to when I proceed to a consideration of the exaltations of special sensibility, viz. :— a. Vision. B. Hearing. S. Touch. Epileptic Vertigo.-Physiologists have described various types of vertigo. 1. When the body appears to move backwards and forwards. 2. In which the movement seems to be on one side. 3. When the illusory sensation is rotatory. It is not my intention to consider in detail these various phases of vertiginous sensation. In all affections of the brain, the sensation of illusory movements, termed vertigo, or giddiness, stand prominently forward among the significant and important incipient symptoms. In some respects it is more characteristically diagnostic of serious cerebral disease, organic and functional, than that of headache, even in its more acute form of manifestation. If the vertigo be clearly an idiopathic encephalic affection, and not, as is often the case, symptomatic of some form of stomach, heart, hepatic, visceral, renal, or blood disease, we may infer that the state of the brain is entitled to careful pathological analysis, and earnest therapeutic consideration. This phase of disordered sensibility, when not obviously arising from the above causes, or connected with states of poisoned blood, resulting from retained excretions, or presence of a toxic agent in the vital fluid, generally indicates serious disturbance of the cranial circulation, and is frequently dependent upon a want of normal balance in the amount of blood distributed to the various sinuses as well as to the venous and arterial cerebral vessels. The cerebral type of vertigo is easily diagnosed by the absence of those affections of other organs which sympathetically disorder the brain, such as gastric and hepatic derangement, loss of blood, and long-continued, exhausting discharges from various parts of the body.* The most important form of vertigo is undoubtedly that associated with obscure and often hidden types of epilepsy, and it is to this form of neurosis of sensibility I am particularly desirous of directing special attention. 'Vertigo, or giddiness," says Dr. Clutterbuck, "though unattended with pain, is, in general, of a more dangerous nature than the severest headache. Vertigo consists in a disturbance of the voluntary power, and in some degree of sensation, especially of vision; and thus it shows itself to be an affection of the brain itself; while mere pain in the head does not necessarily imply this, it being for the most part an affection of the membranes only. In vertigo, objects that are fixed appear to be in motion, or to turn round, as the name implies. The patient loses his balance, and is inclined to fall down. It often is followed immediately by severe headache. Vertigo is apt to recur, and thus often becomes frequent and habitual. After a time the mental powers become impaired, and complete idiocy often follows, as was the case in the celebrated Dean Swift. It frequently terminates in apoplexy or palsy, from the extension of disease in the brain. "Vertigo is induced by whatever is capable of disturbing suddenly the circulation of the brain, whether in the way of increase or diminution: thus the approach of syncope, whether produced by loss of blood, or a feeling of nausea; blows on the head, occasioning a concussion of the brain; stooping; swinging; whirling; or other unusual motions of the body, as in sailing, are the ordinary exciting causes of the disease. Vertigo is exceedingly frequent at an advanced period of life, and generally indicates the approach and formation of disease in the brain. Accordingly, it is a frequent forerunner of apoplexy and palsy. "The immediate or proximate cause of giddiness, or vertigo, that is, the actual condition of the brain at the moment, is probably some partial dis turbance in the circulation there; which all the occasional causes mentioned are obviously calculated to produce. It is more or less dangerous, according to the cause inducing it, and the state of the brain itself, which may be sound or otherwise. And as this cannot be certainly known, nor the extent of it when actually present, the event is of course uncertain. At all times, your prognosis should be guarded; because vertigo seldom occurs under favour able circumstances of age and general health; uniess when produced by so slight a cause as bloodletting, or a trifling blow upon the head. Whenever vertigo recurs frequently, and at an advanced period of life, and more particularly when it is accompanied with drowsiness, weakness of the voluntary muscles, impaired memory or judgment, or, in short, any other disturbance or imperfection in the state of the sensorial functions, an unfavourable result is to be expected; because all these afford decisive evidence of a considerable degree and extent of disease in the brain." This type of epilepsy has been termed by the French pathologists, the Petit-mal, and, by English writers, epileptic vertigo. It is observed, at all periods of life, in various degrees of severity. It is a common affection of childhood, and often, before its existence is suspected, fatally damages the bodily health and undermines the intelligence. Much of the defective and enfeebled intellect observed among children, associated with great disorder of the general health and impaired vital and nerve force arises from this subtle and mischievous phase of epilepsy. In the majority of cases, particularly in adults, these attacks of pseudo epilepsy are unassociated with any form of convulsive action. The patient never falls down in a characteristic fit, neither is he deprived for any length of time of consciousness. The malady exhibits itself at all periods of the day, and in all possible positions of the body. The fit occurs in the middle of the night, during the transition state between sleeping and waking, early in the morning on first rising, during meals, whilst engaged in conversation, and when walking in the streets. The patient, for a second or two, and occasionally for a longer period, is seized with severe vertigo, and momentarily loses his consciousness. This disorder of sensation often developes itself whilst the patient is actively engaged in his accustomed vocation. I have known clergymen attacked whilst preaching in the pulpit, merchants when engaged at the desk, or on the Stock Exchange, barristers whilst addressing courts of law. I have in many cases traced the malady back for a period of some years, manifesting itself under all conceivable physical and mental conditions. This affection is rarely considered of an important character, until the bodily health and mental condition of the patient begin to be affected. It is then dis covered that the invalid has been subject for a lengthened time to undetected and unobserved attacks of epileptic vertigo, which have been considered either as symptomatic of a disordered state of the stomach or liver, or as simple fits of ordinary syncope. We may observe "It is scarcely possible," says Trousseau, "to describe these epileptic attacks except by examples. In childhood, when it is especially common, it may manifest itself thus: The child stops short in the middle of its play, remains motionless, with fixed eye and suspended respiration, returning to itself after seven or eight seconds, and sometimes hardly two. analogous examples in the adult. A person while playing at cards finds the movement of his hand suddenly arrested when about to play, the card remaining in his hand as if affixed to it. A deep inspiration occurs, the suspended movement is completed, and the vertigo has passed away. At other times the patient rises, walks he knows not where, striking against objects, and stops short at the instant he returns to himself. At others he mumbles some unintelligible words, or repeats the same word, as his own name, obstinately, during seven or eight seconds. In all these cases the individual is completely without the external world. Sensation is abolished, and we may shake or pinch him without his feeling anything. In certain cases, as in a patient now in the wards, the vertigo is announced by a peculiar sensation, to which authors have given the name of aura, and which, in the great majority of cases, consists in the feeling of a current, that mounts up from one of the limbs, or some other point of the surface, towards the head. At other times there is a sensation of pain, of formication, or of little imperceptible convulsive shocks. In a great number of cases these phenomena constitute the entire affection, and deserve the name of epileptic vertigo. At others, they go on increasing until the fit itself occurs, and then it is usually by the thumb that the aura commences. But the fit is only preceded by the aura quite exceptionally." A child, five years of age, was brought for M. Trousseau's advice. Several times a week, and more than once a day, the child became the subject of hiccough, which, accompanied by remarkable paleness, lasted for several seconds, and never more than a minute, headache and hebetude succeeding. M. Trousseau, alone in his opinion, pronounced this epilepsy, and a year after the child had regular epileptic fits. At other times," says the same authority, "epilepsy manifests itself by a marked sensation of cardiac suffocation. The patient, seized with most violent palpitations, becomes extremely pale, and loses all consciousness. In ordinary palpitation, consciousness is always preserved; and it is well to be aware of these palpitations in the epileptic, since the patient complaining only of his heart, an erroneous idea of the nature of the disease may be easily formed. "Disturbances of the intellect are very frequent after the epileptic fit, and they are also met with subsequent to the vertigo. The head is heavy and aching, the patient being morose and taciturn, and as if stupified for a while for a half or whole hour. For the purpose of diagnosis, it is of extreme importance to observe these changes; for we find them as a consequence of no other nervous spasm, however violent it may have been. There may be exhaustion after a violent fit of hysteria, but the intellect always remains very clear. This relative confusion of the mental powers may escape the physician's attention, but it is very rare for it to escape that of the patient or his relatives, so that they should be always interrogated upon this point. "There is nothing special in the vertiginous form, as it depends upon the same causes as the fit; and very often |