APPENDIX I 



Such attacks, particularly if repeated at varying intervals, even 

 when not accompanied by complete loss of consciousness, are frequently 

 as characteristic of epilepsy as the severe convulsions. 



Epileptic convulsions usually involve the entire body in sharp 

 jerking movements, with blueness of the face or lips, complete loss of 

 consciousness, and are usually followed by a period of sleep or drowsi- 

 ness, and are frequently accompanied by frothing at the mouth, biting 

 of the tongue, and occasionally by wetting or soiling of the clothes. 



Another class of convulsions is the hysterical, which are often 

 difficult to distinguish. The hysterical convulsion, however, differs from 

 the epileptic in the following respects. The hysterical patient often shouts, 

 cries or raves, not only previous to but frequently throughout the attack, 

 and is often able to reply to questions during the convulsion. The 

 epileptic gives a single cry, immediately followed by unconsciousness 

 and the spasm. The movements in the hysterical convulsion are often 

 accompanied by bowing of the body backward, and very frequently 

 simulate intentional or voluntary movements, such as tearing the hair, 

 pulling at the clothes, and such things; while the epileptic movements 

 are characterized by their jerking or twitching character. The hysterical 

 patient, also, in place of a convulsion, may strike an attitude, such as of 

 fear or entreaty, often accompanied by raving or singing. This again 

 may follow the convulsion, taking the place of, and strikingly contrasted 

 with the almost invariable sleep of the epileptic, which is almost never 

 seen in hysteria. Hysterical patients if they fall seldom injure them- 

 selves by the fall, as epileptics frequently do. Biting the tongue almost 

 invariably indicates an epileptic seizure, as does wetting or soiling the 

 clothes when it occurs. 



Cases of epilepsy, whether mild or severe, require treatment, and 

 advice as to whether they should be removed from school. Many cases do 

 not require to be withdrawn from school, and are benefited by its discipline. 



III. Excessive nerve fatigue, which is shown by irritability or 

 sleeplessness, may indicate a neurasthenic condition, that is, a threatened 

 nervous breakdown. Such symptoms may be due to irregular habits, 

 want of proper sleep, lack of suitable food, poor hygienic conditions, or 

 simply from the child being pushed in school beyond its physical or 

 mental capacity. 



Excessive fear or morbid ideas, bashfulness, undue sensitiveness, 

 causeless fits of crying, morbid introspection and suspiciousness may 

 also be symptoms of a neurasthenic condition, and call for investiga- 

 tion, and for the teacher's sympathy and winning of the child's confi- 

 dence, to prevent developments of a more serious nature. 



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