Diseases of the Nervous System

70 Art. VI.? No. II. :Author: Robert Boyd, M.D.Edin., F.R.C.P. Loxd.

President Medico-Psychological Association, 1870, late Physician and Superintendent County Somerset Lunatic Asylum, formerly Resident Physician St. Marylebone Infirmary, and Lecturer on Practice of Medicine.

Of these diseases, next in succession to Convulsions comes Epilepsy, which is essentially a convulsive disorder, and is closely allied to Idiocy. All epileptics under puberty in the Somerset Asylum were also idiots. Convulsions, epilepsy, and idiocy appear to form a natural order, a distinct class in themselves ; whilst in- sanity in its various forms, which often alternate in the same individual, would form a second class of the functional disorders of the brain.

The practical reasons adduced for the division and separation of these classes are, that the association of epileptics with others in lunatic asylums is injurious, and that the younger idiots are capable of instruction, and ought to be removed to institutions established for that purpose. Convulsions were shown, in the previous number of this Journal, to be a common accompaniment and even, as it were, a forerunner of disease. In a severe epidemic of measles in the St. Marylebone Work- house, before the eruption appeared, some infants died almost suddenly in convulsions.

Epilepsy, or the falling sickness, has been described under various names by the oldest medical writers. Sometimes it presents the most distressing symptoms, convulsive distortions occurring in paroxysms, attended with sudden loss of conscious- ness and sensibility, accompanied and followed by coma. The muscles of the face and eyes are much affected, also the muscles of the lower jaw, whilst at the same time a frothy moisture issues from the mouth. The convulsions have for some moments remissions, but are again suddenly renewed with great violence ; after a short time they generally cease altogether, and the person remains without motion, but in a state of insensibility, and under the appearance of profound sleep. Sometimes suddenly, but for the most part by degrees only, the person recovers his senses and power of motion, but without any recollection of what passed from being first seized with the fit; all are sad and depressed after the attack. During the convulsions, the pulse and respiration are hurried and irregular; but when the convulsions cease, they return to their usual regularity and healthy state. Dr Beid remarks : ” The first symptom of an attack is the suspension of the action of the heart, and consequently an intermission of the pulse, which may continue from a few seconds to about three minutes, which was the longest period of intermission I have yet seen.” The effect of the common exciting causes of fright, grief, anxiety, &c., which most remarkably disorder the actions of the heart, show the importance of more frequently directing our attention to this organ in our researches respecting the nature and treatment of epilepsy. The form of the disease varies in different persons, ?r in the same person on different occasions. I here is a form of epilepsy, termed by the French ” petit mal,’ without con- vulsions. Dr Prichard describes a form intermediate between apoplexy and spilepsy, preceded by vertigo, in which the patient falls insensible, but without rigidity or convulsions of the mus- cular system. In epilepsy, however, the functions of the biain are lost, while those of the spinal cord are increased. In some cases the eyelids shut and open rapidly, and some- times become fixed ; the lips project and extend towards the ears, and are covered with frothy saliva; the tongue is swollen, and often cut between the teeth, the grinding of which is so violent that they are sometimes broken. Grinding of the teeth I have also observed in cases of general paralysis. Two remark- able instances occurred in the Somerset Asylum in males in a state of melancholia, combined with pulmonary phthisis ? one ?f whom had convnlsions, the other epileps}7. Esquirol states that frothing of the mouth occurs sometimes in apoplexy, asphyxia, and hysteria: “the pathognomonic character of epilepsy consists in convulsions, the entire suspension of sensibility, and loss of consciousness.” In epilepsy the convulsions are concen- trated, and are more violent on one side of the body than the other. In hysteria the convulsions are expansive, and are more uniform.

In many cases of epileps}^ there are, or appear to be, no pre- monitory symptoms. On the other hand, there are persons who have only the premonitory symptoms of an attack. I he con- ^ ulsions not being general, perhaps only a convulsive movement of one limb, the head,or lips, presents itself, and there is sometimes only a stunning sensation. Some run, others turn round. Iliese attacks of epileptic vertigo are often the prelude to the com- plete attack. Amongst the old cases in asylums, there is often a great difference in the severity and in the continuance of the attacks. In the severer forms the first intimation is a cry ; the patient suddenly falls down insensible, and suffers from convul- sions, which may either be general, or affect one side more than the other. The face is bloated. Epileptics sometimes howl, and sometimes make a noise like a person strangling. The neck is rigid, and the trunk and limbs in a tetanic state. The flexure of the thumb is frequent, and has been considered by some a distinctive sign of epilepsy. The ” epileptic aura ” (a term used since the time of Galen) is a sensation of cold, or, as it were, a vapour which goes from the external parts, or from the chest or abdomen, to the brain, when the attack is breaking forth. The inhalation of aromatics, or stimulants, or ligatures to the limbs, are at this time emplo}red to ward off the attack. Many epileptics, when forewarned, endeavour to induce the attack by quarrelling, or imbibing stimulants. Long intervals may occur between the attacks, or they may occur daily, and even many times a day. The duration is from a few seconds to several hours. When the intervals are very long, the patient may be for days in an unconscious state, and have repeated attacks of convulsions, and death often occurs during one of those severe attacks. Amongst females especially, the attacks are said to return on fixed days.

With a view of fixing the treatment, the commonly adopted division of epilepsy is into ” idiopathic,” which arises in the brain or spinal cord; and ” sympathetic,” where the exciting- cause is in some other remote organ. These terms are synony- mous with “centric” and “eccentric,” employed by Dr Marshall Hall. The writers who believe in sympathetic forms admit that the seat of the paroxysm is the encepbalon, its causes being often in other organs. Hence they subdivide the sym- pathetic species. Sauvages and Sagur [Systema Morborum) make as many varieties as there are principal exciting causes. A similar proposal with respect to insanity has been made by the late Dr Skae, of Edinburgh, in his classification of mental diseases. Epilepsy is complicated with defects or disorders of the mind in various ways. The following classification is recom- mended by the Metropolitan Commissioners in Lunacy: 1st. Epileptic idiots whose intellectual faculties have never been developed; 2nd. Epileptics who are imbecile or demented; 3rd. Epileptic maniacs, who, without obvious disorder of the mind, when epileptic fits are coming on, are irritable, morose, malicious, and dangerous, and sometimes perpetrate the most atrocious acts. In some instances the mental disorder has the form of acute mania, or rather raving delirium. The patient is seized with a sudden paroxysm, during which he sings, roars, shrieks, or resembles a man in a violent fit of intoxication.*

• A remarkable instance of this kind occurred in a man, aged 45, in the

Somerset County Asylum, wlio was suddenly seized with a rapid succession cf DISEASES OF THE NERVOUS SYSTEM. <D

4th. Epileptics whose intellects are not impaired. Boys and girls, -when they have become a trouble to their parents, as well as dangerous to themselves, have sometimes been sent by Boards of Guardians to asylums for protection. The Commis- sioners do not consider this a sufficient reason for associating* this class of epileptics with the insane. Arrangements are made in dormitories for epileptics, that other patients may not be disturbed by them at night. In the clay there is no special arrangement?they are classed with other patients. Some of them are rational in the intervals between their attacks, which may be for weeks, or even months, during which time they go to work daily with the other patients. In those epileptics in whom these intervals were -congest, the attacks when they occurred were most severe and continuous?often confining them to bed for several days, and sometimes terminating fatally. Many epileptics?some imbe- cile or idiotic, some dangerous and of filthy habits, and some rmless?had also to be placed with other patients; for they could not be placed in a class by themselves, as the asylum ?would not admit of a subdivision.

idiopathic epilepsy commences in early life; the attacks are lri’egular and occur without notice, and the convulsions aie slight. Hereditary predisposition is a very frequent cause. Malformation of the cranium and lesions of the Meninges and brain are given as causes. Inequalities in the cerebral hemisphere I have found not unusual in epileptics. ? ,Urtlours all sorts, cysts, and concretions in the brain have a so been observed. The Wenzels, Sims, and others found c anges in the pituitary and pineal bodies. Sympathetic ?pi. ePsy ^ay be caused by worms, gastric and intestinal jlnRation, abscess of the liver, suppressed eruptions on the lead recovery in the latter taking place after the eruption Was lestored. Moxa applied to the nape of the neck, on the appeal ance of the first symptom, is said to have been followed j recovery. Idiopathic epilepsy, if not cured at puberty, lemams incurable, and, according to Esquirol, epilepsy com- bined with insanity is never cured. In a case related by him, ieie the aura commenced in the great toe, the toe having* een cauterized to the bone, there was no longer an aura, but A attacks were more violent and frequent than before. After numerous dissections of the brains of epileptics, both -i’oville and Andral agree that there is no special lesion epileptic fits after receiving grievous intelligence respecting liis wife. lie was in good r^a. tll? and had ?nly about four fits in a month. Previous to the last attack, lie pe eel about like a drunken man, was sometimes in a state of stupor, and some- irnes in a state of fury. He had 23 fits in two days, and died. attending tliis malady. Andral insists upon the necessity of distinguishing between those cases in which the patient dies in a tit, and those in which death occurs in the interval, as in the former there will be congestion of blood in the cerebral vessels, which is the effect and not the cause of the fit, as some might suppose.

Although our knowledge of the causes and treatment of epilepsy has but little advanced since the days of Hippocrates, numerous writers have not failed to give their different views on the subject. Mr. Monsford, on the supposition that the nervous and electro-motor fluids are identical, has contended that the brain is constantly generating them, and that in health they are controlled by the will in opposition to their natural tendencies?their formation, retention, and discharge thereby being duly regulated; but when weakened by disease, this control is irregularly or imperfectly exercised, and their accu- mulation is favoured, until it reaches its maximum, when it explodes in an epileptic seizure. This opinion is founded on the identity of nervous influence with the electric, to which few will subscribe. Dr Brown-Sequard states that in many cases an unfelt irritation starts at the same time as the aura, from some centripetal nerve, and is the real cause of the epileptic seizure. Epilepsy often occurring without any appre- ciable cause, it is necessary to admit a predisposing and a specific cause. S. Frank states that of 300 cases investi- gated by him, very few occurred in persons who had been perfectly healthy previous to the accession of the disease, fissot has treated specifically of tlie diseases which precede epilepsy. Copland considers it nearly related to apoplexy on the one hand, and convulsions on the other: in its more idiopathic states to the former, and also to mania and idiocy; and in its symptomatic states, to the latter, to hysteria, ecstasy, and some other nervous affections.

Dr Alison states that there are hardly any chronic local diseases in which congestions of blood do not occur?as in very various derangements of the functions of the nervous system, such as headaches, giddiness, transient imperfections of sense or of memory, fits of epilepsy, of hysteria, or other spasms, even of mania, in those predisposed to these diseases* Some cases of transient paralytic affections, and many of apoplexy, appear to result from simply increased afflux of blood to the brain without rupture of its vessels, disorganisa- tion of its texture, or even increased effusion of its serous fluid. Burrows has shown that the vessels of the brain may contain a larger quantity of blood at one time than another. Dr Sieveking, in his learned treatise on Epilepsy and Epilep- tiform seizures, gives the comparative statistics of that dis- ease. He refers to Brown-Sequard’s experiments, and remarks that the seizures in the guinea-pig appear to have borne much more the character of tetanus than of epilepsy. In epilepsy in the human being, the evidence shows the brain to be the organ primarily involved. Dr Sieveking does not adopt Sir T. “Watson’s views with regard to the absence of cerebral congestion in the epileptic paroxysm: but fully agrees with him in his views in relation to the brain and spinal cord m epilepsy?namely, that there are good reasons for believing that the change, whatever it is, which is the cause of the epileptic fit, may originate in the spinal cord, and thence extend to the train and vice versa. With regard to the part of the brain itself affected in epilepsy, Sauvages long since ascertained, by experi- ment, that the hemispheres of the denuded brain may be punc- tured without exciting sensibility; but that, as soon as the instrument reaches the origin of the nerves, or the medulla ob- longata, epileptic convulsions are produced, and hence concluded, that whatever especially atfects those parts, may induce the dis- ease. Dr Marshall Hall’s doctrine, that all convulsive diseases ar? diseases of the spinal cord cannot properly be applied to epilepsy. In the epileptic vertigo, or ” petit-mal,” there is equently a suspension of consciousness without any convulsion at all. Tlle brajn js therefore essentially concerned.

Epilepsy appears to be a functional disorder , of the brain and spinal cord. Fright has induced convulsions, which have Jeen repeated till they terminated in a most deplorable case of epilepsv. The symptoms, even though so severe as to cause eath, and that suddenly, often leave no post-mortem change ] ?m what is considered the ordinary healthy condition of the nervous centres. No doubt changes from the ordinary state aie found frequently in the skull, in the membranes of the rain and spinal cord, and in the structure of the nervous centaes, in cases of epilepsy; but the same changes are found in the bodies of those who have never been subject to epilepsy. ? ome of these changes?such as thickening and opacity of the inembranes, with an increased quantity of fluid in the ven- ules, ^ believe to be a natural decay, which may be prema- 11 e, or, when the brain becomes diminished in size, the effects old age. In epileptics there is sometimes found a partial absorption or diminution in the size of the brain, and, on the ner hand, it is sometimes found enlarged. An instance occurred in a young man, aged 23, affected with epileptic s from childhood. Three days previous to his death a rapid Recession of fits came on ; his respiration was laboured, at ^ lines, indeed, almost suspended, with frothing from both nose an mouth in large quantity. The chief peculiarity in this case was the great size of the encephalon, which appeared to be too large for the skull, and weighed 3 lbs. 6 oz. Another rapid case occurred in a boy aged 14, a congenital idiot, of a healthy family, and the fourth of eleven children, whose mother had had a fever and was in a bad state of health for six months preceding his birth. At the age of 12 he became violent and dangerous to the younger children, and was sent to the asylum, where he had for the first time an epileptic seizure. He had, however, only two fits, at long intervals.

The day before his death he had twelve fits, fell into a comatose state, and died at noon. The head was unusually large, fore- head prominent; the enceplialon weighed upwards of 3 lbs., and the cerebral vessels were congested with blood.

Enlargement of the brain in cases of sudden death was first observed at the St. Marylebone Infirmary by Dr Sims. Several cases occurred in that institution, when, after a careful exa- mination, no other cause for death could be discovered. Two epileptic females in the Somerset Asylum had a pecu- liar appearance: both having hemiplegia, were crippled, one on the right, the other on the left side; the right wrist in one of them was much contracted, the hand almost useless ; the arm and thigh on that side were each two inches smaller in circumference, and also shorter than the opposite limbs, and both patients walked with a limp. These peculiarities in the limbs existed in both from childhood. The fits were less severe in these cases, and the patients were sharper in their intellects than the other epileptics. One of them learned her alphabet, and also to spell, after her admission to the asylum, and had an inclination to learn. They were both passionate and spite- ful; and one of them, not so fond of learning as the other, was particularly given to thieving. I had never seen any notice of similar cases, but had had previously several opportunities of examining the bodies of such patients after death, having invariably found a deficiency in- one cerebral hemisphere, which in nearly every instance was on the side opposite to the paralysed one. A most remarkable case of the kind occurred in 1842. A man, aged 47, fell in a fit in the street, and was brought to the St. Marylebone Infirmary, where he died shortly afterwards. The left extremities were very much smaller than the right. It was ascertained, at the coroner’s inquest, that he had always been lame on the left side, with the arm contracted ; that he was slovenly in his habits, a miser in disposition, and an inordinate eater. His business had been that of a linendraper; he was considered a good accountant, and had been at one time a lawyer’s clerk. On making the post-mortem examination, a large quantity of fluid escaped which was confined in an abnormal membrane over the right cerebral hemisphere, the convolutions of which were wanting”, and which was only half the size and weight of the other, viz. 9? oz. The left hemisphere weighed 18^ oz., which is not above the average weight in an adult male. A notice of these cases of arrest of development, with a drawing of one, from the brain deposited in the Museum of the Royal College of Physicians, will be found in the 39tli volume of the ” Transac- tions of the Royal Medico-Chirurgical Society of London.’’ In 45 out of 89 male epileptics, there was an inequality in weight of from to 6^ oz. between the two hemispheres ; also in 35 out of 61 females, an inequality of from ? to 2jr OZ.

1. The youngest case of epilepsy recorded in the necrological register of tlie St. Marylebone Infirmary was that of a male infant of one month. When a fortnight old, the baby had fits similar to those of its mother, who had been for some years epileptic. The fits were- almost continual; abscesses formed on the left knee and right hand. Head and brain, natural; weight of encephalon, 1 oz. Chest. an ulcer, size of lialf-a-crown, which had eaten its way from the surface between the costal cartilage, through the anterior mediastinum, to the anterior edge of each lung ; right lung, 1-Jr oz.; left, 1 oz. The other organs natural.

2. A cabinetmaker, aged 34, imbecile ; epilepsy of four years’ standing ; ten weeks under treatment in the Infirmary. Head: much fluid in the cerebral ventricles; brain small, o/-s oz. . Chest’, lungs natural; heart small, G~r oz. Abdominal organs small. 3. A bootmaker, aged 35 ; married; epilepsy for four years, combined with mania. lie suffered acute pain in the head, for which he had been occasionally under medical treatment at his own home, and also m the Infirmary. Ilis illness was so severe that for the last year he was unable to follow his trade. The fits came on in rapid succession the evening before and continued to the night of his death, with scarcely five minutes intervening. Ilead : arachnoid thickened, brain quite hard and wasted?it did not nearly fill the skull. The process on the right side of the “sella turcica” projected three times as high as the opposite one, and the sulci in the right parietal bone were un- usually deep, and had high sharp edges; the encephalon weighed 4l? ?z- Chest: old pleuritic adhesions; organs natural. Abdominal organs natural.

4. A linendraper, aged 40, long subject to epileptic fits, and an habitual drunkard. Brought to the Infirmary by the police, having fallen down in the street as if shot through the head. He had a severe wound on the forehead. In a few hours after he had a severe fit, and was violently convulsed. He was relieved after being cupped, and the next day was quite rational. On the day following the fits again returned, and continued with short intermissions for thirty- six hours, Avhen he died. Head : general congestion of blood in the brain. Chest: heart enlarged, 14^ oz. Abdomen: liver large and fatty, ‘ ? oz? Other organs natural.

5. Male, aged 19, epileptic, died of typhus; the ridges of the skull unusually prominent in the temporal fossa ; brain, 46| oz. G. Male, aged 20; subject to epileptic fits for four years from a fright; died of typhoid combined with pneumonia. An encysted tumour or gelatinous bag, the size of a filbert, was found on the left cerebral hemisphere, with thinning of the corresponding portion of the skull. In other respects the brain natural; weight, -47-g- oz.

7. Male, aged 18, epileptic; found dead in bed in Idiots’ ward in the St. Marylebone Workhouse. Had epileptic fits since he was five years of age. Hemiplegia of the right aide, the wrist firmly flexed, the right ankle likewise flexed firmly; the right lower extremity one inch shorter than the left; the right thigh was two inches less in circum- ference, 17 inches, the left 19 inches; the calf of right leg was 10^ inches, the left 13 inches; and the right arm and forearm were two inches less in circumference than the left, owing to arrest of de- velopment. Head: the left cerebral hemisphere was devoid of convo- lutions, their place occupied by fluid contained in the meshes of a thick membrane ; the cerebral structure, brown and tough, giving considerable resistance to the knife, compared Avith the rest of the brain. Right cerebral hemisphere, natural, 21^ oz.; left, 14f oz.; cerebellum, 4? oz.; medulla, f oz.; encephalon, 41^ oz. Respiratory and abdominal organs natural. Height, 5 feet 1 inch; weight, 104 lbs. 8. A whip-maker, aged 19 ; died of typhus four days after his admission to the Infirmary. For several years he had been subject to epileptic fits, and was reported to have frequently had as many as thirty fits in the twenty-four hours. Head: brain quite natural; weight, 46^ ?oz. In the left temporal fossa the ridges were unusually prominent, but not so on the opposite side. The head only examined.

9. Male, aged 25, admitted with gangrene of the lung to the in- firmary from the Idiots’ ward in the workhouse. The epileptic fits were reported to have come on about eight years before, from a fall off a ladder and fracture of the skull. He was seldom more than three days at a time free from fits, and sometimes had five or six at night; sometimes noisy and troublesome. Gradual emaciation. Head : large healthy brain, 49 oz.; no sign of fracture of skull; the process on left side of basilar more pointed than usual. Chest: recent lymph on right lung; the anterior portion of the iipper lobe gangrenous, 40tt oz., left, 27-^ oz.; heart, 9^ oz. Abdominal organs natural. 10. Idorse-dealer, aged 33. Epilepsy combined with mania. Fits of recent occurrence, succeeded ty mania ; under treatment nearly three.months, arachnitis, roughness of the lining-membrane of the fourth ventricle; brain large; weight, 51^ oz. No organic disease in chest or abdomen.

11. Male, aged 41, epilepsy combined with idioc)^, congenital; a brother likewise epileptic. Brain small, in other respects natural; weight, 38^ oz. Died from pulmonary phthisis.

12. Surveyor, aged 48 ; epilepsy combined with mania ; fits very frequent, as many as fifteen reported in one night; had been subject to them for many years; they were supposed to have been caused by too close application to his business; under treatment for three months previous to his death. Head : the vessels of the brain were congested with blood ; that organ was unusually large ; weight 53^- oz. Chest: pneumonia of the left lung. Abdomen, organs natural.

13. A girl, aged 12 ; subject to epileptic fits since she was five years old. A large head, very broad posteriorly, narrow across from ear to ear. She has had as many as thirty-two fits in the twenty-four hours, never for a day quite free; seldom less than ten in a day; when to- lerably free in the day, six or eight generally occurred during the night. Head: brain large and extremely firm, no other change; 44| oz. Other organs natural.

14. Female, aged 27, an epileptic for many years. Admitted from the Workhouse to the Infirmary, for gangrene of the lung, eight days before death ; had also obstinate constipation of the bowels. Head: oedema of the pia mater, and softening at the base of the right cere- bral hemisphere, with opacity of the arachnoid and gelatinous appear- ance of the membranes ; the encephalon weighed 40^- oz. Chest: a small portion of the back part of lower lobe of right lung gangrenous; redness of the bronchial membranes; right lung, 14^ oz.; left, 13-jj ozs. Abdominal organs natural. Height, 4 feet 10 inches; weight, 801bs.

15. Female, aged 32. Has had epileptic fits for the last three years, which recently have greatly increased in frequency. Admitted to the Infirmary only two days before death, having lost all power in 10 .ft side four days previously. She had convulsions almost with- out intermission. Consciousness remained till the day before her eath. ^ Head: congestion of blood in cerebral veins, opacity of ‘ racimoid, anterior portion of the right hemisphere adherent to mem- r’lne> and a portion of brain of the size of a walnut disorganised, and in structure cellular, and filled with serum; encephalon, 2 oz. Chest: pneumonia lower lobe, right lung, 23 oz.; left, 17 oz.; le.irt, 9 oz. Abdominal organs natural.

1G. Female, aged 34, in Workhouse; epileptic fits periodic, not P ec^enk Stupid at the time, but well in the intervals. Head: cere ral ^ convolutions flattened. Weight of encephalon, 48 oz. test, right lung, 16 oz .; pleuro-pneumonia of left, 34 oz. Other organs natural. 1 1 Female, aged 38; epilepsy since infancy. She died unex- pec edly in a fij, and had been an inmate in the Workhouse for years. en between four and five years of age after a fit, she had lost partially the power of left side, and the convulsions were ever after- 1 s strongest on that side, being most frequent in warm weather. \ els constipated, menses irregular and scanty. Head: right cere- ra hemisphere small, 18f oz.; left, 20-^ oz.; cerebellum, 5^ oz.; pons. 1 oz.; encephalon, 45? oz. Other organs natural. 18. female, aged 40. A congenital idiot, subject to epileptic fits rom childhood. She died in the workhouse ward for idiots. Head: mall, skull unusually thick, the cerebral vessels congested with blood, nearly an ounce of clear fluid in the lateral ventricles; weight of the )ram, o8|- oz. Other internal organs natural. Analysis of the eighteen foregoing cases of epilepsy, twelve Eiales and six females.

The weight of the encephalon was natural in the infant, also very nearly so in the two males, as compared with the average weight of the encephalon in the sane, which is found to be nearly 46 ounces avoirdupois in the male, and 42 in the female adult. In one male no weight is given, in three males and four females the brain was above the average weight; and in two males and two females below it; both of the males and one of the females being idiots. In one of the males there was a remarkable difference between the cerebral hemispheres, one being only two-thirds the weight of the other, which was the cause of the arrest of development of the limbs on the opposite side (Case 7).

In one of the females there was also a difference of two ounces between the cerebral hemispheres. Death was sadden in these cases, and there was no other serious organic disease, beyond the chronic affection, viz., the inequality of the two cerebral hemispheres. Sharp bony ridges and projections in the base of the skull were observed in three of the males; in one male acute pain in the head was persistent. One was a confirmed drunkard. An encysted tumour was found in one male, and the skull above it was partly absorbed. A cyst occurred in one of the females ; congestion of blood in the brain in two males and one female ; arachnitis in two males and one female. The brain and membranes natural in two males. There was softening of a portion of right cerebral hemi- sphere in one female, and fluid in the ventricles in one female. The disorder was combined with typhus fever in two males, and in one of them also with pneumonia; in two males and two females with pneumonia alone ; in one female with pleuro- pneumonia ; in one male and one female, with gangrene of the lung; in one male, with pulmonary phthisis. Two of the males and two of the females were idiots, and in two males the disorder was combined with mania or raving- delirium.

Esquirol found in 339 epileptics that four-fifths were more or less insane.

In the Somerset County Lunatic Asylum during twenty and a quarter years, 9|- per cent, of the patients admitted were subject to epileptic fits, combined in the young under twenty years with idiotcy; in those of more advanced years very frequently with mania and with other forms of insanity. Contrary to the experience of Esquirol, who states the number of female epileptics to exceed the males by one-third, of the 310 epileptics in the Somerset Asylum, the males exceeded the females by nearly a sixth. Esquirol considers epilepsy to be contagious by the fright which an attack occasions to some beholders. This opinion is supported by the facts previously stated relative to the contagiousness of convulsions, so fully described in Heckei s ” Epidemics of the Middle Ages.” This disorder is so closely allied to epilepsy that many persons hardly make a distinction between the two. Teething in infancy is regarded as a frequent cause of convulsions. An experienced dentist informed me that he has known the cutting of the wisdom teeth to cause epilepsy. So here the making of a distinction would seem to be influenced simply by age. The greater size of the head in the male foetus, and consequently its greater liability to injury in parturition, renders the male more liable than the female to convulsive diseases in early life. There were at least three remarkable instances of persons not known previously as epileptics having been seized with epileptic fits aftei kindly giving their assistance to patients in their attacks ; one a sempstress (251), aged 66, three years after admission had, for the first time, epileptic fits, 33 occurring within four months. The fits continued for a year, gradually becoming less frequent. Her mental state ultimately improved, and at the end of seven years she was discharged, relieved. . ? n It is certain that in some cases of insanity epileptic fits have been induced by frequently witnessing them in others, and that the association with epileptics is hurtful to the insane. I he Metropolitan Commissioners in their report made it a matter of complaint that the epileptics in asylums were not separated from the insane. Instead of enlarging the present asylums it would be very desirable if some adjoining counties were to unite and build suitable asylums for epileptics and idiots, 01 appropriate some of the workhouses for that purpose, many of them being comparatively empty. The facilities under the lunacy Acts, and recent legislation have enabled parishes to transfer their aged and troublesome paupers, and fill the county asylums with unfit cases.

Some time ago it was reported that an hospital for 2,000 epileptics, not insane, was to have been established in the South of France. The means thus obtained for the study of the milder forms of the disorder would probably lead to beneficial results.

The terminations of the 310 cases of epilepsy, 181 males and 129 females, admitted to the County Somerset Asylum were:?

Recovered for the time, 6 males, 2 females. Relieved, 10 males, 11 females. Not improved, 17 males, 11 females; transferred to asylums and friends.

Died, 103 males, or 57 per cent.; 65 females, or 50 per cent. Remaining’ in asylum, 45 males, or 24f per cent.; 40 females or 31 per cent.

In two of tlie six recoveries in tlie males, the fits were attri- butable to excessive drunkenness, not an uncommon cause in the experience of military surgeons.

The first of these (441), a flyman, had imbibed freely on a holiday, at Cheddar Cliffs, the favourite resort of excursionists in the neigh- bourhood. He was subject to fits, and had attempted suicide on this occasion ; but his senses very soon returned, and he was discharged at once. The 2nd case (1,082) Avas of much longer duration; a printer, aged 37, married; was admitted on three separate occasions in three years, once after an interval of thirteen months between the attacks, and again after an interval of twenty-one months, each attack being attributable to the same cause?namely, excessive drinking. The fits were attended with mania, and he Avas dangerous both to himself and others. Being quite rational, he was discharged on probation. He had been free from fits for a month previously. The 3rd (541), a carpenter, aged 62, married ; was a case of eclampsia of two years’ duration, who had been for one week reported as dangerous to himself and others. Pulse 96, health indifferent, fancies he is bewitched, and that his wife exercises supernatural power over him. Two months after admission he took diuretics for oedema of the legs; he worked in the carpenters’ shop ; the fits came on suddenly, and he would fall if not caught. He lost con- sciousness, but never frothed at the mouth, or was convulsed ; grasped tightly anything he might have in his hand. There was the spasm and contraction, alternating with relaxation as in convulsions. At the ex- piration of five months he was discharged recovered. The 4th (799), a labourer, aged 43, married; first attack; duration, thirteen years ; dangerous one week; attempted to injure his wife and children; maniacal; fits sometimes lasted three hours; intervals of two and three months. He was discharged relieved, and again admitted, after nine years, in a similar state, violent and destructive. At the end of five months he was discharged recovered for the time. The 5th (1,014), a carpenter, aged 38, married ; first attack, eighteen months’ duration; health indifferent; pulse 75. Fits mostly occur at night, and are peculiar; he dees not seem entirely to lose consciousness. There is no frothing at the mouth, or spasmodic action of the limbs, but jacti- tation of the whole body, and he knocks himself about violently. After eight months fits became less frequent, and in eighteen months he Avas discharged, having been for three months free from fits, and rational. The Gth, and last male (1,069), an ostler, aged 28, single; brought from the Bridgewater Infirmary, after having had an epileptic fit combined Avith mania three days preA’iously; fits not frequent or seTere ; in a convalescent state in six months, and discharged in eight months, recoA^ered.

A laundress (213) aged 24, married; with child; Avas admitted for a second attack of epileptic mania, Avhich, like the present, came on during the seventh or eighth month of pregnancy. She Avas A’iolent towards her husband; good health; pulse 104; fits occur about one in a week; her previous attack, two years ago, was of two months’ duration; during the interval to this attack she remained free. She seemed free from all dislike to her husband in a month after her a mission, when he visited her, and she was discharged five Aveeks a ter admission recovered for the time, and had her confinement shortly afterwards.

A female (284), aged 25, married ; two children; first attack since i ast confinement, seven months before admission; she has been un tted to attend to her household duties. Her only delusion is that ? G is bewitched, and she beat her mother-in-law, whom she fancied 4/n ed ^er’ linking that if she drew her blood, and that of her Clen> she would be relieved; pulse 84 ; indifferent health ; had an a tack combined with hysteria, during which, in the night, she screamed and threw herself about violently, as did the male (1,014). ‘ ie got over her delusions, and at the end of fourteen weeks was dis- c laiged, recovered for the time.

Ten cases of epilepsy in males discharged, relieved. ^?}lrer (75), widower, aged 72 ; subject to epileptic fits three lived J>r?V^?Us to admission to the Somerset Asylum ; both his parents four 1? aSed ; a paternal uncle had epilepsy ; of his nine children, he]1” waters were epilcptic ; in bad health from asthma; pulse 90; attack . ]n*? ^e fire and into the river. This is his second “wife ^rst attack was eleven years before, on the death of his 1 e.’ a. was afterwards for seven years free from fits. After his Prov^1011 ^uee hts in the Asylum. His bodily health im- e > and after five months he was discharged to his home, relieved, per, t ^arAen?r (76), married, aged 57; his third attack; of intem- wei’1 ? 1 ]n drinking ; fits occurred at considerable intervals, and consicTer,K”|SeV-ere’ Pu^se 72 ; he took the tincture of sumbul for some ol.o,1 Gnra time; was quite rational, and, after several years, dis- charged, relieved.

firs^n^011’68861’ (133)’ married’ aged 40; the second attack. In his his L<1 l ? seven years previous, he had a fall, and struck the back of ulcer^ Sreat force. He was addicted to drink; pulse 92 ; had lipiltl! ^ ^eSs; which were also ocdematous. The ulcers healed; his year ,lmProved; he worked at his trade; and, at the end of four i ‘1S’ lcr Was discharged, relieved, and went to assist his son, a liair- sser, m London.

years’ ^’U^u’r (^’~j)j married, aged 45; his fourth attack ; case of two sister .rat*on> maniacal; has several delusions; pulse 94; has a thi t an Soon after admission he had several fits; remained i een months in the Asylum, and being free from fits for the last AVas discharged, relieved.

atte ah?urer (G10), aged 50, married ; third attack; excited, and fort suicide^ first attack, seven years before admission. He had dis ^tS ^ anc* ten hy night, in one year; he was arged after nearxy three years’ residence in the Asylum, relieved. durat’11 excavator (762), aged 85, married; third attack; seven months’ 10n, pulse 98; excited and violent; took phosphate of zinc. Had no fit for two months previous to his discharge; twelve months in the Asylum.

A butcher (801), aged 30, married; second attack; duration, seven years. Cause, a blow on the head; violent fits occur almost daily; pulse 90 or more; four fits in a day. Discharged in three months to his home, relieved.

A collier (1,322), aged 17 ; second attack ; six months’ duration ; cause, an injury to the head; maniacal; pulse 90; after two months he had but two fits in the month. He was discharged to his home at the end of five months, relieved.

A tailor (1,349), aged 23, single ; first attack; three years’ dura- tion ; his father’s mother insane; violent occasionally; bad health; pulse 84 ; his health gradually improved, discharged in twenty-one months to his home, relieved.

A labourer (1,414), aged 37, single; subject to fits from child- hood, which occur about every six weeks; maniacal occasionally and incoherent; health indifferent; pulse 78; he became phthisical and quite rational; discharged to his home two-and-a-half years after his admission by the desire of his father, relieved.

Eleven cases of epilepsy in females discharged, relieved. An agricultural labourer (No. 44), married, aged 55 ; three months before had for the first time epileptic fits, with melancholia, after the fatigue of attending on a sick daughter. None of her relatives subject to fits. Her health improved slowly and fits became less frequent. Discharged to her home in twelve months.

An upholsteress (57), married, aged 4G ; fourth attack, of eight months’ duration; her parents lived to be aged, and she has had eight children and four of the number died in convulsions, and a daughter subsequently became epileptic and insane. Has worms (lurnbrici); fretful and desponding; pulse 90; fits of daily occurrence. Her husband stated that her first attack came on after taking some drugs from a quack doctor for worms. She was upwards of fourteen months in the Asylum before any permanent amendment took place. She had anthelmintics, also cotyledon umbilicus, and finally tincture of sumbul. She was discharged in eighteen months, having had but one fit in the three last months.

A laundress (80), single, aged 52 ; first attack of twelve years’ duration; maniacal; destructive; fits principally occur at night, and are very frequently as many as ninety-six in twenty-four hours; pulse 90, reduced by infusion of digitalis to G4, a large flow of urine beinc caused. No fit for a month, she passed lumbrici, fits were less frequent afterwards, and in two years she returned home.

A laundress (213), married, aged 24 ; had a previous attack. Both came on during pregnancy; fits occur once a week ; maniacal. She became quiet after admission, and soon improved in health and was discharged to be confined five weeks after admission, to the Bath Union. A charwoman (370), single, aged 37 ; attacked after a fright, three years before; maniacal; had a brother in the Asylum demented; health good ; pulse 8G ; had five fits in the first month after admission, and so continued for two years, when tlie fits became less frequent. In the winter of her fourth year in the Asylum she had an apoplectic fit; hemiplegia of the right side and gangrene of the toes. Six months afterwards she so far recovered as to be able to dress and feed herself; “was quite sensible and rational; and in a year returned to her friends, having been four years and ten months in the Asylum.

A widow (371), aged 70; fits of three months’ duration; trouble- some in the workhouse ; had only four fits in six months; quiet and harmless; discharged after being four-and-a-half years in the Asylum. A sempstress (594), single, aged 24; after fever; second attack; strumous habit; destructive and violent; case of six weeks duration; pulse 78. She gradually improved under use of cod-liver oil. She was one year in the Asylum.

A sempstress (774), single, aged 33; in bad health; subject to epileptiform seizures for ten years, more like ” syncope recurrens than epilepsy. She had been violent occasionally at home. Alter taking tincture of sumbul, the fits became less frequent, and she was discharged in ten months… .

. A tailor’s wife (823), aged 50 ; subject to epileptic fits for tlnrty- six years; violent for three weeks ; had been in Colney-Hatch Asylum for six months; five or six fits in a month. After seven months m the Asylum, she was discharged, relieved.

A female (1,376), single, aged 17 ; for two weeks violent; bad health a quick pulse; had eight fits in the first month ; general health improved ; only one fit the month previous to her discliaige six months after her admission.

A laundress (1,493), married, aged 47; the second attack of seven weeks duration ; had seven daughters, four of whom were alive; first attack after the birth of her third child ; dangerous to others; fits not frequent but severe; one month free from them. Returned home after six months’ residence in the Asylum.

In these twenty-one cases which were relieved, ag& does not appear to have influenced the result, and as regards the civil state, 3 males and 5 females were single, G males and 5 females were married, and one of each sex widowed. All tlie males with one exception, and 4 of the females, had one or more previous attacks. The pulse on admission, in the majority of cases in both sexes, was above tlie natural standard. The causes assigned were, in 3 males, drunkenness; in 2, injuries to the head; in 2 males, phthisis; and 3 females, bad health, 2 of them had worms; 2 males and 2 females inherited the disease ; in 1 female during pregnancy, being the second attack from the same cause; in 1 female from fright and anxiety; in 1 female it was combined with hysteria; and in 1 with syncope; in 1 male and 2 females no cause was assigned. Two of the females liad lost several infants in convulsions ; one of them had lost 4 out of 8 from that cause.

Post-mortem examinations were made in 155 of the 168 fatal cases?94 in males and 61 in females. The following- is a summary of the results in each sex at decennial periods of life: age?under 20 years: there were 8 males and 1 female, all of whom were congenital idiots:?the period from 20 to 30 included the greatest number of males?31; i.e., nearly a third, and only 12 females:?from 30 to 40 years there were 20 males and 23 females, being the greatest number of the latter sex, and above a third of the whole number :?from 40 to 50, the num- bers fell off to 13 males and 14 females :?from 50 to 60, there were 9 males and 7 females:?from 60 to 70, 6 males and 3 females:?and from 70 years upwards, 7 males and 1 female. It thence appears that epilepsy is most prevalent at an early age, and also, that the greatest mortality is at an earlier age in males than in females.

The forms of mental disorder at the decennial periods of life were under 20 years, as already stated; all were idiots, and with two exceptions among the males, violent and dangerous:? from 20 to 30, 6 males and 4 females were violent and dangerous idiots ; 19 males and 6 females were maniacal; 3 males melan- cholic ; and 3 males and 2 females demented :?from 30 to 40, 2 males and 3 females were idiots; 13 males and 18 females maniacal; 4 males and 1 female melancholic; and 1 male and 1 female demented:?from 40 to 50, 1 male and 1 female were idiots ; 7 males and 8 females maniacal; 1 male a monomaniac; 4 females melancholic ; and 4 males and 1 female demented: ?from 50 to 60,1 male and 1 female were idiots; 5 males and 3 females maniacal; 1 male and 2 females melancholic ; and 2 males and 1 female demented:?from 60 upward, 1 female was idiotic; 8 males and 1 female maniacal; 1 female melancholic; and 5 males and 1 female demented.

Causes?Under 20 years all the cases, viz., eight males and one female were congenital or dated from infancy. The disease was hereditary in one male.

From 20 to 30, the disease was congenital in eight males and three females: it existed from childhood in two females, was hereditary in one male and two females.

Amongst the other causes were bad health after fever in one male and phthisis in one female, falls and injuries in four males, critical period in one female, fright in two males, religion in one male, and the cause was not ascertained in fourteen males and three females.

From 30 to 40, congenital in one male and four females; from childhood in one male and two females, hereditary in five males and four females; cerebro-spinal disease in two males ; falls and other accidents in three males, pulmonary disease in one male, grief in one male and three females, love in one female, frig’lit in two males; cause not ascertained in foiu males and nine females.

From 40 to 50, congenital in three males and one female; from . childhood in two males and one female, hereditary in one male, cerebral disease in one male and one female, injury to head in one male and one female, puerperal in one, fright in one female, religion in one female, poverty in one female, intemperance in two males; cause not ascertained in three males and seven females.

From 50 to 60, congenital in one male and one female, hereditary in one female, puerperal in one, cerebial disease in one male, grief in one female, intemperance in one female ; not ascertained in seven males and two females.

Upwards of 60, congenital, one female; injury to head, one male ; poverty, one male; fright, one male and one female , n?t ascertained, ten males and two females.

Assigned cause of death at each ‘period of life. Under twenty years, in eight males and one female menin- gitis in one male and one female, hypertrophy of the biain in two males, combined with pulmonary phthisis in one and enteritis in the other case; cerebral apoplexy in one male; pul- monary phthisis in one male; pneumonia in one male; two males died from asphyxia in tits, one of them was cachectic. From 20 to 30 years, the causes in thirty-one males and twelve females were meningitis in five males, combined with pulmonary ap?plexy in one, and erysipelas in another; the latter was also the cause in one female; congestion of blood in the cerebral vessels in five males and one female ; cerebral apoplexy in three males and in two females, with p. phthisis in one; apoplexy of the spinal cord in two males ; hypertrophy of the brain in two males, with pneumonia in one; cerebritis and myelitis in one male and myelitis in two females; pneumonia in six males, combined with bronchitis in two cases, as it was also in two females. It was associated with gangrene of the lung in one female. Scrofula was the cause in two males; pulmonary phthisis in five males and four females; peritonitis in one male; ulcer in the stomach in one male.

From 30 to 40 years, in 20 males and 23 females:?menin- gitis in 2 males and 4 females, combined with broncho-pneu- monia in one; congestion of blood in the brain in 3 males and 3 females; apoplexy of the spinal cord in 1 male; myelitis in 1 male and in 1 female; tumour in the brain in one male; pulmonary apoplexy in 1 male; broncho-pneumonia in 1 male and pneumonia in 2 females ; typhoid pneumonia in 1 female; pleuro-pneumonia and gangrene of lung in 1 male; pulmonary phthisis in 4 males (combined with pneumonia in 3 of them) and in 10 females; enteritis in 1 male; sudden deaths in fits, asphyxia in 2 males and in 2 females.

From 40 to 50 years, in 13 males and 14 females:?meningitis combined with pneumonia in 1 male, and in 3 females with con- gestion of lungs in one and myelitis in another; congestion of cerebral vessels in 1 male and bronchitis, and of 2 females, with pneumonia in one; cerebral softening in 2 males, with tubercles in the brain in one; tumour in the brain, apoplexy, and pleuro- pneumonia in 1 female; myelitis in 2 males, with blood in spinal canal in one and pleuro-pneumonia and gangrene of the lung in the other; congestion of blood in lungs in 2 males; pleuritis and gangrene of lung in 1 male; pleuro-pneumonia in two males, in one with atrophy of the brain and in one with cerebral congestion; pneumonia in 1 male and 4 females, with conges- tion of blood in cerebral vessels in one; tubercular pneumonia in 1 female; pulmonary phthisis in 2 females; general dropsy in 1 male; hydrothorax in one female.

From 50 to 60 years, in 9 males and 7 females :?meningitis and an unusual quantity of fluid in the cerebral ventricles in 1 male and 1 female; cerebral apoplexy in 2 males, with enlarged heart in one and hydrothorax in the other, and in 2 females, combined with gangrene of the cerebellum in one and cerebral atrophy in the other; cerebritis in 1 male and pneumonia; cerebro-spinal softening in 1 female; tumour in the brain in 1 female ; bronclio-pneumonia in 1 male and Bright’s disease; pneumonia in 2 males ; pulmonary phthisis in 1 female ; hydro- tliorax in 1 male and enlarged heart; lumbar abscess in 1 female; asphyxia, sudden death, in 1 male.

Upwards of 60 years, in 13 males and 4 females:?meningitis in 4 males, combined with pulmonary emphysema in 1, with cardiac disease in 1, with pneumonia in 1, and an ulcer in the stomach in 1 ; an unusual quantity of fluid in the cerebral ventricles in 1 male with hydrothorax, and in 1 female; cerebral softening in 1 male and pneumonia; cerebritis in 1 male with bronchitis, and in 1 female; paralysis in 2 males, with gangrene of lung in one ; tumour in brain in 1 male and Bright’s disease; broncho-pneumonia in 1 male and bron- chitis and emphysema in 1 female; pleuritis in 1 male; Bright’s disease and fatty heart in 1 female; erysipelas in 1 male. In epileptics the average height and weight of the body, average measurements of the skull, and the weight of the internal organs at different periods of life in males and females, were as follows :?

Age 20 to 40 ( years 40 to 60 Upwards ( of 60 Sex ? , , Measurement Dod->’ of head ft. in. 5 7 5 0 5 6 5 1 5 6 5 2 lbs. oz. 115 0 86 0 112 0 82 4 22-1 21-7 22-2 21-5 116 95 12 22-2 20’8 13 12-8 13 129 12-8 11-9 Cerebral Organs Cerebrum 12-2 12-2 12-3 12 11-9 11 ???3 S’s 21-4 19 20 18-3 196 174 i-T W 21-6 19-3 204 186 19-2 17-6 oz. 5-1 4-6 5-1 4-8 1 49-1 1 43-9 1-1 j 46-6 1 1 42-7 4-8 4’5 Thoracic Organs 11 11 M 11 1-1 25 22 21 I 18 25 j 21 21 ! 20 9-3 11 9-6 28 18 22 15 11-6 10-6 Abdominal Organs 5*4 6 5-3 5-4 53 oz. 54 43 49*5 45 5-2 4 5-3 3 3-2 3 35 2’7 4-4 4 4-7 4 46 34 4-2 4-2 4-9 3-7 1-6 1-9 1 144-6 1 | 40-5 | 1-1

The total average ?weights at all ages in Epileptics, compared with those in all cases examined in the Somerset County Lunatic Asylum:? Epilep 1-9 Asym. Epilep. Asym. 5 6 5 6 5 2 5 1 114 104 5 88 81 3 22-1 22-2 21-3 21-3 12-9 13-2 12-5 12-8 12-1 13-2 11-7 12-6 20-3 20 18-2 18-4 20-4 20-2 18-5 18-6 a 5-2 4-6 4-9 1 1 1 ?9 46-8 46-6 44-7 42’9 1-1 1-1 26 25-6 M 20 ?9 I 18 22 22-3 18 16-3 10 6 10-7 9-3 8-1 56 5-7 5-2 50-5 50-5 44-7 42-8 5-3 4-5 3-8 4-3 3-2 3-5 2-9 29 4-6 4-8 3-8 4-9 49 5 4 4 1-8 1-6

Tlie post-mortem appearances in these epileptics were, in the head, in 8 males and 1 female under 20 years, were adhesions of the dura mater and opacit}7 of the arachnoid in 4; congestion of blood in cerebral vessels in 1; hypertrophy of brain in 1 ; about 2 lbs. of blood effused in brain and spinal cord in 1 ; brain unusually firm and small in 2 ; in the female congestion of blood in cerebral membranes. In the female the dura mater adherent and congestion of blood in the cerebral vessels.

Spinal cord?white specks of bone on arachnoid in 1; the membranes adherent in 1 ; partial softening of cord in 2. Chest?thymus present (f oz.) in 1, and adherent to peri- cardium in 1. Pulmonary tubercles in 1 ; pneumonia in 1 ; bronchial glands enlarged in 1. Abdomen?ulcers in ileum in 1.

From 20 to 30 years, in 31 males and 12 females, the scalp was infiltrated with blood in one female; the skull was unusually thick in 2 males and 2 females, the diploe absent in one; skull unusually thin in 1 female ; the ” crista galli ” and other bony points very prominent in 1 female ; dura mater preternaturally adherent in 6 males and 3 females, and opacity of the arach- noid in 3 males; pia mater adherent in 1 male ; much fluid in the cerebral ventricles in 4 males and in 3 females; congestion of blood in the cerebral vessels in 9 males and 2 females; blood effused on cerebral surface in 2 males and 2 females; lymph on base of brain in 1 male; brain unusually firm in 4 males, pale in 2 males and 1 female ; soft in 3 males; extreme atrophy of left hemisphere, only 8 oz., in 1 male, and inequalities of weight of 2 oz. in hemispheres in 1 female.

Spinal cord?blood in spinal canal in 3 males and on the surface of cord in 1 female; congested in 1 male ; lymph on cord in 1 male; cord soft in parts in 6 males and 4 females; unusually firm in 1 female.

Chest?old pleuritic adhesions in 10 males and 2 females ; recent effusion of lymph in 1 female ; congestion of blood in 2 males and 3 females; pulmonary apoplexy in 1 male; bron- chitis in 3 males; pneumonia in 5 males and 2 females; hydrothorax in 1 male; pulmonary tubercles and tubercular cavities in 8 males and 2 females; hearts small in 6 males and 4 females; large in 3 males; and from one to two ounces above the average weight in 6 males and 4 females.

Abdomen?old peritoneal adhesions in 3 males; fatty omentum in 1 male; worms in intestines in 2 males ; scrofulous tubercles on liver in 1 male, and on peritoneum in 1 female; stomach elongated in 1 female; enteritis and ulcers in ileum in 4 males and 1 female; mesenteric glands enlarged in 1 female.

From 30 to 40 years, in 20 males and 23 females :?Ilead the dura mater adherent in 1 male and 4 females ; bony spiculse on falx in 1 female; opacity of the arachnoid in 1 female ; the cerebral vessels congested with blood in G males and 8 females; an unusual quantity of fluid in the cerebral ventricles in 4 males and 4 females; the cerebral hemispheres unequal, the left being- 1 oz. heaviest in 1 female; the brain large in (j males and 6 females, and unusually firm in 3 males. Spinal cord?blood in spinal canal in 4 males, and fluid in canal in 1 female; the cauda partly softened in 4 males and 3 females ; softened throughout in 1 male.

Chest?old pleuritic adhesions in 6 males and 5 females; recent lymph in 2 males and 1 female; pulmonary congestion of blood in 8 males and 7 females; pulmonary tubercles in 3 males and 4 females; and tuberculous cavities in 2 males and 4 females; the heart large in 4 males and 1 female, and small in 3 males and 6 females.

Abdomen?enteritis and ulcers in ileum and colon in 3 males and 7 females; entozoa in duodenum in 1 female; tubercles on uterus in one; cancerous lymphatic glands in 1 male ; stomach soft in 1 female; fatty liver in 1 male and 1 female; spleen enlarged in 1 female; nephritis in 1 male; horse-shoe kidney in 1 male.

From 40 to 50 years, in 13 males and 14 females the skull was unusually thick in 1 male; projecting points in temporal fossa in 1 male; bulbous protuberance in place of crista galli in 1 female; matter in sphenoidal sinus in 1 female ; dura mater adherent in 3 males and 5 females ; opacity of the arach- noid in 1 male and 1 female ; cartilaginous specks on arachnoid in 1 female; blood effused in base of skull in 1 male; much fluid in the cerebral ventricles in 3 females ; cysts in 1 female ; the brain unusually large in 4 males, and pale in 1, also in 3 females ; the brain small in 3 males and 4 females.

Spinal cord?blood in canal in 1 male ; much fluid in the- canal in 1 male : the cord partly softened in 5 males arid in 3 females.

Chest?-old pleuritic adhesions in 1 male and in 1 female; the pleura tuberculous in 1 male; pulmonary tubercles in 3 females, combined with pneumonia in 1 of them ; fluid in the chest in 1 maie and J female; pulmonary congestion in 5 males and 3 females; bronchitis in 1 male and 1 female; pleuro-pneumonia in 4 males, and gangrene in 1; pneumonia in 6 females.

Heart?enlarged above the average in 4 males and 1 female, and small in 3 males and 3 females.

Abdomen?ascites in 1 male ; tubercular peritoneum in male; fatty omentum in 1 male; enteritis in 3 males; ulcer in colon in 1 male and 1 female ; the stomach unusually large in 2 males and 2 females; the stomach contracted and small in 2 females; the liver enlarged in 2 males; containing hydatid cysts in 1 female, and waxy in 1 male; the spleen unusually soft in 2 males, enlarged in 2 females; the pancreas large in 2 males ; right kidney enlarged in 3 males and 1 female, and small in 2 males and 2 females ; granular in 1; blood in renal capsules in 1 male.

From 50 to 60 years, in 9 males and 7 females :?effused blood beneath the scalp in 1 male; the dura mater adherent in 2 males and in 4 females; the arachnoid opaque and thickened in 1 male and in 1 female; blood effused on the arachnoid in 1 female ; congestion of blood in the cerebral vessels in 2 males; about 2 oz. of blood on the cerebrum in 1 male; an unusually large quantity of fluid in the cerebral ven- tricles in 2 males and in 2 females, and cerebral softening in one of them; the brain unusually firm in 1 male; small cavi- ties in centrum ovale in 1 female; fungoid tumour in 1 female; the cerebral hemispheres unequal in 2 females; a difference in weight of 2 oz. in one in the right, and the other in the left hemisphere ; spinal cord partially softened in 3 males and in 1 female.

Chest?old pleuritic adhesions in 2 males and in 3 females; pulmonary congestion of blood in 3 males and in 1 female; hydrothorax in 1 male; bronchitis in 1 male; tuberculous cavities in 1 female; pneumonia in 3 males and 3 females. Heart? fluid in the pericardium in 1 male; the heart greatly enlarged, 24 oz. in 1 male, and above the average weight in 3 females; the heart unusually small in 2 males and 2 females.

Abdomen?omentum fatty in 1 male; an abscess beneath the ensiform cartilage in 1 female; the peritoneum thickened in 1 female ; granular kidneys in 1 male.

60 years and upwards, in 13 males and 4 females:?Head ?cerebral membranes adherent in 5 males and 1 female; opacity of the arachnoid in 5 males and 1 female; the vessels and sinuses engorged with blood in 2 males; much fluid in the membranes and ventricles in 5 males and 1 female; softening and small cavities in corpus striatum in 1 male; a tumour in right hemisphere and amaurosis in 1 male; apoplectic clot in 1 male; a rusty deposit and cavity in 1 male and 1 female ; the brain tough in 1 male, soft in 1 female, and small in 1 female. The spinal arachnoid adherent in 1 male; the cord unusually pale in 1 male, and soft in 1 female.

Chest?old pleuritic adhesions in 4 males and 1 female; liydrothorax in 1 male; pulmonary congestion in 2 males; bronchitis in 3 males; empl^sema in 3 males and 1 female; tubercles in 1 female; broncho-pneumonia in 1 male and 1 female; pneumonia in 1 male; heart enlarged in 4 males and 2 females; the valves thickened in 2 males; clots in aorta in 1 male.

Abdomen?ulcer at pylorus in 1 male ; stomach enlarged in 1 female; liver enlarged in 3 males, and softened in one of them; spleen softened in 3 males, and enlarged in 1; spleen soft in 3 males and large in 1 ; kidneys granular in 1 male; small and pale in 1 female.

From a summary of these 155 cases of epilepsy, diseases of the cerebro-spinal organs were found in 52*3 per cent., and in largest proportions in the youngest and oldest; diseases of the pulmonary organs were most prevalent at middle-age, amounting in the whole to 344 per cent.; diseases of the abdo- minal organs in the proportion of nearly 13 per cent. Epilepsy, if combined with insanity, is considered incurable, and the treatment of it, in a great measure, empirical; unless, perhaps, when the affection is symptomatic of disease of the circulating, digestive, or generative organs. A great variety of remedies from all the kingdoms of nature have been recom- mended, and many of them have long fallen into disuse. Attention to diet and regimen is of importance. In some instances, especially in young persons, the bromide of potas- sium has been administered with relief; and in other instances has had the effect of keeping the fits in abeyance, and some- times of diminishing their frequency and severity. Aperients have also been found to alleviate the severity of the fits, Counter irritation to the nape of the neck by moxa, or by the I’ed-hot iron, has been tried, as recommended by Erown-Sequard, and like other forms of treatment may have at first mitigated the disorder, but the fits have returned again, and often with renewed severity. Dr Marshall Hall recommended a severe operation, tracheotomy, but it has not been practised to any extent, and lias not succeeded when tried. Pressure on the carotid was also tried without relief. Dr Eouth, at a recent meeting of the Medical Society, recommended a trial of the nitrate of amyle.

In the treatment of epilepsy, in the paroxysms, all liga- tures and cinctures should be at once removed, the patient should be placed on a bed in an airy apartment, witli the head and shoulders raised, and a cork or wedge-shaped piece of soft wood introduced between the teeth, and the struggles should be gently restrained, to prevent the patient from injury from his or her own violence. When the injury is preceded by the ” aura epileptica,” a tiglit band should be placed just above the part where the sensation is experienced, as this has been known to prevent the attack. In first attacks in plethoric and san- guineous temperaments, blood-letting, cold affusion on the head, and purgatives, particularly turpentine in combination, have been beneficial. The careful regulation of the diet is of im- portance, which should be light and easy of digestion, and also nutritious.

The endless complications which may accompany epilepsy must be regarded, and render the treatment most varied. The imagination has, especially in females, much influence in many forms of epilepsy. In many cases the moral treatment is as important as the physical. Varied occupation is of great service as a means of abstracting the mind from the disease; sudden changes of remedies have rendered tlie attacks less frequent. Except in epilepsy brought on by fits of drunken- ness, which generally recover when total abstinence is enforced, as does ” delirium tremens,the opinion that recoveries from epilepsy are for the most part only temporary, and that even after many years’ cessation the fits will recur, is borne out by cases here recorded; as is also - that which holds that epilepsy when combined with insanity, may almost be regarded as hope- less. When combined with hysteria, and in puerperal cases, relief has been afforded, and also in a few of the milder cases, when between the paroxysms the mind has been unaffected. Such cases occurring amongst the poor are sent, perhaps unavoidably, to the asylum, the most improper place for them with a view to recovery, as the associations in it are most likely to confirm their malady.

The treatment employed has been regulated by the symptoms in each individual, and these have arrived at the different periods of life. In the youngest, i.e. those under 20 years, counter irritants, as valerianite of zinc, artemisia vulgaris, and also stimulants and tonics were employed, also treatment for phthisis and diarrhoea. In those from 20 to 30, in addition to these, bloodletting and purgatives, tincture of sumbul, digitalis and codliver oil. Cases of pneumonia and gangrene were also treated; from 30 to 40, blisters, expectorants, sedatives, antispasmodics; from 40 to 60, general treatment, setons, sumbul, mugwort, aperients, stimulants, anodynes ; also cases were treated for phthisis, bronchitis, pneumonia, diarrhoea, erysipelas, carbuncle, burn, and gangrene of finger; from 60 and upwards, in addition to the general treatment, stimulants, counter irritation, blisters; cases of influenza, bronchitis, phthisis, dropsy, diarrhoea, and abscesses w?re treated.

In England and Wales, in a period extending over six months the deaths from epilepsy were very nearly double those from insanity, as given in a table in Copland, viz., from insanity 147 males, 138 females; from epilepsy 278 males, 292 females. Congenital idiocy, and congenital imbecility, are classed together. Congenital idiots are persons whose intellectual faculties have never been developed. In infancy they have large or ill-formed heads, are puny, often squint, cannot walk until late, or articulate until six or eight years of age. Their features are repulsive, they drivel from their mouths, their organs of sense are imperfect, both of taste and smell, and they are often deaf and dumb. Their bodies and limbs are ill-formed, they are commonly rachitic or scrofulous or paralytic, and many, about one-half, are subject to epileptic fits. Memory is strong in some, in others it is weak ; they are generally timorous, in- constant, and often irascible. Many arft prone to lying and stealing, and they often sink into melancholia and are given to masturbation ; some evince particular talents, as for music. They commonly present much of the character of children. There are many degrees of imbecility ; but as the original defect may present every grade from the slightest to complete idiocy, it is difficult to draw any line of demarcation between sound- ness or unsoundness of mind. The examples chiefly found in lunatic asylums are persons labouring under this weakness in an extreme degree. It is only when the idiots are violent and dangerous or otherwise troublesome, or of filthy habits, that they are sent to the asylum.

There were 170 idiots, chiefly living with their friends, periodically visited as paupers, by the parochial medical officers in the county of Somerset, as directed by the Lunacy Asylum Act, 1853. These visits must be paid quarterly, and a return made, with the list of the names and a certificate that they are properly cared for ; or if the medical officer thinks otherwise, he must specify those which ought in his opinion to be sent to an asylum.

In the Appendix to the Report of the Commissioners in Lunacy for 1847 the number of idiots exceeded the lunatics in the county by 36. In those returns but two classes are specified, namely, lunatics and idiots; chronic demented cases being generally included with the latter. In like manner Dr Duglison in his statistics of insanity in the United States,* represents that the idiots slightly exceed the insane, one idiot to 1469, and one insane person to 1485 of the general population. Insanity owing to intemperance was more common among the foreign, white, and free population than amongst the slaves. * Xorth American Med. Chir. Review, July 1860.

There is a district in the county of Somerset, including the parishes of Cliiselborough, Stoke-under-Hamden and Barring- ton, where idiocy manifests that endemic character called cretinism, which is so well known in Switzerland. In some families of the district there are several cretins of both sexes in whom the characteristic bodily deformities were present. Bronchocele, or, as it is termed in the locality, ” the thick neck,” was common among females reared in this neighbour- hood, the patients presenting no appearance of weakened or impaired faculties. There is no necessary connection between bronchocele and cretinism beyond that of their common birth- place, and it is somewhat remarkable that, although we had several patients admitted into the asylum with bronchocele, we had no case of cretinism. Insanity occurring with broncho- cele is quite fortuitous, and it is common enough for such patients to recover their reason, and leave the asylum without any alteration in the bronchocele, which may even be larger than before. The removal of cretins in infancy to an open, elevated, mountainous situation, to obtain purer air and stronger light, has been attended with beneficial results. It is also beneficial in these cases to pay attention to personal cleanliness, and oblige them to exert themselves in some useful employ- ment.

A visit to the idiot asylum at Earlswood, in Surrey, is suffi- cient to show the wonderful results that may be obtained by proper care and training of imbecile boys and girls. Besides school-teaching and out-of-door occupations, the boys are taught tailoring, slioemaking, and mat-making, and the girls also are taught industrial work.

Ten years ago, in the five counties which form the south- western division, there were in the union workhouses 534 male and 624 female idiots. From these it was suggested that oo the younger ones should be separated, and that the counties should unite and form an establishment for their care and education.

Of the first three thousand admissions to the County Somerset Asylum, 3*3 per cent, were idiots merely, and in nearly an equal number idiocy was complicated with epilepsy. The cases of epilepsy altogether amounted to 9*6 per cent. There were 86 of this class, including idiots and imbeciles, admitted to the County Somerset Lunatic Asylum ; 52 were males and 34 females. Of these, 4 males and 4 females were discharged, relieved ; 6 males and 5 females not improved ; 12 males and 11 females died; and 30 males and 14 females remained in the asylum at the end of 20? years. The 4 males relieved were, to a certain extent, educated. All could read, and 2 could write imperfectly. Only one of the 4 females was at all edu- cated ; the habits of ali were much improved before they were discharged. Of the 6 males discharged, not improved, 3 were idiots, 2 dumb, and 1 deaf and dumb; two were removed to other asylums not being county patients, and one was taken charge of by his mother ; the three others, imbeciles, one of them blind, were removed to workhouses, of the 5 females, 4 were removed to workhouses, and one with pulmonary phthisis was taken home by her mother.

Of the 12 males and 11 females who died, 3 males and 1 female were under 20 years of age on admission; 4 males and 3 females from 20 to 30 ; 1 male from 30 to 40; 4 females from 40 to 50 ; 2 males and 2 females from 50 to GO ; and 2 males and 1 female over 60. Three males and tin ee females were imbeciles, and the remainder of each sex idiots, and usually of filthy habits. Two males were nearly blind, one entirely of one eye, and the optic nerve of that eye was atrophied; two males and one female were dumb, and 1 female was a cripple, the spinal cord was soft and enlarged, and weighed I4- oz. luve males and four females had small biains, vaiying in the males from 33^ to 43? ounces, and in the females from 19??, an exceedingly small brain (arrest of development), to 38? ounces. In three males and four females the enceplialon was about the average weight, and in four males considerably, and two females slightly, above it, varying in the males from 47 to 53 ounces, and in the females from 42f to 43 ounces. The causes of death were pulmonary phthisis in 5 males and 6 females, generally combined with ulceration in the ileum or colon, and sometimes in both, attended in the last stage with diarrhoea. There was pneumonia and ulceration of intestines also in 3 males, and bronclio-pneumonia in 1 female; scrofula and curvature of spine in 1 male ; skull thick, and unequal cerebral hemispheres, in 1 male; arachnitis and distended cerebral ventricles in 1 female; cerebral apoplexy in 1 male; paralysis in 1 male; softened brain and Bright s kidneys in 1 female; general dropsy and pericarditis in 1 female; erysipelas and gangrene of arm in 1 female.

Four males relieved, J. M. (121), aged G6; congenital imbecility; an agricultural labourer: can read and write indifferently ; lias latterly been violent and destructive.; usually kindly and good-tempered ; “was industrious in the asylum; and, after six and half years, was removed to the union “workhouse. _ E. P. (125), aged 50; imbecility ; a thatcher; can read and write; noisy, and occasionally violent; transferred from a licensed house; TART I. VOL. II.?NEW SERIES. G 98 DISEASES OF THE NERVOUS SYSTEM. became quiet and harmless; Avas fifteen years in asylum, and was re- moved to the wards established for chronic cases in the Bath Work- house.

II. C. (19G), aged 26; imbecility; can read; habits destructive and filthy ; transferred from a licensed house; sent as a criminal for felony ; eighteen years in the asylum ; discharged in good health, and of cleanly habits, to chronic ward of Bath Workhouse.

J. S. (239), aged 34; imbecility; can read; hereditary predis- position ; sister died insane; obstinate, irritable, and dangerous to others; quiet and industrious in the asylum; his health improved; he remained two and half years, and was then discharged to live with the farmer who had previously been his employer.

Four females relieved.

C. P. (559), aged 27 ; imbecile ; can read; hereditary, predisposi- tion on mother’s side; a violent refractory pauper ; recently discharged from prison, where she was sent for destruction of property; quiet and orderly in the asylum; she worked in the laundry, and, after sixteen months, she was discharged to the workhouse.

H. M. (G48), aged 36; imbecile; youngest of two sisters; parents dead; violent towards some of the inmates of the workhouse ; eight years in the asylum ; industrious; discharged to workhouse. F. A. (671), aged 5-g- years; imbecile; had convulsions when eighteen months old; passionate; second of three sisters; parents alive; became quiet; two and half years in the asylum; removed to an institution for idiots.

E. B. (1,255), aged 18; imbecile; no education; cleanly habits; occasionally violent; fourteen months in the asylum, when she became quiet and harmless; discharged, relieved, to the chronic ward of Bath Workhouse.

Six males discharged, not improved.

M. B. (29), aged 22; congenital imbecility; mischievous; can read ; in good health ; cheerful; idle; one of a large family, none of whom are afflicted; after fifteen years in the asylum was removed to the union workhouse.

J. P. (69), aged 33; congenital imbecility; removed from a licensed house ; reported as occasionally dangerous; no education; quiet; works out of doors; after nine years in the asylum was re- moved to the workhouse.

W. L. (185), aged 22; imbecility; blind from birth; general health, good; quiet; able to dress himself and make his way about; nearly six years in asylum ; discharged to workhouse. G. Y. (505), aged 16 ; dumb idiot; mischievous; hasty temper; filthy habits; suffered from worms, ” lumbrici,” for which he was given oil of turpentine, with benefit; three; months in asylum; discharged at request of relatives.

C. W. P. (856), aged 12; idiot; deaf and dumb; from St. James’r?, Westminster; after nine months transferred to Colney-Hatch Asylum, Middlesex.

J. E. (958), aged 13 ; dumb idiot; five years in an asylum ; trans- ferred from Colney-Hatch, and subsequently removed, with others, to the new Glamorgan Asylum. J. C. (1,1G8), aged 1G ; idiocy; five months after admission dis- charged to the care of his mother, at her request. Five females discharged, not improved. M. P. (82), aged 32 ; congenital imbecility; could never learn her letters, or tell the hour by the clock; very obstinate and irritable; youngest of three ; her brother and sister intelligent; transferred from a licensed house ; seven years in the asylum ; quiet, and harmless; discharged to the union workhouse. F. J. (292), aged 32; imbecile; no education; occasionally vio- lent ; two years in asylum; discharged, by request, to the workhouse. M. F. (597), aged 22; idiot; no education; parents living; fourth of five children ; violent; filthy habits ; enjoyed a bath ; nearly eight years in the asylum; became quiet and harmless ; discharged to work- house.

C. B. (GOO), aged 30 ; idiocy; no education ; parents living; con~ duct outrageous: second of four children ; mother states that she had a fright previous to her birth; filthy habits ; bad health; removed, with others, to the chronic ward in Bath Workhouse. M. F (1,113), aged 17 ; imbecile; mother alive; father died nine weeks before her admission ; the youngest of two sisters; violent; ten months in the asylum; has pulmonary phthisis; her mother took charge of her. Tivelve males, died. T. L. (85). aged 50 ; congenital idiot; irritable ; filthy habits ; no education; was in a licensed house for the insane, previous to which he was kept by his brother for eijrht years in a strait waistcoat, fastened by a chain and ring round his leg to a staple in the floor; his mother s mother was in an asylum, and recovered ; motion, awkward and un- steady ; blind of left eye, from lime having been thrown in his face twenty-two years ago by a man who was subsequently hanged,^ at Ilchester, for violence to a female. He died of pulmonary phthisis nearly two years af terhis admission to the asylum. Head: circumference, 20 inches; antero-posterior measurement, 11 inches; and transverse, 13 inches; more fiuid than natural in the lateral ventricles; the left optic nerve wasted, not more than half the size of the right; the brain appeared to be natural; encephalon, 45 oz. Chest: old pleuritic ad- hesions ; a large cavity in apex of right lung, and tubercles in various stages towards softening in both lungs; heart, small, 5 oz. Abdomen: horse-shoe kidney?they were united, weight 5 oz.; othei oigans eiy small; body emaciated, weighed only 54 lbs.; short stature. G. F. (137), aged 1G ; a slavering idiot, scarcely able to articulate; the parents in good health; an only child ; of filthy habits; emaciated, and in a very feeble state; died fourteen weeks after admission. Iluid . brain natural, except that there was a little more iluid than usual in the lateral ventricles; weight of the encephalon, 41-o oz.; pleuro- gpneumonia of tlie right lung, also ulceration of the lower portion of colon and rectum ; liver large, 52 oz.

J. S. (25G), agecl 27; idiocy; epileptic during childhood; unable to articulate distinctly ; passionate ; transferred from a licensed house ; filthy habits ; totters in walking ; appetite ravenous; this deterioration came on three years after his admission ; subsequently diarrhoea oc- curred, and he died in four years and nine months from general paralysis; body thin; weight, 8G lbs.; length, 5ft. 7 in. Head: circumference, 21 in. ; anterio-posterior, 13 in., and transverse measurements, 13^ in.; the dura mater strongly adherent to the skull; the brain appeared natural, rather small; each cerebral hemisphere, 17; cerebellum, 4^; pons and medulla, ; encephalon, 39^ oz.; lower part of spinal cord softened for in.; pleuro-pneumonia left lung; enteritis also.

W. C. (313), aged 6G; imbecility; can read; quiet, but given to wandering from home; suffering from asthma; in bad health ; he died fourteen months after admission from cerebral apoplexy, asthma, and enlargement of the heart. Head : circumference, 22^ inches ; antero- posterior and transverse measurements, each 14^- inches ; a large quan- tity of blood; about 6 oz. escaped when the skull-cap was removed; the brain large, 50 j oz.; spinal cord natural; emphysema of the lungs; heart, lGf oz.; abdominal organs healthy; body, 149 lbs. ; length, 5 ft. 8 in.

J. P. (451), aged 25 ; idiocy ; dumb ; dangerous to himself; very filthy ; died four months after admission from pulmonary phthisis and pneumonia; the body emaciated; weight, 75 lbs.; length, 5 ft. 8 in. Head : circumference, 22^ in. ; antero-posterior, 13 in.; transverse, 14 in.; cerebral vessels congested with blood; encephalon, 47 oz.; spinal cord natural ; grey matter distinct, and seemed more in propor- tion to the white than in an older subject examined at the same time. Chest: tubercles and small cavities in the apex of right lung; tubercles also in the left; heart small, 7^ oz.; the mucous membrane of descending colon was ulcerated.

J. S. (509), aged 12 ; dumb idiot; eldest of five children; parents alive ; large head ; filthy habits; ate dirt or grass; very thin ; diarrhoea at the last. He was thirteen and half years in the asylum. Head : circumference, 22 in.; antero-posterior, 13 in., and transverse measure- ments, 11 ^ in.; the brain unusually large; each hemisphere, 23^ oz. ; cerebellum, 5^oz.; and pons and medulla, 1 oz. ; encephalon, 53 oz.; the spinal cord also large, lfoz. ; pneumonia right lung; mucous membrane of descending colon dark coloured.

J. P. (617), aged 04; idiot; became violent four weeks before his. admission ; in bad health ; had ulcers on both legs ; nearly blind ; died eight years after admission; weight of body, 112 lbs. ; length, 5 ft. 6 in. Head: circumference, 22 in.; antero-posterior, 11 in.; and transverse measurements, 10 in. ; the skull unusually thick ; the cerebral veins congested with blood; the brain small; cerebral hemi- spheres unequal; right, 14^-oz.; left, 13 oz.; encephalon, 33i oz.; the grey matter darker than natural; spinal cord natural, 1 oz. Chest: old pleuritic adhesions; organs natural. Abdomen: liver large, G3 oz.; spleen also large, 10 oz. 101 H. D. (G92), aged 24 ; congenital imbecility ; a criminal, sent to prison for stealing a dog value ol.; occupation, a farm servant; can read a little; was upwards of ten years in the asylum, and died, alter four days’ illness, from an ulcer in the stomach, and hemorrhage from an artery from the coeliac axis. The measurements of the head were circumference, 21 in.; antero-posterior, 12 in., and transverse, 10-3>- in.; the brain and spinal cord both unusually pale ; no other change ; weight of encephalon, 45^ oz.; old adhesions of heart and pericardium ; ?weight of the body, 144~lbs.; length, 5 ft. 5 in.

H. T. (713), aged 27 ; congenital idiocy ; parents living; an only child; father imbecile; of filthy habits; occasionally violent, anil dangerous to children ; had an ear for music, and could sing; he died of pulmonary phthisis fifteen months after his admission; tuberculous cavities in the left lung; heart small, 7 oz. Head: ordinary size; encephalon, 45? oz. ; the dura mater adherent to the skull; brain firm ; about j oz. fluid in the lateral ventricles ; the white poi tion of spinal cord softened; weight of the body, 04 lbs.; length, 5 ft. 7 in. J. M. (1,032), aged 30 ; idiocy; dumb; paralysis; helpless, harm- less ; has been living with his mother who died recently ; father also dead; the eldest of three children ; died ten months after admission. A backward curvature of the spine ; body emaciated, G2 lbs.; length, 4 ft. 9 in. Head: circumference, 19 inches; antero-posterior,^ 9tt inches; transverse, 10 inches; cerebral structure pale; convolutions not fully developed; right cerebral hemisphere one ounce heavier than the left; encephalon, 35 oz.; spinal cord soft ; the organs like those of a young person not fully developed, except the kidneys which weighed 8f oz.

C. C. (1,048), aged 18 ; imbecile ; injury to head at the age of 3 ; mother dead, father alive; nearly seven years in the asylum; de- structive, and of filthy habits; emaciated; died of pulmonary phthisis. Ilcad and brain natural; encephalon, 43^- oz.; spinal cord rather soft; both lungs full of tubercles; heart small, oz.; enteritis.

T- P. (1,127), aged GO ; idiocy, idle, harmless; twenty months in the asylum; died of pulmonary phthisis. Head: natural; brain natural; encephalon, 48 oz.; spinal cord rather soft ; old pleuiitic adhesions ; dark pulmonary tubercles in upper lobes of both lungs not softened; heart small, 8 oz.; weight of the body, 108 lbs.; length 5 ft. 7 ins. Eleven females, died.

II. B. (36), aged 59; congenital imbecility; can read imperfectly; three years in a licensed house for pauper lunatics ; six years m the asylum; died of pulmonary phthisis and ulceration of the intestines. Head: circumference, 21 inches; transverse and antero-posterior measurements, each 13 inches; more fluid than natural in the cerebral ventricles; the right hemisphere, 17 oz.; left, 17tt oz. ; ence- phalon, 40] oz.; tubercles and cavities in lungs; heart small, 0 oz E. D. (222), aged 59; imbecility, hereditary on fathers side; eldest of eight children, six mules and two females5 unable to read} turbulent; idle and irritable; dangerous and destructive; in bad health, diarrhoea; she died a month after admission. Weight of body, 79 lbs.; length, 5 ft. Head: ventricles distended with fluid; fourth ventricle rough from crystals, rhombic cubes; encephalon, 41^ oz. ; fluid also in the spinal canal, and the membrane partially adherent. Heart enlarged, 14 oz.

E. B. (331), aged G3 ; idiocy ; nearly three years in the asylum; filthy habits ; refused food; had frequently to be fed by stomach tube ; ?weight of the body, 94 lbs.; length, 5 ft. 1 in. Head : membranes unusually adherent; brain pale and rather soft; encephalon, 42f oz.; spinal cord natural; heart flabby, fatty degeneration; also in the kidneys ; albuminuria ; Bright’s disease.

S. C. (379), aged 48 ; dumb idiot; violent, bites her arms; filthy habits; she died three months after admission ; erysipelas; gangrene of left arm. Head : small skull, unusually thick ; dura mater preter- naturally adherent; brain natural, but small; encephalon, 34|- oz. Chest: organs natural; Abdomen : stomach elongated and large ; other organs natural.

M. A. G. (448), aged 24; imbecility; can read; lived with her parents; violent for six months previous to admission, two years before her death; scrofulous ulcers; pulmonary phthisis; body emaciated, 54 lbs.; length, 5 ft. Head: circumference, 19tt inches; antero- posterior, 13 inches, and transverse measurements, 13^ inches; the brain firm ; veins congested ; each hemisphere 17^ oz.; encephalon, 40-g- oz. Chest: small tuberculous cavities in both lungs, some gangrenous; heart small, oz. Abdomen : ulcers in ileum; mesen- teric glands enlarged.

G. M. (491), aged 25; idiocy; removed from workhouse; re- ported violent and abusive; died three years and three months alter admission, of pulmonary phthisis and diarrhoea; weight of body, G8 lbs.; length, 5 ft. Head: brain natural; encephalon, 43 oz.; spinal cord natural. Chest: old adhesions; tubercles and cavities in both lungs ; heart, G^ oz. Abdomen : peritoneal adhesions; scrofulous deposit in right renal capsule; ulceration in ileum.

C. S. (815), aged 15; idiocy; hasty, violent, and destructive; youngest of several children; parents alive; insanity in her mother’s family. Eight years and two months in the asylum ; died of pulmonary phthisis. Head: unusually small; circumference 17 ; antero-posterior 9-^-, transverse 5-^ inches. Cerebral structure appeared natural; each hemisphere 7-g-; encephalon only 19^ ounces. Tubercles and cavities in lungs; heart only 3 ounces. Ulceration in lower part ileum; all organs small. Weight of the body, 51 lbs. ; length, 4 feet 5 inches. M. R. (1,034), aged 40; idiocy; passionate, violent; refused food; filthy habits; nearly three years in the asylum; died of pulmonary phthisis. Head: circumference, 21 in.; antero-posterior, 11 in., and trans- verse measurement, 11 inches. Brain unusually pale; each cerebral hemi- sphere, 17^-; encephalon, 41; spinal cord, also pale, 1 ounce. Chest i dense pleuritic adhesions; tubercles and small cavities in both lungs; heart small, G-f oz.; ulceration in both ileum and colon.

E. W. (1,107), aged 48; stubborn; filthy habits; youngest of seven children, four males and three females; had to be fed; noisy; died three months after admission, of influenza and broncho-pneumonia. Head-, circumference, 20^, antero-posterior, lli, transverse measure- ment, 11 inches. Skull thin; dura mater adherent; encephalon small, 33^ oz.; spinal cord, soft at centre, oz. Chest: old pleuritic ad- hesions on both sides; right lung in first stage pneumonia, 23 oz., left, :17 oz. ; redness of bronchial lining membrane of both lungs.

L. C. (1,205), aged 2G; idiocy; youngest of two; father alive, mother dead; has lived since for eight years with her married sister filthy habits; ” ophthalmia tarsi.” Three years in the asylum; died of pericarditis and dropsy. Head: circumference 19f in.; antero-posterior, 11 inches, transverse, 10 inches. Brain small and pale; each cerebral hemisphere, 17; encephalon, 381. Chest: pleuritic adhesions; twopintsof fluid by measure in the chest; a few tubercles in the lungs; heart and pericardium adherent by recent lymph, weight 12 oz. Abdomen distended with straw-coloured fluid; nutmeg liver, 53 oz; kidneys large, each 5 oz.; cortical structure pale. Body weighed 91 lbs.; length, 4 ft. 9 in.

A. D. (1,218), aged 43 ; idiocy ; filthy and stubborn ; no education ; bad health; a cripple; died suddenly after dinner. Body weighed 58 lbs.; height, 4 ft. 10 in.; limbs contracted. Head: circumference, 21; antero-posterior, 12, transverse, 11 in. Brain appeared natural; each hemisphere, 18 oz.; encephalon, 41-g-; spinal cord rather soft, 1^ oz. Chest: miliary tubercles in both lungs; cavities in the right apex. Abdominal organs natural.

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