I have a much larger number of cases occurring in private practice, but, for that reason, am obliged to omit them. I shall, however, when a longer time has elapsed, publish them. CHAPTER VIII. IDIOTCY AND INSANITY, WITH CASES. As epilepsy is a much graver disease than hysteria, so is the sequel of the former—dementia or idiotcy—much more permanent and difficult to be removed by treatment than insanity, which is the ordinary sequel of hysteria. I shall give but one case of idiotcy, because I regret to say that I have never yet been able to thoroughly restore the mental powers in any patients suffering from this dreadful affliction. Epilepsy is such a chronic disease, and seems to me to produce not only weakening of the mind, but to cause it to be often entirely lost, that, although we may get, as in the following case, a temporary re-kindling of the mental energies, I fear we are not yet able to give much hope of complete recovery. Even here, however, I have such faith in the efficacy of perseverance in constant watching, that I am almost inclined to believe that, had this patient been in a condition of life to ensure vigilant medical supervision for a lengthened period after operation, we might at last have succeeded in, if not complete, at least, much creator restoration than in a public institution, or to those in humble circumstances, the surgeon is in a condition to promise. CASE XLII. EPILEPTIC FITS, WITH COMPLETE IDIOTCY—OPERATION—GREAT TEMPORARY RELIEF, BUT NOT PERMANENT BENEFIT. Mary J., æt. 19, single; admitted into the London Surgical Home Feb. 15, 1864. This patient was brought to me by Dr. Marley, with the following account:— “Has the appearance of a child of 10 or 12 years old; mammæ not developed; has had epileptic fits ever since 12 years of age. Is now almost idiotic; stares vacantly; slobbers at the mouth; passes her motions anywhere, without regard to common decency, and cannot retain her urine. I find from her mother that she is incessantly irritating her genitals. Her fits vary in frequency, from two or three a day to four or five a week. Being satisfied of the cause of her fits, I sent her to you.” _History_, taken at the Home from her mother.—Had perfect health until she reached her eleventh year; was forward in her lessons, and well educated for her age and position. At this time she was suddenly seized with a severe fit, for which no cause could be assigned. A period of two years elapsed before she had a second, when, being placed under medical treatment for eighteen months, she had great relief. Since the expiration of that time to the present she has constantly suffered from fits.