larvata, is the term given to a condition succeeding a minor at- tack of epilepsy, in which there arc random re- marks made and automatic acts performed by the stupid and dazed patient. Gowers is responsible for the statement that imperfect loss of conscious- ness with automatic action constitutes the minor seizures in some cases, without any initial epilep- tic stage. He considers epilepsy as a disease of the gray matter of the brain, most frequently of the cortex, which results in an impairment of the resistance of the nerve-cells to the liberation of energy. A sudden and violent liberation of nerve force results in derangement of function and im- pairment of consciousness. Certain cases un- doubtedly depend upon organic disease, as tumors or injuries to the brain and its membranes, more especially near the surface. Local sources of irri- tation in other parts of the body have acted as reflex exciting causes of epilepsy, and cases are recorded in which the disease has been cured by the amputation of a finger or the division of a nerve. The treatment of epilepsy should consist of alleviation of conditions and depends upon the variety of the disease. Iron, zinc, nitrate of silver, borax, digitalis, antipyrine, the bromides, and many other drugs have been used. Bromides con- trol the fits, while they arc used, in almost all cases, but are not curative, and their effect is deteriorating and deplorable. Attention to the digestive tract and prevention of fermentation therein, out-of-door life, proper food (a most im- portant matter), and baths have resulted in re- covery in a few cases. Any treatment must be prolonged at least two years. Marriages of epileptics should be absolutely forbidden. Medico-Legal Importance of Epilepsy. At- tacks of psychic epilepsy are of vast medico-legal importance. Epilepsy is common among the criminal class, and the lower type of epileptic is cunning, deceitful, treacherous, and bold. Bevan
