n 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, after contracting to bright light soon enlarge
again.

The facial expression of most epileptics indicates abnormal mentality. When
the seizures have been so frequent and severe as to cause mental decay, the
actions are awkward, and the gait slouching and irregular. Progressive poor
memory is one of the first signs of intellectual damage consequent upon
severe epilepsy.

Though the disease may occur at any age, most cases occur before the age of
twenty, there being good reason to look for other causes (often syphilis)
in cases which occur after that age. Of 1,450 of Gowers' cases, 30 per cent
commenced before the age of ten; 75 per cent before twenty. In Starr's
2,000 cases, 68 per cent commenced before the patient was twenty-one.

According to Turner, the first epoch is from birth to the age of six,
during which 25 per cent of all cases commence, usually associated with
mental backwardness, and some due to organic brain trouble. The second
epoch is ten to twenty-two, the time of puberty and adolescence, during
which time no less than 54 per cent of all cases commence. This is, _par
excellence_, the age of onset of genuine epilepsy, the mean age of maximum
onset being fourteen in men and sixteen in women. The remaining 21 per cent
of cases occur after the age of twenty-two.

In 430 cases of epilepsy in children, Osler found that 230 were attacked
before they reached the age of five, 100 between five and ten, and 100
between ten and fifteen.

Epilepsy, then, is a disease of early youth, coming on when the development
and growth of the nervous and reproductive systems is taking place. During
this period, causes, insignificant for stable people, may light up the
dise