certain noticeable limitations rather than aberrations. The patients lack initiative; they are restricted in their ideas and tedious in their expression of them. Memory is unimpaired; intellection, within the limits of the patients' capacity, is fair; they appear to have no disturbances of consciousness whatever in the intervals between their fits. With this, however, there is often, and one may say generally, an irritability of disposition. and a certain loss of self-control, showing itself in attacks of temper or an unpleasant peevish disposition. It is often said that the first signs of mental disorder in epileptics are seen in a change of character, and a special type of perverted emotionalism and disposition has been described as characteristic. According to this view, epileptics are generally in this stage either vicious and violent or cajoling and treacherous; in either case liable to violent explosions of temper and unreliable. This is true only to a certain extent; there are many epileptics who are of these types, and there are more, in our opinion, who are not. Even the characteristic irritability is not by any means universal; there are many mentally affected epileptics who are actually insane at times, whose disposition and character are excellent, and the general charges made against them as a class do not do them justice.

In many more abnormal cases the weak-mindedness passes into decided dementia of the stupid order, memory, general intelligence, going together by the board, till in the final stages the patient simply lives a sort of vegetative existence, unable to even care for himself in the slightest matters. This, however, is not characteristic epileptic insanity; it is simply an organic dementia of epileptic origin, of which it retains no special trace, except perhaps a still-retained peculiar irritability and the recurring convulsions.

The characteristic insanity of epilepsy is that directly connected with the attacks and coloring to a

greater or less extent the intervals between them. In a very large proportion of cases we can hardly call these patients insane during these intervals; they are rational; fairly intelligent; their recollection of events occurring during this stage and of previous events is good; they understand their condition and are willing often to do what they can to mend it; they exercise more or less self-control; in short, they are rationally sane individuals in all or nearly all respects. In some cases, indeed, one cannot call them at all insane or abnormal during these intervals, though they may be dangerously so, at times, in connection with their attacks. In many other cases, however, and in most after long continuance of the disease, there is a mental state or disorder of the intervals as well as of the attacks. Sometimes this is only a mild grade of dementia; the patient is simply weak-minded or semiimbecile, often amiably so, but more often irritable and liable to fly into a violent passion on the slightest provocation, which renders him to some extent dangerous and requiring restraint. Frequently both qualities are combined; the patient is jovial and happy as a rule, but "ready to fight at the drop of a hat," as the saying is. One such patient, a happy, careless-dispositioned epileptic with very moderate signs of dementia, told the writer, we believe truthfully, that he had served at least forty bridewell sentences, mostly for fighting and disorderly conduct. His scalp was one mass of scars, largely, if not solely, obtained in this way, but in the asylum, under judicious management, he was a very tractable and useful individual.

Very often, however, the condition between fits shows a more manifest change of character or abnormality, and this has rather formed the popular opinion of the epileptic, as an unpleasant and morally as well as mentally deteriorated individual. We must remember that the chief symptom is irritability and loss of control

to a large extent, and this, superimposed upon the natural disposition, handicapped by the disease, and often aggravated by bad management and misunderstanding, and often by actual maltreatment, is not a favorable condition for the development of the more amiable traits. It is not surprising, therefore, that the epileptic is considered a rather unamiable character; it is more surprising that we find so many who are not such. Add to this irritability a certain degree of mental weakness, and the chances of unpleasant modifications of the natural disposition are increased. Many epileptics suffer from occasional hallucinations connected with their attacks of acute mental disorder, which will be described later, and these have sometimes an influence over them in intervals between. There is sometimes an offensive egotism, but this is no more frequent in these patients than in most other forms of chronic mental derangement, and it must be said in favor of the epileptics generally, that they are rather more sympathetic toward each other and toward others than the insane generally. Their inconsistent religiosity that has often been noticed to their disparagement is, in many cases at least, only evidence of an honest attempt to better their lives, baffled by their infirmities. It is not uncommon in asylums to see explosions of violent temper with profanity in patients when disturbed, for example, at their somewhat ostentatious devotions, and this has been remarked upon, somewhat unjustly, to their discredit. We have known violent, irritable epileptics to voluntarily seclude themselves on this account, and forego many privileges they appreciated, to avoid provocation that might cause acts they regretted. In some cases, it is true, there is developed a vicious or excessively disagreeable disposition; they are unreliable and treacherous, or peevish and childish, always wanting and asking sympathy or demanding attention in a most persistent and offensive way.