EPILEPSY. % 395 



lowed at first by tonic contractions, in which the body and extremities 

 are extended, the head drawn backward or to one side, the mouth 

 firmly closed, the eyes wide open, and rolled upward or inward, the 

 thorax fixed, and the respiratory movements arrested. After a few 

 moments, during which the jugular veins become distended and the 

 face purple, the tonic spasms are converted into clonic ones, which soon 

 convulse the whole body. The. countenance, hitherto immovable, is 

 now thrown into active agitation ; the angles of the mouth are drawn 

 hither and thither, the forehead and eyebrows twitch, the eyes open 

 and shut, the jaws are forcibly pressed together, and are worked back- 

 ward and forward, so that the teeth grate audibly. The teeth are not 

 unfrequently broken off, the tongue bitten through, and even the lower 

 jaw may be luxated. Upon the lips there appears a saliva, rendered 

 frothy by the constant movements of the mouth, and which, too, is 

 often bloody from wounds of the tongue or cheeks. The head is jerked 

 forward and backward, and from side to side ; while the convulsive 

 twitchings of the muscle of the trunk pitch the body hither and thither. 

 In the extremities, and especially in the upper extremities, quick 

 kicking, striking, twisting, and twitching motions occur in turn, and 

 with such violence as sometimes to result in luxation or fracture. The 

 fingers usually are flexed, the thumb being pressed into the palm of 

 the hand, a sign which the laity erroneously believe to be pathog- 

 nomonic. Sometimes it seems as if the violence of the convulsions 

 were remitting, and as though the fit were about to abate ; but the 

 lull is soon followed by a fresh outbreak, and the convulsions become 

 more violent than ever. Sometimes the twitching is superseded, for a 

 few moments, by a tetanic condition like that by which the paroxysm 

 commenced. Throughout the whole fit the respiration is much em- 

 barrassed, owing to the impediment offered by the tonic or clonic 

 spasms of the respiratory muscles to the regular heave and fall of the 

 chest. Still more is this the case when the glottis is closed by spasm 

 of the laryngeal muscles. As on all other occasions of unusual mus- 

 cular exertion, the beat of the heart is accelerated, the pulse is small 

 and sometimes irregular, while the skin is bathed in sweat. The 

 bowels and bladder are often evacuated unconsciously ; more rarely 

 erections and seminal emissions occur. Throughout the entire seizure, 

 consciousness is so completely extinguished that the patient is not 

 aroused, nor does he betray any sign of pain, even though he may 

 strike against a red-hot stove, or fall into the fire so as to completely 

 char a limb. Opinions are divided as to the state of the reflex ac- 

 tion during the attack. I admit that I find it very difficult to take 

 note of it in the more violent class of fits. During seizures which aro 

 mild from the beginning, or during the period of subsidence of more 



