The following pages contain an account of the microscopical examination of the central nervous systems of forty-one cases of idiopathic epilepsy, which form the data on which I base my thesis that epilepsy is a disease occurring in persons with a defect of the nervous system either congenital or involutional, and in whom also there is an abnormal state of the blood, characterised by a special tendency to intravascular clotting, and that the fits, whether of the nature of grand mal or petitmal,owe their exciting cause to sudden stasis of the blood stream in some (generally limited) portion of the cortex, resulting from the blocking of cerebral cortical vessels by these aforementioned intravascular clots. I have already in a paper read at the pathological meeting of the Neurological Society in December, 1905, and published in the British Medical Journal March 3rd, 1906, given a short account of my views, but it was impossible in the limit of time at my disposal when reading the paper to deal in any but a very cursory way with many interesting aspects of the question, nor could I then give sufficient details of the microscopical examination of the individual cases.

This class contains sixty-five cases of presenile dementia–i.e., of insanity ending in dementia, and occurring between the periods of maturity and of senility. Of the 728 cases of insanity under consideration, the present class, therefore, includes 9 per cent., and of the 445 cases of dementia 14.6 per cent. Though attention has already been drawn to the distinction which is necessarily made between “presenility,” an age-period in all individuals, and “prematurely induced senility,” it is perhaps permissible to remark here that cases of the latter type have been included in the class of “senile or ‘ worn-out ‘ dementia,” which was described and illustrated in the last section of this paper.

When a few months since I was asked by Dr. Bedford Pierce to address the nursing staff of this time-honoured institution it was a moot point in my mind whether I should take as my thesis some general subject connected with the history and profession of nursing or direct my remarks to you in a more personal appeal than so general a theme would permit.

In his paper on “Amentia and Dementia “Dr. Bolton has intercalated such a vigorous dissent from some of my speculations on the localisation of cerebral function, and a complaint so bitter of my criticism of some of his earlier researches, that I am forced to offer a defensive response.

The extension of the scope of the Royal Commission on the Feeble-minded has unexpectedly brought the desirability of an increase in the strength of the Lunacy Commission under consideration. The Report of a Royal Commission is not soon issued, and its recommendations are not usually acted on with precipitation, so that the hoped-for change may still be far distant.

The Inland Revenue returns show a steadily progressive decrease in the consumption of beer and spirits in the United Kingdom since 1899; that is in encouraging contrast with the equally steady but more rapid increase up to that date.

It is agreed that all statistics require careful reading, but those relating to insanity are more exposed to misreading than are most others. The following abuse of statistics is so grotesque that it would not be worth criticism had it not tended to cause unnecessary alarm and mischief.