2, Plate III, exhibit the changes of physiognomy which occurred during a single month. Fig. 1 is from a photograph taken just preceding the first operation; Fig. 2 is from one taken a month later.

From time to time the patient has been seen. She continues in robust health and her intellect has returned. An attempt to send her to school, some months after her return home, was followed by a very slight relapse, but her friends were advised to wait a year before allowing her much close use of her eyes. A year after this her condition continued good with no return of the malady, and a year and a half after the operation, her physician wrote that she continued well. (I have heard, indirectly, just as this manuscript is about to be sent to press, that the girl has a renewal of her attacks. If so, she has, beyond a doubt, some remaining muscular disability, which may still be removed.)]*

J. P., aged fourteen, April, 1883. Was fairly well, with the exception of an attack of pneumonia, until a year ago. Then had his first attack of epilepsy. During the year has had twelve severe attacks at intervals of about a month, and many attacks of petit mal.

Examination of the eyes showed hypermetropia. Right 2 D, left 2.25 D. Insufficiency of external

recti 7°.

Glasses for partial correction of hypermetropia were used, and on the 23d of April partial tenotomy of the internal rectus of the right eye was made,

* Case introduced in present edition.

followed by a similar operation upon the internal rectus of the left on the 29th of April. May 1st, no insufficiency of the recti muscles is manifest.

The last attack of epilepsy occurred April 20th, three days before the first tenotomy. He has been well, even in respect to petit mal, more than seven months.*

G. S. G., July, 1883. During the past year has had quite a number of epileptic attacks, does not know exactly how many. Has a feeling of indefinable nervousness, and his mind is so much affected that he has been forced during the whole year to abandon his business, that of an apothecary. Has suffered much inconvenience during the past eight years from constipation.

He has astigmatism corrected by, right eye 1 D cylindrical, axis 90°; left eye 0·75 D cylindrical, axis 90°. There are also slight insufficiency of the external recti muscles and deficient adducting energy.

The patient was advised to use correcting glasses, and his eyes were exercised by means of prisms.

No further attacks have occurred, the obstinate constipation is entirely relieved, and the patient writes, under date of November 21st, that he is quite well.

[Miss M., aged twenty-nine. Subject to epilepsy and chorea from the first year of her life. Epileptic attacks occur from three to five times daily. Occasionally the fits are of great violence, but they

*Nothing has been known concerning this patient since the above record was written in 1883.