the drug would be followed by a renewal of the attacks, and during the two months preceding her visit to me, notwithstanding the use of six drachms of the solution daily (about 240 grains bromide), the fits had returned in nearly the former frequency. The face was devoid of any expression of intelligence, and saliva flowed from the angles of her mouth. When attempting to speak, as she did only in monosyllables, the voice was smothered in the fluids of the mouth. Indeed, the patient presented a typical picture of marked dementia.

Her attendants believed that she did not see well, and as nearly as could be ascertained there was slight apparent myopia, with vision. The eyes being brought under the influence of atropine, the ophthalmoscope revealed hyperopia 1.50 D. There was an appearance of decided insufficiency of the externi, but there was too little intelligence on the part of the patient to admit of any exact determination by the equilibrium tests.

The bromide solution was discontinued at once, and a little wine was administered two or three times daily, and convex glasses 1 D were used. Under this régime some improvement in the mental and physical condition could be observed after the first week. The fits, however, became more frequent and severe in proportion to her recovery from the influence of the drug. Thus, during the week ending May 3d there occurred fifteen fits, in each of which unconsciousness continued from ten to thirty minutes. During the week ending May 31st there

were twenty-nine very severe attacks, and attacks of petit mal in great numbers.

By the 29th of May, after almost daily trials, it was hoped that some progress had been made in the knowledge of the relations of the eyes, and it was supposed that an insufficiency of the externi of from 10° to 20° at twenty feet existed while using the convex glasses.

With a clear understanding, on the part of the father of the girl, of the difficulties attending the determination of precise conditions under the cir cumstances, and with his full approval, an operation for insufficiency of the externi was made on the right eye, June 4th, and two days later a similar operation on the left, after which the appearance of the eyes was improved, and little if any insufficiency was shown by the tests, such as could be made.

June 1st, she had five fits.

June 2d, she had seven fits; and,

June 3d, she had five.

From June 4th (the day of the operation) to

June 14th no attacks occurred.

June 21st she had eight attacks.

From June 14th to

June 21st to June

28th, three attacks, all of which were unusually light. No petit mal since June 4th.

July 7th, she returned home, her last attack having occurred June 25th. The change in her mental condition had been since the operations truly marvelous, and her physical condition had equally improved. The photograveurs, Figs. 1 and

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.