done by our predecessors, though it clashes with many of our views. When we read the careful histories that they have handed down to us, it is often impossible not to be struck with the masterly manner in which they handled their tools. The remark applies forcibly to a disease like epilepsy; the advantages supplied by physical diagnosis' have afforded us no means of elucidating the affection which was not possessed by the writers alluded to. I cannot hesitate to admit that Prichard, Cooke, and others have found venæsection an important auxiliary, in some cases the sheet anchor, in the treatment of epilepsy, although I have hitherto not met with cases in which I should be disposed to employ it. The prevailing character of the pulse during the free interval in my cases was feeble, indicating anæmia rather than plethora, and demanding an infusion of new, healthy blood, rather than a diminution of the small current taking its sluggish or petulant course through the vessels. The employment of leeches in small numbers is indicated where we desire to draw away the blood from a part, rather than diminish the general tension of the vascular system; thus in persistent congestive headache their application to the nares or temples; as an adjuvant to the restoration of the catamenia, their employment at the perinæum or hypogastrium, is often valuable.

"The prevailing opinion among writers of the present day is that anything like heroic antiphlogistic treatment in epilepsy and epileptiform disease generally ought to be eschewed,-an opinion that I cordially adopt; the drugs pertaining to that category ought to be so used as to restore order where disorder prevailed; to rectify the vitiated secretions where they can be shown to be deranged; to remove local congestions or other accumulations where such means suffice for the purpose. While, then, I do not deny that epilepsy may be the result of too high a pressure, the evidence proves it in the vast majority of instances which we meet with in the present day to be due to a want of steam-of more pressure. Accordingly, the remedies most in repute in the treatment of epilepsy are those which are commonly classed together as tonics; and among these we find especially the mineral tonics to deserve and to hold a high rank. Drawing the circle still narrower, I should be disposed to place the preparations of iron and zinc first, as those which have done me most service. The various salts of iron may be given according to the different constitutions of our patients; but generally the vegetable salts, the ammonio-citrate, the potassio-tartrate of iron, the ferrum pomatum (a malate) of the Prussian pharmacopoeia, with which we may class the lactate, are preferable, on account of the facility with which they are digested. Where there is want of appetite the citrate of iron and quina is a very appropriate form of administering iron. The irritant properties of the sulphate of iron render it generally ill-suited. A very elegant form of administering iron, and one that is particularly well

adapted for young children, is under the guise of Allarton's steelbiscuits, which are most palatable, so as to be eagerly taken, even by the infant.

"Of zinc I would speak very favourably, though by no means with the confidence of M. Herpin. It appears to me to exercise a distinct influence over the epileptic paroxysm in many cases, which could not be traced to any local irritation, and therefore, according to the common nomenclature, deserved to be called centric. I much prefer the soluble sulphate to the insoluble oxide. The former affords us an instance, proving the extreme power of the system in adapting itself to hostile impressions, if we may say so, provided the attack be gradually made. To a person in health, five grains of the sulphate taken at once are liable to prove emetic; but by cautiously increasing the dose, epileptic patients can be brought to take more than seven times that quantity repeatedly in the day with beneficial results."

The preparations of silver have not answered the author's expectations, but opiates and narcotics he thinks we should do well to employ in the commencement of the disease, "as we can scarcely doubt that during sleep an irregularity in the action of the nervous system supervenes, such as may be met by soothing agents." The cotyledon umbilicus he "still thinks worthy of some consideration." For the curiosities of treatment, modern and ancient, the indigo of Ideler, the ligature of the carotids, the mistletoe, (which ought to be cut with a golden sickle in druidical form,) we must refer our readers to the interesting and learned pages of the work. The remarks on physical and moral hygiene, the influence of pure air, cold bathing, rest, moral discipline, and the development of a well regulated will, are most judicious. Of cold bathing the author says:

"Next in importance to the air in the hygienic treatment of epilepsy or its congeners, is the use of water, as beverage undoubtedly, but still more as a roborant, externally applied. To those who are habituated to the daily use of the shower or sponge bath, it seems almost impossible to exist without them. And yet even with us, proverbially a cleanly people, it is surprising how many go, from the beginning to the end of the year, in utter ignorance of the purifying and invigorating influences of a general bath. The discomfort resulting from the omission of the daily bath, the feeling of restlessness and almost feverishness which affects us, when from accidental causes it has been passed over, are feeble indications of the derangements of the nervous system which must ensue when the ablutions, for months and years together, are confined to the face and hands. As an hygienic application, then, the daily use of he cold bath on rising is to be ordered, where there are no special

grounds that counter-indicate it. I would not undertake the treatment of a case of epilepsy in which its use, advised by myself, were objected to."

The work concludes with a tabulated and synoptical summary of fifty-eight cases of epilepsy treated by the author, shewing the history, the probable cause, the prominent treatment, and the result. How far this was likely to be from the termination of the disease may be guessed by asylum physicians, from the fact that only two deaths are recorded in the fifty-eight cases, one of which was from carbuncle. This and similar experience of the physicians of general hospitals, may justify the opinion of the author, that epilepsy is not a fatal disease; but the experience of the physicians of asylums, who see the real termination of their cases, will be decidedly opposed to this opinion. They are compelled to believe that epilepsy is one of the most fatal of diseases.

But whatever the eventual termination of the cases may have been, the study of this summary is highly instructive, and appears to us to form one of the most valuable parts of Dr. Sieveking's work, which we must designate as learned, able and judicious. It possesses the rare merit of a work on epilepsy, that it is peculiarly free from hypothesis. The opinions it expresses are candid and careful, and are not permitted to travel beyond the record. It is a most valuable contribution to medical literature.

J. C. B.

Insane Colony of Gheel. By HENRY STEVENS, m.d., Lond., Medical Superintendent of St. Luke's Hospital.

At a time when the provisions for the care and treatment of pauper lunatics are almost completed in compliance with the legislative enactments of 1845, cavillings are heard, not as to minor details or local discrepancies, but against the first lines, the root and trunk-growth of the scheme. County asylums have arisen in every shire, attended in many instances by their satellite borough institutions, and some men, not ignorant on these matters, have looked on, and pronounced the arrangements to be good, very good; some, perhaps prejudiced, or short-sighted, or inexperienced, have gone so far as to say, that in no country in the world could

similarly well ordered provisions for the maintenance and recovery of the poor insane be found, as we see raised at distances of twenty or thirty miles apart, over the length and breadth of this favored land of ours. Each institution a ready recipient of every needy being, whose taint, or toil, or trouble, or perhaps vice, if this precedes insanity, has reduced him to knock at the friendly door. Once admitted-every one who has bowels that can be sympathetically affected by the miseries of others, to a sufficient degree to induce him to care for, and to look into the plans adopted for the amelioration of the afflicted, can satisfy himself of the real good offered, and the benefit likely to be conferred by admission into one of these havens of rest. He will find within a well-planned building, divided into separate compartments exactly suitable for almost every phase of the disease to be treated; every arrangement for ventilation, warmth, and cleanliness; means for the regular elaboration and punctual distribution of a carefully devised dietary, every thing ready to hand; every appliance that modern notions suggest for the medical and moral treatment of the insane, and for the individual and personal and separate watching, nursing, and complete and effectual treatment of each unfortunate inmate.

The patient once within the walls will soon find himself, -or suppose we say herself, why not? She will find herself handed over to one of her own sex; one who has been trained to be her sister in everything but blood; one who will put up with impatience patiently; anger quietly; mourning with sympathy; and with violence without retaliation; one whose whole life will be, while an attendant, devoted to the cheering of the mourner, and the calming of the excited. These two, patient and attendant, will be companions, for the period of the patient's residence.

All the arrangements are practically the recommendations of one man, a member of the medical profession, one selected for his experience in and knowledge of the disease, and of the peculiarities of the insane; from him all the small ordinances of the household emanate, and he is ever present to see that the cosmogony is built up and works well. On the whole, probably a better form of government than that of an English county lunatic asylum could hardly be found; and the results of its work, as regards the cure of its charge, may be gathered from a perusal of the different asylum reports, or from reviews or criticisms of such. Its benefits in other respects, in the general well-being of its inmates, &c.,

cannot be represented in a tabular return, or imagined without continued experience. It must be borne in mind that the county asylum is equally applicable and convenient for the treatment of all phases of the disease; for each case affording a proper amount of liberty, in some amounting to almost perfect freedom, and to others a qualified deprivation of liberty and a substitution of judicious control and direction. But there is another picture: A poor creature bebecoming insane, utterly helpless, no longer a free agent, a wife and mother with friends around her, a husband and relations, children, and perhaps an infant, the last, whose age can be recorded but by weeks. Again, the father of a family whom sudden misfortune has bereft of reason, a man loving his family and beloved of them, whose chief joy and consolation in this life has been centred in his little flock, "how ridiculous is your vaunted charitably-conducted asylum in their cases," say some, "they might as well be sent to prison," &c., &c. And some again object that if these poor creatures become insane, how cruel must it appear to their ill-regulated minds to find themselves the detained inmates of an institution, an asylum, or of any place, under any name, out of which they cannot get at their own will, &c. How much better would it be if they could be treated at home, or at any rate if the place at which they were treated could be assimilated somewhat more to their home, &c., &c., and so on.

There is nothing new in all this. We bear in mind the scenes at well-thought-of asylums even at the commencement of the last half century, and more, we cannot help noticing the alteration that has taken place since so late a date as 1845; but yet more is required--quite natural that more should be required. May progress never be checked in this or in any other branch of England's government or economy ! But is it progress that some objectors urge as their ground for objecting to the county asylum constitution? Is it not rather a carrying out of what we find to be the usual train of events in the history of all human institutions. The proposition or commencement, the carrying out to almost perfection, the staggering on the pinnacle, the doubt, the hesitation, and either the downfall, the continuance, or the trial of some new scheme. At any rate there are those who take much exception to the almost perfected arrangements authorised and presided over by the Commissioners in Lunacy; they urge that the asylum plan is altogether a mistake, and that with more experience and thought, much better provision for our insane poor might have been made. And