The photographs show more than I am able to tell, but even they do not convey a perfect idea of the wonderful revolution which had taken place in the mental and physical condition of the boy in eighteen days].*

[Plate VI is introduced here as representing one of the cases treated by attention to ocular conditions at the Willard Asylum for the Insane during the summer of 1886. Space does not permit of a history of any of these cases, but the photographs fairly represent the average change of physiognomy in these people who had, during many years, been confined in an asylum].*

It follows, then, that in mental troubles, also, the condition of the eyes should be carefully inspected, and sudden and gratifying relief will often reward attentions intelligently directed to any embarrassment which may hinder them in the performance of their offices.

HEREDITY.

Enough has been shown in the discussion of neuralgia to render it evident that to a certain extent the construction of the eyes constitutes an important element in hereditary predisposition to neuroses.

The orbit and its contents are facial features, which are, in their general form and relations to other parts of the face, characteristic in families. The resemblances so strikingly exhibited in many families depend very largely upon the construction of this portion. of the face. The form of the eyeball and the length * In present edition only.

of the straight muscles are materially modified by the form of the orbit. A broad, flat face at once suggests to the oculist a hypermetropic eye. A narrow face, with prominent features, is more likely to be associated with a lengthened eyeball, and, if the bones of the face are quite unlike on different sides, there is a presumption of astigmatism. With many exceptions, these general rules afford a tolerable estimate of the conditions of the eyes; but with varying depths of the orbit there must also be varying lengths of muscles. In many families a want of equilibrium of muscles is as characteristic a feature as hypermetropia or astigmatism.

Thus in the family of case No. 91 of the table, at page 145, the patient had hypermetropia, and had also converging strabismus. She had one brother and three sisters, all of whom were cross-eyed. Oculists often meet with such instances. Hence, the muscular balance of the eyes as well as their refractive condition enters largely into the composition of family similitudes.

If, then, the eyes in certain families are, as facial features, generally too short, or if there is in the family a tendency to squint, even if the tendency is not manifest to the ordinary observer, there is imposed upon that family an inordinate task, either in accommodating the eyes for near points or in maintaining parallelism of the visual lines. While the subjects of such defects are in full vigor, or while the parts subjected to the unusual demand are used but moderately, there may result little or no inconvenience.

There is under these circumstances sufficient nervous energy to supply the ordinary draft upon the nervous system and to perform this extra task; but if other excessive calls upon the nervous energy are made and the surplus vigor is expended, the difficult task of adjustment or of accommodation can no longer be performed without manifestations of nervous exhaustion. Hence, so long as no assistance is rendered to these overtasked muscles, disease or nervous prostration arising from their disability is exceedingly chronic, and long periods of rest with tonic medicines are required in order that a sufficient amount of reserve energy may be acquired to perform their function and also the requirements of active life.

The same nervous irritation does not always react in the same manner. This is well shown in BrownSéquard's experiments in tickling. One subject laughs, another cries, a third has contortions of the limbs, and the fourth tetanic rigidity of the muscles.

In case of irritation from difficult accommodation from refractive anomalies or excitation from muscular insufficiencies, family characteristics, such as hypermetropia or insufficiency of the externi, for instance, react in various ways. One member of a family suffers from migraine, another from chorea, and a third from neurasthenia. Again, in one such family the neuropathic tendency consists in eyes of insufficient length, while in another family the tendency may originate in a want of equilibrium of muscles. Thus the various forms of features, when deviating from an ideal standard of anatomical perfection, may give