ity of these buildings have proved entirely satisfactory. Home life, the one thing so very essential for our people, has been more nearly attained in these small cottages than in any others we have.

Buildings 4 to 7, inclusive, are occupied by the large number of persons making up the middle class. Each building holds from 28 to 30 patients, each having a cook and a nurse in charge, while the smaller cottages mentioned above have but one employe, nurse, cook and housekeeper combined. Prototypes of these buildings are on the Village Green and are occupied by 120 of the best male patients. An illustration of one of these cottages is also shown in this report.

Building 16 in the rear of the group is an infirmary for bedridden and helpless cases, and also has a special wing with isolation rooms for those temporarily mentally disturbed. This building holds from 40 to 50 cases, but might readily be made larger, for the reason that classification has less value in the care of such patients; the problem here being rather an economic

one.

Of the 740 patients now at the Colony, approximately 200, or about 25%, live in the best buildings of class one; about 440, or 60%, live in buildings of class two, designed for the greater middle class; while the remaining 100, or 15% of the whole, live in the infirmary buildings for feeble and bed-ridden cases and comprise, under our classification, class three.

While our classification is not an elaborate one, it is practical and satisfactory; and in our opinion it is necessary to have buildings of each of these types in every colony for epileptics.. We have observed that many patients who, on admission, may belong to the first class, in a few months, by reason of the prog. ress of their disease, require to be placed in a building of the second class, and eventually become infirmary cases.

other hand, many are admitted into buildings of the middle class, who, by reason of their great improvement, later on livein buildings of the first class.

OCCUPATION.

Wherever there is work to be done, and that is everywhere, in every department, indoors and out, epileptic labor is to be found; and this is as it should be. Our facilities for the useful employment of such labor are not yet adequate or complete, but we are developing them as fast as possible.

In the sewing-room in the women's group, by epileptic labor, is made practically all the clothing worn by women; while the tailor in the male department, with epileptic labor, begun some time ago to manufacture all clothing worn by men.

In the brick yard an average of twenty to twenty-five patients were employed during the past season to great advantage. On the farm and in the garden many more find regular work; while numbers have steady employment in the care of stock, in the poultry house, on the lawns and roads, in the power house, in the various furnace rooms, the carpenter shop, the bakery, the mat tress shop, the plumber's shop, the engineer's department, the printing office, laundry, in the store and warehouse, in delivering supplies to the various buildings, in office work, as assistants to nurses in the care of sick, in dining-room and chamber work, and various other things too numerous to mention.

In our opinion the Colony will never be self-supporting. A community of sick folks like this can never do as well as a community of well folks. The chief handicap the epileptic bears as a factor in industrial life is that more than threefourths of them acquire the disease in childhood, which deprives them of that early training the skilled laborer must have. We find that it takes many years to put our people in proper condi tion to perform useful labor and do it methodically. And many can never do it.

EDUCATION.

In our Third Annual Report we summarized the needs and indicated the lines along which epileptics should be educated, and our opinion has not changed since then.

In school work for epileptics we seek to attain two things. First: To inculcate certain principles. A few hours daily spent

in the atmosphere of the school room, where order is enforced, discipline maintained, and continuity of action patiently taught, will in time instill into the students habits of industry and principles that can be applied to good advantage in the ordinary vocations of life. Second: To give them a common school education.

A great majority of the young people committed to our care have so long been afflicted that educational advantages have hitherto been denied them. The doors of ordinary institutions of learning are closed to them.

All the educational work of the Colony is now proceeding along these lines. It is all practical, designed to be useful, and we try not to make it of such a character as to put it beyond the power of the epileptic student to grasp and comprehend.

It is difficult to teach persons who have passed from childhood into young adult life, who yet retain the minds of children; difficult for two reasons: First, their powers of comprehension have never been exercised and they do not know how to learn. Second, what they may learn to-day is apt to be forgotten tomorrow. A seizure has occurred in the meantime and largely destroyed all that was recently acquired. This fact makes repetition necessary and also calls for the education of as many faculties or special senses as possible at the same time. That is why finger, hand and brain work combined is best for them. That is why manual and industrial training is preferable to that which is purely intellectual, remembering that in acquiring the latter they must always get some of the former.

We now have two teachers who devote their time to the girls. They instruct them in ordinary school branches, in manual work along kindergarten lines, and in exercises for the physical development of the body. The Sloyd school has recently been enlarged and continues to be the most useful agent we have in the education of the boys. Sloyd work is not all manual; to carry out its principles requires the constant exercise of the highest faculties of the mind.

NOTES ON TREATMENT.

THE VALUE OF EARLY ADMISSION.

Elsewhere in this report it is stated that more than threefourths of all cases of epilepsy develop under the age of twenty years, making it essentially a disease of early life.

The time when the most promising results are more likely to be secured is when the disease is recent, for its tendency is to become quickly and firmly established. It is a matter for regret that the Colony receives very few cases in which the disease is not of long standing. The family physician has really the best opportunity for treating it when possibility of cure is greatest; but he is nearly always handicapped by a lack of needful facilities that it is difficult to command in the patient's home; for while the drug treatment of the disease is most important, we have learned that to be successful we must be in a position to use at the same time a large number of other agencies difficult to command in the patient's home.

DURATION OF EPILEPSY ON ADMISSION.

Out of 1,070 cases admitted to the Colony, only 15, or less than 14%, had had epilepsy less than one year; 197 had been epileptics for from 1 to 5 years; 267 from 5 to 10 years; 405 from 10 to 20 years; 156 from 20 to 40 years; while 30 had had the disease 40 years and over.

AGE OF ADMISSION.

Only one person was less than 5 years of age when admitted; 33 were between the ages of 5 and 10; 422 between 10 and 20; 486 between 20 and 40; while 128 were 40 and over.

SURGERY IN EPILEPSY.

From the nature of the nervous disease which the Colony cares for, emergency and accident surgery constitutes a large part of the surgical work. During the seizures the patients frequently sustain severe lacerations and contusions of various parts of the body and the slighter wounds and bruises occasion

ally become infected from repeated trauma and abscess or cellulitis more or less extensive results. Fractures are common as a result of falling during attacks. These occur on almost all parts of the body and in the epileptic are particularly diffi cult to treat, owing to the difficulty in keeping the parts immobilized during epileptic convulsions. Dislocations of the shoulder and lower jaw occur occasionally in some epileptics as a result of the violent muscular contractions in the convulsions. Several cases that habitually have dislocations of the shoulder in seizures have been fitted with an apparatus devised for us by Dr. Charles McBurney of New York. The appliance consists of a canvas shoulder cap and jacket fitting closely about the chest to prevent the arm from abducting during the attack. When abduction can be prevented the dislocation will not occur. The apparatus has proven a very uesful appliance in such

cases.

Numerous operations have been performed to correct deformities resulting from burns about the face and other parts of the body sustained during seizures; plastic operations and skingrafting have been frequently resorted to in these cases.

Very little can be done at any time for the direct treatment of the epilepsy by surgical intervention and much less for cases of traumatic epilepsy admitted to the Colony in which the trauma has necessarily been of long standing. However, as a palliative measure, three cases that presented evidences of focal epilepsy have been trephined. In one case the dura was greatly thickened over a small area. This part was removed and a piece of gold foil inserted between the brain and the skull. No adhesion occurred between the scalp and the cortex after the healing was complete. All the cases trephined were temporarily benefited but they still continue to have infrequent seizures.

Three cases were operated upon for disease of the ovaries. The diseased organs were removed, but there was no permanent improvement in the character or frequency of the epileptic seizures as a result of the operations, although the general health of the patients was much improved. The uterus was removed

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