Convulsions in Children often occur before or after some other ailment. Such children need careful training, but less than 10 per cent of children who have convulsions become epileptic. Epilepsy should only be suspected if the first attack occurs in a previously healthy child of over two years of age. There are many possible causes for infantile convulsions, and but one treatment; call in a doctor at once, and, while waiting for him, put the child in a warm bath (not over 100° F.) in a quiet, darkened room, and hold a sponge wrung out of hot water to the throat at intervals of five minutes. Never give "soothing syrups" or "teething powders".

The "soothing" portion of such preparations is some essential oil, like aniseed, caraway or dill, and there are often present strong drugs unsuitable for children. According to the analyses made by the British Medical Association, the following are the essential ingredients of some well-known preparations for children:

Convulsions During Pregnancy. Send for a doctor instantly.

Feigned Epilepsy is an all-too-common "ailment". The false fit, as a rule, is very much overdone. The face is red from exertion instead of livid from heart and lung embarrassment, the spasms are too vigorous but not jerky enough, the skin is hot and dry instead of hot and clammy, the hands may be clenched, but the thumb will be outside instead of inside the palm, foam comes in volumes but is unmixed with blood, and the whole thing is kept up far too long. Almost before a crowd can gather an epileptic seizure is over, whereas the sham sufferer does not begin seriously to exhibit his questionable talents until a crowd has appeared.

Pressure on the eye, which will blink while the "sufferer" will swear; bending back the thumb and pressing in the end of the nail, when the hand will be withdrawn in feigned but not in true epilepsy; blowing snuff up the nose, which induces sneezing in the sham fit alone, or using a cold douche will all expose the miserable trick.

It is, unfortunately, far easier to suggest than to apply these tests, for anyone foolish enough to try experiments within reach of the wildly-waving arms will probably get such a buffet as will damp his ardour for amateur diagnosis for some time.

CHAPTER III

GENERAL REMARKS

Starr's table shows that combinations of all types of epilepsy are possible, and that mental epilepsy is rare:

The majority of victims have attacks both by day and by night. Of 115,000 seizures tabulated by Clark, 55,000 occurred during the day (6 a.m. to 6 p.m.) and 60,000 by night.

The usual course of a case of epilepsy is somewhat as follows: the disease begins in childhood, the first convulsion, about the age of three, being followed some twelve months later by a second, and this again by a third within a few months. Then attacks occur more frequently until a regular periodicity—from one a day to one a year—is reached after about five years, and this frequently persists throughout life.

The effect of epilepsy on the general health is not serious, but it has a more serious effect on the mind, for epileptic children cannot go to school (though special schools are now doing something towards removing this serious disability), and grow up with an imperfect mental training. They become moody, fretful, ill-tempered, unmanageable, and at puberty fall victims to self-abuse, which helps to lead to neurasthenia. Then they may drift slowly into a state of mental weakness, and often require as much care as imbeciles. If the fits are severe from an early age, arrest of mental development and imbecility follow. If the disease be very mild in character, and especially if it be petit mal, the victim may be very precocious, get "pushed" at school, and later become eccentric or insane.

Adult victims necessarily lead a semi-invalid life, often cut off from wholesome work and from the pleasures of life, and become hypersensitive, timid, impulsive, forgetful, irritable, incapable of concentration, suspicious, show evidences of a weakened mind, have few interests, and are difficult to manage.

About 10 per cent—the very severe cases—go on to insanity; either temporary attacks of mania, calling for restraint, or permanent epileptic dementia with progressive loss of mind. Some victims are accidentally killed in, or die as a result of a fit; about 25 per cent—severe cases again—die in status epilepticus, but the majority after being sufferers throughout life are finally carried off by some other disease.

There are many exceptions to this general course. Some patients have attacks very infrequently, and are possessed of brilliant talent, though apt to be eccentric. Others may have a number of seizures in youth, and then "outgrow" the complaint.

A few victims are attacked only after excessive alcoholic or sexual indulgence, some women only during

their menses, while other women are free from attacks during pregnancy, which state, however (contrary to popular belief), commonly aggravates the trouble. Victims may be free from attacks during the duration of, and for some time after, an infectious disease; while Spratling says that a consumptive epileptic may have no fits for months, or even years.

Some epileptics are normal in appearance, but many show signs of degeneration. This is common in the insane, but less frequent and pronounced in neurasthenics. An abnormal shape of the head or curvature of the skull, a high, arched palate, peculiarly-shaped ears, unusually large hands and feet, irregular teeth from narrow jaws, a small mouth, unequal length and size of the limbs, a projecting occiput, and poor physical development may be noted.

These are most pronounced in intractable cases, in whom mental peculiarities are most frequently seen—either dullness, stupidity and ungovernable temper, or very marked talent in one direction with as marked an incapacity in others. In all epileptics, the pupils of the eye are larger than normal, and,