Clinical study of a recently observed phenomenon, i.e., analgesia of the ulnae nerve (Biernacki's sign) in the epitroch lear space, between the internal condyle of the humerus and the olecranon. One hundred and thirty epileptics, including 30 females and 50 males, were observed. Of the 80 females, 40, or 50 per cent., showed normal ulnar-nerve symptoms on both sides. In 11 cases, or 23 per cent., there was diminished sensibility on both sides. Normal sensibility of one side only was present in 9 cases, while there was complete analgesia on both sides in 14 cases, and complete analgesia on one side in 10 cases. Thus there were 55 per cent. normal nerves, 20 per cent. with diminished sensibility, and 24 per cent. with complete analgesia. In 50 male epileptics 58 per cent. showed normal sensibility, 28 per cent. diminished sensibility, and 14 per cent. were anal gesic. This symptom should not he con sidered as one of the stigmata of epi lepsy. As a helpful sign in the diagnosis of hysteria from epilepsy, however, it may have some value. Lannois and Car rier (Revue de Died., Nov., '99).
Syphilitic epilepsy may be recognized from the history of infection, together with a history of the symptoms, which are, with remarkable constancy, pre monitory of syphilitic invasion of the brain. Unless the epilepsy develops in early or middle life, without other as signable cause, the first convulsion hav ing been preceded by periodically-recur ring headaches of evening onset and nocturnal exacerbation, associated with marked insomnia, or, less often, somno lence, with general malaise, and irritabil ity of temperament, the diagnosis of syphilis, as a source, should be rejected in spite of a history of infection. If this prodromal syndrome be present, it should be strongly entertained in spite of a denial of infection.
Etiology.—Heredity, age, sex, occupa tion, and the history of previous or co existing disease, or injury, are all factors demanding investigation in determining the etiology in every case of epilepsy.
Heredity is remarkably common as an etiological factor, especially in idiopathic epilepsy.
Two cases of epilepsy in which there was a shortening of the humerus on one side of the body, and attention called to the fact that there has been but one other case of epilepsy reported in which this stigma of degeneration is empha sized. L. P. Clark (N. Y. Med. Jour., May 13, '99).
Epilepsy is a symptom of some brain its continual presence tends toward mental deterioration. The men tal responsibility of the epileptic depends upon the extent to which mind or self has been impaired by the epi lepsy. The legal test of insanity is not
sufficient, as mental irresponsibility is not incompatible with a knowledge of right from wrong. Epileptics are, to some degree at least, responsible for criminal acts, more especially when the epilepsy is produced by their own fault. Criminal acts of epileptics appeal to medicine rather than to law for their proper adjudication. ln all cases of murder in which epilepsy is proven the law should be amended to allow of like commitment to an insane hospital rather than to the penitentiary. The mental responsibility of the epileptic in case of murder should be referred to a medical commission, appointed by the court, which again may be referred to local or comity medical societies to name its members. John Punton (Med. Record, Nov. 15, 1902).
Heredity is variously estimated as present in from 15 to 50 per cent., Ham ilton believing that it exists in one-half of all cases. It should be borne in mind, however, that he included immediate and collateral ancestral phthisis and apo plexy as evidences of heredity, which is not admitted by most clinicians. Epi lepsy itself in the parent or grandparent or brother or sister is quite frequent. I have found parental epilepsy alone in 15 out of 77 cases. Insanity, migraine, al coholism, consanguinity of parents, and major hysteria are among the more com mon ancestral taints observed. In Gowers's table of 1450 cases heredity peared in the history of 36.6 per cent.
As regards age, epilepsy is peculiarly— though not exclusively—a disease of childhood and early life.
Study of 120 cases of epilepsy in 7 of which there was a history of typhoid fever. In 4 of these there was entire absence of family tendency toward nerv ous disturbance or personal history of any such conditions as infantile convul sions which might have been the cause of the epilepsy; it seemed, therefore, probable that typhoid fever was the cause of the disease. They had had typhoid fever shortly before the outbreak of the epilepsy, and the fever had been severe and accompanied by violent delir ium. Typhoid may act as an accidental exciting cause in those predisposed by hereditary influence and in those predis posed by infantile affections, as convul sions, etc., or in a certain number of cases it does of itself cause the disease, probably from the effect of toxins. Hide (Revue de MCA., Feb. 10, '99).
Of Gowers's cases, 422 occurred under the age of 10 years, and 10S7 under the age of 19 years.