EPILEPSY AND EXOPHTHALMOS. 415 



ing case is one of purely spasmodic exophthalmos, in the inter- 

 vals of which the symptoms entirely disappeared. Not having 

 witnessed one of the fits myself, I am obliged to rely solely 

 on the testimony of the mother for the accuracy of my facts. 



M. M., a girl aged 13, first seen on Wednesday, August 26, 

 1874, middle height, fair, well nourished, slightly strumous- 

 looking ; has a somewhat vacant expression. The eyes are not- 

 prominent, nor is the thyroid gland larger than usual. Mammse 

 not developed. There is a loud systolic murmur at the apex of 

 the heart, faintly audible over the base. 



About 20 months ago a large weight fell from a window 

 and slightly grazed her nose. Three days afterwards she had a 

 fit. According to her mother's account, this fit was not pre- 

 ceded by any warning. The first thing noticed was that the- 

 eyes became very prominent, or in the mother's own words,. 

 " stood out shocking." The hands were clenched, and the arms- 

 drawn up towards the head. The body was drawn somewhat 

 to the right side, and the mouth also to the right. This lasted 

 for 4 hours and 20 minutes. She then fell asleep, and slept 

 for four hours more, only awakening once during that time. 

 During this sleep her eyes returned to their ordinary size. 

 About 14 months afterwards she had another fit ; a third one 

 on June 21 ; a fourth one about four weeks ago ;• and a fifth 

 one last Monday, August 24. During the fit she foams at the- 

 mouth : there is also some bleeding from the mouth ; in the last 

 fit from the ears also. After the fit she complains of pain in ali 

 her limbs ; and a fortnight before the fit comes on she complains- 

 of being very tired, and of aching in her back and sides. She 

 has never menstruated, the appetite is good, the tongue covered 

 with a thin white fur. Bowels open two or three times a 

 week. 



Ordered— Ferri et ammoniae citrat., gr. viii. ; ammon, carb., gr. ii ; spt. cliloro> 

 form, ni X. ; tinct. nuc. vom., n|, x. ; infus. quassise, ad 3 i. : ter die sumend^ 

 Pil. aloes et myrrli, gr. v. : omni nocte sumeud. 



August 31. — In statu quo. Has had no more fits. 



Kpt. haust et pil. 



October 9. — The same treatment has been continued. There 



