EPILEPSY. 399 



sovery. Such a termination appears to occur somewhat more fre- 

 quently among women than among men; and it is likewise more 

 common among children and old persons than among those in the 

 prime of life. We must beware of building our hopes too sanguinely 

 upon the long-continued intermission of the fits, as this disease very 

 rarely terminates with one violent paroxysm. A better sign is when 

 the fits not only grow rarer, but feebler, and when a distinct change is 

 taking place, both in the physical and mental condition of the patient. 

 In some women, but not in all, there is an intermission of the fits 

 during pregnancy. Such an intermission, however, is nearly always 

 observed during the course of acute febrile disease. Sometimes a per- 

 manent cure dates from the period of invasion of some acute intercur- 

 rent malady, from the appearance or cessation of the menses, or from 

 the occurrence of some violent mental emotion. It is said that the 

 exanthematous eruptions, and the breaking out of old ulcers, some- 

 times have a similar effect. But, although epileptics seldom recover 

 fully from their disease, and although they are not often long-lived, yet 

 they rarely die during an epileptic fit, in consequence of suspended 

 respiration, or of extravasation of blood into the brain, or of general 

 paralysis during the comatose state which follows the fit. Their death 

 is much more frequently due to the progress of cerebral disease, which 

 has given rise to the epilepsy, or to the effects of injuries which the 

 patient has received during his paroxysms, and, oftener still, he dies 

 of some acute or chronic affection, which is in nowise connected with 

 the epileptic disease. 



We shall have more to say regarding the difference between epi- 

 leptic and hysterical convulsions when we come to treat of hysteria. 

 In my opinion no sharp distinction can be drawn between epilepsy 

 and eclampsia, although the convulsions occurring in protracted cases 

 of urasmic intoxication are considered to be eclamptic by some authors 

 and epileptic by others. It is tolerably easy to unmask simulated cases 

 of the disease. The anaesthesia is often enough cleverly imitated, and 

 we must not expect that all malingerers will wince when burnt, 

 pricked, or pinched, although such reaction hardly ever fails to occur 

 when a violent stimulus of this kind is applied to them unawares and 

 suddenly. Watson's suggestion, to direct the nurse, in the hearing 

 of the patient, to pour hot water upon his feet, the nurse being 

 previously instructed to pour cold water instead, is both practical and 

 original. Nearly all malingerers keep the fit up too long, and devote 

 too much attention to certain symptoms, which they believe to be 

 pathognomonic, such as turning in the thumbs, foaming at the mouth, 

 etc., which an attentive observer cannot fail to perceive. It is a sus- 

 picious sign, when a person who claims to have been epileptic for a 



