years, and is now advanced in her studies beyond most of her companions of the same age.

The two portraits of Plate I, reproduced from photographs, represent a child ten years of age, who from infancy had been the victim of headaches. She was feeble, always tired, and rarely free from pain. Attempts to send her to school had proved unsuccessful, for she no sooner commenced attendance than she became prostrated. She had insufficiency of the externi, and operations for its relief was made, upon one eye June 8, 1883, and upon the other June 12th. It is needless to tell one who examines these two pictures that the change was marvelous. The weary, heavy, discouraged aspect of the child as shown by the portrait of June 8th is in remarkable contrast with that of June 20th, where vivacity and courage are embodied in her expression. The child returned home to enter school, where she has done excellent work.

In the cases above cited, headaches have been relieved by the removal of irritation induced by- 1. Hypermetropia, with insufficiency of the external recti; 2. Astigmatism, with enfeebled adducting force; 3. Enfeebled energy of the muscles of accommodation; and, 4. Insufficiency of the external recti muscles uncomplicated with any very important refractive

error.

It will thus appear that these various conditions of refractive and muscular anomalies may act as disposing causes of headaches, and that the removal of the

irritation arising from such conditions is sufficient to afford permanent relief to the nervous suffering.

The number of cases of chronic headache* in the private practice of the author, in which examinations of the ocular conditions have been made, is twelve hundred and eighty. For nearly all these, advice in regard to the correction of the ocular defects has been rendered; but, inasmuch as the period during which these examinations have been made extends through several years, it is manifest that it is impossible to know the result of this advice in all cases. A very large proportion of these are transient cases, in which a single consultation has concluded the relation of physician and patient, and as many of the cases reside in cities distant from the residence of the writer, some even of those who receive treatment for a longer time are lost to observation. In order, however, to arrive at some basis of facts from which one not in the constant observation of these phenomena may be enabled to draw some conclusion as to their value, an analysis of the results in one hundred consecutive cases of chronic headache is here given. The list extends backward from December 31, 1882, to the 2d of June of the same year. This, while allowing sufficient time to have elapsed since the most recent date, to determine the permanent results, is also sufficiently recent to enable a recollection of the cases in some measure to supplement the written record.

Proceeding, then, to the analysis of these cases, it

* Chronic in the sense of continuing during more than one and in general during several years.

is found that of the number, nothing is known of the patients after their first consultation in twenty-two cases. In five other cases, in which more than a single visit was made, no knowledge of the subsequent history is possessed. Sixty-one are known to have obtained permanent relief. Nine are known to have received temporary and marked improvement, while in three cases no improvement resulted.

If we exclude the twenty-seven cases the history of which, since the examinations or after a very few calls, are unknown, we shall find that the proportion to one hundred is as follows:

Permanently relieved.......... 83.6 per cent.
Improved.

Not cured.. . . .

12.4

It should be observed, in passing, that the cases upon which these statistics are based are in all respects typical cases of chronic headache, of which the illustrative cases given above are fair examples. No cases of simple asthenopia or of temporary headaches are included.

It should be further remarked that in these cases drugs have not been administered, except in rare instances, for temporary relief of some other symptom, and in no case can the influence of drugs be regarded as a factor in the result of the treatment. This statement will also apply to classes of cases hereafter to be reported. In fact, the results in these cases must be attributed solely to the removal of the