partly to the accumulation of Chinese patients in the asylums, as they very rarely recover their reason sufficiently to allow unconditional discharge, have no friends to take charge of them whilst still insane, and appear to live to the average age; and partly to the fact that the present Chinese population consists largely of the unsuccessful and hopeless classes, the cream of the population having obtained money and returned to China, whence, since the cessation of alluvial golddigging, there has been little migration into this colony.

Thirty-four Chinese patients have in six years come under my immediate care, and of these four only have been discharged, and two have returned after a short absence from Hospital. Of this number 13 were admitted for melancholia without marked delusions; 11 for delusional insanity, in which the type was melancholia in more than half the cases; and 10 for dementia. The causes of insanity in the cases in which information was obtained, were abuse of opium, loss of money, desertion of wife, starvation, and masturbation, the two former being the most frequent. Among the whole number of patients now under care one only is an epileptic, and the memories of officers who have been long connected with this institution fail to recall more than one other instance of epilepsy among this class. I have never seen nor heard of a general paralytic. The Chinese patients, as a rule, speak very imperfect English; communication with them is, therefore, difficult. The manners, customs, modes of thought and feeling of the Anglo-Saxon are altogether foreign to them, and the impression so often made on other patients by kind and timely persuasion or advice, and by association with those of sound mind, is altogether lost to them. These facts may in some degree account for the want of success in treatment.

Will

Information on insanity as seen in China would be of the greatest interest to almost all alienist physicians in the Australian colonies, and, perhaps, to many others. some medical missionary or medical practitioner in China kindly furnish it?

Case of Acquired Idiocy, complicated with Unilateral Convulsions. By KINGROSE ATKINS, M.A., M.D., Assistant Medical Officer, District Lunatic Asylum, Cork.

As the subject of epileptic and allied convulsions is just now attracting a considerable share of attention, both from pathologists and clinical observers, I think the particulars of

the following case may be of sufficient interest to be placed on record.

J. R., a lad, aged 10 years, was admitted into the Cork District Lunatic Asylum January 24th, 1874, with the following history. His mother states that her confinement with this child was perfectly natural and easy. The boy during infancy was of average development and intelligence; he began to speak when about a year and a half old, and continued to do so until three years of age, when a change became noticeable in him; he began constantly to turn his head from side to side, and shake it, and at the same time it appeared to increase in size. Co-existent with this he became quite foolish, ceasing to speak, and becoming quite cross and unmanageable. As he grew older, year by year he became very wicked, if irritated or annoyed. When he was about six years old he was seized with a fit, falling down insensible, but not being convulsed, and in a short time he recovered. About twelve months after he had another attack, in which both sides of the face and both arms were slightly convulsed, and again, in a year and a half after, he had a third seizure; and this time the convulsions were general, much more severe, and extending over a longer period. During the four years which had elapsed since the first attack his mental state had become worse; he grew extremely cross and unmanageable, biting and tearing anyone who interfered with him. His bodily health and physical condition were not at all impaired; he was as strong and active as any boy of his age, and his limbs were well developed. If not constantly watched, he was continually wandering away from home, and running into danger. About four months previous to his admission here he had another convulsive seizure, worse than any of the former attacks, from the effects of which his mother thought he would have died; the muscular movements in this attack, apparently, also affected both sides of the body. After this fit, and in consequence of his irascibility and proneness to wander away from home, if not closely watched, he was admitted here, though not exactly a suitable case for an institution of this nature.

His family history is good, the parents and other children being healthy. No member of the family had ever been insane, though the mother states that the father is of a very hot and passionate temper, and prone to intemperance.

On admission the boy appeared stout and well nourished; apparently about ten years of age. His head, though not of the hydrocephalic type, seemed rounder and fuller than normal; it measured 21 inches in circumference, 144 inches from root of nose to occipital protuberance, and 12 inches across the vertex, from ear to ear. His expression denoted want of power of attention and comprehension; he had not, however, the peculiar stare and unmeaning look of the congenital idiot, nor had he the high vaulted palate peculiar to that class. He was very restless, noisy, and unmanageable; attempted to bite and scratch anyone who went near him, and was very dirty in his

habits. He could not articulate a word distinctly, though he appeared to make attempts to do so, and was constantly uttering a sharp, prolonged cry, and at the same moment clapping his hands violently together. He evidently understood what was said to him, as when he became more docile he came when called by name.

On the evening of his admission he was attacked with a convulsive seizure, and when I saw him some four or five minutes after, he was just emerging from the fit, being quite unconscious, breathing heavily, the outer angles of the eyelids and of the mouth were twitching in a direction upwards and outwards, as well as both arms and legs, which were also slightly convulsed, but at longer intervals and in a lesser degree. These spasms soon subsided, and by next morning the little fellow had entirely recovered from their effects.

The second attack he had since coming here occurred some months ago, on the day after his mother had visited him, and was reported to have been in all points similar to that which he previously had. The next attack, and the one I wish to draw particular attention to, happened in the beginning of last August. I witnessed, I may say, the whole of the fit, as I happened to be entering the ward as he fell. He first became quite unconscious, lying on his back with his eyes directed upwards. As the convulsion came on, the outer angle of the left eyelid was drawn upwards and outwards, both eyes simultaneously moving in the same direction. Almost at the same moment the left angle of the mouth was drawn in the same direction, by the action evidently of the zygomatic muscles. As the spasm proceeded from above downwards, the left arm was jerked up and drawn across the chest, and the left leg was bent and drawn towards the body by the muscles passing from the trunk to the thigh, and at the same time the whole left side of the body was jerked upwards, and partially rotated from left to right. During the time these convulsions lasted, the entire right side of the body was perfectly motionless, not one of the muscles of either the face, arm, or leg twitching in the slightest degree. The spasms were throughout clonic, the contractions subsiding almost instantly, and recurring again with as short an interval. The pupils were widely dilated, the right one reacted to the influence of a candle held close to the eye. These unilateral left-sided convulsions lasted, from being almost momentary in the face, for about seven or eight minutes elsewhere, the intervals gradually growing longer and the spasms less severe, the pupils at the same time becoming smaller and resuming their natural size. The twitching of the eyelid and mouth continued for some minutes after that of the arm and leg had subsided, in a few minutes more the patient returned to consciousness, and in a little time was as bright and lively as before, there being no drowsiness or stupor, as is generally the case after ordinary epileptic attacks.

On October 9th he had another seizure at about 10.30 in the morning. The spasms commenced in the left side in a similar manner to the last, and after a short time subsided; however, after a few

minutes' interval, they recommenced, and this time both frontal muscles were first affected; the right orbicularis next began to work, and gradually the entire right side became severely and momentarily convulsed, the spasms being more or less irregular, and the left side not being engaged. This attack lasted until two o'clock in the afternoon, when it subsided, and the lad was as well as ever again. Since then he has had one other "right-sided" seizure, which differs from the others in that it was followed by hours of sleep, though occurring in the morning as before.

On the pathology of this interesting case few practical remarks can be offered. All that can be said must of necessity be more or less theoretical. The history and symptoms pointing to "hydrocephalus," I would feel inclined to place the case-in Dr. Ireland's classification-under the head of "hydrocephalic idiocy." I say from the history and symptoms, as although there is now no decided enlargement of the head, yet from the peculiar cry and mental restlessness, taken with the initial symptoms, the presence of effusion at one time or another may be fairly suspected. In several cases recently published, in which effusion was found both in the arachnoid and lateral ventricles, there was no increase in the size of the head, and this, I think, may be explained in this way: that as general development takes place, the head also naturally increases in size, but the brain, from being pressed upon by the fluid present, does not undergo any corresponding development, a space is naturally left within the cranium, which the effusion can occupy; and therefore the bones of the cranium, not suffering the same amount of internal pressure as they did before, will, after the lapse of several years, present an almost natural appearance, the abnormal expansion which would otherwise have taken place being compensated for by the diminished internal pressure. The convulsive seizures are evidently a symptom of disease, and the question which first, and most naturally, demands our attention, is to what are they due, and where is the lesion to which they owe their origin? As Dr. Hughlings Jackson has well said, all cases of convulsions and paralysis should be regarded "as experiments made by disease on particular parts of the nervous system of man." They are the exact homologues of the artificial experiments made by the physiologist, who, when he wishes to determine the exact distribution of a nerve, both stimulates and destroys it. Indeed, this double method of study is essential to a correct understanding of these cases of nervous disease, as a “destroying" lesion of a circumscribed portion

of the cerebrum may produce no obvious effects, while a "discharging" lesion of the same portion may produce very striking results. As an illustration of this, I may cite the case of a celebrated mathematical professor at Oxford, who up to the time of his death was occupied over the most abstruse problems, and yet on a necropsy being made, one hemisphere of the brain was reduced to a mere sac of pus, thus showing that such extensive disease may exist without the development of correspondingly severe symptoms. In fact, in all cases the convulsions, or paralysis, as the case may be, are only symptoms of the disease, and that not constant ones, as the disease itself may be present, and yet there may be no symptoms to declare its presence, or mark its progress.

Taking now the foregoing case as an example, I would say that the attempt to localise the movements present in the "fit" in some portion of the brain, is more easily done, and with a better chance of correctness, by adopting Dr. Hughlings Jackson's suggestion, and comparing the convulsions present with the paralysis present in a case of hemiplegia. Keeping in view the "left-sided fit," we see that the convulsions followed the same course, and were in the same ratio, as the palsy in a case of left hemiplegia. Now, knowing as we do from the recorded results of many cases of this disease that the "destroying lesions" causing the paralysis are situated in or near the corpora striata and optic thalami, or the surrounding convolutions, we may, with a fair show of reasoning, localise the site of the " discharging lesion" giving rise to the convulsions, and affecting similar groups of muscles supplied by the same nerves, in somewhere about the same region of the organ. To some it may seem a thing almost impossible that the cerebral convolutionsthose organs from time immemorial considered to be solely for the evolution of ideas-can ever give rise to movements, but it has now been, by the march of scientific inquiry, put almost beyond the region of uncertainty that sudden discharges give proof that sensori-motor processes are the anatomical substrata of ideas. Granting now, from the results which this comparison affords, that the locus of origin of the convulsions lies in some of the convolutions of the corpus striatum, we have next to inquire what is the nature of the discharging lesion causing these convolutions, a task even more difficult than the last, as here we are entirely in the region of speculation. Are the convulsions the result of a local irritation from a collection of fluid, tumour, &c., or