DR. W. B. Fletcher, Superintendent of the Indiana Hospital for the Insane, Indianapolis, reports, in the American Journal of Insanity, October, 1887, 8 cases of trephining for traumatic epilepsy. In these cases insanity did not occur at or near the time of the injury, but some years afterwards. In 3 cases epilepsy preceded the insanity, but remote from the time of the injury. In all but one (and in that case the injury was most extensive in appearance) very strong adhesions to the dura were found. All the patients were, at the time of the operation, melancholic, suicidal, profane, and 4 destructive to clothing; none are so now.
"I believe," says Dr. Fletcher, "that in traumatic injury, in which sunstroke is included by most authorities, the pain and reflex nervous affections most frequently arise from the inflamed and adherent dura, at points where one of the three sensory branches