398 GENERAL NEUROSES, OF UNKNOWN ANATOMICAL ORIGIN. 



persons, the fits gradually come closer together. Perfect regularity 

 in their sequence is never seen, or but for a short time ; although in 

 women a periodical type .is sometimes approximated to when the seiz- 

 ures only occur at the periods of menstruation. In some persons the 

 attacks are more frequent during the day; in others they occur chiefly 

 at night. Nocturnal epilepsy is considered to be of an especially 

 malignant and obstinate character. Generally speaking, it is im- 

 possible to detect the exciting cause of the fit ; but, besides the fits 

 which occur spontaneously, there are always some which are unmis- 

 takably ascribable to psychical emotion, especially to fear; others 

 which may be traced to onanism, to coitus, and, as we have already 

 stated, to menstruation. Sometimes we can tell, from the altered mood 

 of the patient, and from his complaint of a sense of weight in the 

 limbs, headache, or dizziness, that an attack is coming on. In the out- 

 set of the disorder, the seizures are usually of the complete form ; as 

 it advances, and especially in inveterate cases, both complete and in 

 complete paroxysms occur. It more rarely happens, instead of this, 

 that the attacks are incomplete in the beginning of the disease, and 

 afterward develop into complete ones as it advances. As, in some 

 cases, each fit is followed by temporary mental aberration, so, too, in- 

 veterate epilepsy often results in permanent and incurable insanity 

 either mania, confusion, or idiocy. But, besides the large number of 

 epileptics who close their lives in the insane asylum, the "morbus 

 sacer " (which the ancients ascribed to the wrath of the gods), in course 

 of time, nearly always completely changes the mental and physical 

 habit of the patient. Acuteness of judgment is lost; memory and 

 power of imagination diminish ; the gentler and nobler impulses recede 

 more and more ; while the excited and unbridled propensities, lascivi- 

 ousness and gluttony, often impel the patient to commit violent or 

 criminal actions. They often avoid society, are odd and capricious ; 

 are very troublesome to those around them, and are apt to burst into 

 violent fits of anger. The personal appearance of the patient also un- 

 dergoes a change in cases of long-standing epilepsy. Esquirol calls 

 attention to the coarseness of the features of an epileptic, to his swollen 

 eyelids, his thick lips, faltering look, and clumsy body, remarking that 

 this malady deforms the most beautiful countenance. 



With regard to the termination of epilepsy, recovery must be re- 

 garded as rare, in spite of the opposite opinion of many observers, 

 especially Herpin. The more distinctly the malady is traceable to 

 hereditary tendency, and the more plainly it depends upon structural 

 disease of the brain ; the longer it has lasted, the more violent the fits, 

 the more frequent their recurrence, and the deeper the impression 

 which they leave behind them, so much the less is the chance of re- 



