After an introduction and historical sketch of this rare and interesting disease, the authors give a detailed analysis of the recorded fifty-seven cases as to aetiology, symptomatology, prognosis, diagnosis, and treatment. The aetiology rests largely upon a family predisposition of degeneration, plus a transient and slight excitant of the character of a toxic or autotoxic agent In the development of the disease epilepsy appears first a few weeks to several years in one half the cases; in rare cases the epilepsy ceases in later life. The epileptic attacks are usually grand mal in character, preceded by myoclonic spasms. For a greater or longer period of time after the fits the patient is free from his myoclonus. The myoclonus is often atypical in degree and character. There is usually much mental impairment attending the development and end of the disease. The prognosis is poor, yet life is often prolonged for years, the patient dying finally of inanition, pulmonary congestion, and premature senility. The children begotten of myoclonic epileptics usually die early of an intercurrent affection, yet they in turn may live to develop the disease. The disease has been found in many cases indirectly as well as directly transmissible. The disease is largely one of the family type of neurosis. The authors place emphasis upon the fact that faulty diagnosis is the result of laying too much stress on single symptoms of the disease. The treatment, while largely palliative, must be undertaken with great care in the proper use of large doses of sedatives. Bromides rank in first place. The hypochlorisation adjuvant principle is highly recommended. Cases not benefited by bromides are decidedly in the minority. Chloral in connection with bromides is recommended in stubborn cases. Care of the diet, general hygiene, and a non-stimulative country existence are found to give best results. The authors present three new cases, which, in addition to one previously reported by Clark, constitute the only cases of the association disease at present in the English language. A study of the cortex in one case under ideal conditions of methods was made, and lesions found were in the second and third layer of cells, those of sensory and motor type. The changes in the second or sensory type are those which the authors have previously urged as the characteristic lesion of epilepsy, while those in the third or large pyramid cell are charged to the myoclonus. The lesions as demonstrated by camera lucida drawings were a destruction of the intra-nuclear network and its replacement by a granular substance. As a consequence of this change in the cell, body abstraction of the nucleolus occurred easily and frequently in making the sections. The exhaustive lesion of chromatolysis was shown over the entire cortex. The pathogenesis of the association disease appears to be an intoxication or auto-intoxication of motor and sensory cortical cells, probably brought about by a faulty chemotaxis of such because of their inherent cellular anomaly.

This is a report with full anthropometric details, and illustrated by two photographs, of a somewhat uncommon case of sexual abnormality with arrest of mental development.

The aim of this paper is to investigate the frequency of suicidal tendency in the insane, and the forms of mental disease in which such tendency is more common, and further to determine how often and under what conditions asylum patients find means to commit suicide.

The patient was a child of 7 years, of good family history, both direct and collateral. No other members of the family suffered from epilepsy, and there was no evidence of syphilis. Somewhat slow in development, she began to walk and speak in her fourth year. About this time she would fall down with loss of consciousness lasting from five to six minutes. Bromide diminished these attacks, but afterwards marked convulsions developed, without aura or cry, with frothing at the mouth, incontinence of urine, marked prostration, and headache. Further symptoms supervened. On examination the patient was found to be well developed and nourished. Each three or four months she suffers from the convulsive attacks previously described. Percussion of the head causes the following phenomena:—A light blow on the scalp or face without warning to the child causes either an immediate fall or sudden and very marked trembling, and movements in the upper limbs are noticed. These bear no relation to the strength of the blow, and any hurt to the body produces no effect. Methodical percussion over the motor areas does not produce any isolated contraction. There is no difference on the two sides of the cranium. Excitement increases the effects. Anæsthesia of a skin area by chloride of ethyl produces no alteration. Electrical stimulation does not influence the condition. After the fall the child arose crying and agitated, the walk was uncertain and hesitating, the arms being used to balance, and she walked zigzag, as if the power of directing herself were lost—almost like a cerebellar gait.

The author observed 104 general paralytics, but only 30 of these passed through the three stages, the others dying either in the first or second stage; 750 successful observations were made altogether, from which the following important conclusions among others are made by the author. The light reflex is more often abnormal than normal, and the alteration is almost invariably in the sense of diminution. Diminution and abolition were about equally frequent, and mostly the same in the two eyes. Abnormality was found in about one fourth of the admissions. Certain differences in the frequency of abnormalities were found according to the form of general paralysis, and according to the apparent aetiology. In the first two stages of the disease the light reflex was more altered in cases exhibiting motor affection. No clear relation seems to have been observed between alterations of the light reflex and sensory affections, except that diminution of tactile sensation was associated generally with some abnormality of the light reflex or its abolition. While examination of the light reflex, by revealing frequent and early alterations, is useful in the diagnosis of doubtful cases of general paralysis, it is of no assistance in prognosis.

Dr. de Montyel gives the results of his investigations on the sixth of the reflexes which he undertook to study in general paralysis. The discrepancies noticed in the conclusions of many other observers are attributed to their studying patients in various stages; in all researches of this nature it is indispensable to follow the only method susceptible of furnishing data which may be compared with one another,—that is, following up and examining the same patients from the onset to the termination of the disease. Out of 104 cases of general paralysis this method was satisfactorily carried out in the case of thirty only, the others having succumbed either in the first or second stage; 680 satisfactory observations were made, and the results of these are carefully tabulated. The following are some of the author's general conclusions:—Accommodation is more often abnormal than normal in general paralysis; exaggeration of the reflex is rare; diminution is twenty-four times more frequent—abolition being slightly more common than simple diminution. The reaction is nearly always equal on the two sides; in a few rare cases one finds normal accommodation on one side and abolition on the other. In the early stage only does one find normal accommodation more frequent than abnormal; but in the second, and more so in the third stage, abnormality is the rule. Abolition is commoner in the late stage. In more than a third of the remissions there was abnormality. Certain differences in the accommodation reflex are found in the various forms of the disease; it is more often and more profoundly altered with conditions of excitement. As regards the ætiology the reflex was always found abnormal in traumatic general paralysis; next in frequency (i. e. after abnormality of reflex) comes the alcoholic form. Alteration of the reflex is common with cases at the extreme ages of incidence of the disease (after fifty and below thirty). Accommodation was more often and more profoundly affected in the first two stages of general paralysis in proportion to the impairment of motor power. The investigation of the accommodation reflex on account of its frequent and early alterations may be helpful in the diagnosis of doubtful cases, but it affords no indication as to the slow or rapid evolution of the disease. H. J. Macevoy.

Out of a total of 3916 cases of insanity (2493 male and 1423 female) observed at the Moscow Clinique for Mental Diseases between November, 1887, and January, 1901, there were 682 of general paralysis —590 men and 92 women; so that nearly 25 per cent, of the male and 6.57 per cent, of the female cases were general paralytics. The proportion is larger in recent years than in the earlier years of the foundation of the clinique. The greater number of cases in men were between thirty-six and forty years of age; in the case of women the commonest age is thirty-one to thirty-five years. The authors give notes of three cases of juvenile general paralysis. Various tables of classification dealing with occupation, nervous heredity, alcoholic inheritance, presence of syphilis, etc., are given, and the following are some of the authors' general conclusions:—General paralysis is uncommon or even rare in the case of farm labourers. The importance of heredity is great in the case of general paralysis, as in other psychoses or mental diseases. Syphilis was present in more than 75 per cent, of the cases, and in 90 per cent, of these there was an interval of from six to twenty years between the date of infection and the appearance of morbid symptoms. Alcoholism is of importance in the ætiology of general paralysis in men; in over 60 per cent, there is a marked history of abuse. The demented form of general paralysis was observed in half the male cases, the maniacal form being next in frequency. In women two thirds of the cases were of the demented type, and a quarter of the maniacal. The demented type was decidedly commoner in recent years. Concerning certain symptoms especially noted in general paralysis, the authors found that among men exaggeration of the knee-jerks was present in about half the cases, absence in one fifth; among women exaggeration was found in about 60 per cent., and absence in 15 per cent.

This is the interesting account of a case, mostly the autobiography of the patient, relating the development of an idea of morbid blushing in a boy, which persisted for years, and finally apparently led to suicide, after the victim had at one time seriously contemplated blinding himself on account of his ereuthophobia.

The case is that of a girl æt. 18 years, who was admitted into the Mulhouse Hospital on January 11th, 1899. She was illegitimate, and her family history was unknown. From the age of eight she had frequent convulsive attacks, occasionally preceded by an aura (visual), during which there was loss of consciousness, frequent biting of the tongue and lips, and injury to the head, and occasional involuntary micturition (no doubt epileptic). At the onset of menstruation she had some nervous disturbance. After admission two small bluish spots were noticed on the right knee; similar ones had apparently been present before, and others were observed on several occasions during her stay in hospital. They were painless, and usually disappeared in a few days. During her stay in the hospital she had several apparently typical epileptic attacks. She was treated with bromide of potassium.

A. D. Q— was admitted into Armentières Asylum, September 14th, 1888, at the age of 39. His early symptoms began apparently after the death of his wife about four months before; he was depressed, said he couldn't eat, that he was dead, left off working, and stayed in bed. On admission he presented all the signs of general paralysis of the melancholic type, with delusions of negation. The disease progressed rapidly, and he died in January, 1889.

In a reprint from this journal Professor Pick describes the case of a woman æt. 41 years, who after confinement showed symptoms of mental derangement. She was much excited and tore her clothes; speech was much disordered. When admitted to the clinique at Prague she was found to speak indistinctly, slurring over some consonants. The same deficiency was found in her writing, which scarcely recalled the words she was supposed to signify. She could understand reading, and what was said to her, though her intelligence was notably impaired. After a short stay in the hospital she was discharged, but was brought back eight months after in a much worse condition. In her writing, both to dictation and spontaneously, she only reproduced a few letters, though she copied correctly. There was paresis of the right side. The mental power went on diminishing, and the speech getting more unintelligible, till she died of pneumonia ten months after admission.

This number is wholly occupied by a paper on this condition. The author has already in previous numbers described seven cases, and he now records fourteen others, in addition to which he has collected from various sources over fifty cases.

The author recalls that since Quinke, in 1891, directed the attention of the Wiesbaden Congress to the use of lumbar puncture, numerous publications have appeared on the subject. He observes that the high expectations of the therapeutic value of this operation have not been realised, any improvement following being seldom lasting. It has been used with most effect in acute, serous, and sero-purulent meningitis, and less so in simple hydrocephalus, brain tumour, and tubercular meningitis. Lumbar puncture has, however, been an important addition to our means of diagnosis. Through it we are able to ascertain whether there is abnormal increase in the spinal fluid. This gives an important indication in cases of brain tumours and of serous meningitis with obscure symptoms. In doubtful cases of tubercular meningitis the detection of tubercle bacilli in the spinal fluid determines the diagnosis of the disease.

The author criticises adversely the experiments and theories of Dr. Ceni published in a paper analysed by Dr. Sainsbury in this Journal (vide page 782), and records a series of observations which he has made with a view to testing Ceni's results.

In this paper the author has put together some general observations suggested by his exceptional experience in the treatment of the inebriate. It is noteworthy that, on the whole, his attitude is distinctly optimistic. In the first place he pleads for more discrimination of cases. He distinguishes three classes of inebriates: (1) paroxysmal cases, where there are often premonitory symptoms in change of character, morbid impulses, etc., treatment of which may abort the attack; (2) delusional inebriates with mental exaltation, which may be prodromal to general paralysis; for such cases rest and change with eliminative and subsequently tonic treatment are indicated; and (3) senile and demented cases.

The authors give the results of their treatment of epileptics by the method suggested by Richet and Toulouse, according to whom diminution of the excess of chlorides present in the organism favours the curative action of bromide salts in epilepsy without disturbing appreciably the normal physiological metabolism. They experimented on twenty patients, eleven men and nine women, who were taking from 45 to 120 grains of bromide per diem. Chlorine was suppressed from the diet. They noted the number of crises during the six months preceding this special treatment, during the forty days of treatment, and during the two months following. A brief history of each case is given. No objection to the treatment occurred on the part of the patients. Their general conclusions may be thus summarised:

The author observes that the treatment of acute cases of insanity by confinement to bed has made good progress, in spite of criticism, during the last ten years.

In this lecture, delivered before the University of Lausanne, the author defines the issues between the old classic school of penology and the modern scientific spirit.

This is the report of a case of great medico-legal interest.

The author shortly reviews the opinions which have been held regarding the relationship of alcoholism to tubercular disease. There are three possible views, and each has had its advocates: (1) that alcoholism is antagonistic to tuberculosis; (2) that alcoholism has no special relationship to tuberculosis; (3) that alcoholism definitely predisposes to tuberculosis. The last view is that which at present tends to prevail, and the most reliable sort of evidence—that afforded by the pathological study of a large mass of cases—is strongly in its favour. For instance, in ten fatal cases of alcoholic polyneuritis the author found pulmonary tuberculosis in eight. And examination of the records of the Manchester Royal Infirmary showed evidence of tubercular disease in 23 per cent of the fatal cases of common hepatic cirrhosis.