222 THE PITUITARY, THYROID AND ADRENALS AS A SYSTEM. 



operations referred to, including those in epileptics, must have 

 been performed within three years. If the history of these 

 epileptics is studied from our standpoint, the 6 patients who 

 died "either in epileptic attacks or as a result of an inter- 

 current disease" are to be included in the series "carefully 

 followed," and we have as a result, 25 cases which, within three 

 years, showed a mortality of 24 per cent. In other words, 

 nearly one-fourth of the cases operated succumbed within that 

 time, and, as all -the operations were not performed during the 

 earlier months of the three years, it stands to reason that some 

 of the 6 must have died within a shorter time subsequent to 

 the surgical procedures. This in no way reflects upon Jon- 

 nesco's records, since he only refers, in keeping with the present 

 custom in this particular, to the immediate effects of the opera- 

 tion, while we are studying remote results from a new stand- 

 point. Why this great mortality? 



Can we conclude that, in every series of 25 unoperated 

 cases of epilepsy, 6 die "in epileptic attacks or as a result of 

 an intercurrent disease" within such a short period, and say, 

 with Jonnesco, when referring to the remote effects of bilateral 

 resection of sympathetic ganglia, "there are none"? He can 

 legitimately say this, referring, as he does, to the trophic psy- 

 chical and general well-being of the patient immediately after 

 the operation; but, as is well known, such a mortality does not 

 attend idiopathic epilepsy. Although the occurrence of death 

 during attacks cannot be said to be rare, it is too infrequently 

 observed to enable us to ascribe the lethal results over and 

 above the usual ratio to this cause. Evidently the operation 

 must exert some morbid influence in the after-history of cases 

 in which it is performed. 



This is further emphasized by the statistics of 37 operated 

 cases collected by G. Marchant, 64 including 7 of his own. The 

 series showed 8 deaths: 5 immediate and 3 remote. Three of 

 the former are ascribed to "grippal pneumonia" or "pulmonary 

 congestion," the fourth to "erysipelas," and the fifth occurred 

 in a chronic drunkard, who died on the third day after show- 

 ing "extreme agitation." Two of the "remote" cases died 



* G. Marchant: Semaine M6dicale, Nov. 2, 



