Now, while these are the ordinary features of a regular fit of epilepsy, there are many attacks that can be set down as nothing else than modi. fled fits which have yet little resemblance to the fully-developed form of the disease. One of the most notable examples of these unusual forms is where the person may become suddenly unconscious, arrest for the moment whatever work he may be engaged in, and after a few seconds resume the business he was engaged in, without being aware of any interrup tion. Thus a professor lecturing to his class has suddenly stopped in the middle of a sentence, his eyes looking fixedly in one direc tion, his hands retained in the attitude in which they happened to be at the moment, and after a few seconds has resumed the thread of his discourse, where it was left off, without any knowledge of the stoppage. French writers distinguish between the severe and mild form, by calling the former grand mal, and the latter petit mal. But the business or action with which the person is occupied need not be arrested. Thus a violinist has been known to be seized while playing, but to go on with per fect accuracy. Again, a man, working at his bench, has been known to drop his tools, on being attacked, put on his hat, and walk a con siderable distance, all the time unconscious, and has wakened up to find himself seated in a public-house, quite at a loss to understand how he got there. So in other unusual forms of the disease, the person may commit not only strange but wild acts, commit an unprovoked assault in the street, be roused out of his sleep by the seizure to brutally beat his wife or dash out the brains of his child. In all these remark able forms the features are the entire uncon sciousness of the person during the attack, however guided by purpose may seem his ac tions, and the complete ignorance of what has occurred after the attack has passed off. The latter forms are not common, but probably the first irregular form described—that of simple momentary unconsciousness and arrest of move ment —is much more common than is supposed.
Epileptic fits are commoner during night than day, especially the mild form. Thus a person may regularly suffer from epileptic attacks, which come on in bed, of which neither he nor anyone has any knowledge, and whose only indication is a feeling of fatigue and soreness felt in the morning. If the fits be of the severer form, then a swollen some state of the tongue, and blood upon the pillow, perhaps also urine discharged into the bed, are the evidences. Death, owing to suffocation, some times results from epileptic attacks occurring during the night. Epileptic attacks may recur often or seldom. Sometimes a person will suffer from daily fits for some time, and then be free for mouths or longer, and again have a period of recurrence. They nifty occur not only daily, but several times throughout the day or night. In spite of their frequent recurrence, they do not immediately tend to shorten life, but they affect the patient's health and mental condition. Treatment is often a matter of considerable difficulty, some cases stubbornly resisting all methods. The treatment during the fit is
simple. Lay the patient flat on the floor, in sert a pad of some sort between his teeth to prevent injury to the tongue, and otherwise let anything be done to prevent the person injur ing himself. The clothing about the neck and waist should be loosened. Apart from this nothing avails anything, and one must simply wait till consciousness returns. A person liable to fits should never be in circumstances when the occurrence of the seizure might endanger his life. He should not, for instance, ride on horseback or a bicycle, or drive in a gig, nor be sitting beside a fire in such a way that he might fall into it, nor walk along dangerous pathways, or go out boating or fishing alone.
Much may be done to diminish the liability to the attacks by general treatment. Good easily-digested food, fresh air, moderate exer cise, abstinence from exciting foods, drinks, exercises, or amusements, especially abstinence from sexual excesses and degrading habits con nected with them, should be the rule. Mode ration in all things will aid much his general bodily and mental strength.
Whatever be the ultimate cause of epilepsy, and the ultimate cause is yet doubtful, it is certain that a fit may be determined in a likely person by some irritation, for instance in a child by irritation in the bowels due to worms, and in a woman by irritation connected with the womb. Such irritating causes must, therefore, be removed by appropriate treatment. This, however, only treats the tendency to the disease. For the disease itself a vast number of drugs have been tried—opium, arsenic, zinc, digitalis, &c. Undoubtedly the two most useful are bromide of potassium and belladonna, the latter urgently recommended by M. Trousseau, the distinguished physician of Paris. The former is given in doses from 5 (for children) to 30 (for adults) grains in water thrice daily, and it will be found useful to give it with half to one tea-spoonful of aromatic spirit of ammonia (sal volatile); the latter is given in pills containing (for an adult) id) grain of belladonna extract, and the same quantity of the powdered leaves, one at night or in the morning according to the usual time of the fit. One pill is to be given daily for the first month, then two for the second month, three for the third, and so on till five and even more are taken daily. Both remedies should be continued for a long time. If the use of these drugs has held the disease in check, then after some months probably a pill containing grain of phosphorus would be of value in the way of restoring nerve tone. A very useful remedy is ordinary borax, 10 grains given in water thrice daily. It is neces sary to state that a distinguished German pro fessor, Schroeder Van der Kolk, believed the disease to be seated in the medulla oblongata, and to be due to chronic irritation and con gestion. The treatment he urged as of most advantage in old cases was cupping the neck and the use on the neck of issues, and specially setons, continued for a long time. These re medies he believed acted by withdrawing blood from the medulla, and diminishing congestion.