in another case and found to be a retention cyst. The patient has had no attacks since the operation, a period of sixteen months. Previous to the operation she had several attacks daily.

Some of the operations that have been performed for surgical conditions not directly connected with the epilepsy are: Circumcisions, varicocele, hernia, fistula in ano, resection of the rectum, hemorrhoids, uterine polyps, appendicitis, tubercular peritonitis, amputations, ectropium, entropium, tenotomies of eye muscles and various other minor operations.

MEDICAL TREATMENT.

While we have employed all the older remedies in the treatment of epilepsy, which are well known and too numerous to mention here, we have relied chiefly upon the bromides to control the frequency and severity of the seizures. The potassium, sodium and ammonium salts, either singly or in combination, are those most preferred and frequently employed. The chief difficulty in their use, as in all the bromide salts, has been to combat bodily and mental intoxications resulting from the necessarily continuous sedation. To accomplish this end tonics, reconstructives, massage, gastro-intestinal antiseptics, eutroclysis, hypodermoclysis, baths and special dietetic principles have been employed constantly.

In our further efforts to reduce the possibility of bromism, some adjuvant principles to the bromide treatment have been very successfully used, such as Toulouse hypochlorization or salt starvation in the epileptic dietary. Briefly considered, the plan is to undersalt or withdraw sodium chloride (table salt) from the dietary, in order to induce the body tissues to take up bromine in place of the deficiency of chlorine from any one or a combination of the bromide salts. Ordinarily we use the sodium salt, which is given on the patient's food in the prescribed doses, as it forms a very good substitute flavoring for table salt. By this method the tissues store up and hold the bromine for a much longer time than by the older methods. Thus bromine substitutes chlorine physiologically and acts as

a therapeutic agent of sedation. As one-half the ordinary doses of bromide are necessary by this plan, its economy is obvious.

Notwithstanding the advantages of this plan, bromide intoxications have occurred to some extent while using the bromide salts, therefore we have endeavored to still further modify the bromide treatment by using organic bromine in a preparation known as Bromipin. The bromine is united in a 10 per cent. solution with ol. sessamum, thereby losing its characteristic odor, taste and irritating properties. While the expense of the preparation has precluded its extensive use, we have noted in conjunction with the hypochlorization dietary the general absence of gastro-intestinal irritation, constipation, mental hebetude and other well-known evidences of bromism. Bromipin has also been used to advantage in some cases of status epilepticus by hypodermic injections and also in the weak and feeble. epileptics in the form of nutrient emulsion. Its usual dosage is about twice that of an equal volume of the bromide salts.

While these adjuvant principles of sedation are very great improvements on older lines of treatment, they undoubtedly reach their highest efficiency when carried out in conjunction with colonization principles of care. Indeed, the minute and painstaking application of general hygienic rules to every individual epileptic is rather more necessary than ever. The patient is a biological unit in which both the epileptic and the epilepsy must be given unremitting attention. Therefore special dietetics, exercise, educational occupation and special medicopedagogical plans for physical and mental development in colonies especially constructed to meet these requirements are absolutely essential.

THE EFFECTS OF EPILEPSY ON THE MIND.

We have made a systematic and careful study of the effects of epilepsy on the mind in 1,070 cases admitted to the Colony since its opening. These studies include in every case the sex, age, duration of the disease, the patient's mental condition on admission, hereditary causes and the subsequent mental condi

tion, and we present a brief summary of the results of these studies for the following reasons:

First, to further illustrate the need for classification; second, to show that all epileptics are not proper subjects for our present system of Colony care; third, for the scientific interest that attaches to such a study.

(In explanation of the showing made by the mental condition in the following studies, it should be stated that it is due to the fact that the Colony has received large numbers of chronic cases from county poor and almshouses and from the homes of the poor, where the specialized care and treatment all epilepticsneed could not be applied. We hope in future to receive more patients less affected by the ravages of the disease, and in whom. the possibility of improvement or cure will be greater.)

In speaking of epilepsy and insanity in our report a year ago, we said: "Scientifically speaking, epilepsy and insanity are closely allied in so far as they affect the mind. In one, mental perversion is periodic, in the other continuous; both have an origin in common in the brain, both dependent on that organ for their manifestations. Unchecked or uncured, both tend to (impair or) destroy the faculties of the mind."

In the same report we stated that out of 845 epileptics admitted to the Colony in four and one-half years, twenty had been transferred to State hospitals as being legally insane, and

that we still had forty cases suffering from incomplete forms of insanity. We took no account at that time of the large number who were feeble-minded or of imbeciles, idio-imbeciles, or idiots.

From the data made in the 1,070 cases, it appears that 31 were received whose mental condition at the time was regarded as good "-normal in every way-and that later on two of these failed sufficiently in mental vigor to pass into a lower class.

Two hundred and sixty-seven were classed on admission as "fair," being little less sound in mind than those marked good, while later on 56 of these lost enough mentally to place them in lower classes.

Four hundred and forty-seven were feeble-minded on admission, and this number later dropped to 377.

One hundred and forty-six were imbeciles on admission, and this number was later increased to 148, a gain of 2 only.

Forty were pronounced idiots when received and later on the same number belonged to that class.

One hundred and twenty-four were suffering from dementia, complete or partial, when admitted, and it is notable that this number was later increased to 212. The great majority of those that passed out of the feeble-minded class went to swell the number of those having epileptic dementia, or other forms of insanity.

Fifteen were insane when admitted, and this number was later increased to 53, a gain of 38.

Seven hundred and forty-five of the whole number admitted, all included in the first three classes given above, were very good cases for Colony life, there being little or nothing in their condition unfitting them for the freedom so essentially a part of such a life.

Because of the marked mental impairment in the remaining 325 cases-impairment due in most instances to the effects of the disease, but in some congenital-we do not feel that an unmodified system of Colony care, such as it seems this Colony was designed to be, can give them the form of treatment and close custody their condition requires.

PHYSICAL INFIRMITIES IN 1,070 CASES ON

ADMISSION.

CEREBRAL PALSIES.

Many patients are admitted bearing clearly defined evidences of a former paralysis, about which the accompanying certificate is silent, and it not infrequently happens that the family or friends of the patient learn for the first time of a former paralysis, after the patient's rigid and systematic examination at the Colony.

One hundred and sixteen persons--67 males and 49 females— were suffering in some degree from some form of paralysis on admission.

Males. Of the 67 males so affected, 6 were between the ages of 5 and 10 years; 37 between 10 and 20; 20 between 20 and 40; while 4 were 40 and over. Of the entire number 28 suffered from right hemiplegia, 38 from left, and 1 from diplegia.

In 35 of the 67 cases, the degree of helplessness was slight; in 16 partial; in 8 marked; and in 3 complete. Left hemiplegia out numbered those of the right side by 10%.

Females. Of the 49 females, 5 were between the ages of 5 and 10 years; 21 between 10 and 20; 21 between 20 and 40; while 2 were 40 and over. Of this number 23 had right hemiplegia; 24 left; and 2 had diplegia.

The degree of helplessness in 26 of them was slight; in 14 partial; and in 7 marked; helplessness in two cases of diplegia being complete.

Although we had difficulty in trying to fix the age of onset of the paralysis, we were able to do so to the extent that led us to feel without reservation that practically all originated in infancy. This fact, if needed, would be additional proof that epilepsy is a disease of early life.