Starr's table shows that combinations of all types of epilepsy are possible, and that mental epilepsy is rare: Grand mal 1150 Grand and petit mal 589 Petit mal 179 Jacksonian 37 Mental 16 Grand mal and Jacksonian 10 Grand mal, petit mal and Jacksonian 8 Grand mal and mental 3 Grand mal, petit mal and mental 6 Petit mal and mental 2 Fits by day only 660 Fits day and night 880 Fits by night only 380 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.