sometimes attended with a degree of contraction nearly or fully equal to the advantage gained by the operation, in which case a renewal of the operation upon the same or the opposite eye may be made.

The results have been extremely satisfactory, although, as might have been expected, in attempting a process in surgery which was practically new and before tried only with the most doubtful, if any success, some difficulties have attended the accomplishment of the end, more especially in the earlier cases.

Whatever difficulties may have been encountered, however, have been insignificant when compared with the notable and even surprising advantages resulting in the great majority of instances.

It is not too much to say that the attending disadvantages are less in this than in almost any operation in surgery from which results in any degree commensurate can be expected.

The use of the extract of calabar bean or of the sulphate of eserine applied to the eyes in cases of deficient accommodative energy is often of great temporary benefit in a variety of nervous conditions. Instances have been shown in the foregoing pages in which the use of this agent has been followed by the happiest results, and many more might be given.

In cases in which the tension of accommodation is extreme, the use of atropia applied to the eyes is often followed by immediate relief to nervous symptoms and by removing a chronic condition of tension may, in some instances, effect a permanent relief.

The researches of a class of scientific observers, of

whom Cohn may be justly regarded as the leader, have shown how prevalent among children attending schools are found anomalies of refraction of the eyes.

As the work of these children is to be performed principally with these organs, is it not simple justice to them that the function to be most employed should be enabled to be used with the least possible difficulty?

Children are sent to school with the most complete ignorance on the part of parents and teachers of defects which may demand, on the part of the little ones, great expenditure of nervous force, and they are required to keep apace with those who enter upon the same work with no such incumbrance.

If they fail to perform the task of accommodating and of adjusting the eyes, and at the same time of maintaining their positions in their classes, they are condemned as idle or stupid.

If, on the other hand, by virtue of great persistence and determination, they succeed in keeping abreast of their more fortunate companions, they perform their task at the expense of vital energies, and often lay the foundations for future disease. If it were required. that the eyes of children should be examined before entering schools, and if the indications shown by such examinations should be observed, an infinite amount of suffering might doubtless be avoided. And should the custom of giving careful and intelligent attention to the conditions of the eyes become general, there can be no doubt that the prevalence of disease of the nervous centers would undergo a marvelous reduction.

TABLE

Containing the records of diseases in the families of one hundred patients suffering from nervous complaints, and in whom marked errors of refraction have been found. The table includes successive cases between the ages of fourteen and sixty-four, stating the age of the patient, the complaint for which he or she was treated, the refractive condition, the result of treatment so far as it is known, with the physical condition of the living, and the cause of death of those not living, when known, of parents, brothers, and sisters.

No.

Age of Nature of Refractive
patient. complaint.

error.

Result of treatment.

Family history.

Cured. Father died of acute disease; mother well; one brother has neurasthenia.

Cured. Father died of cholera; mother died of cholera; one brother died of fever; one sister died of consumption; two sisters well; one brother well.

Cured. Father died of acute disease; mother has paralysis; two brothers died of Bright's disease; two brothers well; two sisters have nervous diseases.

Cured. Father well; mother well; two sisters have chronic neuralgia.

Cured. Father died of consumption; mother died of paralysis; no brothers or sisters.

Father died of paralysis; mother well; four brothers well.

Father died insane; mother has had hemiplegia; three brothers well; one sister well.

Not known. Cured.

Not known.

Family history.

Father died of apoplexy; mother well; one brother well; one brother and three sisters died of consumption; one sister died, cause unknown.

Cured Father died of Bright's disease; mother well; one brother has paralysis; one brother well; two sisters nervous invalids; one sister well.

Not known.

Father died, cause unknown; moth-
er has headaches; one brother
died of discase of brain; one
brother died of heart-disease;
one brother died of consumption;
one brother well.
Father died of pleuritis; mother
died of cancer; two brothers
died of consumption; one sister
well.

Cured. Father died of pneumonia; mother
died of consumption; one sister
died of consumption.

Cured. Father died of fever; mother died in child-birth; one brother is an epileptic; one brother well; one sister has rheumatism; one sister well.

Not known.

Father has rheumatism; mother died of Bright's disease; one brother died from accident; one brother has consumption; two brothers well; one sister well. Father well; mother died of consumption; one brother well; one sister has Bright's disease; one sister well.

Cured. Father died of consumption; mother has rheumatism; two brothers died of consumption.

Father died of fever; mother died of consumption; one brother died of consumption; one brother well; one sister died of consumption; one sister has consumption. Cured. Father died of cerebral disease; mother well; three sisters well; three brothers well.

Not known.

Not cured.

II. 1.00.

gia.

Not treated.

Father died of rheumatism; mother died of fever; six brothers well; one sister has consumption.

H. 1.25. Improved Father died of epilepsy; mother has migraine.

24 52

Headaches.

H. 1.75.

H. 2.00.

As. 1.50.

Cured. Father died of acute discase; mother subject to neuralgia; one sister has consumption; one sister has neuralgia.

Cured. Father subject to migraine; mother well; four brothers well; one sister well.

Cured. Father died of apoplexy; mother has neuralgia; one brother died of consumption; one brother has consumption; one sister a nervous invalid.

Cured. Father died of paralysis; mother of pleuritis; one brother of con

sumption; one brother of some nervous disease; one sister has neurasthenia; one sister died of rheumatism; one sister died of paralysis.

Cured. Father not well; mother has cancer; one brother well; one sister well.

Cured. Father died of accident; mother died of paralysis; one brother well; one sister well.