SEXUAL PSYCHOSES AND NEUROSES 221 



Hysterepilepsy is a pathological entity and occurs Menstrual 

 only in association with the menstrual function. It n< 

 must, however, be pointed out that practically all 

 female epileptics suffer with more fits during men- 

 struation than during the interval ; indeed, the fits 

 during the menstrual week may greatly exceed in 

 number those occurring during the other three weeks 

 in the month 1 . As I shall show directly, this periodic 

 increase in the frequency of true epileptic seizures is 

 in all probability due to the same causes as those which 

 lead to hysterepilepsy. 



This disorder is seen both in those who otherwise 

 menstruate normally, and in those who cannot men- 

 struate owing to the absence or malformation of the 

 uterus, yet have active ovaries. Probably the worst 

 cases are those in which there is no menstruation. In 

 some the epileptiform seizures recur with great regu- 

 larity and severity, and, in consequence, the mind and 

 health of the individual may be seriously impaired. 

 When the attacks occur with menstruation they are as 

 a rule of a minor character, and may resemble petit mal. 



Some years ago I observed two cases carefully, 

 and found that in the interval the patients had a low 

 calcium index in the blood, and that the sudden further 

 drop, which always occurs at the onset of menstruation, 

 reduced the blood calcium index to such a low level 

 (0'2 in one case) that epileptiform seizures resulted. 

 I also found that these cases could be successfully 

 treated by the administration of calcium salts 2 . Ringer, 3 

 many years previously, had proved that calcium salts 

 reduce muscular excitability. 



Since my work was published Voetglin and Mac- 

 Callum 4 have shown that the convulsive seizures 



1 Litteljohn, A. R, Lancet, 1909, vol. i, p. 1382. 



2 Bell, W. Blair, Proc. Boy. Soc. Med. (Obstet. and Gyncecol Sect.), 

 1908, vol. i, p. 291. 



3 Ringer, S., Journ. Physiol, 1884, vol. v, p. 247 ; and 1887, vol. 

 viii, p. 20. 



4 Voetglin, C., and W. G. MacCalluin, Journ. Pharmacol. andExper. 

 Therap., 1911, vol. ii, p. 421. 



