fitting its victims for useful employment or enjoyment during its early periods, it generally robs them of intellect and reason in the end.

Any additional knowledge of this fearful malady must prove a valuable contribution to science, if it can be made available for the relief of any proportion of its victims.

For the purposes of this discussion the form of epilepsy only which does not depend upon visible anatomical lesions is to be considered.

It has, of course, no "pathology," so far as the description of physical alterations of structure are concerned, and it is unnecessary to dwell upon any description of the phenomena of the disease.

Doctrines respecting the etiology of this malady are extremely unsatisfactory, while it is by all conceded that epilepsy may be the sequence of certain immediate causes, such, for instance, as blows, the irritation of dentition, mental emotions, and prolonged and excessive fatigue or anxiety.

It is also very generally supposed that these exciting causes would be ineffective in producing a long series of epileptic seizures were not some predisposing cause present.

Of the nature of such predisposing cause or causes, only a vague kind of knowledge has been possessed.

Heredity has been regarded as the great predisposing cause, but in what manner this hereditary tendency is transmitted there has been no satisfactory explanation. To assert that this disease is hereditary implies little if any practical knowledge of what can

be done for its relief unless we are prepared to determine something of the nature of the inheritance. It may not be out of place to repeat, what has already been stated, that it is scarcely reasonable to suppose that one disease is the direct sequence of another; or that epilepsy is directly inherited from chorea or phthisis. The inheritance, then, is a tendency or predisposition, and not the disease itself.

Is the tendency, then, a part of the physical conformation inherited by the offspring, or is it some spiritual essence which passes from parent to child?

This latter alternative need not at the present day engage our attention. Diseases are neither entities, which find a lodgment in the systems of certain persons and there work out their malign missions, nor are they spiritual manifestations.* They are physical irregularities, depending upon physical causes and obeying physical laws.

It is not to be presumed that all the mystery of inheritance in disease will ever be revealed, nor is it at all probable that all the obscurities which surround the subject of epilepsy will ever be lifted away, yet it is possible that sufficient light may penetrate this darkness to enable us to hope for better results from treatment than have heretofore rewarded the efforts of the physician.

If the views of hereditary tendency in nervous dis

* This view does not imply that toxic agents are not destructive, nor that microscopic organisms may not so multiply in certain parts, or in the whole body, as to generate disease, nor does it ignore many other forms of injurious or destructive agencies.

eases which have already been suggested in discussing the subject of neuralgia, and which will be somewhat further discussed in a section to be devoted to the subject of heredity, are correct, an important element in heredity is to be found in the construction of the eyes and of their surroundings.

However extravagant the view, that an hereditary tendency to nervous diseases may descend with this physical feature, may appear to one who has not fully considered it, it can not in the light of facts be dismissed.

There may, in view of all the knowledge which can at present be brought to bear upon the subject, be different estimates of the frequency and of the importance of this factor in the cause of the neuropathic tendency, but its existence as a factor must be admitted.

Without attempting further discussion of this as a supposed cause, or of other known causes, the practical results of experience in this form of disease will be given.

Examinations of ocular conditions have been made in one hundred and forty cases of epilepsy, eighty-five of which were in private practice. The general result of these examinations has been to reveal the existence, in these cases, of refractive anomalies in a considerably greater proportion than has been found by Cohn in his examinations of the eyes of school-children, or by other observers in similar investigations prosecuted in Germany, Russia, and America.

In one hundred consecutive cases there existed:

Hypermetropia (including hypermetropic
astigmatism) in

59

Myopia (including myopic astigmatism) in. 23
Emmetropia, or refractive errors less than

1 D......

18

100

In four of the cases in which notable errors of refraction were not observed, atrophy of one of the eyes existed.

In the greatest number of cases examined in private practice very marked insufficiency of the motor muscles of the eyes was found, and it may be here observed that, so far as ocular irritations are concerned in the origin of a tendency to epilepsy, muscular irregularities are doubtless much more efficient than refrac tive anomalies.

The proportion of refractive errors stated above, would not of itself prove a relation between the state of the eyes and epileptic condition, although the proportion is notably in excess of that found by examina-. tions of those in health. This circumstance, however, taken with that of a state of insufficiency of the ocular muscles existing very generally, renders it probable that the ocular defects may be in relation to the epileptic tendency.

The facts, however, which have already been presented in regard to other nervous affections must have a certain weight in this connection, and must add to the probability of the relations suggested.

If now we add to these evidences, which are in

themselves only important suggestions, the results of treatment based upon the supposition of epileptic influence arising from ocular defects, we shall find it certain that these relations are of the highest import

ance.

Of the eighty-nine cases examined in private practice, thirty-four only have been treated and observed for any length of time beyond one or two visits.*

Of this number five have withdrawn from treatment before obtaining any relief from important ocular defects, and should not be included in calculating the results of treatment. The remaining twenty-nine cases have been treated only by the removal of ocular defects. Of these twenty-nine cases, fourteen may be considered well; two, who are still under observation, are believed to be permanently relieved; three others, still under treatment, have received such marked relief that it is believed that an entire discontinuance of the malady may be expected. One, who had manifested some improvement, died of accident four months after his first visit. Seven others have received temporary relief, while two have manifested no improvement.

In order that a proper estimate may be made of the value of treatment directed to the eyes in these cases, a considerable number of them will, at the risk of demanding some patience on the part of the reader, be reported at such length as to enable one to determine whether the results have been incidental and facti

* In the haste of preparing this memoir as originally presented, a few cases of epilepsy were overlooked; hence these numbers do not exactly correspond with those given in the original paper.