EPILEPSY FITS FALLING SICKNESS. 263 



almost to have done the patient good. Many people are unusually vivacious before 

 a fit, and then when it is over they suffer from the most horrible depression for many 

 days. Such are some of the different ways in which an attack may give notice of 

 its approach. In some people there is absolutely no warning of any kind ; in others 

 it occurs with such regularity that the patient is enabled to move from a position of 

 danger. 



As we have said, at the commencement of an attack the patient gives a cry. 

 This cry, which we should mention is often absent, is sometimes a groaning sound, 

 seemingly squeezed out of the chest, but more frequently it is a piercing and terrifying 

 scream. Women have been thrown into hysterics on hearing it, and it is said to 

 have caused pregnant women to miscarry. Even the lower animals appear to be 

 alarmed by it, and we are told that "a parrot, himself no mean performer in 

 discords, dropped from his perch seemingly frightened to death by the appalling 

 sound." 



Usually at the outset of an attack the spasm twists the head round so that the 

 patient seems to be trying to look over his shoulder. The limbs are rigidly 

 contracted, the hands firmly clenched, the thumbs bent towards the palms, the toes 

 curved downwards, and the feet arched. When the convulsive struggles begin the 

 face becomes frightfully distorted, the brows are knit, the eyes quiver and roll 

 about, or are fixed and staring, or they may be turned up, the whites only being 

 visible ; the mouth is drawn on one side, the tongue is thrust out between the teeth, 

 and often severely bitten, so that the foam that collects around the lips is tinged 

 with blood. The arms and legs are thrown about, striking the body, or bruising 

 themselves against the floor or furniture. When the struggle has reached its crisis, 

 the convulsions subside, and the sufferer looks at those around him with a bewildered, 

 stupid, or sad expression, and perhaps essays to speak. He has a jaded, exhausted 

 look, and seems tired and disposed to sleep. When the convulsive paroxysm is over 

 the after-stage of stupor sets in. The patient after awhile awakes, and is often 

 confused and incoherent for a time ; by degrees, however, he resumes his ordinary 

 appearance and condition, but he remembers nothing of what passed during the fit. 

 Vomiting often follows the attack, and with some people it is a constant sequence. 

 Large quantities of urine are passed in many instances. 



In many cases the symptoms are much milder than we have described. There 

 may be no convulsion at all, nothing but a momentary loss of consciousness. The 

 patient may be in the midst of talking, when suddenly a blank occurs which may 

 last three or four minutes. There is a fixed, absent gaze, a totter perhaps, a look of 

 confusion, and that is all. Consciousness returns, the patient goes on talking, or 

 resumes his work where he left off, and is not always aware of what has happened. 

 These absences or blanks may occur several or many times a day, perhaps for years. 



These slight attacks are called by the French petit mat, while the severer form, 

 previously described, is named grand mal, and these names have passed into general 

 use. The slighter attack is sometimes spoken of as epileptic vertigo, to distinguish 

 it from the ordinary epileptic fit. The best proof that these apparently dissimilar 

 affections are in reality one and the same is afforded by the fact that they may both 

 occur in the same individual. Sometimes a man will for a long time be affected with 



