We again note epilepsy as the chief cause of death, this being the cause in 14 cases out of the 33. Valvular heart disease was

the cause in 4; pulmonary tuberculosis in 3.*

One young man, without the slightest previous manifestation of insanity, committed suicide by the knife. It is a mistake to suppose that epilepsy is not a dangerous disease, for, apart from its liability to destroy the mind, any epileptic may die suddenly as the result of a seizure at any time; or be killed by a series of attacks running into "status epilepticus." The average age of those who died was 28.65 years.

So far as it lies in our power, we do not permit patients to leave the Colony unless we arrange for their going away. Sometimes they are needed at home and we let them go for two or three months, discharging them at the end of that time if they do not need to come back. In other cases, where their condition has been so much improved that they are capable of earning a living outside, we advise them to go out and try it, and nine-tenths who go in this way do not have to come back. Still others, who appear to have been entirely cured after two or three years here - and no epileptic can be cured in less time than that go away on trial with permission to stay if they get along all right, and in but one case has a patient of this kind had a recurrence of his trouble, and that was because he failed utterly to lead the form of life his condition demanded.

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*"The question of sudden death," says Brouardel, author of 'Death and Sudden Death,' "in the course of an attack of epilepsy, is of great interest. In such cases death is due either to rupture of the heart or to the passage of food from the mouth (or stomach) into the trachea or bronchi, or to asphyxiation resulting from the position occupied by the patient during the fit, such as may cause the mouth to be pressed into the pillow. But besides these there is another mode of sudden death, which, in all probability, sometimes occurs during a fit of epilepsy, viz. Sudden paralysis of the respiratory center. Its occurence was firmly believed in and taught by the late Dr. Hilton Fagge, and it is, perhaps, the best explanation that can be given of the death of those chronic epileptic patients who are occasionally found to have died in their sleep without any evidence of their having been seized with convulsions or of their having been accidentally asphyxiated."

1 A CLOSER CONTROL OVER SOME EPILEPTICS

DESIRABLE.

Not infrequently we are confronted by the curious anomaly of trying to force charity on an individual who does not want it, and who will not voluntarily stay at the Colony while we are trying to get him to take it, no matter how greatly he may need it. In the absence of a judicial commitment, we find it difficult to keep some patients who do not want to stay, yet who by all means should do so. Many of such cases do well so long as they remain at the Colony, but do badly as soon as they get outside. For these we ought to have an amendment to the law that would enable us to keep on the premises such cases as we feel, for obvious reasons, should not live in the outside world.

CHARACTER OF NEW ADMISSIONS.

On the whole, the character of those admitted during the year was better than any previous year, due to greater care exercised in the selection of cases.

We have repeatedly called attention to the lack of wisdom in trying to care for the irresponsible in the same way we care for the responsible; and since it seems the Colony is destined to be for a mixed class, caring for some who have good minds along with those who have little or no minds, the only thing left for it to do is to build rightly for the several classes. The enlargement of the two infirmary groups as now contemplated is with this idea in view.

WE NEED HOUSES MORE LIKE HOMES FOR MANY

PATIENTS.

We sometimes feel that we ought to apologize to some patients for the seeming crudeness of the home life we are able to offer them. It distresses many of the better class to be put into houses in which from three to five have to live in one room, while the chief thing many of them want and ought, without any unreason, to have, is a room to themselves, or one in which there is

but one other person. Here again comes in the great value of classification, and we ought to try hard to build up that important side of the institution. Experience has taught us that we can no more fill up a big house with all sorts of epileptics and have things go right in it, than we can put out a fire with a liberal deluge of kerosene oil.

THE SIMPLE BETTER THAN THE STRENUOUS LIFE FOR THE EPILEPTIC.

However much we may admire the strenuous life for the majority of people, for the epileptic it will not do. He demands the simpler kind. With his higher nervous system "set on a hair trigger," so to speak, ready to "explode" or "discharge " under the slightest unusual irritation, he must lead a form of life far removed from that of the strenuous type.

There is for him a modicum of activity combined with a modicum of quiet that is just right. He neither requires to rest to the point of rusting, nor rush to the point of destruction. It is important that he work; important for medical, moral and economic reasons, but most of all for medical, for in doing this he typically exemplifies the truth of the saying, "The working hand makes strong the working brain." And in a Colony like this there are perpetual tasks suitable for all.

There is no finer sight at the Colony than to see a man who has been a clerk or bookkeeper, accustomed to long hours. of labor in a dark, unwholesome atmosphere, pale and anaemic when he enters the Colony, don a suit of overalls, rough shoes and a broad-brimmed hat and take his place with a hoe in the garden or on the farm, where his face is constantly "kissed by the sun and bronzed by the wind." When he does this kind of work he goes to his meals full of the desire to eat and with plenty of ability to digest, and his slumbers, early commenced and early ended, are sweet and natural and never need to be induced or disturbed by the use of unwholesome drugs.

It is a capital thing for many persons of sedentary occupations, especially if they be subject to epilepsy, to get back to primitive conditions in matters of toil, because that sort of life serves so

admirably, and without expense, to banish brain fatigue and nervous instability, at the same time it builds up muscle and brawn.

GENIUS AND EPILEPSY.

Our experience so far has not led us to believe that genius and epilepsy, when the latter is genuine, are often, if ever, associated in the same individual, although we have seen many persons of fine intellect who suffered from occasional convulsions; and our views in this respect agree so fully with those expressed by the distinguished English scientist, Sir Lauder Brunton, that we venture to give an extract from a paper read by him at the meeting of the British Medico-Psychological Association in November, 1901:

"It is quite true," says Sir Lauder Brunton, "that some of the most remarkable men in the world's history have been epileptics, but I do not think that Julius Caesar, Napoleon or Mohammed were great because they were epileptics. As a rule, epilepsy tends to destroy mental power rather than to increase it, and the curious lethargy which Napoleon exhibited at the battle of Leipzig, and which there led to his defeat and consequent ruin, is probably rather to be ascribed to his epileptic tendency than to the indigestible bun which is said. to have led to the disaster. Julius Caesar and Napoleon were great men, not because of their epilepsy, but in spite of it; and the visions of Mohammed alone would not have given him his extraordinary power over his countrymen and over the then known world had it not been that they were backed up by extraordinary mental power and energy in the intervals between his fits."

A WORD ABOUT SOME EPILEPTICS WHO NEED NOT HAVE THE DISEASE.

When a man (we have seen a number of cases among men only) who has reached middle life and begins to have convulsions, at first three to six or eight months apart, then oftener, wants to learn the cause of such attacks, he may be told without reservation that they are due to one of three things, 75

times out of 100: too much alcohol, too much food of an improper kind, or syphilis of the brain. Some ten or twelve cases of this kind have come under our observation during the past two years, and two cases due to too much improper food and alcoholic drink that I saw three years ago, and that reformed in their habits, have been entirely cured.

Epilepsy is often preventable in middle or adult life when convulsions develop for the first time at that period.

NERVE NOSTRUMS.

In previous reports we have spoken of the harm suffered by epileptics through the use of nerve nostrums so glowingly described in the public prints. The last "sure cure for epilepsy to come to our notice is manufactured in Ireland and reaches the United States through Canada, in one-pound cans, hermetically sealed. If the claims for this particular nostrum could be substantiated, 98 per cent. of all epileptics need not have the disease longer than it would take to consume a pound or so of this alleged remedy.

An analysis of it showed it to be equal parts of ordinary brown sugar and the bromide of potassium, being like all other nostrums for "epilepsy or fits" in having one of the potassium salts as a basis and having the same shallow, deceptive virtue of the rest in being able to suppress the attacks for awhile but possessing absolutely no power to cure. And while this suppression is going on the patient's mind is being destroyed and his digestion ruined. We say to all epileptics that it is far better to let such nostrums entirely alone.

IS EPILEPSY CURABLE?

We have no hesitancy in saying it is in many cases if it is taken in time and rightly treated, and the treatment kept up long enough. And notwithstanding the fact that substantially all cases we get at the Colony are chronic,* we have permitted some eighteen or twenty patients whom we regarded as entirely

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