Characteristic paroxysm of the Major attacks.—­This may be ushered in by a localized sensation, known as the Aura, in some part of the body; but it may come without any warning and suddenly.  The convulsions begin suddenly and at first are tonic, that is, it does not change but holds on.  Thc patient falls unconscious regardless of the surroundings, and the unconsciousness may be preceded by an involuntary piercing cry.  The head is drawn back and often turned to the right.  The jaws are fixed (tonic spasm).  The fingers are clenched over the thumb and the extremities are stiff.  The breathing is affected and the face looks blue.  The urine and bowel contents may escape; but this occurs oftener in the next stage.  This tonic spasm usually lasts from a few seconds to a half minute when it is succeeded by the clonic spasm stage.

[Nervous system 289]

Clonic spasm stage.—­In this the contraction of the muscles is intermittent. (Tonic spasm is the opposite condition.) At first there is trembling, but it gradually becomes more rapid and the limbs are jerked and patient tosses violently about.  The muscles of the face are in intermittent motion, the eyes roll, the eyelids are opened and closed convulsively.  The jaws move forcibly and strongly, and the tongue is apt to be caught between the teeth and bitten.  The blue look now gradually decreases.  A frothy saliva, which may be bloodstained from the bitten tongue, escapes from the mouth.  The urine and bowel contents may escape involuntarily.  The length of time of this stage is variable.  It may last two minutes.  The contraction becomes less violent and the patient gradually sinks into the condition of deep sleep, when the breathing is noisy and stertorous, the face looks red and swollen, but no longer bluish.  The limbs loose their stiffness and unconsciousness is profound.  The patient, if left alone, will sleep for some hours and then awakes and complains only of a dull headache.  His mind is apt to be confused.  He remembers nothing or little of what has occurred.  Afterwards the patient may be irrational for some time and even dangerous.

The minor attack or “petit mal.”—­There is a convulsion; a short period of unconsciousness, and this may come at any time, and may be accompanied by a feeling of faintness or vertigo.  Suddenly, for example, at dinner time the person stops talking and eating, the eyes are fixed and staring and the face is slightly pale.  The patient usually drops anything he may be holding.  The consciousness returns in a moment or two and the patient resumes conversation as if nothing had happened.  In other instances there is a slight incoherency or the patient performs some almost automatic action.  He may begin to undress himself, and on returning to consciousness find that he has partially disrobed.  He may rub his beard or face, or may spit about in a careless way.  An eminent physician states:  “One of my patients, after an attack, was in the habit of tearing anything he could lay his hands on, particularly books; violent actions have been committed and assaults made, frequently giving rise to questions which come before court.  In the majority of cases of “petit mal” (light attacks) convulsions finally occur, at first slight, but ultimately the grand mal (major attacks) becomes well developed, and the attacks may then alternate.”