- and that to the most marked degree, by adding together the three mean class-position numbers of each group, subtracting therefrom the number three, which represents health, and so arriving at a number which illustrates the whole amount and degree of deviation from health. Thus, in the first group, the numbers are, mental, 1.1; motorial, 2.2; organic, 2.2; making together 55;-but as the number 3 would be that which indicated health, this would be subtracted from 5.5, leaving 2.5, which is approximatively the degree of deterioration from perfect health, of body and mind.

In the following table the several groups, according to the duration of disease, have affixed to them the sum of the means of their triple class-positions; and also, in another column, the degree in which each deviated from entire health :

From this table we learn that, if all the possible deviations from a healthy standard are represented by 9, and various degrees of deviation are registered by numbers ranging from 1 to 9; or, in other words, that if individuals are examined in regard of nine different particulars in which their health may become impaired, and the number of modes in which such impairment takes place is represented by figures from 1 to 9 inclusive, so trifling is the influence of time in the production of these different degrees of impairment, that there is but the

difference of 4-10ths to be observed between the mean condition of seventeen individuals whose epilepsy had existed for less than three years, and the mean condition of four individuals in whom the disease had existed twenty, thirty, and forty years.

This element of duration, therefore, being thus shown to be of no effect in the production of any one or all of the morbid phenomena observed during the interparoxysmal period, we must, for the reasons already assigned, regard those phenomena as standing in some other relation to epilepsy than that of consequence;" and our general conclusion is, that epilepsy does not produce, i. e., that it, per se, does not cause failure of memory, of apprehension, or of ideation, tremor, clonic spasm, or tonic, loss of nutrition, temperature, or strength.

This has been believed before, but it has been regarded as exceptional. Dr. Bright says, "In a few cases but little permanent effect has been produced either on the mind or the body by repeated paroxysms, but these are fortunate exceptions: and this would, I think, be the opinion of the majority. What I have endeavoured to show is, that in simple epilepsy the rule is what the exception was regarded to be. That this difference of result should be arrived at is matter for no surprise, when we observe the heterogeneous character of the cases denominated epilepsy. For example, those just referred to, recorded as they are, with wonderful power by Dr. Bright,† are twenty-two in number. Of these, however, but five are examples of simple epilepsy. In four there was congestion of the brain as a notable phenomenon; in five some distinct cerebral lesion; in three tumour in the encephelon; in three morbus Brightii; in two eccentric convulsions and hysteria.

V. THE COMPLICATIONS OF EPILEPSY.

It is not my intention to describe the numberless evils of all kinds to which the epileptic is, in common with humanity generally, exposed, and from which he, more or less frequently, suffers; but to limit the observations I have to make in this

Reports of Medical Cases, Vol. X.,

p. 513.

† Ibid.

section to those conditions which may be held to depend, more or less directly, upon the attacks.

Reasons have already been given for doubting the existence of any necessary "consequences" of the malady, but there may be and are occasional or accidental complications of the disease, requiring, probably, for their production some special predisposing conditions; but, such conditions being present, having for their immediate cause the convulsive paroxysm.

The complications referred to exist in either intellectual, animal, or vegetable life, and may, therefore, be grouped into three classes-mental, sensori-motor, and organic.

A. COMPLICATIONS, SPECIALLY "NERVOUS" IN THEIR CHA

RACTER.

Besides the failure of intellect which has been already shown to be frequently associated with epilepsy, there are special conditions of disturbance to be met with in some individuals; these conditions occurring in more or less definite relation to the attacks. Thus, mania not unfrequently complicates the affection of the epileptic; and epileptic mania has a character of its own.

Epileptic Mania.-In the sixty-nine cases which have been analysed in this treatise, some attack or attacks of mania occurred in seven individuals, or in 10 per cent., viz., four males and three females. In one of the cases the mental disturbance was extremely trifling in degree; in another it occurred but once; in a third it was extremely rare; in the remaining four cases maniacal excitement was more or less frequently found in immediate relation with the attacks.

M. Esquirol states that "La fureur des épileptiques éclate après les accès, rarement avant; elle est dangereuse, elle est aveugle, et en quelque sorte automatique; rien ne peut la dompter, ni l'appareil de la force, ni l'ascendant moral qui réussissent si bien à l'égard des autres maniaques furieux.

According to Delasiauve, Morel, and other authors, the mania of epilepsy is usually "furious" in its character; but this is by no means universally the case. Delasiauve describes very

accurately an ecstatic form of mania, in which the patient assumes attitudes, "son regard est fixé, immobile, il paraît en proie à une vision intérieure; articule des mots vagues et confus. Si on le questionne, il reste muet ou ne répond que par des phrases décousues, des gestes ridicules, ou des mots trahissant de grotesques préoccupations."* This form of mania is illus

trated in the following case:

CASE VII. M. N.-Female: No hereditary predisposition to epilepsy; convulsions in infancy; epileptic attacks commencing at æt. 17; occurring only at night, and always beginning in right hand, upon back of which is congenital vascular enlargement; period of recurrence irregular, unconnected with menstruation. Mental condition much impaired; peculiar maniacal attack; recovery from this; gradual deterioration.

§ I. Female, æt. 18.

§ II. A.

Daughter of persons in easy circumstances.
D. No hereditary predisposition.

§ III. B. When weaned was taken in convulsions; during dentition, "for a fortnight was insensible, and had convulsions during the whole time." No subsequent attack until seventeen years of age, when a convulsion occurred during sleep, two nights after she had been told of the death of her aunt. Since that time the fits have recurred at irregular intervals; sometimes she passes one, two, or three weeks without them. When they occur there are often three in the night, and they never take place during the day. They have no relation to the cata

menia.

Attacks. These come on when she is in sound sleep, and breathing gently; the right hand begins to shake; she rises up, and has sometimes said that "she feels as if something was breaking in the hand." If the hand is immediately seized and held, nothing more occurs; if not she falls back, and becomes insensible, all the limbs shake, the face becomes blue, then red, then white; she is convulsed for a few minutes, and then falls into a sleep without stertor for a quarter or half an hour. Her memory has failed gradually from the first attack.

* Traité de l'Épilepsie, p. 150.

section to those conditions which may be held to depend, more or less directly, upon the attacks.

Reasons have already been given for doubting the existence of any necessary "consequences" of the malady, but there may be and are occasional or accidental complications of the disease, requiring, probably, for their production some special predisposing conditions; but, such conditions being present, having for their immediate cause the convulsive paroxysm.

The complications referred to exist in either intellectual, animal, or vegetable life, and may, therefore, be grouped into three classes-mental, sensori-motor, and organic.

A. COMPLICATIONS, SPECIALLY "NERVOUS" IN THEIR CHA

RACTER.

Besides the failure of intellect which has been already shown to be frequently associated with epilepsy, there are special conditions of disturbance to be met with in some individuals; these conditions occurring in more or less definite relation to the attacks. Thus, mania not unfrequently complicates the affection of the epileptic; and epileptic mania has a character of its own.

Epileptic Mania.-In the sixty-nine cases which have been analysed in this treatise, some attack or attacks of mania occurred in seven individuals, or in 10 per cent., viz., four males and three females. In one of the cases the mental disturbance was extremely trifling in degree; in another it occurred but once; in a third it was extremely rare; in the remaining four cases maniacal excitement was more or less frequently found in immediate relation with the attacks.

M. Esquirol states that "La fureur des épileptiques éclate après les accès, rarement avant; elle est dangereuse, elle est aveugle, et en quelque sorte automatique; rien ne peut la dompter, ni l'appareil de la force, ni l'ascendant moral qui réussissent si bien à l'égard des autres maniaques furieux."*

According to Delasiauve, Morel, and other authors, the mania of epilepsy is usually "furious" in its character; but this is by no means universally the case. Delasiauve describes very

Des Maladies Mentales, Tome I., p. 286.