when the case is tried, the opinion of one medical man is supposed to be as good scientific testimony as that of another. The Court and jury, knowing nothing of the scientific merits of the question, so ignorant of its very elements that it is impossible they should be instructed during the brief period of the trial, have no means of appraising the relative value of the opinions given, and when they find a conflicting testimony, take no account of the medical evidence. So it comes to pass that the trial is no better than a solemn farce. And yet in most of the cases in which the medical testimony is conflicting, it is perfectly certain that a proper tribunal would have no difficulty in arriving at the truth. Certainly, had the judge in the Duncan Will Case been assisted by the competent advice of an eminent physician sitting by his side as assessor, the medical testimony would not have occasioned him any trouble. Whatever lawyers may think of the disagreement of doctors, we can assure them that definite medical knowledge does exist, and that much medical evidence which is given now because its worthlessness easily escapes exposure, would never be given before a competent tribunal.

We should not have referrred to this case, which has no scientific importance-which seems to us of interest only to Americans, as it concerns medical morality and the administration of justice-had not Dr. Ray's article brought back to our recollection that in May, 1872, we were asked for an opinion on the case. The opinion, given in writing, in answer to questions, the purport of which will appear from its tenour, was as follows:

I have perused carefully the evidence taken to sustain the will of the late Thomas G. Duncan, which has been submitted to me-namely, the evidence of Joseph Ferris, draper, and of Robinson Scott, Wesleyan minister, who were witnesses of the will; of Thomas H. Pardon and William Aitken, the physicians who attended Thomas G. Duncan during his last illness; of James Stewart, law clerk, and James Rhea, U.S. Consul at Belfast; of James Lindsay and Mrs. Lindsay, together with a report of the post mortem examination by Dr. Murray.

The report of the post mortem examination proves that Thomas G. Duncan died from disease of the heart and lungs. The morbid appearances described in these organs are quite consistent with the existence of a sound state of mind. They would not, by themselves, warrant a suspicion of any failure of mind.

The brain itself is said to have been free from disease, and the opacity of the arachnoid membrane over both hemispheres, though often observed in the bodies of those whose minds have been

affected, is sometimes met with in the bodies of those in whom there has been neither mental derangement nor mental weakness.

The symptoms exhibited during life were such as would naturally accompany the morbid conditions found after death. The difficulty of breathing, the inability to lie down in bed, and the lowness of the voice were attributable to the state of the heart and lungs. The wish to return to America a few days before his death, when he was manifestly unfit for such a voyage, seems to have been such a longing as is sometimes exhibited by dying persons, who believe, in spite of assurances to the contrary, that they might recover if they were only back in the scenes of their youth or of their former activity and health. It may be presumed that the increasing weakness of body during the last few days of life, and a probable deficient supply of blood to the brain in consequence of the diseased state of the heart, had in some degree impaired his judgment and affected the vigour of his mind.

Whether the provisions of the will indicate entirely free and rational action will, of course, depend somewhat on what were the testator's former relations to his brothers, and to those persons to whom he has left the bulk of his property.

The medicines which he was taking up to the time of his death were not of a character to affect the mind.

Judging from the data supplied in the evidence of the witnesses, and in the report of the post mortem examination, I do not perceive valid reasons for supposing that the will signed on the 20th May, twelve days before death, was not the voluntary act of a person of sound mind.

The gentleman who did us the honour to request our opinion upon the evidence, and who introduced himself as a Judge, was, we fear, disappointed with the result. We have heard no more of him since. He no doubt believes that English physicians give gratuitous advice to their American cousins. H. M.

CLINICAL NOTES AND CASES,

Bromide of Potassium in Epilepsy, by P. NORTON MANNING, M.D., Inspector of the Insane in New South Wales.

In the "Practitioner" for January, 1874, the late Dr. Anstie related a case of Epilepsy "cured" by Bromide of Potassium as the solitary instance within his own experience in which well-developed fits were completely stopped and remained absent long after the discontinuance of the medicine, and mentioned that Dr. Hughlings Jackson, whose general experience on this subject was in substantial agree

The com

ment with his own, had never seen such a case. bined experience of Dr. Anstie and Dr. Hughlings Jackson must have extended over such a wide field that I do not doubt but that the two following cases, in which Bromide of Potassium, in combination with Cannabis Indica, appeared to 66 cure "well-marked and established Epilepsy, will be interesting:

The

Wm. J. B., æt. 6, was admitted into the Asylum for Imbeciles, &c., at Newcastle, N.S.W., on February 5th, 1872, from the Catholic Orphanage at Parramatta. The Lady Superior, who was not able to give any information as to his parents, stated that he was one of two brothers who had been for upwards of two years under her care, and that he was a bright, intelligent boy. The first epileptic attack came on without apparent cause six months before his admission to the Newcastle Asylum, and was very severe; the subsequent attacks were frequent and severe, and the lad slowly became imbecile. Visiting Medical Officer of the Orphanage, in signing the necessary forms for admission, described him as extremely imbecile, and quite incurable. On arrival he was found to be very weak-minded, dirty in habits, and partially paralysed in the lower extremities; the fits were very frequent and severe, and no peripheral cause whatever could be detected. After admission he slowly retrograded until early in July, 1872, when special treatment was commenced by Mr. Richard Harris, the Medical Officer of the Asylum, to whom I am indebted for notes as to the treatment of the case. Fifteen grains of Bromide. of Potassium, with fifteen drops of Tincture of Cannabis Indica, were given three times daily; the fits soon became less frequent, and at the end of four months, during the whole of which time the treatment was steadily continued, had quite ceased. With the cessation of the epileptic paroxysms there was decided improvement in both mental and bodily power, and by the end of the year health had been completely re-established. In April, 1874, treatment having been for many months discontinued, and the fits remaining absent, I concurred in recommending his discharge from the Asylum, and he returned to the Orphanage, where he has remained quite well up to the present time.

T. B., æt. 17, was admitted into the Hospital for the Insane, Gladesville, N.S.W., on June 9th, 1873. He had been an epileptic for eleven years. The fits at first occurred at rare intervals, but had latterly became much more frequent and severe, and decided failure of mental power had supervened. On his admission the manner was dull and heavy, and the memory much impaired. The epileptic fits were frequent and severe, occurred both by day and night, and were often preceded by an "Aura" consisting of pain and twitching in the right hand and arm. No peripheral cause could be discovered, and the

assigned cause, an injury to the head occurring three years before the fits commenced, and leaving no scar, was more than doubtful. After remaining under my immediate observation for six weeks, the patient was transferred to the Newcastle Asylum, and Mr. Harris at once placed him under treatment consisting of Bromide of Potassium and Tincture of Cannabis Indica, in half-drachm doses, three times daily. He had no fit after commencing to take the medicine, which was continned for eight months. The mental condition greatly improved, and the patient showed himself aware of the benefit of regular treatment, and applied for an extra dose of medicine on the occurrence of any threatening symptoms. The patient was discharged in April, 1874. He has since lived at a short distance from the Newcastle Asylum, and up to the present time has remained quite well. His father, in a letter received a few days since, speaks of him as quite well, and as "never having a fit or a sign of one," since discharge.

With respect to the general value of Bromide of Potassium in Epilepsy, the experience of Mr. Harris at the Newcastle Asylum, as well as my own in the Gladesville Hospital, is largely in its favour. In all except a small number of cases the frequency and severity of the paroxysms are much reduced, whilst the health improves under its administration. In a considerable number of cases in which fits occurred three or four times daily they have been reduced under treatment by the Bromide to one or two a month, whilst a great improvement in general health has been coincident with this marked diminution in the number of epileptic paroxysms. It has always seemed to me much more efficacious in combination with Cannabis Indica than alone, and much more serviceable in children than in adults, and in young adults than in old ones. In a small number of cases, whilst diminishing the frequency of the fits, it has seemed to increase their severity, and caused the collection into one paroxysm of the mental and bodily disturbance which before found vent in a series, but I am quite unable to point out anything to distinguish these cases, except that they are, as a rule, if not always, adults of at least 30 years of age.

The Proportion of Epileptics to the Ordinary Asylum

Population.

The proportion which Epileptics bear to other patients in asylums was suggested as an interesting subject for report at the meeting of the Medico-Psychological Association held in August, 1873. As nearly the whole of the insane in this colony are collected in four institutions, the number living

with friends being extremely few, as none are sent for treatment to institutions beyond the limit of the colony, and as the census was taken with great accuracy, and great care taken in subsequent estimates of changes in the number of the population, the information on this head was easily collected, and is valuable as being more definite and exact than could be furnished by the majority of superintendents of British Asylums.

The following return shows the Proportion of Epileptics to the Asylum Population in New South Wales on December 31, 1873 :

Totals

942 584 1526 80 42 122 1 in 11.77 1 in 13.90 1 in 12:51

The percentage, as will be seen, is-Male 8.49, female 7·19. Total 7.99. The very little difference in the proportion in the two sexes, and the total absence of Epilepsy among the patients in the Criminal Divisions of the Parramatta Asylum, are curious facts.

The total population of the colony on December 31st, 1873, was 307,329 males and 252,946 females, a total of 560,275, the proportion of insane persons being 1 to 367 of the population.

Chinese Lunatics.

The total number of Chinese patients in the Asylums of New South Wales on September, 30, 1874, was 47, and their proportion to the Chinese population of the colony, which has been estimated by the excellent returns made to the Registrar-General with great accuracy, was 1 in every 140.

This enormous proportion is no doubt due partly to the decrease in the Chinese population of the colony through return to China, which, in the decennial period 1861-71, was 44.41 per cent., and which has gone on steadily ever since;

Those classed as convicts were originally deported to this colony, became insane before the expiry of their sentences, and are still at the charge of the Imperial Treasury. They are mostly aged patients.

The criminals are confined under the Criminal Lunacy Statutes in force in the colony, and include a certain number of Queen's pleasuremen.