EPILEPSY. 393 



epilepsy afflicts many of its members throughout several generations. 

 Sometimes the disease skips a generation, and the grandchildren are 

 attacked, but not the children. Cachectic subjects, drunkards, and 

 onanists, are more liable to it than healthy, vigorous persons, although 

 the latter are by no means exempt. The chief of its exciting causes 

 are violent mental emotions, sudden fear, terror, and the sight of an 

 epileptic fit. In more than a third of all cases the first attack has fol- 

 lowed upon some violent fright. The most common structural altera- 

 tions found in the skull and brain, which, however, like the mental 

 emotions, are not constant, and only give rise to epilepsy under cer- 

 tain unknown conditions, are asymetry, imperfect development of the 

 skull, diffuse thickening or exostosis of the skull, thickening, adhesion 

 and ossification of the dura mater, tumors and deposits in the brain, 

 chronic hydrocephalus, and cerebral hypertrophy. Alteration in the 

 appendages of the brain, which Wenzel mentions as a constant lesion 

 in epilepsy, is absent in the majority of cases. Changes of structure 

 hi the spinal marrow are not so frequently found in epilepsy as similar 

 changes in the brain; but perhaps this is because the former have 

 been less diligently examined than the latter. We have already 

 alluded to the neuromata, tumors, and scars, which sometimes give 

 rise to the disease by the pressure which they exert upon peripheral 

 nerves. In a similar manner, epilepsy may arise from an abnormal 

 irritability of the sensory nerves, induced by some severe irritation at 

 their peripheral extremities. Thence, according as the irritation in- 

 volves the nerve-tips of the thoracic organs, those of the organs of 

 digestion, or those of the urinary or sexual apparatus, the epilepsy is 

 classified into epilepsia cardiaca, pulmonalis, abdominalis, nephritica, 

 uterina, etc. It is manifest that we may easily err in attributing the 

 disease to irritability of one or other of these organs. Uterine epi- 

 lepsy is perhaps the least ambiguous of all, as a gradual transition 

 from hysteria to epilepsy may sometimes be observed, and as some 

 women become epileptic upon their first coitus. The presence of 

 worms in the intestines also is sometimes an unmistakable cause of 

 the disease. 



SYMPTOMS AND COURSE. Epilepsy is a chronic disease, character- 

 ized by convulsive attacks, accompanied by loss of consciousness, with 

 intervening periods of exemption of variable and sometimes of very 

 ong duration. Loss of consciousness during an epileptic fit necessa- 

 rily involves loss of sensation and incapacity for voluntary motion. In 

 incomplete epilepsy, the "petit mal" of the French, there usually are 

 no convulsions during the seizure, or else merely a few twitchings. 

 Such rudimentary attacks, of course, are not to be called incomplete 

 epilepsy unless they alternate with well-pronounced seizures, or arise 



