resting facts and arguments, having a more or less immediate bearing upon the subject actually under consideration, are dispersed throughout the book. Most of these we have necessarily passed over. We are tempted, however, to bring together some observations upon the effect of isolation on the mind, and on the influence of the cellular system in the treatment of insanity, on account of the great practical importance of the question in the construction and regulation of asylums and prisons.

....

Every individual who isolates himself is very near the confines of insanity, either by going beyond the ideas of the times, when he loses himself in the uncertain, or by exaggerating his individualism, when he opposes his isolated strength in open conflict with the collective force. Beneath the weight of these influences many succumb. The moral sense must be wonderfully developed that can elude this catastrophe; and we well know that it is the exception. It is in the isolation of this force that lies the first step to mental alienation. . . . . Many insane patients are incoherent only when left to themselves. Many individuals keep in the straight path so long as they are supported in it. This is also the history of collective unities, and even of nations which, abandoned without a guide, present the spectacle of the most complete incoherence, or raise themselves to the sublime when a powerful and enlightened authority directs them. M. Renaudin relates the case of a patient who evinced a constant regret for the period when his confinement in a cell was attended by a more rigorous coercion. It was at this period, he says, that his power was greatest, most unlimited. We should all have been saved if I had remained there, he says. In proportion as his dwelling has been improved, his power has declined, and he is become the more docile by being allowed a larger measure of liberty. This remark cannot be lost sight of when the question of cells in asylums is considered. When cells were abandoned, all our patients, like the one referred to, lost the power which stimulated their excitation, and we are thus supplied with the solution of the most important problem in the organization of an asylum.

With these passages we must conclude our analysis of M. Renaudin's present series of essays. We cannot better show the high opinion we have formed of their merit, and of the instruction they convey upon some of the most initial, and therefore most difficult and important questions in medico-psychology, than by expressing an earnest hope that the author will not long defer the fulfilment of his promise to publish a continuation of his researches.

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ART. IV.-ON EPILEPSY.

(Continued from page 51.)

VII. How is Epilepsy distinguished from other Affections?—The characters of epilepsy are in general so well marked and distinctive that there is no difficulty in the diagnosis. It may be confounded with eclampsia, of which it may be considered a chronic form-its termination, or recurrence as a chronic affection, will sufficiently distinguish it. From hysteria, epilepsy is distinguished by the total loss of consciousness during the attack, which is never met with in hysterical patients, and by the more regular convulsive action in hysteria, by its mode of accession, and by the circumstances as to age, sex, &c., of the patient.

In apoplexy, there is little or no convulsion, and though there is complete unconsciousness, there is none of that embarrassment of the circulation and respiration, which is so characteristic of the epileptic seizure. For the distinction between epilepsy and the simulated affection, we refer to systematic writers on the subject; sensibility to pain, or the action of the pupil when exposed to sudden light, will in general be sufficient tests.

VIII. Prognosis.-From what has been already stated, it will readily be concluded that the prognosis of epilepsy is most serious, and fully justifies the forcible remarks of Georget: "Epilepsy is one of the most horrible of diseases, it shortens life, it kills occasionally in one attack, it finishes ordinarily by degrading and annihilating the intellect, it excludes the sufferer from society, and renders his life insupportable." The opinions given upon its curability are most strikingly at variance with each other, even from the highest authorities. We will quote a few of these by way of illustration.

Hippocrates recognises its curability under these limitations:"Whoever is acquainted with such a change in men, and can render a man humid and dry, hot and cold by regimen, could also cure this disease, if he recognises the proper season for administering his remedies." Aretæus considers that when once firmly fixed and rooted in the system, it lives with the patient, and only dies with him.

Paulus Ægineta considers it susceptible of cure, without drawing the distinction between centric and excentric epilepsy. Of moderns, Maisonneuve considers its resistance to treatment almost insurmountable; Pinel gives a guarded and doubtful opinion; Hufeland says:"the prognosis is sad, and the disease difficult to cure,—the curability is in the proportion of one to twenty-the immediate mortality is rare." Chomel considers medicine as "almost always powerless" in curing epilepsy. It is proper to observe here, that these remarks refer

chiefly to centric or cerebral epilepsy. Portal considers epilepsy one of those diseases which is the most rarely cured, but that more success attends the treatment than is generally supposed. M. Foville concludes that by a careful attention to causes, great success might be hoped for in a majority of cases. M. Esquirol, a very high authority, after stating his endeavours at the Salpêtrière, and their occasional results in suspending the attacks, adds:

"Plusieurs de nos épileptiques se sont pretées à mes essais plusieurs années; mais, l'avouerai-je! je n'ai pu obtenir de guérison."

He considers the suspension of the attacks in most cases to be due to the mental excitement of trying new means of cure or of consulting a new physician, and concludes that epilepsy is rarely curable. Of the reported cures, he considers some to be hysteria, and others to be mere suspensions of the attacks, the patients being lost sight of.

Henry asserts that the cure of epilepsy ought to be regarded as an extremely rare exception, and that epilepsy complicated with insanity is never cured.

M. Lelut, at the Salpêtrière, and M. Delasiauve, at the Bicêtre, disbelieve altogether in the curability of epilepsy, and consider the attempt as "le desespoir de la médecine."

On the other hand M. De la Rive thinks epilepsy curable by nitrate of silver in most cases, whilst M. Foville speaks in terms of the strongest reprobation of it; and M. Debreyne thinks it curable by extract of belladonna, whilst others of high authority consider it quite useless.

M. Herpin gives the particulars of sixty-eight cases analysed with great care, from which he draws the following inferences as to the general prognosis:

1. That epilepsy is not generally spontaneously cured by the efforts of nature alone, though this may occur in one-twentieth of the cases observed.

2. That treatment appears to produce a beneficial result in threefourths of those treated: that a cure may be expected in half, and great amelioration in about one-fifth.

3. That about one-fourth of the cases are incurable.

This summary would be more valuable, if the distinction we have so frequently mentioned had been kept in mind-viz., between the centric or cerebral and the excentric or symptomatic epilepsy. How are we to reconcile such contradictory evidence? and to what conclusions are we to come?

For the extremely unfavourable judgment given by Monneret and Fleury, Delasiauve, Esquirol, and Lelut, we may partly account, inasmuch as their experience was probably chiefly amongst old and con

firmed cases, and such as were complicated in most instances with mental affections, at the Salpêtrière and Bicêtre and such cases,

we have before stated to be nearly if not altogether incurable. It is more than probable that all these would be cases of epilepsia centrica vel cerebralis.

On the other hand, M. Herpin's calculations, and those of many of the others, are founded upon private experience, or the practice of such hospitals as receive cases more promiscuously than the above, and where there would consequently be a great proportion of the more frequently occurring cases, those of epilepsia eccentrica vel sympa thetica; and in this we have a key to the varying accounts.

A reconsideration of the phenomena will assist us again in forming a rational prognosis. A person of 20 years old, in the enjoyment of apparently perfect health, is seized with a series of epileptic fits, but in the intervals, the health is good, the intellect sound and vigorous, the muscular system unimpaired, and the functions generally performed properly; and we can trace no deformity of cranium, or other indication of malformation. We conclude, or hope to find, this to be a case of excentric or symptomatic epilepsy, dependent upon some functional disorder; and, seeing that in such a subject, there are times when the functions are so co-ordinated as to be compatible with perfect health, we have reason to hope that by a judicious use of hygienic and therapeutic agents, this state may be attained and permanently preserved. And as a general rule, we may state with regard to symptomatic epilepsy, that it is curable in so far as the source of irritation is capable of relief or removal, and in proportion to the care and skill brought to bear upon the exciting functional disorder. And thus we may hope, with care, to cure the majority of such cases, and to benefit many more. And what of the centric or cerebral epilepsy? The same general rule of prognosis will apply, but with restrictions. There is evidently a condition of the functions compatible with health; and a careful observation of the precise energy of each function during health, combined with judicious attempts to preserve them in that state, will not fail greatly to diminish the number and violence of the attacks, even though perfect success may not attend our efforts. So far these remarks apply to the general prognosis of the disease; when we wish to form an opinion upon any individual case, we have many other circumstances to take into account.

The hereditary tendency to the disease is an unfavourable sign, as indicating the probability of its being E. centrica. Sex appears to exert some little influence upon the curability of epilepsy-women are more liable to the attack, but more easily cured. The most favourable age for the first attack, as regards curability, is from 10 to 20. Long

duration of the disease is evidently conducive to an unfavourable judgment. M. Herpin holds an opinion very strongly, that the curability or obstinacy of epilepsy may be predicated with considerable certainty from the number of attacks already experienced. We give his conclusions, but offer no opinion upon them :

"A cure may be assured almost certainly to patients who have only the petit mal,' who have it not very frequently, and with whom it has not lasted above 10 years.

"In the ordinary attacks the prognosis is favourable if they have not exceeded 100.

"The chances of success are less between 100 and 500.

"The prognosis is extremely unfavourable when the attacks have exceeded 500."

We cannot conclude this branch of the subject without referring to the aphorisms of M. Esquirol on the subject of epilepsy:

1. "Epilepsy is a long and dangerous disease; rarely fatal in the first attack." 2. "When hereditary, it is rarely curable." 3. "Symptomatic epilepsy is more easily cured than the centric form, though this last is not always incurable." 4. "Sometimes epilepsy disappears for many years, to re-appear without any known cause." 5. "Those attacked soon after birth, are rarely cured; if puberty has not the effect, they remain incurable." 6. "Those attacked between 3 and 4 years are generally curable, if treated in time." 7. "Those attacked just before puberty are cured on the completion of the crisis." 8. "Marriage only cures genital epilepsy; it aggravates other species." 9. "A pregnant woman, who becomes epileptic, runs very great risk." 10. When the crises increase in frequency and intensity, death is probably imminent." 11. "Death does not take place during the horror of the convulsions, but the period of the depression afterwards." 12. "Epilepsy complicated with mental alienation is never cured."

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IX. The Treatment of Epilepsy-Fifty years ago, it appears that the remedies for epilepsy were so numerous as to occupy 150 quarto pages of the "Analecta Literaria Epilepsiam Spectantia,"-they have since multiplied-it is utterly impossible to give even the briefest analysis of them. One author vaunts belladonna as almost invariably successful; another, after a fair trial, pronounces it worthless. The same is the case with valerian. Dr. Heim pronounces nitrate of silver to be the most effectual remedy he has found in an extensive practice of sixty years. M. Herpin upholds oxyde of zine as the most valuable of all remedies. M. Foville speaks in terms of the strongest reprobation of the use of both these remedial agents, and all metallic oxydes.

The weight of testimony amongst reputable authors is quite against the use of specifics; and indeed, it seems but rational to suppose, that if epilepsy depends upon a disorder of the stomach, it will not be