A MIEDICAL man who lad been overworlied and dlistutrbed, but not distressed, by unusual mnental excitement in tlle sulmnmer of 1910 lhad planned to take a golfinlg lioliday in Scotlalnd. On tlhe day of departure hle was summonled to a case in Gloucestershire, witlh tllc restult tlhat oiily after mutich travelling was lie able to reacll Edinburgh about ten o'clock at nigilt. He slept badly, and startecl early next morning, in order to reacll llis destination. He did so by ten o'clock, and,

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... lh very tired and unfit for exertion, played two rounds of golf that day Next mnorning, about 6 o'clock-, lie was waked fromii sleep by a lhorrible feeling of vertigo, the pictures in the room seeming to go round, and the bed in which lie lay to oscillate from side to side. He was very sliglhtly sick, and quite unable to raise his hlead without extremne giddiness. He sweated profusely; graduallv all symiptom-s disappeared, except a feeling of extremne prostration. Not unnaturally, perlhaps, lhe ascribed hiis experience to fatigue and stomachl distuirbance, due to over-exertiin after muchl work and over-mucll travellinig. Six miontlls previously lie h-iad had a similar experience, also abotut 6 a.m., which was thought to be due to a bilious attack. Thlis soon passed off, and in tlle course of a few lhours he was able to get up, cat breakfast, and go to wvork. Witlh this exception Ilis health liad invariably been excellent andc his digestion perfect. His only trouble had been increasing deafness in thle righit ear and a neverceasilng tinnitus, sliglht on tlle left, extremne on tlhe righlt side. Tilis he had learnt to accept as inevitable and incut-able. No association between the ear symiiptomus and the tNvo attacks of early morning vertigo lhad crossed liis muind. For three days lie remained in Scotland, golfing too muich; smoking, perlhaps, too much, but careful in diet and quite abstemious in the matter of alcohol. Giddiness and very slight vomiting occurred eacll morning, but he soon recovered and becamrre fit for the day's exercise. After four days lie lhad to leave lhurriedly amid go to Cornwall. Thouglh he was naturally tired, lle began at once to play golf, and during the first weelk had several recurrences of early morning vertigo and sickness. Theni onie night, after chatting with a friend, about 11 o'clock lie left tlle room to go to the lavatory on tlle other side of the corridor. Suddenly, whlile liglhtineg the gas, he felt as tlhough somue one lhad hiit hiim a terrific blow on the Ilead. He fell prone, not losinig consciousness, but feeling deadly sick and lhorribly giddy. He felt hiis eyes oscillating violently and vomited uncontrollably. Despite the unpleasantness of this, he was uniable to move; any attempt to lift hiis licad was associated wiLlh giddiniess beyond the power of words to describe. He sweated profusely and lay for perlhaps half an lhour in the greatest prostration. Finally, lie managed to slidle to tihe open door and call out to hiis friend in the roomil opposite. By tllis time lie had realized what hadl liappened-tllat lie was sufferinig from Meni6re's diseaseso lie was able to reassure hiis friend, and got him to pull hiini by the heels along the passage into tlle other room. He could not to save his life have raised hlis head or have attenmpted to walk, After lying on the floor for a couple of hours, he was lifted on to a sofa, and remained tllere sweating and prostrate until 6 o'clock. He was able then to strtuggle up to bed and to sleep. Beyonid great prostration and weakness ino ill effects could be nioted, and iil a fortnight he was able to leave the west ancd go to Harroaate. Durina the fortniglht he lhad several attacks of giddiniess, but no sickness, and at no tineC haci lhe any lheadaclhe eitlher before or after tlle severe seizure. Very fooliAily lhe acted on the advice to lhave somiie ratlher exlhaustinig batlhs at Harrogate, and in thlree days again ha( a severe attacl. After a good breakfast hie sudcldenly becalmie very giddy, slipped out of an armiichair and lay on the floor vomiiiting and sweating for two or tlhree hoturs. \gain no loss of consciousness-no headache. Very slowly lie began to gain strenlgtlh. but aniy atteimipt to taLe exercise or undergo fatigue resulted in ani attack of suell giddineiss tllat lhe lhad to fall or lie down. In tlle course of a imionitlh lie was well enloughl to retirn to active worlk, buit lhad to live very quietly and subordinate everything to hiis duties in hospital or practice. Once onily did lhe fall dloNvn, and tllat in the street after A very fatiguing day. He frequently got the imrpression that lhe was going to be giddy and felt a curious sensation of -warmith all over the bodv as tllouglh he were going to sweat, but if lhe refrained froin exertion lhe was able to avert furtlher trouible. After twvo years' incessant watchfulness and care lhe regarded himself as cured. To-day the deafness of one ear and tlle tinnittus reniaiii as at the onset, but lie is not giddy lnor is lhe ever sick. Two distinctive features characterize(d eaclh attack-one the feeling of warmtlh of skin followed by sweating. and the other, when an attack occurred, a feeling as thlough his brain were loose inside the craniumi and being dashed fromii side to side. For two years tlle condition was very distressing, on account of a terrible apprehenision that he was going to be giddy. The foregoilng is typical of tlle worst class of cases of _1e4ni6rels symuptom; there were only tlhree absolutely uncontrollable attacks of giddiness when he fell as though poleaxed, anid two or thlree wlhenihe had to lie down, but from 1910 to 1912 there were numerous occasions when lhe got the sensation of his brain being loose and when he felt warmii and sweated. No specific treatment was of use -hybrobromic acid upset hiis digestion and bromide depressed him. I lhave seen a considerable number of cases during the last few years, and mny experience of treatment confirms my frienid's experience. All the cases have done well, and in every case tllh only useftul treatment has consisted in the correction of imiiperfect digestion, of hypernmetropia, of anaemia, alnd of any other symptomatic conditions, but chiefly in the avoidance of fatigue. Meniere was of opinion that in certain cases haeilmorrliage into the labyrinth was the cause of symptoms, but it is quite certain that haemorrhage could not hiave occurred eacll time my patient was uncontrollably giddy, thouglh it was possible there might have been solue on two occasions. Most cases occutr in people of advanced middle age, and in a large proportioni of tllose among them wlho have acquired gout, or are undergoing ossification of the structures of the internal ear. Such changes miiight predispose to tlle attacks, but are almost certainly not the cause. Many things point to a vasomotor disturbance being at the root of tlle troutble, especially the sensation of warmth and tlle sweating. This suggestion would explain the analogy of somewhat similar symptoms arising from the abuse of tobacco and from sea-sicliness.