tinue long, heat and stimulants may be applied to the epigastriuni, abdomen, and legs. If there be premonitory signs, the fit may not unfrequently be prevented entirely, by the administration of an emetic, a purgative, or, as Dr. Radcliffe has observed, in some cases, by a stimulant, as a glass of wine. The choice must be made between those according to the circumstances of the individual case.

We regret that our limits compel us to be thus fragmentary in our hints on treatment. We leave the subject with a firm persuasion that much may still be done in this intractable disease, by a careful application of a rational system of treatment, founded upon the principles laid down-and with a full conviction that earnest observation and patient inquiry will, in this and all other sciences, compel nature to an answer, and ultimately force her to reward her faithful votaries by the revelation of her long-cherished secrets.

Since the preceding article has been in print we have received M. Delasiauve's recent treatise on Epilepsy, and this we will now proceed to notice in a sequel, rather than that our readers should not be at once acquainted with it.

The position occupied by this author, the numerous cases upon which his observations are founded, and the evident care and pains adopted to obtain correct deductions from accurate observations, make the statements contained in this work of great value-and even those from which we are compelled to dissent have their own peculiar worth in another respect, which we shall afterwards notice.

The first point worthy of specification is with regard to the division of epileptic attacks into the major and minor kinds. One author very properly and accurately defines the differences between the slightest possible kind (absence), the second (vertige), the third (accès intermédiaires), and the fourth (chutes-attaques ou accès complets). The symptoms are well drawn, but we think that it is an error to consider the last form alone as the type of the disease when confirmed and fully established. We have seen already, that in some cases (the number bearing a very appreciable relation to the whole) there are only the incomplete attacks or vertigoes; no convulsions, or only such as are very slight, occurring; and that these, so far from being, as our author terms them, but "shadows and abortions" of the full attack, are followed even more quickly and certainly than the convulsive attacks, by those systemic derangements and those mental degradations which are amongst the most fearful of the consequences of epilepsy. Dr. Delasiauve does not appear to recognise this as essentially true, yet as seen above, high authority is very positive on the point.

Our author lays much stress on the duration of the complete attack, limiting it to a minimum of two minutes and a maximum of five.

Our own experience is very much at variance with this, as we have known many instances where the attack has lasted for hours, even taking the indication of its termination, as pointed out in the work before us, at the moment when the respiration recovers its freedom. Two cases have come under our immediate care recently, which illustrate this point. One, which was epilepsy of eleven years' standing, had fits varying from one minute to several hours, and the final attack, which was fatal, lasted above twelve hours. In all these there was the most severe embarrassment of the respiration. In the second case, which still survives, the last attack which we witnessed lasted four hours and a half, the convulsions all this time being violent, and the respiration so very much impeded, that even the desperate resource of tracheotomy was entertained, though ultimately dispensed with.

The researches into the precursory symptoms are very valuable; our author finds them to be much more numerous than are generally supposed; in fact, that the attacks with premonitory signs are about one third more numerous than those occurring without any warning immediate or remote. In 264 carefully observed cases he found immediate precursory symptoms in 150 cases, and remote signs in 35. Another interesting point mentioned is, that occasionally these premonitions have been objective exclusively; that is, they have been unnoticed by the patient, but evident to the bystanders.

We have already given the very vague and varying statistics of these warning signs; we would urge this as a point especially deserving of attention on all who are interested in the study of this affection, inasmuch as we are convinced that close observation will most frequently detect some change, which may serve as a shadow of the coming event, and also that the recognition of such changes, and the instant adoption of such therapeutic or hygienic applications as they may seem to indicate, will be most important agents in the prevention and ultimate cure of the attacks, and most especially in those cases where we do not suspect organic mischief, but where an evil habit of system requires breaking off.

With regard to periodicity; it is recognised as feebly marked in some few cases, and in some others as indicating the type of intermittent fever, and then becoming a useful guide to treatment. The following table as to the recurrence of the fits is interesting:

To make these statistics more complete, we add a table of the results obtained by M. Herpin, M. Beau, and M. Leuret, for convenience of comparison all reduced to the proportions of 100.

With regard to anatomical lesions, Dr. Delasiauve adds to our stock of observations, but, as he confesses, little to our knowledge of the disease derived from thence. In 95 cases he found important lesions in 43, equivocal lesions in 31, and a total absence of lesion in 21; and he concludes with regret that we do not yet know, nor even suspect the true seat of epilepsy.

But one of the most important points which we have to notice, is the hereditary transmission of epilepsy, in reference to which we find some extraordinary data in the work before us. We have seen above, that in a great majority of the instances tabularized by M. Herpin, there were indications of a family tendency either to epilepsy or to some disease of the nervous centres, or at least to some considerable functional disturbances.

Thus in 68 cases, slightly to recapitulate, he meets with 10 cases of ancestral epilepsy, 24 of mental alienation, 11 of apoplexy with hemiplegia, and 13 of chronic meningitis and hydrocephalus. We must, however, bear in mind that these were not all in separate individuals, and therefore the proportion of ancestral affections is not quite so large as from a cursory glance it would appear. Yet, even making every allowance, how different is this statement from the results indicated in the following table! Out of 300 cases there was

Absence of hereditary indications in
Positive declaration of non-existence of such
indications in

Existence of epilepsy in relations in
Nervous and cerebral affections in

Perhaps this striking difference may be in part accounted for, by taking into consideration that these 300 cases were hospital patients, in whom, for obvious reasons, the difficulties attendant upon eliciting information are very much greater than in private practice. There is also an irresistible tendency to conceal facts bearing upon this question.

But making all possible allowances, we find most startling discre pancies in the writings of various authors on this branch of the subject-these and other differences we shall have again briefly to allude to in the sequel.

We do not find much additional light thrown upon the already discordant views of the influence of menstruation and pregnancy, on either the development or the progress of the disease. With regard to solitary vice, Dr. Delasiauve gives it a more prominent causative place than most authors-thus, MM. Bouchet and Casanvieille attribute epilepsy to this cause in 3 out of 77 cases; M. Beau, in only 1 in 273; M. Herpin in 1 in 27; Dr. Delasiauve gives 25 in 200 as the proportion M. Leuret alone exceeds this calculation, 12 in 67 being the relativ numbers. It must, however, be always impossible to calculate the precise influence which a vice so general has upon any given disease; but that it has a striking and powerful influence, by reducing the general powers, and by exaggerating irritable mobility, cannot be doubted.

With respect to treatment, we find nothing especially new; tonics appear to enjoy less favour, and sedatives somewhat more, than we have been inclined to accord to them. The effects of the preparations of copper are "isolated, slow, and suspicious ;"-nitrate of silver almost useless-sulphate of quinine not answering the expectations formed of it. Valerian, assafoetida, artemisia, and camphor, are spoken very highly of, the latter being of use, chiefly indirectly, through its aphrodisaic action. Ammonia is of much service.

The earnest and sincere searcher after truth for its own sake, has no more distinguishing characteristic than that total and absolute self-negation, which ever and again leads him to distrust himself rather than nature, to relinquish theory rather than to neglect or warp fact and observation. When convicted of error, instead of mortification that he is wrong, he finds matter of congratulation and rejoicing that there is still another chance, by rigid observation and rectification of error to discover the truth of the secret which has so long eluded him. He perceives that still the mystery is not demonstrated to be unfathomable, since the most accurate means have not yet been taken to elucidate it. Such is the foundation of our hope, that yet we may have light shed upon the obscure subject of our essay. We have seen that the significance of symptoms is mistaken, that the varieties of disease are doubtful,-that the pathological and anatomical conditions are involved in mystery,-that the causes are obscure in their operation and their efficiency, that the prognosis is not agreed upon,—that the treatment is empirical. Yet we have hopes for a better state of things,

for do we not see plainly that observation, accurate and untheorizing, is yet deficient? This is sufficiently answered by the varying accounts which are given by different authors of simple matters of fact. A better state of things is arising; observations, honest and sincere, are multiplying and accumulating, but "non tantum numerandæ sunt, sed etiam perpendendæ observationes," we must have facts well weighed and well observed, and in sufficient numbers-then, and then only, shall we be in condition aptly to interrogate nature as to her meaning. We cannot better conclude our remarks than by the closing paragraph of M. Herpin's introductory chapter:

"Of the hundred thousand physicians who practise their art in Europe, let but one tenth-one hundredth, devote but a minute fraction of their time, to observe conscientiously, to note exactly, and to review methodically, the results; * * and it will require

comparatively but a few years to elevate a magnificent monument which neither the efforts of sectaries nor the wear of ages can injure. Each generation will add to it its own work, but it will respect that of its predecessors, and the edifice will gain in grandeur, and lose nothing of its solidity or harmony of proportion."

CRITICAL REMARKS ON THE "PLEA OF INSANITY," &c.
BY RICHARD POOLE, M.D.,

Fellow of the Royal College of Physicians, Edinburgh, formerly Superintendent
of the Royal Lunatic Asylum, Montrose.

66

"NEXT after minors," says Baron Hume, commencing this portion of his justly esteemed work, we may attend to the case of those unfortunate persons who have to plead the more miserable defence of idiocy or madness, which, if it is not pretended, but genuine, and is withal of the due degree, and is fully proved, brings the act to be the same as that of an infant, and has equally the privilege in all cases of an entire exemption from any manner of pain; Cum alterum innocentia concilii tuetur, alterum fati infelicitas excusat. (L. 12 ad Legem Corneliam de Sicariis.)"

Observe-if genuine of the due degree-and fully proved-implying serious obstacles in the way of sufficient legal excuse; and these are specially enforced -more particularly on one main point. "I say," continues Baron H, "where it is fully proved, and is of the due degree: For if reason and humanity enforce the plea in these circumstances, it is no less necessary to observe such a caution and temperament in the application of it, as shall hinder it to be understood that there is any privilege of mere weakness of intellect, or of a strange and moody humour, or of a crazy and capricious or irregular temper and habit"-the Commentator expressly declaring, "None of these things"namely, “mere weakness of intellect," "a strange and moody humour," crazy and capricious or irregular temper and habit"-" either are or ought to be law. In plain words, weakness of intellect, with the adjuncts enumerated, can form no defence in the eye of law, which, according to Hume, speaking decidedly as an authority, is in this matter consistent with reason and humanity.

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