tory nerve, which extend from a hollow coneshaped prolongation of the brain wall, are derived from both right and left halves of the brain, and the walls of this cone-shaped lobus olfactorius of Amphioxus are derived from the right and left halves of the neural neuroporic lips. It is true that the distal extremity of this lobus becomes pushed over to the left side, but this distortion does not disturb the fact of its bilaterally symmetrical derivation from right and left halves of the brain.

In consideration of the above facts it becomes evident that the anterior end of the brain coincides with the territory lying between the nose, and the hypophysis, or, in other words, with the naso - hypophysial groove and its terminal organs; that the dorsal end lies between the nasal pits and the ventral end at the posterior border of the hypophysis. This being the case, it is evident that the anterior end of the neural axis is not a point. It is co-extensive with the length of the naso-hypophysial groove. Also that it does not lie in the lamina terminalis, since this structure lies cephalad and above the naso-hypophysial region, and is entirely a dorsal territory and not a terminal territory; that it does not lie in the optic chiasm, since this structure only arises much later as a crossing of fibres athwart the neuroporic groove; that it is not placed at the apex of the infundibulum, as Von Baer concluded, since this represents only one point at the posterior end of the naso-hypophysial groove; that it does not lie in the pineal gland, as Goette held, as this is a strictly dorsal structure lying far back of the anterior end of the brain; that it does not coincide with the lobus olfactorius impar, as Kupffer contended, since this represents only one point, the dorsal end of the anterior neuropore. The unique condition of the pharyngeal canal in Bdellostoma now receives its complete explanation, since it is shown to be the primitive condition which exists equally well in Amphioxus, namely, the continuation of the naso-hypophysial groove backward into the pharynx.

With regard to the cranial nerves of Amphioxus, zoologists have recognized nerves Nos. 1 and 2. No. 1 arises from the ventral edge of the anterior end of the adult brain, and runs forward to supply the sense organs of the snout region. No. 2 arises behind the first pair from the dorso-lateral region of the brain tube, and extends forward to innervate similar sense-organs of the snout region. These two nerves are thus nerves of special sense, and both of them are in reality dorsal in nature, since the first pair have been carried downward by the overgrowth of the walls of

FIG. 2.-View of the dorsal surface of the mouth of an embryo Bdellostoma to show the naso-hypophysial groove, the nasal pits, the hypophysial From aperture and the naso-pharyngeal groove. a model.

tory pit marks the dorsal limit and hypophysial pit the ventral limit. It is thus shown that the ventrad curvature of the anterior end of the brain axis is the smallest found in any existing vertebrate, and has served to carry only one-half of that original end around to the ventral surface.

When we examine Bdellostoma for a comparison of cranial nerves with those of Amphioxus, we find the two nerves that were just described for Amphioxus. One of these nerves issues from the brain through the socalled trigeminus trunk, the other leaves the brain from the roof of the medulla. Both pass forward to supply the lateral line canal organs of the snout region. All of the evidence points to the conclusion that with the exception of the olfactory nerve, these two nerves are the most ancient of all of the cranial nerves found in the vertebrate stock.

Amphioxus possesses a pair of olfactory nerves, three pairs of nerves which may be called cranial, two of which belong to the lateral line system, the third pair general cutaneous in function; while the other cranial nerves of higher forms remain in a condition of spinal nerves, or have not yet been called forth by the physiological demands of the body.

The olfactory nerves arise as hollow projections of the brain tube corresponding with the infundibular funnel. The two lateral line nerves give rise in higher forms to the specialized lateral line nerves, of which the auditory nerves constitute a further specialization. The optic outpushing of the brain has not occurred in Amphioxus, but indications are present pointing to its beginning development, and the three pairs of eye-muscle nerves are neither present in Amphioxus nor Bdellostoma, although the later form possesses a well-developed optic cup.

There remains, then, of the cranial nerves

fined to the bed most of the time for nearly a year and able to eat but little. I made an injection April 19, 1907, with immediate and complete relief. She declined further treatment until the pain returned, which it has twice done since that date. When it has returned her physician has repeated the injection, which immediately gave relief.

CASE 11.-A woman of thirty-eight years, neuralgia of the middle branch, off and on, for ten months. She received a single injection about six months ago, and has not found it convenient to have it repeated. She had no pain whatever for three months after the injection. In the last three months she has had two very mild and brief attacks.

CASE 12.-A woman, fifty-four years old, having had neuralgia of the inferior branch. for two years, received three injections four months ago, since which time she has been free from pain.

CASE 13.-A woman of sixty.nine years, neuralgia of the middle and inferior branches of one year's standing. She received one injection five months ago. Relief from pain has been so nearly complete that she declines further treatment.

CASE 14.-A man, aged sixty years, neuralgia of fifteen years' standing, involving all three branches. He has had three operations. Five months ago I made one injection with temporary relief. His family physician continued the treatment and he is now perfectly well.

CASE 15.-A man of sixty-two years, very severe neuralgia of the lower branch, duration five years. The first injection was made nearly five months ago. It at once relieved him, but not completely, and he received three more injections in the next ten days. Although he still had an occasional faint twinge of pain, he insisted upon returning home. Four weeks ago the pains began to return, but have not become

severe.

CASE 16.-A man of forty-two years, pain in the distribution of the supra-orbital branch, with the middle branch area as a pain-genetic zone. The case was of only three months' standing, but was severe. He received one deep orbital injection, which afforded no relief. He then received several peripheral injections for the supra-orbital branch and two or three deep injections for the middle branch. The last injection was about three and a half months ago and he has had no pain since.

CASE 17.-A woman, eighty-two years old, neuralgia of one and a half year's standing, lower and middle branches involved. She received two injections, one for euch branch, with immediate aud complete relief. This was four months ago, and she has remained entirely free from pain.

CASE 18.-A woman of forty-six years, neuralgia of the middle and inferior branches of ten years' standing. Has had one operation. She received one injection with only slight relief. I then left the city for two months and the patient disappeared.

CASE 19-A woman of sixty-eight years, severe neuralgia in the lower branch for the last three years. She received two injections, both of which missed the nerve. I have not seen the patient since.

CASE 20-Woman of forty-six years, lower brauch involved, of five years' standing. I gave her two injections, missing the nerve each time;

there was no relief and she declined further treatment.

CASE 21.-Woman of fifty-four years, neuralgia of the lower branch for the last ten years. She received one injection, which probably missed the nerve, but gave her immediate relief. A few days later there was some return of the pain. As I could not promise that one more injection would effect a cure, the patient went away.

CASE 22.-A clergyman of seventy-seven years, neuralgia of the lower branch for the last twenty years, entirely disabling him for his occupation, as talking at once started excruciating pain. This patient had advanced arteriosclerosis and a senile heart. Last June he suffered a cerebral thrombosis and had been totally word-blind ever since He received three injections, but has not had a single twinge of pain since the first one. This was only a month ago.

CASE 23.-A woman of sixty-five years, neuralgia of middle and superior branches for the last two years. She received two deep injections for the middle branch, the first of which missed the nerve, and a peripheral injection for the superior branch. This was only a few days ago, but she went home perfectly well.

The fluid injected is 75 per cent. alcohol, containing ten minims of chloroform and onehalf to two grains of cocaine to the half ounce. In future cases I think I shall omit the cocaine, as it seems unnecessary. Of this fluid I inject two cubic centimeters. If repeated injections are needed the strength of the alcohol is increased up to 90 per cent.

It is not to be expected that these injections will effect a permanent cure, although I suppose this might be an exceptional result. Nevertheless, the operation being entirely devoid of danger, so far as I know, no anesthetic being required, instant relief being obtained when the nerve is reached, this relief enduring for a long time, and the danger of the operation for the removal of the Gasserian ganglion being very great, I believe that these injections constitute the best treatment now at our command for the great majority of cases of trifacial neuralgia.

DISCUSSION.

DR. T D CROTHERS, Hartford, Conn.: I wish to ask Dr. Patrick why he used cocaine instead of pure alcohol There seems to be a shadow of doubt with one grain of cocaine. How could he differentiate between the effects of the cocaine and the alcohol? He, of course, explained, but it is a little doubtful, and it is the element of obscurity that I should like to have cleared up.

DR A. U. WILLIAMS, Hot Springs, Ark.: I should like to ask the doctor whether sterilized water would do as well as alcohol, perhaps?

DR PATRICK (closing): Regarding the question of Dr. Crothers, I should like to say that I am not sure the cocaine is necessary. In the first cases I used the French injection, and afterwards I tried using half as much, which does about as well. I am not sure it could be dispensed with. The reason I use it is this:

When the alcohol is first injected there is rather sharp pain By injecting a few minims with just a little pressure the cocaine acts on the tissues and the remainder of the injection is less painful. As to whether the cocaine should have the effect, the history of this thing clears that up at once. Four or five years before using these deep alcohol injections, following the suggestions of Pitres, Bordeaux, I used peripheral cocaine injections. Some patients were instantly relieved. Öne of these, who had had osmic acid injections, I treated with cocaine with instant but only temporary relief. I have another patient who had relief from a middle branch neuralgia, but they relapse very much more quickly than after the alcohol injections.

Whether distilled water might not have the

same effect, as asked by Dr. Williams, is also cleared up by experience. Such injections have been done many times, and they will relieve, but not for very long. Injections of air will do the same thing, but the results are not lasting. The alcohol injections are quite innocuous, there being no dangerous effects following, such as necrosis, which sometimes follows osmic acid, and the effects being quite as durable so far as we can now judge. I think it is preferable and can be done by anybody. Two of my cases I injected only once. One came in from out of town; the other I visited out of town and the home physician continued the treatment. Both of them have been given a number of injections by their family physicians, and at the present time they are perfectly comfortable.

No. 4.

"Wise in his own conceit.".

Over in the other part of town-the part where the habitants abided-lived the judge whom and whose family-a wife and two fine, manly boys-we had come to know quite well during our summer's sojourn. So, when the sun began to drop into the lake a degree or so farther south each night, when the tinge of frost was felt in the Northern air, and we were about ready to start home, we went to make a farewell call. just at nightfall, and the judge an athletic, strong-voiced, masterful man, once centre on his college team-met us at the door.

It was

'Come right in," he said in his hearty way. Excuse my good wife for a little while; she's up stairs nursing one of the boys. And the servants are up there with her," he added, as if to explain why he himself had answered the bell.

Nothing serious, I hope?"

"Oh, no; nothing. You know how mothers are. If they had their way about it they'd make molly-coddles of all their boys."

This, addressed more to my good wife than to myself, was said in a spirit of intended raillery, but with a reserve note of earnestness that gave to his would-be humor the ring of the counterfeit.

"Why do you think so?" she discreetly replied.

"Well, take this instance: Here's Frank, a strapping boy of fifteen-shall we not sit here in the shadows? Yes, I like it better myself—well, as I was saying, he's a strapping fellow, never been ill a day in his life, positively not a single day. Last Tuesday he was out in the country, and, boy-like,

gorged himself with a lot of green apples. That night he had what I fancy all of us have had at one time or another, and probably from the same cause- a case of old-fashioned cramps. His mother was at once alarmed, and if he hadn't been a cool-headed boy she would have alarmed him, too. Of course,

she wished to send for a doctor right away. But I put my foot down on that proposition. You see, I don't believe in calling doctors for trivial ailments."

This, with a chuckle of good humor that was hardly sufficient to conceal the wire edge of prejudice, was addressed to me.

Yes," I admitted, doctors are often cheated out of their rest by unnecessary calls."

'Just so! Besides, I know a thing or two myself about ills and remedies. Most ills are imaginary, and even when they are not imaginary, nature-nature, I say is their best remedy. Then, too, spirit, pluck, has a lot to do with it!"

The judge's face was wreathed in a smile of self-satisfaction that dissipated the deepening gloom of evening as he mentally reviewed this learned disquisition and paused as if for applause. But before the hand-clapping could begin he continued:

So, when I found Frank inclined to loaf around I made him sit up, even against his mother's protest. That was three or four days ago. Of course, his mother protested. But yesterday I simply made him get up and go to the baseball game. You see, Frank is fond of baseball, and I knew if he got interested in the game he'd forget to grunt."

I thought I scented a family altercation back of this incident, but I simply asked: How did it work?"

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