CASE RECORDThe patient, a clerk aged 42 years, had enjoyed good health with the exception of an attack of renal colic in 1939, when he passed a small stone. There was nothing of note in his family history.One evening in January, 1942, while walking home from work he experienced a sensation of pins and needles in his legs, but this soon passed off and he felt quite well when he went to bed. Next morning his wife found him lying on the bedroom floor-he was unconscious and was incontinent of urine. He recovered consciousness in about an hour and later went to his work, apparently well.From this time onwards he suffered from ' fits '. At first these occurred infrequently, at intervals of some weeks, and always in the early hours of the morning. According to his wife he used to cry out, lose consciousness, and move his limbs in clonic spasms, and he was usually incontinent of urine. He then passed into a deep sleep and awakened up after some hours feeling very heavy and confused. As the day advanced he returned to normal. Nevertheless, he frequently fell asleep in the train on his way home in the evening.On the evening of March 14, 1942, the patient took a large dose of aspirin for a severe headache and retired to bed. Next morning he was found in a state of coma and he remained unconscious during the greater part of that day. O n March 16 he was admitted to his local hospital: his speech was slurred and confused, his
(1935).memory was impaired and he had some slight weakness of the right arm and leg and involvement of the right sixth cranial nerve. These symptoms were transient, and a few days later he was transferred to a neurosurgical centre for complete investigation as a suspected case of cerebral tumour. No abnormality was found and he was sent home again for further observation. The attacks continued, and in June, 1943, during a brief stay in another hospital, a diagnosis of hypoglycremia was made. He found that if he took vigorous exercise he felt ' queer ', as if he were drunk, his speech became slurred, he saw double, and he was confused and disorientated. If he took a dose of glucose, which he now always carried with him, the attack was aborted or cut short. He also complained of dyspepsia. This first appeared soon after the onset of the cerebral attacks and assumed a pattern suggestive of peptic ulceration, with short periods of attack alternating with remission periods of a month or more. Flatulence and a burning epigastric pain, coming on half-an-hour after food and relieved by alkalis and by self-induced vomiting, were the prominent features. All these complaints became gradually worse during the years 1944 to 1947 and he continued intermittently to work and to attend the out-patient department of his local hospital. During one brief stay in hospital adrenaline was used with good effect to control the fits. By
