EPILEPSY. 145 



tongue Is sometimes thrust with violence out of the mouth, and is 

 occasionally caught between the teeth, and severely bitten ; in this 

 .case the frothy matter expelled from the mouth is tinged with blood. 

 To this state, which may last from a few minutes to a quarter, or 

 even half an hour, succeeds a deep sleep, general relaxation of the 

 muscular system, paleness of the countenance, and a gradual return 

 of free respiration ; the countenance for some time retains an ex- 

 pression of stupidity ; the intellectual and sensorial faculties, how- 

 ever, gradually resume their activity, the patient a* the same time 

 experiencing a creeping sensation all over his body. Occasionally 

 it happens that one lit succeeds another, till the patient becomes 

 comatose, and dies ; but, comparatively few die during a fit, unless 

 the disease has existed for a considerable time. In some cases, the 

 attack is much less violent, and consists merely of a momentary 

 loss of sense, with slight and partial convulsions of the eyes, mouth, 

 upper extremities, or fingers, and may or may not be accompanied 

 by a fall. 



The most frequent complications of epilepsy are, apoplexy, mania, 

 paralysis, chorea, hysteria, and catalepsy ; hence the morbid ap- 

 pearances are infinitely various. 



Morbid appearances. — Epilepsy may be connected with any of 

 the organic lesions which occur in the brain and cranium. When a 

 patient dies in a fit of simple epilepsy, the substance and the mem-,' 

 branes of the cerebrum and cerebellum are found gorged with black 

 blood. In comphcated cases of epilepsy, especially with mania, the 

 medullary substance of the brain is found indurated, and its vessels 

 enlarged ; occasionally, however, with dilatation of its vessels, it is 

 soflened and flabby. These structural changes are generally limited 

 in extent. The cortical structure also occasionally presents evidence 

 of chronic inflammation, and is, in some instances, adherent to the 

 membranes. The medulla oblongata and spinal cord present, in 

 many cases, alterations similar to those found in the encephalon. 

 The Wenzels found the pituitary gland and infundihuluQn variously 

 altered in colour, size, and consistence, in nearly all the cases of 

 epilepsy which they examined ; and the crista galli of the ethmoid, 

 and the clinoid processes of the sphenoid bone, more or less promi- 

 nent, or otherwise changed in position and shape, in most of them. 

 In the larger proportion of cases, the pineal gland was also chano-ed 

 in colour, and softened. Caries, thickening, internal exostoses, spicule, 

 malformations, and malpositions of the bones at the base of the skull, 

 with various changes of the membranes, were met with in the larger 

 proportion of cases. The heart, pericardium, lungs, liver, and kid- 

 neys, have been found diseased in rare instances. 



Treatment. — But little can be done for the patient during the pa- 

 roxysm, except placing him in the horizontal position, and preventinff 



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