In all of these sudden invasions of the intellect, the heart and kidneys must he closely examined. Few cases of fatal sanguineous apoplexy occur in which both organs do not present evidence of disease, and probably in all cases one or other is at fault. Serous apoplexy is perhaps more frequently associated with the oil-moue diathesis ; one form of convulsive seizure is directly con nected with blood-poisoning in disease of the kidney, and it is perhaps con joined with effusion of serum. To another condition attention has been drawn of late years—viz., the washing down in the current of the blood of some vegetation which has been gradually growing on the valves of the heart ; this is suddenly arrested in some of the small arteries of the brain, stopping the supply of blood to the parts beyond, and interfering with their nutrition. In consequence of such an accident, paralysis may either supervene rapidly when deficient supply is sufficient to produce it, or may come on gradually when imperfect nutrition has led to disorganization of part of the brain-structure. In either case the mental phenomena of unconsciousness, &II, are generally wanting; and this may serve, along with the physical evidence of valvular lesion, to lead to a pretty correct guess at its cause.
§ 5. Epilepsy.—Epileptic convulsions have been frequently re ferred to, yet something remains to be added to give consistency to its diagnosis. The term is somewhat indefinite in its applica-, Lion, because while on the one hand it is used to denominate a specific disease which has no analogue in, and receives no ex planation from any of the disorders of function to which the brain is liable, yet on the other hand it is applied more or less indefi nitely to any sudden seizure which is marked by convulsions and loss of consciousness.
The grand distinction between epilepsy and convulsion consists not in any peculiarity in the seizure, but in the context of symp toms. It resolves itself into the question is there any disease present in any organ, in the course of which convulsions may and do occur ? On this question being answered in the negative depends the diagnosis of true epilepsy, imperfect as it must be confessed that such a distinction is. This point is quite uncon nected with its curability : the prevailing theory at present is, that the seizure consists in an excess of irritability and over-ex citement of the nervous centres • in curable cases, certain con comitant conditions are regarded as sources of irritation, and these being removed, and the tone of the nerve-fibre itself restored, the disease ceases. The question proposed is not whether there be any such circumstance which determines the attack, but whether disease be present, which either by being seated in the brain itself, or by establishing a certain blood-crasis, tends directly to produce convulsions during its continuance.
The most notable examples are inflammations of the cerebro spinal axis, puerperal states, and albuminuria, or more properly, perhaps, urannia. In true epilepsy we fail to detect any such conditions during life, and although we do find, in certain cases after death, something within the cranium which may have acted as a permanent cause of irritation, its mode of action is unknown, its symptoms are limited to the simple expression of irritability in the epileptic seizure.
The convulsions of childhood may be said to form a class by themselves: more nearly allied to epilepsy than to the secondary convulsions of adults, they seem to depend oh a species of ex citability which is probably owing to the disproportionate de velopment'of the brain of infancy ; as in epilepsy, too, the sources of irritation are various : with the exception of those connected with inflammation, they do not lie within the cranium ; but while one child never shows the slightest tendency to convulsion, another suffers repeated attacks from all the accidents of infancy; teething, worms, intestinal disorder, or mere exposure. Still they are not to be called epilepsy, except they return periodically, without the presence of the exciting cause ; that in some children repeated convulsions terminate in confirmed epilepsy is too true, but in by far the greater number, fortunately, no such lamentable occurrence results.
One great element in epilepsy is its periodicity, whether regu lar or irregular; but the first recurrence may be at so long an interval that the patient is lost sight of before a second fit occurs, and our diagnosis cannot wait for such an event for its confirma tion. Its importance is such, however, that in all convulsive attacks it is desirable to ascertain from friends, or from the patient himself; as soon as consciousness is restored, whether he have ever been at all similarly afflicted.
The severity and duration of the attack vary very greatly, from a transient loss of consciousness with the slightest possible muscular spasm, to the most violent and horrible convulsions. In the former case the patient is arrested for a moment or two in his usual avocation, retains his position without falling, whether standing or sitting, and proceeds with his work as if nothing had happened. In the latter, the mind remains confused when con sciousness is restored, and the patient soon falls asleep, to wake up generally in a short time, stiff; or sore, or bruised, and perhaps complaining of headache, but not otherwise feeling ill. This confusion of mind and tendency to sleep is in rare instances pro longed for some days, the patient remaining, as has been already pointed out, in a semi-comatose state.