rate as seventy-two in the year may damage the mental condition most seriously, and that in five years.

The gross number of attacks of both kinds-i. e. of epilepsia gravior and mitior together-is not, therefore, the sole determining cause of the mental injury: nor is it demonstrably a powerful concomitant influence, or indication; for the difference between the first and fourth classes, in respect of the mean numbers of attacks of both kinds, is little more than five hundred, or one-fourteenth part.

The rate of frequency of the two kinds of attacks taken together is of no great moment; for although the mean ratio is higher in the fourth class than in the first, it was much higher in two cases of the first than in two cases of the fourth.

With regard to epilepsia gravior, the rate of frequency may be very high without entailing mental failure; and, on the other hand, it may be low, and yet the mind may suffer much : the mean frequency of the four cases in the first class is nearly three times as high as that observed in the four cases of the worst class.

The most important fact, however, is with regard to the attacks of "le petit mal." Its rate of frequency in the fourth class was more than eight times as great as that observed in the first; and although it was higher in one case in the first group than in one of the fourth, a very considerable difference existed in regard of the other three. In one case only, which is not represented in the above table, have I observed a higher rate of frequency of "le petit mal" without notable mental failure. In the case referred to, the disease had existed for thirty-one years; the patient had suffered attacks of epilepsia gravior once in twenty-five days, and attacks of epilepsia mitior daily; but the only mental change which I could discover was a slight want of attention, resulting in forgetfulness of trifling passing

events.

The evident conclusion from these facts is, that the mental condition of epileptics is more closely dependent upon attacks of "le petit" than of "le haut mal;" and that the degree of failure is in some general manner related to the frequency of the slighter seizures;-that while neither the one form of attack nor the other necessarily entails upon the sufferer mental injury;

Wide Nadal, ele Mih, je stated the gezeral proportion of the ne ve pak menduk Cinese «,* it is apparent that the mode of causation kom battle or no influence in determining the presence or degree nd mental bulur, Peventeen euses distributed, irrespective of Hoi mool of cumeation, into four mental groups, according to Ho go in cal numerical value of these groups, would be 6-5, 5·4, "1. mod 94; an arrangement so near to that which is the alt of metal olevation, that the introduction of this eti

tiiven at page 43.

ologic circumstance may be regarded as without influence upon the mental condition.

We cannot, therefore, in conclusion, refer the intellectual failure of the epileptic to the fact that his disease has arisen through psychical disturbance.

C. THE MOTORIAL CONDITION OF EPILEPTICS IN ITS SEVERAL RELATIONS.

The influence exerted by the motorial condition of the epileptic upon his mental state has been already examined, in an earlier portion of this chapter. See page 176.

The relation between different degrees of motor disturbance, and the frequency of the paroxysms, has also been exhibited. See page 157.

It remains, therefore, to discover the mutual influences exerted by the motor condition of the patients, and their state in regard of general, organic health.

Those individuals in whom tremor, clonic, and tonic spasm are present, do not exhibit any higher rate of frequency of attacks than do those from whom such disturbances of motility are absent. We may infer, therefore, that the conditions upon which the attacks depend, and those which cause the several disturbances alluded to, are not identical; and that neither one is the cause or effect of the other.

Again, we have seen that the mental condition of the epileptic appears quite independent of that which so affects him, as to induce tremor and spasm; and we have now to inquire whether these disturbances of motility are more common in those whose general health—as judged of by nutrition, strength, and temperature-is sound, or in those in whom it is impaired.

The facts which enable us to answer this question are arranged in the following table :

--

and while great intellectual deterioration may exist with either form, and without the other;-yet, that when the two forms co-exist, the mental failure occupies a more marked and more direct relation to the attacks of "le petit" than to the attacks of "le haut mal."

Another question of some interest is the following:

11. Can the mental failure of the epileptic be shown to depend upon the operation of a mental or emotional disturbance as the occasional cause of the first attack?

It has been already shown (p. 132) that mental and emotional disturbances were referred to as the cause of their disease by twenty patients out of sixty-nine, i. e. by very nearly twentynine per cent. With regard to seventeen of these twenty, I was able to estimate the mental condition sufficiently to classify them; and they are thus distributed :

From this it is evident that although epilepsy may have been occasioned by fright, distress, intellectual labour, or other psychical disturbances, it does not therefore entail upon the sufferer mental injury; for in nearly half of the cases owning this mode of causation, no trace of failure was detected in the mind.

*

And further, by comparing the numbers found in the above. table with those in which is stated the general proportion of the several mental classes, it is apparent that the mode of causation has little or no influence in determining the presence or degree of mental failure. Seventeen cases distributed, irrespective of their mode of causation, into four mental groups, according to the general numerical value of these groups, would be 6.5, 54, 24, and 24; an arrangement so near to that which is the result of actual observation, that the introduction of this eti

* Given at page 43.

ologic circumstance may be regarded as without influence upon the mental condition.

We cannot, therefore, in conclusion, refer the intellectual failure of the epileptic to the fact that his disease has arisen through psychical disturbance.

C. THE MOTORIAL CONDITION OF EPILEPTICS IN ITS SEVERAL RELATIONS.

The influence exerted by the motorial condition of the epileptic upon his mental state has been already examined, in an earlier portion of this chapter. See page 176.

The relation between different degrees of motor disturbance, and the frequency of the paroxysms, has also been exhibited. See page 157.

It remains, therefore, to discover the mutual influences exerted by the motor condition of the patients, and their state in regard of general, organic health.

Those individuals in whom tremor, clonic, and tonic spasm are present, do not exhibit any higher rate of frequency of attacks than do those from whom such disturbances of motility are absent. We may infer, therefore, that the conditions upon which the attacks depend, and those which cause the several disturbances alluded to, are not identical; and that neither one is the cause or effect of the other.

Again, we have seen that the mental condition of the epileptic appears quite independent of that which so affects him, as to induce tremor and spasm; and we have now to inquire whether these disturbances of motility are more common in those whose general health-as judged of by nutrition, strength, and temperature-is sound, or in those in whom it is impaired.

The facts which enable us to answer this question are arranged in the following table: