seizures were prevented by awaking her in time, and on one occasion I saw the effect myself, Gradually her condition improved, the fits were entirely arrested, and now, March 4, she has been sleeping at night for a week without any return of her seizures. She awakes two or three times in the course of the night, and thus lessens the tendency to an attack. She has had no paroxysm since the 11th of December.

This case is interesting as showing one of the probable causes of epilepsy, and that bromide of potassium, which is so generally efficacious in the treatment of this disease, is not adapted to that form of it which depends upon a deficient amount of blood in the brain. It also indicates very clearly the condition of the brain during sleep, and the action of bromide of potassium in still further reducing the amount of blood contained in its substance. It is well known that epileptic attacks frequently come on during sleep. In such cases the sleep is probably very profound, and the seizures are doubtless often due to deprivation of blood in the cerebral tissue.

CONTEMPORARY LITERATURE.

THE meeting of Medical Superintendents of American Institutions for the Insane, which took place in Philadelphia, last May, was well attended. The report of their proceedings1 shows a good deal of activity in the Association. We think, however, that many of the conversational remarks of the members, and the mention of commonplace occurrences, might have been omitted with advantage.

The Association heard a statement from Dr. M'Farland relative to his difficulties in the Illinois Asylum, and very properly, we think, gave him their support without a dissenting voice.

A paper was read by Dr. Harlow, of Maine, on the changes which ensue in the urine in consequence of insanity, which elicited some discussion. The following extract from Dr. Gundry's remarks we quote because, while containing much that is sound, it enunciates one proposition-that the presence of an increased amount of phosphates in the urine contra-indi cates the existence of inflammation-which we know to be incorrect, and which should not, therefore, pass unchallenged.

"The main conclusions established by investigations in urine, seem to be, the increase of phosphates, the occasional increase of sulphates, and the diminution of urea in a certain class of cases. Beyond that, I think, no fixed results scem to be attainable. The increased phosphates negative one proposition, namely, that insanity is dependent upon any inflamed or increased hyperæmic condition of the brain. They seem to negative that idea, because phosphates are not found in any inflammatory condition of the body. The diminution of urea seems to be almost constant in those cases complicated with

Transactions of the Association of Medical Superintendents of American Institutions for the Insane, at the twenty-first Annual Session, held at Philadelphia, May, 1867. Harrisburg, 1867. 8vo., pp. 132.

epilepsy. It is a very difficult thing, however, to get the urine to examine, and the investigations I made were made almost solely with the microscope; but with considerable practice at that time, (which I have lost now unfortunately,) that question was solved to my satisfaction, that the urea was very much diminished in the cases of mania dependent upon epilepsy, and for a short time previous, and subsequent to, the paroxysm attendant upon epilepsy.

"With regard to the quantity of alkaline phosphates found in dementia, I am inclined to think that it is dependent upon cne of the conditions consequent upon dementia, which is the retention of urine in the bladder itself. For I have found, while paying attention to one of those cases, that the patients are in the habit of wetting their beds, and that by constant care and attention in preventing that, you also prevent alkaline urine; that these patients very rarely are in the habit of fully voiding their bladders, and it is simply a mechanical result.

"The alteration of sulphates seems to depend more upon the exercise taken by the patient, than upon an acute mania; and hence where the patient is inclined to exercise freely with his muscles, you will not have it."

A paper on aphasia, by Dr. Wilbur, was read, and has already been published in the American Journal of Insanity. It is an interesting memoir on a subject which is now attracting a great deal of attention.

The greater portion of the transactions is taken up with the discussion of the subject of the Chronic Insane, and the best methods of providing for their comfort.

Dr. Reed, the Medical Superintendent of the Western Pennsylvania Hospital, among other pertinent suggestions, makes some admirable remarks relative to the criminal insane. It is certainly time that so great and wealthy a State as Pennsylvania

Annual Report of the Managers of the Western Pennsylvania Hospital for 1867.

should possess a separate institution for the reception and care of criminal lunatics. We trust the views expressed by Dr. Reed will have weight with the proper authorities.

In regard to the necessity for the early treatment of insanity, Dr. Reed says:

"Of the two hundred and forty-seven patients now in the hospital, one hundred and eighty-one were committed by the public authorities, and sixty-six are private patients supported by their friends.

"Seventy-seven had been insane at the time of admission less than six months, thirty-one less than twelve months, and one hundred and thirty-nine for periods varying from one to thirty years. Of the entire number only forty-two can be considered curable.

"Two hundred and five will remain sad mementoes of the fact, over and over again repeated by those familiar with insanity, that the successful treatment of the disease is dependent on the promptness with which the patient is subjected to the care of those who understand it, and that delay for a few months may consign the helpless victim to life-long lunacy."

Of one hundred and fifty-five patients remaining in the Northern Ohio Lunatic Asylum, one hundred and fifteen are affected with mania, thirty-eight with melancholia, and two with dementia.1 We cite these numbers because they show a remarkably small proportion in the latter class.

Dr. Sawyer gives more space to the description of the magic lantern and Drummond light than to the consideration of insanity in its scientific relations.

'Thirteenth Annual Report of the Board of Trustees and Officers of the Northern Ohio Lunatic Asylum, to the Governor of the State of Ohio, for the year 1867.

Reports of the Trustees and Superintendents of the Butler Hospital for the Insane, presented to the Corporation at their Annual Meeting, January 22, 1868.

The report of Dr. Churchman1 is an exceedingly valuable document, and contains a great deal of important information. relative to the causes and pathology of blindness, and the best means of educating the blind.

Among the causes of congenital blindness, Dr. Churchman give a prominent place to marriages of consanguinity. He says:

66

Proceeding then to a brief consideration of some of the sources of congenital blindness, or a connate tendency thereto, it would seem that among these the reprehensible practice of intermarriage of blood relations has its full share of responsibility, for in an examination of one hundred and twenty cases of congenital blindness, received into the Indiana institution, statistics upon this point being incomplete in the other institutions consulted, we find that one third are the avowed offspring of such unions, and it is believed that if correct information could always be obtained, the proportion would prove to be much greater. It is a matter of common experience among those who have attempted an investigation into this subject, that the parents and friends of blind children are often induced, by a not unnatural delicacy, to give evasive, and sometimes even untruthful answers to their inquiries. The fact here alluded to is one of great significance, and invites the serious attention of those who are laboring for the dissemination of such knowledge as lends its influence to the elevation of the human race."

Dr. Churchman's remarks on the physical and mental effects, of blindness will repay careful perusal. In regard to the means by which compensation is made, he cites the following:

"1. Through tactual impressions, made by reverberations of the intervening atmosphere upon the face and other exposed parts of the person, as well as through auditory impressions

1

Superintendent's Report of the New York Institution for the Blind, at Binghamton, for 1867