Epilepsy is a functional nervous disorder, which may often be considerably improved by careful attention to diet. A very large proportion of cases occur in childhood at a period when existing functional derangements of the nervous system are readily aggravated by improper food. Many rhachitic children with imperfect development of the teeth, feeble digestive organs, and consequent malnutrition develop epilepsy while teething. Of twenty-seven cases occurring among children recently analysed by Osier, more than one half developed before the fifth year and more than three fourths before the tenth year. Very many cases are closely associated with errors in diet or affections of the alimentary canal, and while such conditions may not cause the disease, they readily precipitate epileptic seizures. This statement applies to grand mal and petit mal rather than to the localised or partial convulsions known as Jacksonian epilepsy, which are due to local and definite cortical motor irritation. Of the varieties of epilepsy, petit mal is more favourably influenced by diet than are the other forms.

Patients should have their eating supervised with care. They should be well fed, but must eat only easily digestible food and have their meals at regular intervals, and the principal one must be in the middle of the day in order that digestion at night may be completed before going to sleep. All food should be eaten slowly, and meat, if given, must be very thoroughly masticated, and the stomach should never be overloaded.

As a rule, meat should be allowed but once a day. Some children with petit mal, or even grand mal, improve rapidly on a strictly vegetarian diet or on a bland diet of which milk, bread and butter, and simple starchy foods, such as rice pudding, cornstarch, Indian-meal pudding, etc., form the basis. I have seen cases of epilepsy among young children in which, while the medicinal treatment remained constant, a return to meat diet was invariably followed by convulsions, which were absent on a vegetable or exclusive milk regimen.

As a rule, adults do not seem to be aided by dieting to such a degree as children; nevertheless, they do well to take but little meat and to be abstemious and regular in their habits of eating. Dr. Mersan, of the West Riding Asylum, in England, tried the experiment of putting a number of chronic epileptics for some weeks first upon a diet of flesh and then upon a vegetable diet, and vice versa. The results showed that their convulsions were not materially lessened in number or severity, but it was noticed that while their food consisted largely of meat their mental condition was more stupid. At the epileptic colony of Chalfont St. Peter, the patients are allowed meat once a day, but all the inmates are men, leading an active outdoor life, and hence better able to digest stimulating pro-teid food. Gowers allows his patients meat twice a day, and asserts that he has seen cases in which fewer epileptic seizures occurred while eating flesh than when abstaining from it. One patient had paroxysms only after eating beef, but not in connection with other varieties of meat. It is evident that no definite rule should govern all cases.

It is worth while to reduce the nitrogenous food for a month or two, and if improvement does not follow, or nutrition becomes less active, it may again be added to the dietary.

Dr. Whitmore Steele, formerly of the Utica State Asylum, in speaking of the treatment of chronic epilepsy at that institution, informs me: "We endeavour to reduce the amount of albuminous foods, giving a more liberal and easily assimilated diet also. Invariably overalimentation in our epileptics produces attacks." Epileptics will often gorge themselves with food and drink if allowed to do so.

Some of the carnivores, as well as animals accustomed to a mixed diet, develop convulsions from a too liberal allowance of meat, if at the same time they are kept in confinement. In these cases, however, the convulsions may be due to reflex irritation from the stomach or bowels, produced by large masses of slowly digested food, rather than to the chemical nature of the food. The same thing may occur in young children who are allowed to gorge themselves with any hastily eaten bulky diet, and the resulting convulsions should not be confounded with genuine epileptic seizures accompanied by loss of consciousness, and recurring periodically. Some patients have a distinct epigastric aura preceding the convulsions.

It is extremely desirable to prevent intestinal putrefaction.

Should the stools become offensive, or much flatulence or indi-canuria appear, the patient should be given a milk diet for a week or two, and cathartics and intestinal antifermentatives should be employed, such as salol, creosote, or guaiacol carbonate.

Many are obliged to take large doses of the bromides and other medicines. It will be found that the disagreeable symptoms of bromism are much less apt to occur if the diet be so regulated as to carefully avoid constipation and to insure the consumption of abundant fluid diluents. Vichy or carbonic-acid water and water should be drunk freely between meals, and especially after taking medicine, and daily thorough evacuations of the bowels should be secured by the use of fresh vegetables and fruits, prunes, figs, apples, oranges, etc. Adults should abstain from agents which are likely to over-stimulate the nervous system, such as alcohol and strong tea and coffee. The use of tobacco should also be interdicted.