The above illustration I believe to be typical of a class, and am strongly of opinion that the origin of many cases of epilepsy in the child can be re ferred to a similar accident. In other cases where there is a strong neurotic predisposition, and the gray matter of the brain is in a highly explosive state, it is possible that eclamptic attacks originally induced by some trifling irritant may become perpetuated as epileptic seizures without discoverable cause. Where no such predisposition exists, and no lesion is present in the brain, I know of no proof that convulsive seizures can be so perpetuated.
Pathology.—No anatomical characters have been discovered by which the occurrence of epileptic attacks can be explained, and hence the nature of the disease is still a matter of speculation and doubt. The seizures have been attributed to both anaemia and congestion of the brain, the seat of the faulty action has been referred to the medulla oblongata and the upper part of the spinal cord, to the ganglia at the base of the brain, and to the cerebral convolutions. We have learned by experiment that lesions of the convolutions will induce muscular spasm, and that irritation of the cortex in the motor region will have the same effect. Nothnagel, too, has pointed out on the floor of the fourth ventricle a limited area, which he calls the " convulsion centre," on irritation of which all the voluntary muscles of the body are thrown into tonic and clonic spasms. Any or all of these parts may then be concerned in the production of an epileptic seizure. It can hardly be doubted that sometimes The convolu tions may be the seat of the nervous discharge, for in a certain proportion of cases where at the beginning of the fit the patient is conscious of his condition, the discharge occurs. in a centre .of special sense ; also in cases where the aura is intellectual the hemispheres are probably at fault.
When the attack is distinctly reflex, the medulla oblongata and pops may contain the seat of diseased action ; and the fact that in all cases there is more violence of spasm on one side of the body than on the other seems to point to some controlling influence of the corpus striatum.
The loss of consciousness has been explained to be the consequence of andemia due to spasm of the cerebral arteries and capillaries, and caused by an extension of the discharge to the vasomotor centre. According to
another theory, consciousness is arrested as the result of an influence which radiates from the part affected to the sensorium. The after-symp toms have been ascribed to carbonic acid poisoning from partial asphyxia, and this was long held to be a sufficient explanation, although lately doubts have been expressed as to its correctness. At present, however, no ex planation has passed out of the region of hypothesis, and although dif ferent theories may have different degrees of plausibility, none can be said to rest upon any very solid foundation.
Symptoms..-The symptoms of epilepsy are very various. Although the convulsive movements are the part of the seizure which most forcibly attracts the attention, they are not essential to the nature of the disorder. The most characteristic feature is the loss of consciousness, and this, al though often transient, is very rarely completely absent. A severe fit of epilepsy is much the same in the child that it is in the adult, and it will be unnecessary to describe minutely the characters of a seizure with which everyone must be familiar. The main features of the attack are similar to those already described as characteristic of eclampsia. It is preceded by a prodromal period of variable duration, in which some change is noted in the character, manner, or expression of the patient. The convulsion it self seldom lasts longer than a few minutes. It is followed by a stage of coma, which is usually more protracted, but sooner or later the child re covers consciousness, although he may remain more or less stupid for some hours. Often recovery is marked by a profuse discharge of limpid urine. In many cases the onset of the fit is announced in the child, as it is in the adult, by an " aura." In others the first symptom is vertigo, or a flushing or pallor, or a twitching of some particular muscle. What ever this initial symptom may be, it is usually repeated before each attack.
The more severe seizures (epilepsia gravior or haut mal) seldom appear in all their gravity when the child first becomes subject to the disease. They are usually preceded for months or years by a milder form of the affliction (epilepsia mitior, petit real, or epileptic vertigo) which presents itself in very many different forms.