394 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



from them, or unless, in the further course of the case, the rudimen- 

 tary fits gradually developed into perfect ones. 



In some patients an epileptic fit is regularly, or at all events gen- 

 erally, ushered in by an aura. This aura receives its name from a 

 sensation as of a vapor which rises from the extremities toward the 

 head, and terminates in the fit. This prodromic feeling, however, is 

 only described by a few patients. Far more frequently there are other 

 sensations, such as a sense of creeping, of warmth, or numbness, or a 

 peculiar pain in some part of the body darting thence to the brain, 

 which herald the attack, and which are called the " aura epileptica." 

 Instead of this sensible signal, the fit is preceded in other instances by 

 twitching or palsy of some part of the body. This is called the motor 

 aura, in contradistinction to the sensory aura above described. In 

 other cases, again, the seizure is ushered in by abnormal phenomena in 

 the organs of sense, hallucinations, visions of sparks or of colors, buzz- 

 ing in the ears, the report of a loud crack or other sound, dizziness, 

 and sometimes by the regular recurrence of phantasmagoria of more 

 or less grotesque character. This latter form of sensorial or mental 

 aura by no means proves that the epilepsy is of central origin, in the 

 sense, at least, that the malady is the result of appreciable lesion of the 

 brain ; nor is the occurrence of an aura arising from the extremities to 

 be regarded as a proof of the peripheral origin of a case of epilepsy. 

 It is an extraordinary fact that an epileptic fit may sometimes be 

 averted by binding a ligature firmly above the starting-point of the 

 aura, and thus, as it were, isolating it. That even such a phenomena 

 as this is no proof of the peripheral origin of an epilepsy is in some 

 degree manifested by the experiments above mentioned of JBrown- 

 Sequard. Here it was demonstrated that, in the dogs made epileptic 

 artificially by wounding of the spinal marrow, a fit occurred wherever 

 the skin was irritated within the province of a particular branch of. the 

 trifacial nerve. We cannot tell whether the fit was preceded by an aura 

 in these dogs, but we may positively conclude from these experiments 

 that, even when the individual epileptic attacks are induced by periph- 

 eral irritation, the real cause of the disease may consist in palpable 

 structural disease of central organs. 



Whether preceded by an aura or not, the outbreak of the paroxysm 

 is usually announced by a shrill cry, whereupon the patient loses all 

 sense and falls to the ground, usually backward or sideways. He 

 scarcely ever has time to seek a convenient place, but falls, regardless 

 of place, often in the most perilous situations, striking, perhaps, against 

 a hot stove, a sharp corner, or down the stairs. There are but few 

 epileptics, whose disease is of long standing, who do not carry with 

 them the marks of more or less severe injury. The fall is usually fol- 



