veloped, is intellectually bright, and at times cheer

ful.

There is a murmur with the first sound of the heart, but no other evidence of organic disease.

During the eight years there have been periods of a few weeks when there has been slight remission of the symptoms, but they have never at any time disappeared. She is better if she avoids books and keeps much in the open air.

She has astigmatism of low grade and insufficiency of the internal recti muscle 6° at twenty feet; 7° at one and a half foot.

Early in February, 1882, tenotomy of one external rectus was made and three weeks later of the other. Improvement in the nervous state followed, and entire recovery within a few months.

During the past two years she has pursued her studies abroad, and I learn from a letter, written within the past month, that she is still quite well.

[The two portraits shown in Plate II are those of an interesting case of chorea which had continued during the lifetime of the patient, a boy of sixteen. The boy was feeble-minded and incapable of learning. His whole body was in perpetual motion. This is well shown in the photograph, taken April 28th, when, notwithstanding the rapidity of modern photography, it was quite too slow to get a clear picture. The shaded borders of the picture show the movements of the head. The boy had hyperopia 2.50 D., and insufficiency of the interni, to the extent of producing, much of the time, homonymous diplopia, which was shown when a

red glass was placed before one of his eyes, the refractive error being first corrected. Tenotomy of the left internus was done, April 28, 1885, and of the right on the 6th of May following.

The change in the boy's condition was marvelous. The two portraits do not exaggerate the improvement, nor do they even adequately represent it. He has had no chorea during the two years which have past. He has attended school, where he has made some progress in his studies, and is in every respect mentally and physically greatly improved.*]

Many cases, of which those already described are fair examples, might be adduced to prove the relations between those long-continued cases of chorea and irritations attributable to the eyes. It is needless, however, to accumulate evidence of this kind beyond what has already been offered.

It can not be doubted that the relief so speedily obtained in these cases not only followed the treatment directed to the eyes, but that this improvement was the legitimate result of such treatment.

If, then, refractive and muscular troubles of the eyes are so generally found associated with chorea, and if cases which may justly be regarded as belonging to the class heretofore regarded as incurable, are able to obtain such speedy and complete relief as is shown in the cases described, may we not conclude that chorea is emphatically a nervous trouble depending upon ocular conditions?

*This case, not in the original essay, is introduced here on account of the accompanying portraits of Plate II.

That irritations seated elsewhere may cause the disease, is not to be denied.

Especially may irritations, proceeding from different parts of the body, act as immediate or as complicating causes, but it is probable that cases which occur without any relation to ocular difficulties are rare exceptions to a very general rule.

The indications for the treatment of chorea are evident if the general nature of the cause, as shown, is admitted. Children with the first symptoms of "chorée vulgaire" must be at once removed from school, and from all occupations demanding the use of the eyes. General tonic remedies, fresh air, and agreeable surroundings may all prove valuable as auxiliaries in the treatment of these cases. The use

of a weak solution of eserine applied to the eyes once or twice a day will often serve as a valuable temporary expedient.

The child should not be returned to school without an examination of the eyes in regard to their refractive and muscular states. In chronic cases the cause should be sought for in the eyes. If not found there, at least a very probable seat of trouble will have been explored.

EPILEPSY.

The course of this discussion now leads us to consider one of the most important as well as one of the most mysterious of all the affections of the nervous system. A disease dreadful in its manifestations, and well-nigh hopeless in its prognosis, nearly always un