Immediately after spasm the pulse curve is dierotic or polycrotic, with rounding of the apex, or even with a flattened apex. Experiments made on healthy subjects showed that after vio lent muscular efforts of the arms the same modifications of the pulse-curve are present. This tends to show that modifications of the curve are due simply to muscular effort, and that sphygmo graphic study will prove of no assistance in distinguishing between true and false (imitated) epileptic spasms. F6re (Nouv. Icon. de la May, June, 'SS).
In a fully-developed, artificial, cor tical epileptic attack, during the stage of tonic convulsion the cardiac action is slower and the arterial tension greater, while in the chronic period the heart acts more rapidly. Francois-Franck (La Semaine 316d., Aug. 6, 'SS).
A calorimetric examination and an enumeration of the globules of the blood of epileptics have shown that the num , 1 her of red globules increases, while that of oxyhmmoglobin diminishes with an attack of epilepsy, and these red glob ules assume, examined in serum im mediately after paroxysm, a spherical form, while at the same time their diameter diminishes. Fere (Le Progrs Med., Mar. 23, 'S9).
In 50 per cent. of persons affected with epilepsy there is some albumin present in the urine when the paroxysm is over, the increase of it bearing a pro portion to the severity, and being largest in eases where the cutaneous cyanosis and congestion have been most demon strated. J. Voisin and A. Peron (Ar chives de Neurol., May, '92).
The gastric juice after the attack, when injected into guinea-pigs, causes disturbance7 not produced by normal gastric juice. This toxic power is slightly increased before the attack and immediately after, and varies according to the duration and intensity of the fit. Agostini (Gaz. degli Osped., No. 3S, '96).
In true epilepsy, after a convulsive attack, modifications in the urine in variably found. The nitrogen and phos phates, both alkaline and earthy, but especially the latter, are increased. The toxicity of the urine is diminished.
Perturbations of the general tempera ture noticed, which is lowered during the convulsive period, the period of ster tor, and the subsequent period of sleep. On the patient's awaking it rapidly re gains, or even surpasses, the normal.
The temperature is occasionally, how ever, raised, not lowered, during the periods of convulsions, stertor, and sleep. The hypotoxicity of the urine persists between the attacks, even when they are suspended for a year or more. Mairet and Vires (Bull. de l'Acad. de Med., p. 99, Jan. 26, '97).
It is not uncommon to see subcutane ous facial hmmorrhage in epilepsy when the patient has been in the status ept lepticus, or has had many seizures in the course of the day. Pierce Clark (Med. Record, Mar. 26, 'M.
Special study, in 306 cases of epilepsy, of the premonitory symptoms, the seiz ures and the relations between them and to the intensity of the attack; also the relations between the blad der symptoms and biting of the tongue to other symptoms observed, as well as other details which are set forth in this article of fifty pages in length. Only 14 per cent. were weak-minded. The seiz ures displayed a regularly ascending type in 61 per cent., an intermittent type in 26 per cent., and a. descending type. in 13 per cent. In 6 cases certain post-epileptic symptoms were observed which have been previously regarded as premonitory phenomena. In 1 per cent. the epilepsy was reflex, from adenoid vegetations, and from masturbation in the same proportion. Syphilis was cer tain in only 1 of the 26 patients of over thirty years, and hereditary lues in none. Alcoholic parents were noted in 14 per cent., and 8 per cent. of all were addicted to the abuse of alcohol. Aura were noticed in 23 per cent. They usu ally preceded the milder seizures. M. Biro (Deutsche Zeit. f. Nervenh., xxiii, 1 and 2; Jour. Amer. Med. Assoc., April 25, 1903).
In atypical cases any one or several of these symptoms may be absent or so slight as to be scarcely noticeable. In some patients one or more of these toms may be replaced by substitutive conditions entirely different. In grand mal the post-convulsive somnolence may be replaced by an outburst of excitement or delirium or by states of altered per sonal identity in line with the theory of dual consciousness, during which actions both embarrassing and reprehensible may be committed, involving sometimes grave questions of medico-legal responsi bility.