[Miss M., aged twenty-nine. Subject to epilepsy and chorea from the first year of her life. Epileptic attacks occur from three to five times daily. Occasionally the fits are of great violence, but they usually last only a few minutes. She has never, since her first year, taken objects in her left hand, that side being most affected by chorea. The left elbow is drawn forward and strongly against the chest, the hand turned palm outward, backward, and upward. The left arm, and in less degree the whole body, are in constant and violent motion. If an attempt is made to bring the arm into its normal position, the whole body becomes convulsed, the face distorted, and both arms move wildly. The visual anomalies were hyperopic astigmatism, right eye 1·00 ; hyperopia, 1·00 D, left ; insufficiency of the externi, amounting to diplopia of 5° when red glass was used, and hyperphoria, 2°. The hyperphoria and stigmatism were treated were treated with cylindro-prismatic glasses. Tenotomy of one internus was done under great difficulties, owing to the patients mental state, November 33, 1884, and of the other, January 3, 1885. Great relief followed the first operation, and the fits ceased from the 1st of December. In a month she was able to use the left hand for the first time in twenty-eight years to a considerable extent, and delighted in showing how she could brush the windows of the consulting-room with a napkin. Her intellect improved, and, as will be seen by the portraits (Figs. 1 and 2, Plate IV ; No. 1 taken November 17th, 1884, No. 2, February 2, 1885), her head came to the normal position, and her appearance in every respect was better. Up to April 20th, when the last record was made, there had been no return of epilepsy. I have, however, learned that during the summer the fits returned in less frequency and degree. A recent letter from her sister informs me that it is the purpose of her friends to pursue the treatment which resulted so favorably still further as soon as circumstances allow].*
