The American Journal of the Medical Sciences, February, 1904. A Fatal Case of Poisoning with Oil of Gaultheria.—J. Woods Price and Edward M. L'Engle report this case. The patient was a girl aged two years. She had swallowed about a drachm of commercial oil of wintergreen. She had vomited several times, and continued to do so until lavage could be done. There was nothing abnormal In the child's appearance, and she showed no evidences of suffering pain. There were no further symptoms for two hours, when the patient seemed to have pain in the abdomen, was drowsy, and complained of great thirst. The pulse rate increased to 150. The respirations became Somewhat labored and irregular and there were evidences of impaired hearing and some hallucinations of vision. Later, convulsions took place, the symptoms increased in severity, and the child died of respiratory failure, ten hours after the ingestion of the poison.

The

A Case of Seborrhœa Nigricans (Black Mask of the Face). -Arthur Van Harlingen reports this unusual case. patient was a girl of twenty-three years who had been bedidden for several years. Her general condition was that of an hysterical person. No areas of insensibility were Hisclosed, but the scalp was hyperæsthetic. The forehead and nose were covered with an extraordinary mask or crust, more than quarter of an inch thick, resembling a ind of ham-soft, greasy, sharply defined about the edges, and rounded. It could be easily broken off, and the foreps could be thrust in at any point as if the crust were comprised of soft fat. The color of the crust was exterirly of an inky blackness. The attendants were instructed to wash the mask daily with a solution of sapo viridis in water. At the end of a week, however, the mask had not been at all cleaned off. It was loosened, and there was no difficulty in stripping off the entire coating. The writer believes this to have been a severe case of oily seborrhoea, giving rise to a dusky secretion upon the surface. This had been allowed to accumulate for several years, and had perhaps been added to by the application of ointments, together with accretions from the surroundng apartment.

A Case of Typhoid Fever Presenting an Arterial Complication-Probably an Arteritis.-Walter R. Steiner recorts this case. The patient was a boy of nine years sufferng from an attack of typhoid fever. On the evening of the forty-first day, he complained of numbness and tingling of the right index-finger. There was no difference between the right and left radials. On the following day the right radial pulse was distinctly smaller in volume than the left, but differences between the axillaries and brachals could not be made out. On the day following, the pulse was wanting in the right radial, brachial, and axillary arteries. Much pain was complained of on palpation, and the axillary and radial arteries had a hard, cord-like eel. The right arm was colder than the left, and there was some blueness of the finger-nails. The arm became extremely cold and the finger-nails intensely cyanotic. The patient's condition became desperate. But gradually he began to improve, and thirty-five days after the onset of the arteritis there was noted a return of pulsation in the right radial and brachial arteries. In three days there was no difference between the two sides. The writer regards the arterial complication as one of the peripheral arteritides.

The Nervous Complications and Sequelae of Smallpox.Charles T. Aldrich declares that smallpox, like other infectious diseases, may present various nervous complications and sequelæ. Almost the first effect of the variolous poison is observed in the violent frontal headache, which constantly is an early symptom. These affections may be gross anatomical, purely functional, or both. They invade all possible provinces of the nervous system-the brain, spinal cord, and peripheral nerves. At least four types of the febrile deliria and psychoses are recognized; Initial delirium, febrile delirium, collapse or exhaustion delirium, and true post variolous insanity. True dementia paralytica has been observed to follow variola. Meningitis is a rare complication. It is usually purulent, and probably a metastasis from the skin lesions. occurrence of paralysis in smallpox has been commented upon. Areas of simple softening and blood extravasations may occur in the brain and produce aphasia, monoplegia, or hemiplegia. The relative frequency of cord affections in variola has long been known. The writer believes that a disseminated encephalomyelitis occurs as a complication or sequel of smallpox, which possesses clinical features and pathological changes entitling it to be recognized as a clinical entity. The writer has found fifteen cases in the literature. He concludes by giving a report of various cases.

The

Circumcorneal Hypertrophy (Vernal Conjunctivitis) in the Negro.-Swan M. Burnett states that the distinguishing mark of circumcorneal hypertrophy is that it is not destructive. It is a true hyperplasia. Identical changes

in the conjunctiva of the lid have been revealed. Hypertrophy is everywhere, but destruction of tissue is nowhere found. The usual and characteristic complaint is not of pain, but of an intense itching of the eyes and sometimes of a "burning sensation," quite distinct from the subjective symptoms of phlyctenule. The objective appearance is strikingly distinctive. The dirty gray elevations at the base of the cornea, when marked, bear no resemblance to any other pathological condition found there. The circumcorneal epithelial changes vary greatly in degree. Some lacrymation may occur, but the irritative symptoms are slight. In this disease the palpebral aperture has a dull, soggy look, and a dusky appearance, as though it had been smoked. The cause of this peculiar appearance is a pigmentation of the conjunctiva. The writer believes that both the bulbar and palpebral forms exist together. He also believes that the disease is the manifestation of a dyscrasia-but it is not so certain what that dyscrasia is. Although "scrofula" can never be excluded in a colored patient, still there is nothing about the appearance of the condition itself or in the patient's which would justify the acceptance of any such stigma as a cause. It occurs often in the most robust looking. The disease is most prevalent during the hot months. Strictly speaking, the affection is not a conjunctivitis at all, taking conjunctivitis to mean an inflammation of the conjunctiva. The similarity of the disease to trachoma is only superficial. As to treatment, the indications are for palliative local measures. Operative measures are not advisable. Attention to nutrition and an improvement in the general condition are called for. Most authorities approve of the administration of arsenic in some form.

A Discussion of the Surgery of Tumors of the Brain, with a Résumé of the Operative Records of Four Craniotomies. Charles H. Frazier sums up his paper as follows: (1) All measures recognized as prophylactic of shock should be observed stringently. In these we have the most effectual means of reducing the mortality. The most important of them are (a) the avoidance of prolonged operation; (b) the prevention of excessive hemorrhage, and (c) the avoidance of unnecessarily rough manipulation of the brain substance. (2) A given area of brain can be exposed with the least minimum degree of traumatism and greatest economy of time by the electric engine. (3) Temporary closure of the carotids in operations upon the brain is effectual and not unattended by danger. It should be reserved for extreme cases, and practised on one side only. (4) Observations should be made upon the blood-pressure immediately before and at frequent intervals during the operation. Object of same twofold: (a) as the most reliable index of patient's condition; (b) as the only exact method of determining whether operation should or should not be carried out in two stages. (5) Two-stage operation is indicated when there has been a decided fall in bloodpressure after the relief from intracranial tension, such as follows reflection of the Wagner flap and dura. (6) Lumbar puncture as a means of relieving pressure is a temporary, not to say dangerous, procedure. (7) Bulging of the brain is one of the most embarrassing features of cerebral operations. A distinction may be made between that which occurs immediately after reflecting the dura, "initial" bulging, and that which follows as a result of subsequent exploratory manipulation, "consecutive" bulging. (8) "Initial" bulging is due to the increased tension exerted by a tumor. It is not always present, is often not 66 consecuexcessive, and is not likely to be followed by tive" bulging. (9) "Consecutive" bulging is due to the cerebral œdema set up in normal brain tissue by trauma Consecuinflicted by the exploratory manipulations. tive" bulging far exceeds in magnitude initial bulging, and suggests the absence of a tumor of considerable size at the seat of operation. (10) In order to avoid this tive" bulging, which is a most embarrassing feature of these operations, exploration should be carried out in the most expeditious manner. (11) When the edges of the dural wound cannot be approximated without undue tension or without great laceration of brain substance, the gap should be closed by a graft taken from the pericranium, providing the tumor has not been found and there is reason to question the accuracy of the diagnosis. (12) When there is every assurance of a tumor being present, but it proves to be inoperable or was imperfectly localized, no attempt should be made to close the dura, as in so doing the best possible palliative effects of the operation would be counteracted. (13) Palliative operations should be regarded not merely as operations of propriety, but should be considered imperative whenever the tumor cannot be found or cannot be removed. (14) A statistical study of the results of the last five years is encouraging. The mortality, both immediate and subsequent, has been reduced materially. Recurrence after operations for malignant growths of the brain is no greater than after operations for malignant growths of other structures.

66

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Book Reviews.

THE INTERNATIONAL MEDICAL ANNUAL: A Year Book of Treatment and Practitioner's Index. Twenty-second Year. New York: E. B. Treat & Company, 1904. THE 1904 edition of this volume-the twenty-second annual-is an excellent index of the literature of the past year. The editors have given preference to the practical work that has been accomplished. A new departure in this volume consists in the stereoscopic views that have been introduced. The examination of these with the little instrument provided, greatly facilitates the study of structures which by other methods are very difficult to illustrate. The section devoted to diseases of the ear is specially illustrated by a set of twelve stereograms. There is a series of plates representing the distribution and nature of the cruption in certain of the infectious diseases such as smallpox, scarlet fever, measles, typhoid and typhus fevers. The text is compact, and has been kept within moderate dimensions. In this way the real value of the book is undoubtedly enhanced. The literature of the past year so teems with new matter that this annual is correspondingly interesting. The sections on serum therapy, radio-activity, and electro-therapeutics represent a great deal of careful observation. Although in the past year no great discovery in therapeutics has been made, nevertheless the number of new synthetic remedies has been maintained. Several new hypnotics and analgesics are now on the market, most of which are still on trial. The present volume compares well with its predecessors. ATLAS AND EPITOME OF OPERATIVE GYNECOLOGY. By Dr. OSKAR SCHAEFFER, Privatdocent of Obstetrics and Gynecology in the University of Heidelberg. Authorized Translation from the German with Editorial Notes and Additions. Edited by J. Clarence Webster, M.D., Edin. F.R.C.P.E., F.R.S.E., Professor of Obstetrics and Gynecology in Rush Medical College. With 42 colored Lithographic Plates and many Text Illustrations, some in colors. Philadelphia, New York, London: W. B. Saunders & Company, 1904.

THIS is a fitting companion piece to the "Atlas and Epitome of Gynecology by the same author that preceded it in this series of beautifully executed atlases. The plan is much the same as that followed in the volume devoted to pathology and diagnosis, viz., short sections of text discuss very concisely the important topics and the accompanying plates elucidate the letter press. Short paragraphs opposite the plate serve to point out the significance of the features illustrated. The method is a good one, and is carried out with such attention to detail that the volume should prove most helpful to students and others in grasping details usually to be acquired only in the amphitheater itself. The technique indicated is of course essentially continental and differs in some respects from that practised in this country, but the frequent paragraphs of editorial comment serve to discount this drawback.

HOWE'S HANDBOOK OF PARLIAMENTARY USAGE. Arranged for the instant use of Legislative and Mass Meetings, etc. By FRANK WILLIAM HOWE. New York: Hinds and Noble, 1904.

By an ingenious method of graduating the length of the leaves the "rules of order" are so arranged as to be available for instant reference.

MEDICAL UNION NUMBER SIX. By WILLIAM HARVEY KING. New York: The Monograph Press, 1904. WE heartily wish for this clever little book a widespread dissemination. In a most humorous, but at the same time keenly satirical, manner it points out the weaknesses of trades unionism by depicting conditions supposed to exist in the middle of the century. Even the doctors and clergymen have organized, and through strict adhesion to the rules of unionism the country is depopulated and ruined.

ELÉMENTS DE PATHOLOGIE ET DE CLINIQUE CHIRURGICALES. Par le Dr. LÉON MOYNAC (de Bayonne). Ancien Interne des Hôpitaux de Paris. Ancien Professeur Libre de Pathologie et de Clinique. Huitième Édition, en trois tomes. Paris: G. Steinheil, 1903. It must be admitted that this work on surgical pathology and treatment suffers greatly on comparison with more recent American treatises. The illustrations are crude wood cuts, the paper and print are poor, and nowhere do we see any of the devices to attract readers that are so abundant in modern books. Yet the fact that this is the eighth edition stands for a more than passing popularity, and on closer examination it does not seem so strange that it should have made many friends. The work is really a multum in parvo, almost encyclopedic in its comprehensiveness of scope, which covers all the theory and practice of surgery as ordinarily understood, together with uch specialties as the eye, ear, nose, throat, etc. In its

method of treatment the work stands midway betweer our quizz books, which it far surpasses in point of completeness, and particularly in evidence of the author's practical experience, and the larger treatises which its diffuseness prevents it from equalling. The first volume is devoted to the general principles of surgery and the surgical pathology of the tissues, the second to regional surgery, comprising the head, chest, abdomen, and extremities. The third volume is concerned with the ear, larynx eye, genitourinary tract, and gynecology. All of these subjects are treated with a most agreeable vivacity of style, which does much to cause one to overlook the lack of freshness in some of the views expressed. In short, it is a relic of the days when one man could and did cover the whole domain of surgery in his teaching and practice, and is well adapted to the needs of the student who requires condensed information. It has little value, however, for non-gallic readers, except as a mirror of the older surgical methods of its country of origin. GESAMMELTE ARBEITEN ZUR IMMUNITATSFORSCHUNG, Herausgegeben von Professor Dr. P. EHRLICH, Geheimer Medicinal-Rath. Mit 12 Figuren. Berlin: August Hirschwald, 1904.

THIS Volume of nearly eight hundred pages will no doubt be most gratefully accepted by laboratory workers all over the world. It comprises the most important of the papers on immunity and kindred subjects which during the last four or five years have eminated in such profusion from the laboratory of Ehrlich. It comprises thirtyeight essays, of which about a third are the work of Ehrlich alone or in collaboration, and the others are mainly by his most prominent disciples, such as Morgenroth, Neisser, and Sachs.

Although the side-chain theory has now been officially recognized at nearly every scientific court, there are still some opponents of Ehrlich's views, and one of the most interesting papers in the book is the very last in which Ehrlich defends himself against the attacks which Gruber lately directed against him. Each step in the building up of the theory, together with its underlying experimental evidence, is given with masterly clearness, and the paper forms an excellent means of gaining an understanding of the intricacies of this complex subject. Two other com munications of great practical value are those by Morgenroth and Neisser dealing with the technique of studies in hæmolysis and bacteriolysis, and which were written espe cially for this volume.

The collection forms a most useful work of reference, which will be found almost indispensable by workers in this field.

LECTURES ON DISEASES OF THE NERVOUS SYSTEM. (Second Series.) By Sir WILLIAM GOWERS, M.D.. F.R.C.P., F.R.S. Philadelphia: P. Blakiston's Son & Co., 1904.

THIS series consists of ten lectures that have been revised for publication. The subjects are as follows: (1) Subjective Visual Sensations. (2) Subjective Sensations of Sound. (3) Abiotrophy; Diseases from Defect of Life. (4) Myopathy and a Distal Form. (5) Metallic Poisoning (6) Syphilitic Diseases of the Nervous System. Inevitable Failure. (8) Syringal Hemorrhage into the Spinal Cord. (9) Myasthenia and Ophthalmoplegia. (10) The Use of Drugs. These lectures will not fail to prove instructive reading to those interested in neurological literature. That on "Abiotrophy" (an original term by the author) is of exceptional interest, for it helps to elucidate a class of diseases, such as idiopathic muscular atrophy, the various myopathies, and primary degenera tion of neuron systems, as being due to failure of nutrition from an inherent defect in vitality. The other lectures are equally valuable and bear evidence of wide clinical experience and close observation.

A TEXTBOOK UPON THE PATHOGENIC BACTERIA, for Students of Medicine and Physicians. By JOSEPE MCFARLAND, M.D., Professor of Pathology and Bacter ology in the Medico-Chirurgical College, Philadelphia: Pathologist to the Philadelphia Hospital and to the Medico-Chirurgical Hospital, Philadelphia; Fellow of the College of Physicians of Philadelphia, etc. Fourth edition. Philadelphia, New York, London: Saunders & Company, 1903.

W. B.

THE student of bacteriology is at no loss in these days for textbooks. New books and new editions of older books are continually dropping from the presses, but there must be no lack of purchasers, else the shower would cease. The truth is there is so much activity in this young science that every new writer has something new to say and so his book has value. The work before us is not a general treatise on bacteriology but deals only, or chiefly, with the pathogenic bacteria; nevertheless, it contains much useful material on bacteriological technique as well as hints on laboratory methods. In this new edition the author has brought the whole book thoroughly up to date.

strikingly similar in detail in different members of the same family. The fact that ocular defects were handed down in families with great uniformity was a common experience. Putting these facts together, the heredity of migraine of a fairly constant type with the transmission of certain forms of ocular defects in members of the same family, the correction of which in some cases relieved the sick-headache, and we had a fair basis for the assumption that sick-headache, having all the clinical features of migraine, was often a reflex neurosis of ocular origin. No doubt there were many other sources of peripheral irritation-the pelvic organs, the nose, the digestion, which, however, need not be discussed here. The question raised was this: Where no peripheral factor in the etiology of sick headache was apparent, was not the fault in our defective means of diagnosis? The two obstacles to a solution of this question were a mistaken or confused idea of migraine, and imperfect methods of diagnosis. Many cases in which headaches occurred, which were indistinguishable clinically from true migraine, and could only be differentiated from it by the fact that they followed some peripheral cause, and were removed when that was removed. But those who suffered in this way were subject to attacks from irritations disproportionately small. Thus, when a patient had sick-headache and was cured by correction of 1⁄2 d. of astigmatism, the fault was not with the eyes, primarily, but with the unstable nervous organism which made him susceptible, and this was what migraine resolved itself into. But the fact remained that the disease must be approached at the periphery, and with more hope of. success as our diagnostic and therapeutic measures became more perfect. There were, no doubt, many cases of migraine which were or had become inveterate, and we were tempted to accept the visitations as inevitable, and limit the treatment to the attacks. This attitude was to be regretted, as it was possible, in many of these cases, as a more perfect knowledge of their nature was acquired the conception of hereditary migraine would be modified, and it would be recognized as a reflex neurosis, consisting of an unstable organism, excited by certain peripheral strains which formed the hereditary influence. danger in the passive acceptance of the idiopathic idea was that thereby all effort was abandoned to determine the excitable and removable factor in the etiology. Migraine should be studied statistically, not only with regard to its prognosis and results of treatment, but as regards its natural history; and data, to be valuable, must contain information regarding family history and the family anomalies of structure, as well as the character of the attacks and the relation to the kinds of strain.

The chief

The Relation of Epilepsy, Chorea, and Other Motor Disturbances of the Nervous System to Eye Disease.-Dr. B. SACHS read this paper. He said his part in the discussion was limited to the consideration, chiefly, of the bearing of ocular disturbances upon the development and occurrence of epilepsy, of chorea, and of the convulsive tics. He believed that the dependence of these motor neuroses upon disease of the eye had been greatly exaggerated. It was curious that the claim of the relation of ocular affections to epilepsy and chorea was mainly maintained by American writers, by oculists and pseudo-oculists rather than by neurologists. All who were competent to discuss the subject of epilepsy were agreed that it was a serious chronic affection of the nervous system due to some deeply rooted changes, and the effect of such changes became manifest early in the life of the individual. If one wished to prove that epilepsy was due to some disturbance of the eyes, he said, the argument must rest upon evidence that such ocular disturbance had existed as long as, if not longer than, the epilepsy itself, and that with the correction or cure of the ocular affection, the epileptic attacks would cease. From an argument he put forth, the just inference was that if the epileptic patient presented any marked physical disturbance, whether it be a nasal obstruction, a narrow prepuce, a discharging ear, or other physical dis

turbance, let that condition be remedied, for it might be the exciting cause of the individual epileptic attack; but he asked them not to suppose for an instant that the existence of such physical condition was the actual cause of the epilepsy. From his personal experience he did not know of a single case in which the epileptic seizures had been altogether inhibited or even diminished in number by the weåring of glasses, by the cutting of muscles, or by any other ocular measures which had been adopted.

He said that what had been said regarding epilepsy would apply with equal force to the relation of eyestrain and other ocular disturbances to chorea minor, or St. Vitus' dance. The idea that St. Vitus' dance might be due to some slight lack of adjustment in the ocular apparatus was too absurd to be considered.

There was another disease entirely distinct from St. Vitus' dance, but which bore a superficial resemblance to it and which might sometimes be caused by eyestrain, and this was the condition known as habit chorea, characterized in some by blinking of the eyes—in fact, by all forms of grimaces, by irregular movements of shoulders, of the hands, of the feet, etc. In such cases it would be well to have the ocular apparatus carefully examined, as well as the nasal condition, and any existing defect, however slight, should be remedied.

In summing up all that possibly could be said with due regard for truth, it might be stated that the relationship between ocular affections and epilepsy, chorea, and convulsive tic might be a close one in the minds of some fad dists, but it must remain a very remote one in the minds of those who have no special axes to grind and no special therapeutic territory to exploit.

The Eye Symptoms of Hysteria, Neurasthenia, and the Traumatic Neuroses.-Dr. WARD A. HOLDEN read this paper. He said that since the functional eye disturbances in hysteria and neurasthenia were not always characteristic of one condition or the other and the disturbances of traumatic neurasthenia did not differ from the nontraumatic varieties it was not necessary to classify symptoms according to the underlying neuroses or psychoses. The morbid states which gave rise to these symptoms were: (1) The cornea and conjunctiva might be anæsthetic or hyperæsthetic. (2) The eye muscles might be relaxed from fatigue or might be in a state of spasmodic contraction. (3) The visual perceptive ap paratus might show signs of fatigue and there might be psychical perversions of visual perceptions. The subjective symptoms were pain and paræsthesia in various parts of the head after using the eyes, clouds or bright spots before the eyes, and apparent increase or decrease in the size of objects looked at. The print might fade away because the muscles of accommodation had relaxed from fatigue, or it might be doubled because convergence could not be maintained, or the print might flutter or be come confused because of the abnormally prolonged duration of after-images in the retina. When the lids were gently closed a fine tremor was always noticed. There might be lacrymation, and also photophobia. Complete forcible closure of one or both eyes from tonic or clonic spasm of the orbicular muscle might occur. The reflex closure when the cornea or conjunctiva was touched might be slow or wanting, indicating anæsthesia. The pupils were usually normal in size and reaction. The extraocular muscles often exhibited a lack of balance or exaphoria. A spasm of any of these muscles might give rise to diplopia, but this might be distinguished from actual paralysis by the anomalous behavior of the double images in different directions of the gaze, and the presence of corroborative symptoms. Uniocular diplopia of a purely psychical nature was absolutely characteristic of hysteria. The acuteness of vision in these cases was usually normal, but the patient read slowly and apparently with great effort, often only after much urging, Blindness of one or both eyes might be simulated. Anomal

s of the visual fields were the most frequent and characeristic eye disturbances in neurasthenia and hysteria. he typical condition was a normal field for the usual hite-test object and a concentric contraction of the color elds in their regular order with a diminution of central olor perception. Beside the typical concentric conaction of the color fields in their regular order there was rcasionally a reversal of the sequence, but rarely was are a central defect in the field or a defect of a hemianopic pe. The size of the fields varied from time to time. he forms of the color fields in hysteria were sometimes so zarre that they did not simulate any organic lesion. hough a number of cases of functional eye disturbance young women were cited the trouble was by no means nfined to this class. Some of the most marked and rsistent disturbances were found in strong men with ysteria following injury or nervous shock.

Dr. G. E. DE SCHWEINITZ of Philadelphia was interested what Dr. Dana said regarding melancholia. He ought it was a condition frequently encountered, parcularly among middle-aged school teachers who went to the choreas and states of mental depression. He elieved that Dr. Dana's description of the disturbances of entality from eyestrain was correct. Certainly many ises were seen in the so-called backwardness occurring children; when the eyestrain was corrected the mental ondition became better, and this was a point already well cognized in schools for training where the correction eye defects was gone into carefully. His neurologist iends had stated this to be a trifling affair, but he said was the trifling errors which produced these troubles. I was the constant effort to correct small faults which ure out the nervous mechanism.

He was glad to hear Dr. Cutler's description of migraine. le never thought he could cure a true case of migraine y any correction of refractive errors, although he might essen the number of attacks, because the condition was te sometimes caused by peripheral irritation. He agreed with what Dr. Sachs had stated and he had ever seen a case of chorea cured by glasses. He believed ough the correction of any error of refraction by glasses culd be a part of the treatment, same as the removal of denoids, etc. This same was true of epilepsy. He was ad to hear such a firm stand was taken by many on the Enservative side of the question.

In referring to Dr. Holden's paper he said that bilateral maurosis in hysteria was not a common symptom, someing like fifty cases only being reported, and these were ses of absolute blindness. So many of the cases apeared suddenly and lasted for a few minutes, or a few curs or, in exceptional cases, days. There had been reted intermittent hysterical amaurosis occurring in a ew. In hysteria there might occur concentric contracons in the visual field which was sometimes referred to as tubular field. Hemianopsia he said was a subject much Fritten about, some saying that they never saw a case in ysteria and others saying that they never saw a case without its presence. He believed that in a certain num

er of hysterical amaurosis, bilateral or unilateral, there was a period of hemianopsia that occurred between the ppearance of the amaurosis and the appearance of ormal vision. Sometimes when the amaurosis appeared arly, with a central scotoma would often be found hemiopsia and restoration of the visual field.

Dr. JOHN E. WEEKS continued the discussion, giving the esults of his clinical observations. He said there were wo lines of experimentation: first, of the results which ollowed more or less complete relief of eyestrain by the corrections of the errors of refraction; and second, obserations on the mental disturbances which occurred as the result of eyestrain due to malcorrection of errors of reFraction and malcorrection of errors of muscles. His remarks were based on observations of such cases.

No cases of migraine had been cured, but the number of attacks had been lessened by the correction either of

errors of refraction or errors of muscles. Many mental disturbances had been relieved by treatment of eye conditions, and headaches of certain varieties might be permanently relieved, as well as vertigos of certain varieties, etc. Certain functional nervous disturbances might be relieved in cases of facial spasms, and in which, certain eye muscles were totally or partially affected in one or both eyes. He thought that the motor nervous disturbances which might be modified by attention to the eyes were chorea and some cases of epilepsy.

Dr. JOSEPH COLLINS said that after fifteen years' experience he had never encountered a frank mental disease which itself could be in any way attributed to an anomaly or defect of the eye or muscular apparatus of the eye. The melancholic conditions mentioned occurring at the ages of forty or fifty years he presumed should be looked upon as marked involutional melancholias, and here the eye condition should be considered as an effect rather than a cause of the mental state. Regarding the condition of the eyes found in backward children it seemed to him that this was susceptible of an easy explanation. There were many children whose educations were hampered and intelligence retarded by certain conditions which went without saying; for instance, if they could not get books they were retarded, and if they could not get glasses then too were they retarded. So far as he could see, no cases of dementia præcox, or involutional melancholia were in any way genetically related to the eyes. There was no relationship between eyestrain and the cure of epileptics. One case out of sixty-seven had been benefited at the Craig Colony by attention to the eyes.

So far as chorea was concerned, he did not think it should be discussed at all, because he did not doubt but that it was caused by a microorganism, the same that produced polyarthritis. When the microorganism of chorea was found he believed it would be found to be the same that caused polyarthritis. In looking through the statistics of a large number of cases of migraine one would not find even one case that had been cured, remedied, or benefited by the adoption of glasses. But, on the other hand, he knew of a number of cases of pseudo-migraine that had been cured by the adoption of proper glasses. Migraine and pseudo-migraine were as different as paresis and pseudo-paresis. True migraine was a true neurosis and was due to a lack of proper and harmonious development dating back for years.

Dr. W. P. MARPLE related some interesting cases that had occurred in his experience.

Dr. HERMANN KNAPP said that eyestrain was due to overexertion of the eye. The eye could be overtaxed the same as any other organ. If the eyes are overtaxed the individual must wear glasses or suffer the consequences; and these consequences will be shown possibly in any weakened spot in the body. It may show itself in the nervous system, or in the circulatory system or elsewhere, wherever there is a weakening of a part.

Dr. ANDREW H. SMITH reported the case of amaurosis occurring in a very nervous woman who lived unhappily with her husband, and who strongly opposed her doing what she wished one evening. In a brief time she became absolutely blind and continued to be so for thirty-six hours. The pupils were moderately dilated and fixed.