47 
had an attack of typhoid fever. She menstruated for the first time in December^ 
1887, and since then only in the middle of March. Had worked for four years at 
Milan as a weaver; came to Pavia in October, 1887, to live with her grandmother 
and attend school. Two months before entering the hospital she began to suffer 
with severe headaches, especially while working, and after eating; she also noted an 
increase of appetite, and a slight cardiac palpitation on muscular effort. Digestion 
and bowels remained regular. About a month after the beginning of these symp- 
toms, the patient was rudely accosted by some soldiers. She was not much frightened 
at the time, but on reaching home she was taken with a convulsive attack. From 
this time similar attacks were experienced nearly every day, frequently two or three 
times. She would be found on the ground, unconscious, with a bloody froth at the 
mouth, and biting her tongue. Together with these symptoms there was an acute 
pain in the epigastrium, a sense of constriction in the fauces, and frequently after 
the attacks, diplopia. 
The patient came to the hospital the middle of iMarch, 1888. She was physically 
well developed, somewhat pale, the gait was normal, decubitus indifferent, intelli- 
gence good, character mild^and tranquil, no alteration in the special senses, nor in 
the sensibility and mobility of the face and cervical muscles. The eyes appear some- 
what salient, react regularly to light, movements of the bulb intact, except occasional 
diplopia from insufficiency of the right rectus internus. Tongue normal in size, 
form, and direction, with a number of shallow furrows in the mucosa of the anterior 
two-thirds, irregularly disposed and filled with a whitish scum. There is increased 
appetite without malacia or pica, thirst moderate, speech and deglutition normal. 
There are no abnormalities of neck or chest. The form and volume of the abdo- 
men; gastric, intestinal, uropoietic and menstrual functions; pulse, urine; the 
motility, sensibility, and reflexes of the extremities are all normal. Complete 
apyrexia. The feces contain eggs of Ascaris, Trichuris, very few of Agchylostoma 
duodenale, and a great many of Hymenolepls nana, 7 to 8 or more in every prepara- 
tion. Besides the severe headache, the patient complains of a painful sensation of 
strangling, which is almost continuous, often more intense just before the onset of a 
convulsive attack, and of a persistent pain in the epigastrium, exacerbating on palpa- 
tion. The last sensation is often that of a severe gnawing. 
At the beginning of her stay at the hospital she had a convulsion nearly every 
day, and sometimes two or three. The onset of the attack is usually sudden, some- 
times preceded by an intense pharyngeal spasm. During severe attacks conscious- 
ness is entirely lost. The patient falls with a groan, the face is pale with an 
astonished expression, eyes fixed and expressionless, with a slight mydriasis. The 
superior extremities, especially the right, are shaken with coarse, irregular, clonic 
movements, the trunk is bent to one side, frequently the left, and the lower extrem- 
ities exhibit diffuse clonic spasms with vibrations finer and more rapid than those of 
the upper. 
The pupils are not affected by light; there are no losses of urine or feces; some- 
times there is a slight foaming at the mouth. After a few seconds the patient gives 
signs of regaining consciousness, but for some minutes the face retains its look of 
astonishment and the eyes their expressionless stare. After the convulsive attack 
she complains for several hours of headache and remains somewhat depressed; does 
not recall having had the attack. 
After treatment no worms were found in the feces, but the eggs were afterwards 
absent. The abdominal pains and the pharyngeal spasm disappeared and the epilep- 
tiform attacks were much diminished in frequency. Eggs having again been found 
in the feces, treatment was repeated, and the attacks ceased entirely for fifteen days. 
At the end of this time they returned, but much less intense than at first, and the 
girl left the hospital, uncured, in June, 1888. 
More recently Senna saw the patient, who told him that she suffered from the con- 
