such results follow the exhibition of the drugs we are wholly in the dark. Sometimes a change in diet, or the disuse of certain articles of food, or the diminution of the amount taken, will be followed by a lessening of the number of the fits, while in other cases no such results follow, and an opposite course of a more abundant diet will act favorably. Similar remarks can be made in reference to the use of mineral tonics, several of which were in high estimation several years ago. I have most certainly seen favorable results follow the use of zinc, which was very frequently prescribed in past years. Nux vomica, arsenic, and iron are all of service in an anæmic state of the system, whether attended with epilepsy or not, and they are often indicated in epileptic insanity.

Since 1857, however, the medical treatment of epilepsy has consisted largely of the use of bromide of potassium, and its allied salts, which have been regarded almost as a specific. In that year Sir C. Locock first brought the use of this drug in epilepsy to the attention of the profession in Great Britain. Its prescription very soon became general, and though it has never proved all that its early advocates hoped and claimed for it, yet it has proved to be of vastly greater service in lessening the number of fits, and also in modifying their character, than any or all other drugs together. During many years I have been in the habit of combining it, when it is desirable to continue its use for considerable periods, with the bromides of sodium. and ammonium, and also in some cases with zinc and iron. The depressing effects of the continued use of the bromide of potassium may be largely averted by its combination with these other salts, and when zinc or iron is used with them very little unfavorable effect will result. I now

have two cases under treatment which have used these remedies several months without unfavorable physical effects and have been entirely relieved of fits.

It should be borne in mind, however, that it is not desirable in all cases to stop the fits entirely. Some patients complain of feeling very uncomfortable when a considerable period has passed without their occurrence, and say that they are relieved for a time after one has occurred. I now have a patient, who, although too much demented to understand, and much less to express, her disagreeable sensations, yet always becomes greatly irritable, unhappy, quarrelsome, and impulsive when a certain period has passed without the occurrence of a fit. The medicine is then discontinued until she has had two or three, and then is resumed again. By this means both the patient herself and the attendants are relieved of much suffering, annoyance, and care.

By the use of this combination of the bromides, many cases, in which the cause is not of an organic or an inherited character, may remain well during long periods, and some for life. The fits, however, may recur after the absence of many years, and consequently it is not safe to be too positive of a cure. I am confident that the use of the bromide of potassium alone in large doses tends to produce a weakening of the nervous system and also of the mind, and that it should never be recommended. As I have already intimated, these effects may easily be avoided by additional drugs and food.

The importance of regularity in the daily habits of life, in the use of food, and of sleep, cannot be over-estimated. The same may be said of the moral management of these patients. The largest care should be exercised in avoiding all causes of excitement. Patients are so sensitive to their

environments, and are so readily affected by all untoward influences coming from any source, that they require special attendance at all times by those who have the requisite training and skill. This is especially important before and after the occurrence of fits.

The great success which has attended surgical operations of the brain in recent years, in consequence of after-treatment by the aseptic method, renders it probable that cases of epilepsy may be relieved by such measures, when arising from some forms of organic growths, the pressure of foreign substances, depressed bone, etc., and asymmetrical developments of the skull. Many cases with favorable results have already been reported.

LECTURE XXIII.

ALCOHOLIC INSANITY.

Physiological Effects of Alcohol-Modification of Per Cent. of Alcoholic Insanity-Statistics-Acute Alcoholic Insanity-Symptoms-IllusionsHallucinations — Attention - Temperature - Termination-ExamplesTreatment Chronic Alcoholic Insanity-Symptoms-Irritability-Insomnia-Loss of Memory-Paresis of Muscular System-Suspicion— Hallucinations-Cramps-Hyperæsthesia-Gastritis-Epileptiform Seiz

ures-Delusions-Examples-Pathological Anatomy.

Physiological Action of Alcohol.-The physiological effects of the continued use of alcohol upon the human system are doubtless of the same general character in all cases. It becomes rapidly absorbed into the circulation, and by it is carried at once to those portions of the brain which are more especially concerned in the processes of thought. It speedily acts upon the vaso-motor system of nerves, and thus indirectly stimulates the action of the heart. Its influence is also communicated to the capillary vessels of the grey substance of the brain, causing a dilatation, and when its use is long continued a consequent exudation upon the delicate membranes and into the interstitial tissues. It indirectly excites to abnormal activity the nerve cells of the cortex and thus increases mental function. This increase of function is succeeded by a corresponding diminution after a longer or shorter period, accompanied by a lessening of the temperature of the whole body.

Modification of its Effects.-The effects of alcohol vary in some degree in different cases, and are more pronounced and permanent in some persons than in others. Not unfrequently a small quantity when used by a person of a sensitive and sanguine temperament, especially if accustomed to a sedentary life, has a much more profound effect than a larger amount used by one of lymphatic temperament who leads a life requiring him to be much in the open air. Persons inheriting any of the neuroses are much more susceptible to its influence, which may manifest itself in an impairment of the moral and intellectual faculties, and in the development of a craving which may remain through life.

The effects of alcohol, when taken in the form of beer or some of the lighter wines, are much less pronounced than those resulting from the daily use of whisky or brandy. In the one case it is combined with certain materials of which the physiological action upon the stomach may be highly favorable, and may aid in the more speedy elimination of the alcohol from the system, while, in the other, the effects upon the vaso-motor nerves are more direct, and remain for a longer period upon the elements of the nervous system.

Some combinations of alcohol also affect the system more unfavorably than others, those rich in carbon and hydrogen having the least toxic effect. Persons before the age of twenty, and while the brain is more sensitive to unfavorable influences, and has less of inhibitory power, are more largely affected than those in later life; a special diathesis may become established which renders all successful effort to reform much more difficult, and in the large majority of cases quite impracticable. In many such cases the need of reform is not realized, and consequently there exists no