* *

may thus leave the lower centres uncontrolled and free
to indulge in the most rampant excess of action. *
The importance of the view here advocated is this,
that if it be adopted it may lead to the explanation of
those numerous cases in which maniacal attacks pre-
cede the fits in cases of epilepsy-cases which have
always been obstacles in the way of adopting the hypo-
thesis of Loss of Control."

Another case recorded by Ball, is that of an ecclesiastic, whose convulsive attacks occurred two or three times a month. Each period was preceded for eight or ten days by a melancholic delirium, in which ideas of persecution and hallucinations of hearing were present. Then would follow the convulsive paroxysm and several days of hebetude, after which he would enter upon a period of inexpressible self-satisfaction. This would last for a fortnight, to be succeeded by a state of melancholia and convulsions.

Sometimes peculiar paroxysmal sensations precede for months an outbreak of convulsions in an individual who has previously been free from them. These may be the only indications of epilepsy and are variously described by patients as " reveries," "thinkings,"

66

forgetfulness," &c., there is a momentary confusion of ideas without any convulsive action whatever. That these cases are epileptic is shown by their future history, when undoubted epileptic attacks made their appearance, being then immediately preceded by the same peculiar mental phenomena. Morel remarks that "The epileptic neurosis may exist for a considerable period in

1

an undeveloped or masked form, showing itself, not by convulsions, but by periodic attacks of mania or by manifestations of extreme moral perversion, which are apt to be thought willful viciousness. But they are not; no moral influence will touch them; they depend upon a morbid physical condition; which can only have a physical cure, and they get their explanation, and indeed, justification, afterwards when actual epilepsy occurs."

In another class of cases an epileptic attack is succeeded, after a varying interval of time, by a greater or less degree of mental disturbance. The mental condition following an epileptic seizure varies greatly in different individuals, while the acts performed are often of the most complex nature, indeed, it is sometimes difficult to convince one's self that they are not intentional and under the control of the will. Gowers relates a case of a carman who would drive through the most crowded parts of London without accident for an hour after an attack and retain no recollection of it afterwards, while Dr. Radcliffe knew a young lady who was capable, while in this state, of playing the most difficult music without mistake.

This class may exhibit every degree of mental disturbance, from a dazed stupid appearance, to the most complicated automatic actions, and the wildest acts of maniacal fury. These phenomena are of an automatic nature and are probably due to loss of control of the highest centers over other centers just below them. "The condition" says J. Hughlings Jackson, is duplex

(1) there is loss or defect of consciousness, and there is (2) mental automatism. In other words, there is (1) loss of control permitting (2) increased automatic action."

Attacks of epileptic mania occur most frequently in this class of cases and the annals of crime abound in examples of violence committed by epileptics after a convulsive seizure, but it is also important to remember that post epileptic phenomena are very liable to occur after the slighter seizures, and unless close attention is paid, the preceding attack may be entirely overlooked. It is possible for a patient to have slight nocturnal attacks for a long time without detection which may be followed by otherwise unaccountable actions, their recognition, therefore, is often of the utmost importance as explanatory of many obscure medico legal cases. I have but little doubt that many cases of so-called transitory mania properly come under this head, the slight seizures to which the patient was subject, having entirely escaped observation. The diagnosis of mania transitoria should not be made until a careful research into the patient's past history has eliminated all possibility of the presence of epilepsey. These diseases resemble each other in their sudden outbreaks of blind fury, in the absence of a clear recollection of the morbid period, and in being generally concluded by a deep sleep.

In a third class of cases the transient or prolonged outbreaks of mental disturbance have no immediate connection with either slight or severe epileptic attacks,

they occur independently of either, and often in the intervals between the severer seizures. At times they seem to occur in place of a convulsion, then constituting its psychical equivalent. In these cases there is evidently a convulsion of ideas rather than a convulsion of muscles, the mental centers alone apparently being affected.

This form of masked or larvated epilepsy has been described by Morel and Falret as characterized by wild outbursts of maniacal excitement without contemporaneous convulsion. Of course in some instances these mental disturbances are really post epileptic in character, the preceding slight seizure having escaped observation, but other undoubted examples occur in which the discharge is purely mental and has no immediate relation to any other epileptic manifestation.

(To be continued.)

Transactions of Societies.

THE MEDICO-LEGAL SOCIETY OF NEW YORK.

PRESIDENCY OF PROF. ISAAC LOUIS PEET.

The regular monthly meeting of the Medico-Legal Society was held at Cooper Institute, Wednesday evening, September 15th, 1886, the President, Dr. Isaac Louis Peet in the chair.

The Minutes of the last meeting were read, and on motion of Dr. Bradley were corrected so as to read as proof sheet of same to be published in the September number of the Journal, which was read at the meeting. After such correction they were approved.

Mr. Bell submitted the modified contract between the Medico-Legal Journal Association and the Medico-Legal Society, together with the action of the Executive Committe approving the same, and directing its execution.

The President then introduced William J. Mann, Esq., who read an interesting paper on "Testamentary Capacity." The paper was discussed by the President, Dr. Ed. Bradley, Mr. Clark Bell, and Mr. A. C. Butts. A vote of thanks was tendered Mr. Mann, the reader of the paper, by the Society.

On motion of Mr. A. C. Butts, the Society extended an invitation to Dr. Ed. Bradley to read a paper before it at a future time.

Mr. Bell then read an interesting report on the classifi