in the right ear; no involvement of the palate; impairment of the pain and tactile senses of the trigeminus; the motor branch of the fifth supplying the masseter and temporals was also involved; taste was impaired at the posterior right side of the tongue, and there was corneal ulceration. The first nerve was intact. The third, fourth, and sixth nerves were not affected. The lesion, therefore, affected only the fifth and seventh nerves. There was a reaction of degeneration in the seventh nerve. A diagnosis was made of lesion of the Gasserian ganglion, probably syphilitic, the latter diagnosis being made upon the evidence of the miscarriages, although it was not possible to get the husband to come to the clinic or give any history, and also upon the headache and insomnia. She began to improve at once upon the iodide of potassium, which was pushed until 250 grains were given daily, and at the present time, one year after the treatment began, sensation is almost normal, the paralyzed muscles have almost entirely recovered, although the eye has, of course, remained the same.

CASE VII.-Female, aged thirty-three years, single. Has had headache for three months, worse at the vertex; severe insomnia for the first six weeks of this time; has had mucous patches on the tongue and lips, and throat shows old pharyngeal ulcers, whilst the tongue is ulcerated in its posterior portion; has hallucinations of sight and hearing, chiefly at night. Is very nervous and excitable, but has no delusions. This patient came to the clinic only once, and the subsequent history I do not know.

CASE VIII.-Female, aged fifty-three years, married. Has occipital headache, worse toward evening. Suffers from severe insomnia, and has had both these symptoms for some time, although the history does not state the exact period. Has slight ptosis upon the right side; no strabismus and no pupillary implication. This patient made a perfect recovery in three months under treatment by large doses of the iodide. CASE IX.-Male, aged thirty-seven years. About six years ago began to have constant headache over the brow and occiput, with diplopia. There was no insomnia and no irritability of temper. Four years ago became hemiplegic on the left side, with motor aphasia, without loss of consciousness, when the headache ceased, although this headache returned in the course of a year. Says that he had been weak and tremulous in both legs before the occurrence of hemiplegia. The aphasia lasted about three weeks. Two weeks after the onset of the hemiplegia the arm and leg began to improve, when the right leg became affected. At the time of coming to the clinic, four years after the onset of the hemiplegia, he was paretic in both lower extremities, most in the left one. The hand-grasp was much diminished on the right, but fairly good upon the left. Both patellar reflexes much exaggerated and spastic. Foot clonus present on both sides, tongue deviates slightly to the left; the left naso-labial fold is lost. The pain, muscular, temperature, and tactile senses are intact. He suffers greatly now from headache coming on toward the evening and lasting through the night. Freely admits that he had syphilis ten years ago, but gives no history of any of its sequelæ. This patient first came to my clinic on November 20, 1889. He was put upon a saturated solution of the iodide of potassium, taking 30 drops three times a day, each dose to be increased daily by 5 drops. By December 16th he had attained to 50 drops at each dose, but had such marked symptoms of iodism that it became

necessary to discontinue the treatment temporarily, although the headaches were very severe, and remained so in spite of the treatment by opiates and bromide. On January 13th he was again put upon a saturated solution of the iodide of potassium, 15 drops three times a day, the dose to be increased by one drop each dose. By January 17th his headaches were materially improved. He was then taking 20 drops of the saturated solution three times a day. On February 24th his headaches had entirely disappeared, and he walked somewhat better. Is now taking 36 drops of the saturated solution three times a day. On April 14th, "is much improved, walks much better, has no headaches; feels much better; is now taking 40 drops three times a day." July 2d the patient was so much improved that he was again at his work as a street-car conductor, which he had been obliged to leave some time before coming to us. He walks fairly well, although he is still somewhat paretic, has had absolutely no headaches, his appetite is good, and he looks well.

CASE X.-Female, aged thirty-two years, married. Three months ago. awoke in the morning and found her right upper extremity completely paralyzed, followed by severe pain from the elbow to the fingers during two days. Neither speech, face, nor leg were affected. Has been subject to headaches for several years, and has also had obstinate insomnia occasionally throughout this time. Patient has never had alopecia. There is no adenitis or history of throat trouble. Has never borne any children, but has had two miscarriages; has been married two years. Headache disappeared upon onset of paralysis. Right arm and leg are now paretic without sensory implication. The facial muscles are slightly paretic on the right side, and the tongue is slightly deflected to that side. Right patellar reflex somewhat exaggerated. Subsequent history of the case is not known.

CASE XI.-Male, aged fifty-two years. Has suffered from severe headache for the last six months, so severe as to render him almost wild, with great insomnia. The headache is principally over the brow and vertex. Frankly admits syphilis about twelve years ago, but gives no history of any of the sequelæ except that he has had ostitis of the humerus and radius. The headache and the insomnia disappeared entirely in about six weeks upon the administration of the iodide internally in large doses and inunctions of mercury.

CASE XII.-Male, aged thirty years. Onset about two years ago, with noises in the left ear like the singing of a teakettle. At this time was employed in blasting, in which dynamite was used. These noises, after a time, seemed to him to be voices calling his name. He has also suffered from severe pain and tingling numbness down the legs and in the hands and arms. Occasionally has vertigo. Suffers greatly from insomnia. Has not been intemperate, and has found that beer or liquor makes the noises worse. Denies syphilis, nor is there any objective evidence of it, but he admits that he has frequently had chronic ulceration of the throat and sores on the lips, with shin pains, as well as alopecia, also stating that he has had oedema of the feet, ankles, and hands. There is no cardiac disease and no evidence of nephritis. Lying down increases his vertigo. There is no pupillary impairment, no static or motor ataxia. At times becomes unable to find the words he wants to use, and this symptom seems to be so severe as to deserve the name of temporary aphasia. The patient recovered completely upon large doses of iodide.

CASE XIII.—Male, aged twenty-six years. About three months ago found himself hemiplegic on the right side on waking up in the morning about 5 o'clock. Speech was also affected (motor aphasia) for about three days. Face became very much improved in the first week, and the leg somewhat in about two weeks, and at the present time is paretic on the left face, tongue, arm, and leg, and exaggerated tendon reflexes. Patient admits syphilis seven years ago. Had some sort of eruption afterward over the chest and abdomen, and subsequently alopecia. Has never had headache nor suffered from insomnia. Has not been intemperate. There is no history of any traumatism. Patient's subsequent history is unknown.

CASE XIV.-Female, aged twenty-nine years, married. Has had severe headache for several months, worse toward evening, with marked insomnia. Is very nervous and excitable; says that she sits continuously through the day thinking of queer and unnatural things. Has a sensation of numbness and creeping over the scalp, and is at times slightly deaf for a day or two, although there is nothing about the ear or the throat or the Eustachian tube to account for this. Has had five miscarriages at the fourth, fifth, and seventh months respectively. Has one child living, but child is healthy. Patient has had buccal ulcers, and her hair has been coming out freely for some time. This patient recovered perfectly in about two weeks upon the iodide.

CASE XV.-Male, aged twenty-eight years. Seven years ago patient had syphilis, and was under treatment for it for some time, although the secondary symptoms were mild. Three years ago had to give up his position in a restaurant as a waiter on account of his failure of memory, which symptom began to develop about one year after syphilitic onset. Patient states that he never had headache, but his friend tells a different story, and says that he used to complain often of headaches. He has had obstinate insomnia for some time, and frequently lies awake all night, though not complaining of pain. Patient has marked impairment of memory, frequently becomes so confused as to be almost speechless, though he suffers from no definite type of aphasia, the speech-defect being very evidently due to the mental impairment. He can name objects held up before him correctly, can read written or printed language and understand spoken words, but is unable to spontaneously and quickly recall names of friends and intimates. Is not able, for instance, to give the name of the friend who accompanied him, although he has known him for twenty years. Says his own first name is John, but cannot give his last name. Has never had any paralytic symptoms. Patient's expression is silly; says he likes everybody, and has no enemies except a former wife. There is no ataxia, motor or static. No tremor of face, tongue, or extremities. No facial asymmetry, no implication of the cranial nerves, no pupillary abnormity, and no paresis. This patient was afterward pushed to 200 grains of the iodide of potassium in the day without benefit.

CASE XVI.-Male, aged forty years. Mother had a slight paralysis, nature unknown. Patient had a chancre eighteen or twenty years ago. Five years ago he had a slight hemiplegia on the right side, with motor aphasia. Before the attack had suffered from evening headaches and considerable insomnia, but these disappeared suddenly when the attack came on. On coming to my clinic patient displayed right hemiplegia

still marked, and slight motor aphasia, with exaggeration of both patellar reflexes, especially the right; the left pupil sluggish in its reaction to light. The patient has only improved moderately under the iodide.

CASE XVII.-Male, aged forty-one years. Fourteen months ago had a sudden paralysis of the left arm and leg without facial or speech involvement or loss of consciousness. Previous to the paralysis, for a period of about three months, had suffered from severe headaches associated with marked insomnia. The headaches had been so severe for about a month before the onset of the paralysis that he had had to remain home from business, and they came on generally in the afternoon, lasting into the evening, and disappeared immediately on the onset of the paralysis, at which time sleep also became normal. Admits having had syphilis four years ago, and describes what was probably a keratitis about two years ago, and has evidence of iritis. This patient obtained a fair amount of improvement only upon large doses of iodide.

CASE XVIII.-Male, aged thirty-six years. Was treated for syphilis twenty years ago, and has had since chronic ulceration of the throat and muscular rheumatism. Six months before coming to us he again had a chancre followed by some sort of a rash over his body and afterward sore-throat and rheumatism. Had obstinate headaches associated with insomnia, but the history does not mention the duration of either. He recovered perfectly under iodide in large doses.

CASE XIX.-Male, aged thirty-four years. Has severe headaches over the left eye that are worse during the afternoon and also occasionally in the back of the neck. Insomnia to the extent of obtaining only three to four hours' sleep each night. Headache has been constant and severe for three weeks, during all of which time there has been great insomnia. He himself recognizes the fact that he is becoming extremely irritable. When the headaches are most severe he has diplopia. Had syphilis twelve years ago, but presents no evidences and gives no history of secondary symptoms. Has three strong, healthy children. His wife has had no miscarriages. This patient made a perfect recovery upon the iodide of potash within a few weeks.

CASE XX.-Male, aged twenty-nine years. A first cousin is said to be an epileptic, otherwise there is no history of hereditary neurosis. Patient himself has been always healthy; had no convulsions in childhood. After a trauma, when eight years old, he is stated to have been unconscious for several days, but recovered perfectly, and has had no symptoms until four years ago, when he had his first fit while in bed, which, according to his statement, consisted merely of clonic spasms, without loss of consciousness. Since this period has had from one to three fits a week-not having one for three or four weeks, generally during the daytime, always with loss of consciousness and convulsive movements of the grand mal type. He gives a history of severe headaches and obstinate insomnia following a chancre, which he contracted five years. ago. Shortly after this the patient passed into a condition of dementia, losing his way, forgetting the names of those about him, and laughing in a silly manner without cause.

CASE XXI.-Female, aged twenty-four years. Has had severe pains at vertex for several months past, with obstinate insomnia; has had a severe sore throat for some length of time, had enlarged glands, and has had alopecia. Has lost both of her children, one of hydrocephalus,

she does not know the cause of the death of the other, although she states that it had "snuffles." Has had two miscarriages. This patient made a perfect recovery in a couple of months upon the iodide of potassium in large doses.

CASE XXII.-I frankly admit that this case is not conclusive because of the fact of the cardiac lesions. At the same time I venture to put it in for the value that it may have when considered in conjunction with other cases. Female, aged forty-seven years. The 18th of last August patient had left hemiplegia with aphasia for three days, although it is impossible to obtain a clear history of the exact nature of the speechlesion. Hemiplegia had a sudden onset, but consciousness was not lost, The hemiplegia had been preceded by headaches for several months. worse in the day than at night, and there was also considerable insomnia. The headache and the insomnia have ceased upon the supervention of the hemiplegia. Family history is negative. Patient has four living children, one of whom has epilepsy, another some form of heart disease, a third is said to be very delicate, and the fourth, the oldest, is delicate, and has some sort of attacks in which severe headache is a factor. This patient has a double murmur of the heart. The tendon reflexes and the knee-jerk are exaggerated, and some contracture of the arm and hand, with slight wasting of the muscles is present. The further history of this case is unknown.

CASE XXIII.-Male, aged thirty-nine years. Some two months before coming to the clinic was noticed doing and saying queer things, although he can give no definite account of what the queer things were. About two weeks ago the death of two brothers depressed him greatly, and about this time his memory became seriously impaired. He would sit muttering to himself, lips tremulous. About a year ago began to have very severe headaches, which increased in severity, and the insomnia at this time was very great. Would vomit in the mornings; would have attacks of dizziness on the street; appetite became very poor, and he lost flesh. About six months ago his employer dismissed him, and he was no longer able to attend to his business, which was that of a porter, apparently taking no interest whatever in his work. About this time. had delusions of grandeur and of persecution. Said at first he was going to sue a firm in Germany, then that he had sued, and recovered sixty-nine million dollars; that his sister-in-law wanted to imprison him to get the money. About six months ago was committed to an asylum, where the case was diagnosticated as general paresis. Eight days after going to the asylum had an apoplectic seizure, resulting in a complete left hemiplegia. After this the headache and insomnia ceased entirely. Was in bed four months, and was unable to talk so as to be understood for three months. Gradually improved until he was able to walk slowly with the aid of crutches, still having characteristic gait. He has now to a great extent recovered; is intelligent, although his memory fails at times. Pupillary reflex normal, left knee-jerk exaggerated, slight ankle clonus, fibrillary tremor of tongue, but not of facial muscles. Food has a tendency to lodge in the left side of the mouth. Left side slightly dry. Has recovered control of the bladder and rectum, which was lost after apoplexy. The patient afterward passed away from observation; further results unknown. The patient's friend states that he had syphilis several years ago, and was treated for it by competent physi

cians.