Adducting power at twenty feet, 8°; abducting, 2°. By exercising the eyes for a few minutes daily with prisms, the adducting power in the course of two months rose to 35°, and the abducting power 8°. She had, in the mean time, made use of cylindrical glasses for the correction of her astigmatism.

Her health improved in proportion as the flexibility of the ocular muscles increased, and she went away at the end of two months much better in all respects than when she came.

October 20th, after nearly five months, she calls with her mother. She is in perfect physical and mental health. She shows no indication of nervousness, is rosy, and has a bright, intelligent expression; speaks quickly and without monotony, and is in all respects a healthful, intelligent, and tractable child.

Master I., aged thirteen years. Came attended by his physician, Dr. P. H. Neher, October 30, 1879.

The patient has been the subject of chorea nine years, during which time he has been under the charge of several distinguished physicians, who have treated him by tonic medicines, including preparations of iron and arsenic, strychnine, and other medicines. Electricity and change of climate have also been among the means through which relief has been sought, but not obtained.

The

His condition at the present time is deplorable, although not worse than usual with him. muscular contractions are most violent, and extend to all parts of the body. It is with great difficulty that he can sit in a chair, as the body is thrown

about so violently as to dislodge him from his seat. Even while sitting the legs are thrown in all directions, and his head strikes the back of the chair with frequent and energetic thumps.

When walking, the legs become entangled, and the head is thrown backward with the greatest violence. With much difficulty the condition of the eyes was determined.

He was found to have hypermetropic astigmatism and insufficiency of the externi, with insufficient adducting energy, the latter being sufficient only to overcome a prism of 6°.

The astigmatism was corrected by cylindrical glasses, and the adducting power exercised until it was greatly increased.

When, at the end of two weeks, his physician called to see him, he was amazed at the change that had come over the lad. He was now able to walk with regular and even steps, could sit in his chair at ease, and, indeed, appeared well. With some varyings in his condition which could, in all cases, be associated with equally varying conditions of the eyemuscles, he recovered rapidly, and, with the exception of occasional slight twitchings, has remained well during the four years.

Miss M., fifteen years of age, examined November 27, 1881.

Eight years ago had chorea, which has continued to the present time. There are facial contortions, shrugging of the shoulders, and general restlessness. She is well nourished and finely de

veloped, is intellectually bright, and at times cheerful.

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

OF CALIF