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 So rapid a termination never occurs except after several paroxysms; and probably never without well-marked appearances in the dead body. The variety of poisoning with which epilepsy is most apt to be confounded, poisoning with hydrocyanic acid, has hitherto always proved fatal within three-quarters of an hour, and can probably never prove fatal so late as a whole hour after the symptoms begin, unless the dose has been small and given repeatedly. Poisoning with the gas of privies,—another variety, which sometimes imitates precisely a fit of epilepsy, appears not to prove fatal in its convulsive form later than two hours after the exposure.

5. M. Esquirol, a writer of high authority, says that epilepsy ''very rarely proves fatal in the first paroxysm''. I suspect it may be said that the first paroxysm never proves fatal. For the cases considered and described as such have been either inflammation of the brain or its membranes, or hypertrophy of the brain, or inflammation of the spinal cord, or effusion of serum or blood into the spinal canal, or worms in the intestines,—all of which may be known by the morbid appearances. I have also seen cases of continued fever with typhomania and convulsions, which might have been considered by a careless observer examples of epilepsy fatal in the first fit. On the present characteristic it would be wrong to speak with confidence, as the question regarding the possible fatality of epilepsy in the first fit must depend greatly on the degree of extension given to the term epilepsy. I can only say, that in the course of reading I have not hitherto met with an instance fatal in the first paroxysm, which might not have been referred by the morbid appearances to one or other of the diseases mentioned above.

Of the Morbid Appearances.—With regard to the morbid appearances found in the bodies of epileptics, much difference of opinion prevails among pathologists. The most frequent are tumours within the cranium, excrescences from the bone or dura mater, concretions in the brain itself, or abscesses there, and effusion into the ventricles or on the surface of the brain. Other appearances which have also been remarked are probably little connected with the disease; and at all events have been often seen when epilepsy did not precede death.

The morbid appearances connected with epilepsy are not always to be looked for within the head. The cause which produces the fit is often some irritation in distant organs.—The presence of worms in the intestines of children may occasion fatal epilepsy. It is believed also that they may cause fatal epilepsy even in adults; and whether their presence has been the cause of death or not, it is certain that they have been found enormously accumulated in the stomach or intestines of adult epileptic subjects. The most recent information on this subject is furnished by M. Gaultier de Claubry. In a girl seven years old, who died of convulsions in six days, he found eleven lumbrici in the general cavity of the belly, and the coats